Small intestinal atresia and segmental absence of muscle coats.

The case of a newborn infant with small-intestine atresia coexisting with segmental absence of muscle coats leading to perforation and meconium peritonitis is presented. The theories of pathogenesis of the simultaneous occurrence of segmental absence of gut musculature and atresia are briefly reviewed. A possible etiologic role of vascular accident in utero for both conditions is discussed.

Dyssegmental dwarfism: a histologic study of osseous and nonosseous cartilage.

Dyssegmental dwarfism is probably an autosomal recessive, lethal, generalized chondrodysplasia; it is characterized by anisospondyly , shortening of long bones, and narrow chest. Maturation of chondrocytes at the epiphyseal plates is disturbed. The pathologic features of osseous and nonosseous cartilage in a stillborn female infant with dyssegmental dwarfism are described. The cartilage matrix of tubular bones, vertebrae, ilia , ribs, nose, larynx, and trachea showed acellular areas with accumulation of acid mucopolysaccharides and no increase in collagen fibers. The findings, although not pathognomonic, suggest that this type of dwarfism may be a generalized connective tissue disorder. The abnormal synthesis, structure, or secretion of the components of the cartilaginous matrix may lead to accumulation of acellular material in both skeletal and respiratory tract cartilage.

Hydrometrocolpos and polydactyly.

Two cases of hydrometrocolpos and polydactyly in female infants with persistent urogenital sinus are reported. The importance of considering hydrometrocolpos as the cause of an abdominal mass in female infants with polydactyly is stressed. Cytologic examination of the vaginal fluid may help in early diagnosis.

Opportunistic infections and tumors in immunocompromised children.

HIV infection is responsible for a major proportion of the immunodeficiency disease seen in the pediatric population. The radiologic findings are varied and generally non-specific. The development of secondary neoplasms may present new diagnostic and therapeutic challenges as therapy for superimposed infections becomes more successful.

Computed tomography of the pulmonary parenchyma. Part 1: Distal air-space disease.

Because of greatly enhanced contrast resolution and the advantages of cross-sectional visualization of lung anatomy, computed tomography (CT) has the potential to add significantly to the conceptualization of parenchymal lung disease. Although the value of CT has been well documented in the detection and characterization of lung nodules, the role of CT has been less clearly defined for other types of lung disease. This report describes the CT appearance of distal air-space disease. As demonstrated by the use of inflated and contrast-injected lungs obtained at autopsy, air-space disease is definable by the following: poorly marginated nodules ranging up to 1 cm in size; coalescence of nodules; air-bronchograms and air-alveolograms; ground-glass opacification; and distinct zonal patterns of distribution, including central and peripheral configurations. These patterns of air-space abnormalities are further refined by review of case material, including examples of air-space disease secondary to aspiration and primary intraalveolar disease, evaluated by the authors over a five-year period.

Obstructive jaundice caused by placement of a nasoenteric feeding tube.

Nasoenteric feeding tubes are a safe and effective means for providing nutritional support to the critically ill patient. Serious complications have been reported, but usually are the result of an improper path of the tube during placement. The authors report a case of ampullary obstruction and jaundice caused by a nasoenteric feeding tube, presumably caused by coiling of the tube in the duodenum. This report represents the first such case in the literature.

Chronic relapsing pancreatitis in childhood.

A case of idiopathic, chronic relapsing pancreatitis arising in childhood is presented and compared with the 12 previously reported cases. This entity is a rare cause of severe, recurrent abdominal pain in childhood. The diagnosis is suggested by elevated serum or urine amylase values or pancreatic calcifications. Ultrasound, computerized tomography, or as in this case, endoscopic retrograde cholangiopancreatography can aid in the diagnosis. Surgery yields excellent results.

Breakdancer's pulmonary embolism.

A case of pulmonary embolism caused by breakdancing is reported. There was no clinical suspicion of pulmonary embolism.

Rupture of a non-rheumatoid popliteal cyst: a syndrome mimicking thrombophlebitis.

Rupture of a popliteal cyst and dissection of its contents into the calf may produce pain, swelling, a positive Homan's sign and other findings closely resembling thrombophlebitis of the calf. The correct diagnosis is not often made, and the patient is subjected to needless long term anticoagulant therapy with its potential complications. To avoid this, it is essential that this possibility be kept in mind in all patients in whom the diagnosis of thrombophlebitis is considered. The history of preexisting arthritis of the knee, joint effusion and popliteal cyst are strongly suggestive of a ruptured popliteal cyst. This diagnosis can be verified by arthrography, ultrasonography, computed tomography and radionuclide scanning. Arthrography is preferred because it reveals superior anatomic detail thereby making differentiation between an encapsulated calf cyst, with smooth walls, and rupture, with irregular feathery margins, possible. Three illustrative cases are presented and the literature is reviewed.

Sonography of cerebral infarction in infancy.

Six infants with cerebral infarcts were examined prospectively with real-time sonography to determine the sonographic characteristics of infarcts and their evolution. Patients' ages ranged from 1 day to 7 months, and serial sonographic and/or CT scans were obtained over a period of 2 weeks to 14 months in the survivors. Among our patients the most characteristic sonographic findings of infarction were absence of gyral definition, absence of vascular pulsations, altered parenchymal echogenicity, and territorial distribution. Mass effect, reflected in ventricular size and shift of midline structures, may also be seen and largely parallels the extent of the infarction. Evolution of infarcts was seen sonographically as gradual return of arterial pulsations and concurrent development of cystic spaces. Sonography was found to be a valuable tool in the diagnosis of infarction in infancy and in monitoring its evolution, although CT was necessary for adequate initial evaluation in older infants.

Pediatric hepatic CT: an injection protocol.

OBJECTIVE: To determine an injection protocol for pediatric hepatic CT and to investigate the use of power injection. MATERIALS AND METHODS: Eighty-seven studies were prospectively performed using ioversol (320 mg iodine per cc) at 2 cc/kg. Three techniques were used: helical (1 s/slice); dynamic, non-breath-hold (5.5 s/slice); dynamic, breath-hold (10 s/slice) scans. The liver-scan time for each study was determined. Scan initiation ranged from 25 to 80 s. An injection duration (50-100 seconds) was selected. From the contrast volume (2 cc/kg x kg body wt) and injection duration, the injection rate (cc/s) was calculated for each patient. Each study was grouped by injection rate corrected for body weight (cc/kg/min) into: 1.2-1.5, 1.51-2.0, and 2.01-2.4. The aortic/liver attenuation curves were plotted for each group. RESULTS: Liver-scan time for helical studies was a mean of 26 s, for dynamic, non-breath-hold studies 75 s, dynamic breath-hold scans were 154 s. Injection rates of 1.2-1.5 cc/kg/min produced a scanning interval of 165 s. Injection rates of 1.51-2.0 cc/kg/min produced a scanning interval of 120 s. Injection rates of 2.01-2.4 cc/kg/min produced a scanning interval of 90 s. There was no increase in hepatic attenuation for the injection rates 2.01-2.4 cc/kg/min compared with 1.51-2.0 cc/kg/min. There was one complication related to injection through a central line. CONCLUSIONS: An injection protocol was determined for helical studies with injection rates of 1.7-2.0 cc/kg/min with initiation at 60 s; for dynamic, non-breath-hold studies with injection rates of 1.5-1.7 cc/kg/min with initiation at 50 s; and for dynamic breath-hold studies with injection rates of 1.2-1.5 cc/kg/min with initiation at 45 s. Power injection was used safely in our population.