Computer analysis of magnetic resonance imaging of the brain in children and adolescents after treatment of diabetic ketoacidosis.

Cerebral vascular accidents are one of the causes of morbidity and mortality in children with diabetic ketoacidosis. We investigated the possible occurrence of asymptomatic cerebrovascular infarcts and the course of subclinical brain edema in six patients. Neurologic examinations and computer analysis of magnetic resonance imaging were performed immediately after, and again at 14 days after, correction of DKA. None of the patients had clinical evidence of a neurologic deficit. Neither radiologic evaluation nor computer analysis of MRI identified changes indicating asymptomatic ischemic events. However, a computer analysis of the MRI identified a significant increase of the total ventricle area between Day one and Day 14. Our study does not establish whether this change is a return to the baseline prior to DKA or a new baseline, representing an early manifestation of diabetic encephalopathy.

Interstitial pulmonary edema in children and adolescents with diabetic ketoacidosis.

The acute complications of diabetic ketoacidosis in children and adolescents are well recognized but not completely understood. Clinical studies have focused primarily on brain edema. We have investigated the prevalence and course of interstitial pulmonary edema in patients with severe diabetic ketoacidosis all of whom had uneventful clinical courses. High resolution computed tomography scans of the lungs were analyzed by determining the Hounsfield attenuation level and then converting to physical density values. All seven patients had evidence of interstitial pulmonary edema on the first scan, which was performed within 1 h of hydration and prior to receiving insulin; six of the seven patients had increased pulmonary density 6-8 h into treatment, and all had complete resolution of the interstitial changes at discharge. Our study suggests that subclinical interstitial pulmonary edema may be a frequent occurrence in children and adolescents with severe diabetic ketoacidosis and may very well be present prior to treatment. The study also supports the philosophy of cautious rehydration and the close monitoring of children and adolescents with diabetic ketoacidosis until a more complete understanding of this pathophysiologic event is achieved.

Student and faculty perceptions of interactive learning in the radiology clerkship.

RATIONALE AND OBJECTIVES: The objective of this research is to develop and evaluate medical students' perceptions of interactive learning techniques for teaching the role of radiology in medical diagnosis to senior medical students. METHODS: Students in a 4-week radiology clerkship were given specific learning objectives and tasks that enabled them to be actively involved in radiology. Students rotated through six specialty areas in small groups. Some areas used the interactive format, whereas others used the traditional observation method. In the interactive format, clinical faculty involved student groups in examining patients, checking histories, making clinical/radiologic correlations, and discussing cases. RESULTS: Students consistently rated the interactive rotations higher (4.6 on a 5-point scale) than the observer format (3.3). The faculty and residents found the interactive format to be manageable and conducive to learning. CONCLUSION: Involving students in appropriate decision making and problem solving has proven to be a preferred way to teach radiology to medical students.