Nonionic contrast media in pediatric CT. A comparative study of intravenous use of iopentol and iohexol.

In pediatric radiology there is a great demand for a safe contrast medium. In this pediatric CT trial, the safety, tolerability and efficacy of 2 nonionic contrast media, iopentol (Imagopaque) and iohexol (Omnipaque), were evaluated. The study was performed as a double-blind, randomized, parallel trial, with 55 children receiving iopentol (300 mg I/ml) and 55 receiving iohexol (300 mg I/ml). The dose injected was 2 ml/kg b.w. with an upper limit of 100 ml. Blood pressure and pulse rate were recorded. Adverse events were recorded by observation of the patients up to 24 hours after the examination. No clinically or statistically significant changes occurred. Seven adverse events other than discomfort (2 in the iopentol group and 5 in the iohexol group) were reported. The overall quality of CT enhancement was good or excellent in all cases. The results support the use of iopentol as an alternative to iohexol in pediatric CT examinations.

Characteristics and prognosis of hospital-treated obstructive bronchitis in children aged less than two years.

In a prospective study 101 children aged less than 2 years (median age 10 months), were examined the first time they were admitted to a paediatric ward for asthmatic symptoms. Two-thirds were boys and 58 had parents or siblings with allergic symptoms. During winter-spring, respiratory syncytial (RS) virus was verified in 50% of children. Other viral agents were adenovirus, parainfluenza 3, coxsackie B 2, ECHO 6 and rotavirus. At the acute stage, 54% of the children displayed changes on pulmonary X-ray. The total IgE value was greater than or equal to +2 SD score units in 14 children. At reinvestigation after 3-4.5 years, when the children were aged 3.3-6.3 years, 53% were free from asthmatic symptoms; the median age for the last episode was 2 years. A total of 33% had mild asthma, 8% moderate and 6% severe asthma. The factors which correlated significantly with persistent asthma were: (1) The need for daily medication for at least 6 months. (2) A young age in conjunction with the first wheezing episode and on the first admission to a paediatric ward because of asthmatic symptoms. (3) Other past or present atopic symptoms. Heredity, tobacco smoking at home, having a furry pet, RS virus infection, or high total IgE at the time of the first admission did not correlate significantly with the persistence of asthma 3-4.5 years later. The results emphasize the good overall prognosis of wheezing in early childhood, even when the wheezing is severe enough to lead to inpatient treatment.

Etiology of community-acquired pneumonia in children based on antibody responses to bacterial and viral antigens.

The serologic responses to bacterial and viral antigens were determined in paired serum samples from 336 children, ages 1 month to 15 years, with roentgenographically verified community-acquired pneumonia. Significant increases in antibodies against one agent were found in 40% and against two or more agents in 8% of the children. There were significant increases in antibodies against respiratory syncytial virus in 20%, viruses of the influenza-parainfluenza group in 6% and adenovirus in 3%. A serologic response to one or more of the pneumococcal antigens used (type-specific capsular polysaccharide, C-polysaccharide and pneumolysin) was demonstrated in 13% of the patients. Ten percent of the children had significant increases in antibodies against Mycoplasma pneumoniae. Only three patients had increases against Haemophilus influenzae type b and one each against Legionella pneumophila and Chlamydia. Respiratory syncytial virus was the predominant etiologic agent in young children whereas M. pneumoniae was more frequent in the older age group.

Selective use of excretory urography in women with acute pyelonephritis.

The outcome of excretory urography was analyzed in 103 nonpregnant women followed prospectively after community acquired acute pyelonephritis. Radiological abnormality was found in 40 per cent of the patients (17 per cent had major abnormalities, including renal scarring, calculi and obstruction). All 5 women with surgically correctable lesions had rapid bacteriological relapse or recurrent acute pyelonephritis. Neither a history of urinary tract infection, the acute inflammatory response nor infection due to Escherichia coli with or without adhesins specific for Gal alpha 1----4Gal beta-containing receptors was efficient in predicting major radiographic lesions or the outcome of treatment. Bacteremia was detected in 27 per cent of the patients but in the absence of obstruction. These results suggest that excretory urography is dispensable in most women with acute pyelonephritis, and that those needing such investigation may be identified by failure to respond to antibiotic treatment or by the recurrence pattern.

Lung function in workers exposed to soft paper dust.

In a cross-sectional study, 13 nonsmoking men with heavy exposure to paper dust were compared with 14 unexposed men, mainly office workers, employed at the same paper mill. They were studied using questionnaires, physical examinations, pulmonary function studies, and chest radiographs. Among those exposed there was an increased lung elastic recoil pressure (Pel) compared with controls which was significant (p less than 0.05) at the maximal level of total lung capacity (100% TLC). Furthermore, among the exposed workers there was also a significantly (p less than 0.05) decreased residual volume (RV). Two of the exposed men underwent lung biopsies, one of which showed fibrotic alveolar walls. Among the exposed there was also a significant (p less than 0.05) predominance of symptoms from the lower respiratory tract. We suggest that the observed pulmonary function impairment taken together with the histological examination of the lung biopsies are signs of a nonspecific reaction to high levels of paper dust.

Radiographic appearance and lung function after non-malignant pleural effusion.

In order to study factors associated with changes in radiographic appearance and lung function after pleural effusion, we investigated 178 consecutive patients with non-malignant pleural effusion. At the initial examination etiology, smoking habits, asbestos exposure, ESR, blood eosinophils, size of effusion and other X-ray lesions were registered. At a 3-year follow-up, chest radiographs and lung function values were obtained and the association with the initially registered factors was evaluated. At follow-up, 20% of the patients had developed major additional X-ray lesions and/or significantly reduced lung function. Prognostically unfavourable factors were idiopathic etiology as compared to infectious, medium and large-size effusions and initial radiographs showing converging pleural linear structures and/or rounded atelectasis as compared to no or minor radiographic lesions. Converging pleural linear structures and rounded atelectasis were seen almost exclusively in association with idiopathic effusions. The obvious differences noted between patients with idiopathic and infectious effusions suggest that these effusions represent separate clinical entities.

Dietary fibers in the preparation of the bowel for diagnostic barium enema.

The effect on colon cleanness of adding dietary fiber or placebo to a standard bowel preparation scheme before diagnostic barium enemas was tested in a randomized, double-blind study including 120 consecutive outpatients admitted for diagnostic barium enemas. Colon cleanness was scored as satisfactory, intermediate, or unsatisfactory. No case of unsatisfactory cleansing appeared in the group given fiber. Mean score was slightly better in the fiber group but the difference was not statistically significant. Dietary fiber does not have a negative effect on colon cleansing but may instead have a beneficial effect, which is possibly more pronounced in patients with constipation.

Shrinking pleuritis with atelectasis. Specificity of abnormalities present at conventional radiography of the lung.

Radiographic appearances claimed to be typical of shrinking pleuritis with atelectasis (SPA) were tested by mingling chest films from 6 SPA patients with those from 56 cancer cases. Two radiologists were asked to interpret the films independently, make a diagnosis, and state what abnormalities could be distinguished. No single abnormality or combination of abnormalities was found to be pathognomonic and the wish to diagnose the SPA cases led to misdiagnosis of cancer in one of 56 cases by each radiologist. To prevent underdiagnosis of cancer, further examinations are required. Careful follow-up of SPA cases, if they are not operated upon, is recommended.

[The value of hysterosalpingographic findings in sterility investigations (author's transl)]. / Die Bedeutung der Hysterosalpingographiebefunde bei Infertilitätsuntershcung.

In the material presented, at least 117 women examined with hysterosalpingography became pregnant. Most of the pregnancies (68%) occurred within one year after the radiological examination. Clinical data is failing in many of the other cases, but 66 women were still infertile more than three years after the examination. The hysterosalpingographic findings of a group who got pregnant without any surgery and delivered at full term (73 patients) have been compared to the group of women still infertile and with a healthy partner (50 patients) and with another group of women, whose pregnancies ended in abortion (19 patients). No radiological signs is seen only in one of the groups but pathological changes of the oviducts are more common in the infertility group. Extreme positions of the uterus, irregularities of the cervical canal etc show no difference between the groups. Such findings in the uterus and the cervical canal are of no prognostic value.

[Comparison between hysterosalpingographic findings and lesions observed by laparoscopy and laparotomy (author's transl)]. / Vergleich zwischen Hysterosalpingographie, Laparoskopie und Laparotomie.

Laparoscopy and/or laparotomy had been performed in 91 patients also examined by hysterosalpingography (HSG) during two years. The comparison of the radiological and the operative findings shows, that total occlusion and hydrosalpinx are radiological signs of adhesions in the pelvis. A depot of contrast medium remaining around the fimbriated end of the oviduct is also a sign of adhesions. More than half of the patients with adhesions surrounding the oviducts and/or endometriosis had however normal hysterosalpingograms. Thus, the radiological examination, hysterosalpingography, has a low sensitivity rate concerning pelvic abnormalities.

Radiographic appearance of mycoplasmal pneumonai.

As there are contradictory opinions on the radiographic appearance of mycoplasma pneumonai, the chest examination of 59 patients with at least a fourfold increase of the complement fixation titer were studied retrospectively. The investigation shows that there is a great variety of radiologic patterns from interstitial, disseminated infiltrates to total lobar consolidation. The alveolar pattern seems to be more common in women, but there is no relation to age, duration, season or bacterial superinfection. A development from interstitial infiltrates to alveolar changes or vice versa during the course of the illness was not confirmed in this study. The radiographic variability may be explained by the alveolar infiltrates being an inflammatory reaction to Mycoplasma pneumoniae, and the interstitial densities being an immunologic response. No definite difference between bacterial and mycoplasmal pneumonias was observed, but a multitude of alveolar infiltrates speaks for a mycoplasmal origin.