Heliox therapy for pneumothorax: new indication for an old remedy.

STUDY OBJECTIVE: To evaluate a new method of treating pneumothorax: having the subject breathe a helium/oxygen mixture (heliox). METHODS: We conducted a prospective, randomized, controlled study of nine white rabbits weighing 2.5 to 3.5 kg. Experimental pneumothorax was induced in all rabbits with the injection of 20 mL of air into the pleural space. The rabbits then breathed heliox, oxygen, or room air for 2 hours. Chest radiography was performed 5 minutes after induction of pneumothorax, then at 1 and 2 hours. We determined pneumothorax size on the chest radiograph by measuring the interpleural distance and expressing it as a percentage of the hemithorax. RESULTS: At 2 hours the pneumothoraces in the heliox group had diminished from 17.50% +/- .50% to .17% +/- .29%; in the oxygen-breathing group they had diminished from 17.83% +/- 2.25% to .50% +/- .50%; and in the air-breathing group they had diminished from 18.50% +/- 3.12% to 17.33% +/- .25%. The difference between the air-breathing and the oxygen-breathing or heliox-breathing animals was highly significant; no significant difference was found between the oxygen and heliox groups (P<.0001). CONCLUSION: Heliox, a safe and convenient therapy, is as effective as oxygen in reducing the volume of an experimental pneumothorax in rabbits.

Intussusception: a 9-year survey (1986-1995).

BACKGROUND: Acute intussusception has different clinical features in various parts of the world. The goal of this study was to determine the clinical presentation in different ethnic groups in Israel. METHODS: A retrospective chart review of a 9-year period (1985-1995) was carried out at a university medical center. Data extracted included age, sex, ethnic origin, presenting symptoms and signs, the type of enema (barium or air), and the success rate of non-surgical reduction of the intussusception. RESULTS: Ninety patients suffering from intestinal obstruction due to acute intussusception were admitted. The triad of intermittent screaming attacks, lethargy, and vomiting was observed in 37.5% of study subjects. The majority of patients were admitted during the warmer months of the year. The average age of the patients was 7.8 +/- 3.7 months; 70% of them were between the ages of 4 and 9 months and 92.5% under 1 year of age. The female-to-male ratio was 1:2.1. Air enema was superior to the barium enema in achieving reduction (p < 0.01). The incidence in the Jewish population was similar to that observed in other surveys, and twice that found in the Arab population in our region (p < 0.05). CONCLUSIONS: The overall clinical presentation of acute intussusception found in our study does not differ from other studies. The lower incidence of acute intussusception found in the Arab population can be explained by ethnic, genetic, or nutritional factors.

Increased renal medullary echogenicity in neonates.

The prevalence of increased renal medullary echogenicity in healthy neonates was looked for. A group of 178 neonates underwent renal ultrasound on the first and second days of life. On the first day of life 58% had hyperechoic material in their renal collecting system, whereas on the second day only 33% were found to have ultrasonographically demonstrable increased echogenicity in their kidneys. Urinary protein concentrations in infants with increased renal echogenicity were significantly higher than in those without increased renal echogenicity.

CT of renal densities caused by intravenous infusion of antibiotics.

OBJECTIVE: Patients treated with intravenous antibiotics were seen to have increased attenuation of the renal collecting system on CT scan of the abdomen. To detect whether this was related to certain antibiotics, we undertook a prospective study on patients being treated for sepsis while receiving intravenous antibiotics. In addition, we also tested antibiotics administered to rabbits. MATERIALS AND METHODS: Fourteen patients were tested with cefazolin, gentamicin, cefotaxime, vancomycin, amoxicillin and clavulanic acid (Augmentin), and metronidazole. Ten groups of rabbits received these drugs by intravenous injection. Computed tomography scan of the kidneys was performed prior to and 2 h after intravenous injection of antibiotics. Fourteen patients who underwent CT scan of the abdomen and were treated by intravenous antibiotics were scanned without contrast agent injection. RESULTS: According to our results, cefazolin, cefotaxime, and gentamicin seemed to be the most potent antibiotics in inducing increased attenuation of the collecting system. This effect was synergistic when a combination of drugs was used. CONCLUSION: The elucidation of the potential increase in attenuation of the collecting system by antibiotics in normally functioning kidneys should help to eliminate confusion with other pathologies such as medullary sponge kidney.

Gallbladder size: is it affected by the oral intake of water or dilute contrast medium?

Examinations of the gallbladder are performed by ultrasonography while patients are in a fasting state. In contrast, computed tomography of the abdomen is carried out in fasting patients who were given 2% meglumine diatrizoate (Urografin) solution to opacify the gut. Sonographic examination was performed to establish whether the weight of fluids given to patients had any effect on the volume of the gallbladder. Gallbladder size was measured in subjects with a normal gallbladder. The gallbladder also was measured in 117 people in the fasting state, and 10 and 30 minutes later, it was measured again after an intake of 500 ml of water or a dilute solution of contrast medium. Both groups showed evidence of gallbladder contraction, but no significant statistical difference between them was apparent. It appears, therefore, that the contrast medium solution given before abdominal computed tomography may cause some gallbladder contraction.

Partial multiseptate gallbladder: sonographic appearance.

Multiseptate gallbladder, a rare congenital anomaly, is characterized by the presence of multiple thin septa dividing the gallbladder lumen into various sized chambers, often with a honeycomb appearance. In nearly all cases described previously, the entire gallbladder lumen was traversed by the septa. We describe three children, ages 3, 9, and 16 years, with sonographic features of multiseptate gallbladder, in which the septa were confined to the body and neck of the gallbladder in two, and to the fundus in one. The CT features of the anomaly also are described in one patient.

Multifocal chronic osteomyelitis with exuberant periosteal formation.

A very protracted unusual course of multifocal osteomyelitis in a young child is presented. Initial radiolucencies were followed by a marked periosteal overgrowth, which resulted in severe bone deformities. A viral etiology is suggested.

Dermoids of the posterior fossa. Case reports and review.

Three children are presented with dermoid cysts of the posterior fossa, one of the most common locations of dermoid. They were initially diagnosed as having abscesses. Clinical presentations included hydrocephalus and recurrent meningitis. A helpful clue for identification is a bony defect of the skull on plain film or on a bone-window at Computed Tomography (CT).

Ultrasonographic and computed tomographic diagnosis of benign masseteric hypertrophy.

Benign masseteric hypertrophy in a young child is presented. Diagnosis was confirmed by sonography and computed tomography. Recognition of this disorder obviates the need for further invasive investigations.

Non-functioning kidney associated with neonatal adrenal hemorrhage. Report of 2 cases.

Two neonates, with a palpable mass in the loin, turned out to have adrenal hemorrhage. Both of them had also hypertension and a poorly functioning or non-functioning kidney on the same side. Surgery in one of them reverted blood pressure to normal. The cause for hypertension is discussed.

Ultrasonic diagnosis of duplication cysts in children.

Real time ultrasound is an excellent method of detecting cystic lesions in the child's abdomen. Its accuracy in the diagnosis of intestinal duplication cysts is enhanced when it is followed by a barium study. These cysts may present a variety of ultrasonic appearances and the spectrum of findings is well represented by three consecutive cases diagnosed in 1983.

Blunt abdominal trauma with unrecognized urinary tract injury.

We report three cases of serious renal injuries due to blunt abdominal trauma within the context of multiple organ trauma. The renal involvement was not initially suspected, with resulting serious consequences. We suggest that infusion pyelography be performed prior to or shortly after surgery in all cases with extensive abdominal trauma. A retroperitoneal hematoma on explorative laparotomy in cases of multiple trauma should raise the suspicion of a concomitant serious renal injury, and an immediate diagnostic investigation should be conducted.

Infantile achalasia.

Achalasia in infancy is rare. A male infant who started to have symptoms at the age of 4 months, and who was operated at the age of 17 months is described. Post operatively the symptoms subsided and normal growth and development were regained. Achalasia should be included in the differential diagnosis of children with regurgitation, vomiting and failure to thrive.