PubMed Health⌕ Search

Biomedical subjects

A A Cacciarelli

Publications and source records attributed to A A Cacciarelli.

At least 19 recordsLinked to original sources
PubMed1995

Management of suspected antenatal torsion: what is the best strategy?

Currently, management of the newborn with suspected antenatal torsion is somewhat controversial. Many surgeons recommend early surgical exploration within the first few days of life, primarily to avoid errors in diagnosis. However, since the surgical and general anesthetic risks at this age are increased, it might be preferable to defer an operation until risks to the patient are minimized. The optimal solution to this dilemma would be the ability to diagnose torsion and exclude other conditions noninvasively. We present a series of 12 patients 1 to 14 days old who presented with a scrotal mass secondary to suspected antenatal testis torsion. Color Doppler ultrasound in each case demonstrated abnormal testicular blood flow and architecture consistent with testis torsion. Eventual exploration of all 12 patients confirmed prenatal torsion. We conclude that scrotal ultrasound with color Doppler enhancement can accurately identify neonates with antenatal testis torsion and exclude other scrotal pathological conditions. If elected, surgery for torsion can then be deferred until the risks of anesthesia and surgery are improved.

Humans↗
PubMed1993

Transient acute renal failure in the neonate.

We have observed a transient renal insufficiency in newborns associated with ultrasonographic finding of hyperechoic renal pyramids. This condition rapidly resolves, coinciding with both normalization of the renal ultrasound and the occurrence of significant proteinuria. Others have recognized a similar state of oliguria and cylindruria associated with a prolonged nephrogram on intravenous urography in newborns. There is evidence to suggest that hyaline cast deposition within the collecting tubules may account for these imaging abnormalities. The precise events surrounding the protein deposition are unknown, and it may be either the cause or the result from the transient renal dysfunction. Our 2 cases add to the evidence that there is a distinct entity of acute renal dysfunction, with identifying characteristics, in neonates associated with a good prognosis and rapid resolution.

Acute Kidney Injury↗
PubMed1993

Do all children with an acute scrotum require exploration?

A total of 77 consecutive children ranging in age from 1 day to 17 years was evaluated for an acute scrotum by a single examiner (E. J. K.). In 10 children a definite diagnosis of acute spermatic cord torsion was made based upon the history and physical examination. No imaging studies were performed and torsion was confirmed at surgery in 9 children. The diagnosis of testis torsion was not as clear-cut in the remaining 67 children and, therefore, a color Doppler ultrasound was performed before any surgical intervention. The study demonstrated normal or increased blood flow in 55 of these children and none proved to have testicular torsion, although other scrotal pathology requiring surgery was noted in 5 children. Twelve children did not demonstrate evidence of testicular blood flow on the color Doppler ultrasound and all had surgical confirmation of testis torsion. We conclude that in our experience the majority (71%) of children with an acute scrotum did not require immediate surgical exploration. Color Doppler ultrasound can reliably identify those children with an acute scrotum who require exploration and spare the majority needless surgery. Routine scrotal exploration is no longer necessary for all children with an acute scrotum.

Acute Disease↗
PubMed1992

The sensitivity of renal scintigraphy and sonography in detecting nonobstructive acute pyelonephritis.

Recently it has been demonstrated that any child with proved acute pyelonephritis may be at risk for parenchymal scarring, whether or not reflux is present. Since cortical renal scintigraphy has been shown to detect accurately renal inflammation, we compared cortical scintigraphy with renal sonography in 46 children with documented acute pyelonephritis to determine which modality is best to detect patients at risk for renal injury. Cortical scintigraphy was abnormal in 36 children (78%) and renal ultrasonography was abnormal in 5 (11%). Reflux was demonstrated in only 20 cases (43%). We conclude that cortical scintigraphy is the preferred imaging technique for diagnosing renal inflammation, and it should be used routinely in every child with suspected acute pyelonephritis. A new imaging protocol is proposed.

Acute Disease↗
PubMed1992

Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy.

Various congenital anomalies of branchial origin are found in the neck region. Understanding the varied radiologic appearances of these anomalies is greatly aided by familiarity with their embryologic origins. By considering the anatomic location and radiologic appearance, the precise embryologic origin can be accurately predicted. Defects of the branchial apparatus include branchial, thymic, and parathyroid anomalies, which may manifest as cysts, sinuses, fistulas, and ectopic glands. The embryologic model is used to explain the origins of all branchial apparatus anomalies. The most accepted theory proposes that vestigial remnants result from incomplete obliteration of the branchial apparatus or buried cell rests, and, thus, if cells are trapped in the branchial apparatus during the embryologic stage, they can form branchial cysts later in life. By understanding the embryologic basis for these defects, the radiologist is better able to interpret the findings encountered with the various imaging modalities used in the evaluation of these anomalies.

Branchial Region↗
PubMed1992

Congenital malformations of the cervicothoracic lymphatic system: embryology and pathogenesis.

Familiarity with the embryology of the lymphatic system is helpful in understanding the pathogenesis and radiologic appearance of lymphangiomas of the cervicothoracic region. By considering anatomic location and radiologic appearance, one can predict the type of lymphangioma present, the primordial lymph sac from which the malformation arose, and when it formed in embryonic life. Cystic hygromas are composed of large, dilated lymphatic spaces. They form when a primordial lymph sac fails to reestablish communication with the central venous system from which it arose. These lesions may also result from an aberrant bud arising from a primordial lymph sac. Cavernous and capillary lymphangiomas are composed of smaller lymphatic channels. They form from abnormally sequestered buds of the developing lymphatic mesenchyme responsible for the fine meshwork of terminal branches in the periphery of the embryo. Their growth may be inhibited by the relatively tougher tissues in the periphery (eg, skin and muscle) compared with the relatively loose fatty connective tissue in which cystic hygromas form. Not only can all types of lymphangioma occur in one lesion, but lymphatic and vascular malformations may also coexist.

Humans↗
PubMed1990

Urachal remnants: sonographic demonstration in children.

On 62 of 100 pediatric bladder sonograms a small, elliptical, hypoechoic structure was observed on the middle of the anterosuperior surface of the urinary bladder. One of the these structures was removed surgically, and pathologic examination disclosed a normal urachal remnant. Since it is a common sonographic finding in children, it should not be mistaken for a pathologic process unless it is accompanied by signs and symptoms of infection or bladder obstruction.

Abdominal Muscles↗
PubMed1978

Gray-scale ultrasonic demonstration of nephrocalcinosis.

Nephrocalcinosis was diagnosed by means of gray-scale somography in a premature infant with severe bronchopulmonary dysplasia. The examination provided a way of localizing faint calcifications seen on a plain abdominal radiograph.

Humans↗
PubMed1977

The incidental detection of gallium-67 citrate in a urinoma following a right pyeloplasty: a case report.

An abnormal accumulation of radionuclide was identified within the right juxtadiaphragmatic and juxtahepatic spaces during gallium-67 citrate scintigraphy in a post-pyeloplasty patient. Its mode of presentation, the recent pyeloplasty and the known biologic distribution of gallium suggested that it represented gallium-67 concentration within a postoperatively created urinoma. Diagnosis was confirmed by excretory urography and laparotomy.

Adolescent↗
PubMed1977

Posterior widening of the S1-S2 interspace in children: a normal variant of sacral development.

A lucency in the posterior S1-S2 area of the sacrum was seen in two pediatric patients. Bone scans in both and a myelogram in one case were normal. Follow-up has failed to show any clinical evidence of pathology. The lucencies are felt to represent normal variations in the development of the sacrum. A series of radiographs at different ages is presented to illustrate how normal developmental progresses in this area.

Adolescent↗
PubMed1976

Multichambered bladder anomalies.

This report reviews multichambered bladder conditions, offers a workable classification of them, presents a detailed case report, and discusses the possible causes of these anomalies. We wish to stress the importance of careful examination of the genital area in the newborn and early roentgenologic evaluation of the genito-urinary system when an anomaly is found.

Diverticulum↗