PubMed Health⌕ Search

Biomedical subjects

C K Hayden

Publications and source records attributed to C K Hayden.

At least 19 recordsLinked to original sources
PubMed1996

Ultrasonography of the acute pediatric abdomen.

In this article I have attempted to illustrate just how potentially useful the current ultrasound examination can be in the evaluation of the acute pediatric abdomen. It must be understood, however, that not all radiologists agree on the merits of ultrasound in the evaluation of the gastrointestinal tract, and in practice the choice will reflect the radiologist's experience and expertise as well as the confidence level of the referring physician. Proficiency in pediatric ultrasonography is not gained overnight and cannot be attained by those who only occasionally perform such examinations. Certainly, unskilled use of ultrasound quickly leads to disasters and to profound mistrust by referring clinicians. Nevertheless, in experienced hands ultrasonography can provide valuable information, much of which cannot be obtained by any other imaging modality, and thus will change forever the radiologist's role in the work-up of the acute pediatric abdomen.

Abdomen↗
PubMed1994

Aryepiglottic fold width in patients with epiglottitis: where should measurements be obtained?

PURPOSE: To determine the best site for measurement or assessment of the aryepiglottic folds and determine whether evaluation of the lower portion of the folds is useful. MATERIALS AND METHODS: The lateral neck radiographs from 38 children with epiglottitis were retrospectively reviewed and compared with findings in 100 patients with croup and 100 control patients. In all patients, the fold thickness was measured at three levels: at the midpoint (site 1), just behind the epiglottis (site 2), and at the base, just above the false vocal cords (site 3). RESULTS: Full-thickness measurements obtained at sites 1 and 2 were statistically significant predictors of epiglottitis (sensitivity, 94.74%; specificity, at least 96.50%) in comparison with those obtained in patients with croup and control patients. CONCLUSION: The best site for width assessment is the upper half of the folds. Measurement at the base, where the folds overlie the arytenoid cartilage, is not nearly as accurate and should be avoided.

Child↗
PubMed1992

Mycotic thromboaneurysmal disease of the abdominal aorta in preterm infants: its natural history and its management.

Five infants with mycotic complications of umbilical artery catheterization were evaluated with abdominal ultrasound and followed serially to document their natural history. Methicillin-resistant Staphylococcus aureus was always the infecting organism. There were one female and four male infants and they weighed between 900 and 1,200 g at birth. While two of the catheters were positioned in the abdominal aorta, three were located above the diaphragm. The predominate signs and symptoms included: thrombocytopenia, unexplained anemia, renal failure, hypertension, and embolic phenomena to the toes. Real-time ultrasound always proved sufficient for diagnosis. Serial studies detected the initial aortic thrombosis in three patients and accurately documented its progression to aneurysmal disease over 10 days in one patient and 17 days in another. Three of the infants were diagnosed with aneurysms at their initial examination. Of the five patients, three were treated nonoperatively and died of complications of their aortic disease. One patient was discovered at operation to have necrotic ischemic intestine. Aortic repair was postponed and he died of septic complications. The remaining patient underwent a PTFE interposition graft and survived for 6 months, dying of pulmonary failure with autopsy confirmed graft patency.

Aneurysm, Infected↗
PubMed1992

Sonography of acute appendicitis in childhood: perforation versus nonperforation.

We evaluated the sonographic findings in 133 consecutive children referred for suspected appendicitis. Fifty-eight of these patients (44%) ultimately underwent surgery, with 54 of these proved to have acute appendicitis. Thirty-one (58%) of the 54 had nonperforated appendicitis, and 23 (43%) had evidence of perforation. Previously described sonographic findings that have been employed in the diagnosis of appendicitis were evaluated, with the presence or absence of these findings being compared in patients with non-perforated and perforated appendicitis. In those patients who did not undergo surgery, the following findings were documented and compared to the findings in patients with proved appendicitis: (1) an identifiable appendix and its sonographic characteristics, (2) fluid localized to the right peritoneal reflection or periappendiceal region, or both, (3) free pelvic fluid, and (4) right lower quadrant adenopathy. Our results suggest that high-resolution, real-time sonography, using graded compression, is very sensitive in the identification of acute nonperforated appendicitis. Perforated appendicitis, however, can be a more difficult diagnosis because the appendix frequently decompresses with perforation and yet may not "wall off" or form a well-defined abscess. As a result, the appendix can be very difficult to identify.

Acute Disease↗
PubMed1991

Antropyloric muscle thickness at US in infants: what is normal?

The authors reviewed the ultrasonographic (US) images and medical records of 145 consecutive infants who were seen for evaluation of the upper gastrointestinal tract because of chronic vomiting and/or regurgitation. At US, the antropyloric muscle of each patient was measured in the midlongitudinal plane. On the basis of this measurement, the patients were divided into the following categories: group 1 (1-2 mm; 99 patients), group 2 (greater than or equal to 3 mm; 40 patients), and group 3 (2- less than 3 mm; six patients). Patients in group 1 were considered to have normal antropyloric muscle thickness, those in group 2 had abnormal thickness, and those in group 3 had muscle thickness that was not definitely normal or abnormal. The final clinical diagnoses for all of the infants in the three groups confirmed the authors' initial impressions that antropyloric muscle thickness of less than 2 mm was anatomically normal, muscle measuring 3 mm or greater was abnormal and diagnostic for pyloric stenosis, and muscle from 2 to less than 3 mm was abnormal but not specifically diagnostic for pyloric stenosis. Two of the six patients in group 3 eventually were diagnosed as having pyloric stenosis; thus, the authors believe that only those patients with antropyloric muscle less than 2 mm thick should be considered unequivocably normal.

Female↗
PubMed1990

Enteric duplication cysts in children: are their ultrasonographic wall characteristics diagnostic?

We reviewed eight cases of gastrointestinal duplication cysts to determine whether the combination of an echogenic inner mucosal layer and hypoechoic outer muscular layer could be seen consistently enough to be of diagnostic value. We compared our findings to those seen in twenty-seven other abdominal cysts and conclude that when identified together, the two layers are highly suggestive, if not completely diagnostic of enteric duplication cysts.

Abdomen↗
PubMed1989

Sonographic pitfalls in imaging of the antropyloric region in infants.

Certain pitfalls exist in the sonographic evaluation of the antrum in infants who are vomiting. Unless one is aware of these pitfalls, one can make erroneous diagnoses, miss diagnoses, or obtain erroneous measurements of both the mucosal and muscular layers. A discussion of these pitfalls and how to avoid them is presented.

Humans↗
PubMed1988

How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?

It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.

Apnea↗
PubMed1988

Gastroesophageal reflux: how much imaging is required?

The authors present a protocol for the selection of imaging studies for infants suspected of gastroesophageal reflux. In most cases, only a single imaging procedure is required. Three groups of patients are considered: those suspected of an esophageal or postgastric obstruction who require a barium GI series; those who appear to have reflux and a possible gastric obstruction in whom sonographic study of the gastric outlet is advised; and those suspected of aspirating in whom the possibility of reflux is studied by scintigraphy. Esophagoscopy and other studies are reserved for those refractory to therapy.

Gastroesophageal Reflux↗
PubMed1987

Successful management of congenital tracheal stenosis in infancy.

Seven infants with congenital tracheal stenosis were evaluated and treated to assess the efficacy of current techniques of management. All had multiple congenital anomalies in addition to tracheal stenosis. Notably, three infants had imperforate anus and three had vascular rings. Each infant presented early with respiratory distress. While bronchoscopy and/or bronchography were performed in some, the diagnosis could be made from high contrast x-rays of the chest in each instance. The complexity of the tracheal lesion(s) determined the operative approach. Complicating factors included tracheomalacia, multiple stenoses, pulmonary hypoplasia, and carinal involvement. The trachea was approached through an anterolateral thoracotomy in five cases and through the neck in one. Cardiopulmonary bypass was never required. Simple resection was possible only once. Four patients received costal cartilage grafts, and one graft was created from dura. Grafts varied from 2 1/2 to 6 cm in length and extended onto the bronchi in two cases. All patients with grafts were treated with postoperative endotracheal stents and ventilatory assistance and all were extubated successfully. One patient had trisomy 16p+ detected after successful extubation and died later. One patient was treated expectantly and died. While each case must be individualized, repair of complex tracheal stenosis often results in dramatic immediate improvement and long-term success.

Child, Preschool↗
PubMed1987

Developmental features of the neonatal brain: MR imaging. Part I. Gray-white matter differentiation and myelination.

To establish the normal appearance of the neonatal brain, 51 neonates, 29-42 weeks postconception, underwent magnetic resonance (MR) imaging with a 0.6-T magnet in a prospective study. T1-weighted images were used to devise stages for the appearance of gray-white matter differentiation and extent of myelination. The results show that from 29 to 42 weeks postconception, changes in gray-white matter differentiation and myelination follow the stages in an orderly and predictable fashion. Changes in white matter intensity appear related to progressive decrease in brain water content. Myelination progresses cephalad from the brain stem at 29 weeks to reach the centrum semiovale by 42 weeks. Delayed myelination, defined as the absence of myelin in the corona radiata by 37 weeks, was seen in nine infants with complicated perinatal courses. Awareness of these developmental features should help to minimize misinterpretation of normal changes in the neonatal brain and lead to earlier detection of pathologic conditions, both with MR imaging and computed tomography.

Brain↗
PubMed1987

Developmental features of the neonatal brain: MR imaging. Part II. Ventricular size and extracerebral space.

Magnetic resonance (MR) imaging with a 0.6-T magnet was performed on 51 neonates, aged 29-42 weeks postconception. In 45 neonates, the ventricular/brain ratio (V/B) at the level of the frontal horns and midbody of the lateral ventricles ranged from 0.26 to 0.34. In six other infants a V/B of 0.36 or greater was associated with either cerebral atrophy or obstructive hydrocephalus. The width of the extracerebral space measured along specified points varied little in the neonatal period and ranged from 0 to 4 mm in 48 infants. Extracerebral space widths of 5-6 mm were seen in three other infants with severe asphyxia. Prominence of the subarachnoid space overlying the posterior parietal lobes is normal in neonates and should not be confused with cerebral atrophy. The authors conclude that V/B ratios of 0.26-0.34 and extracerebral space widths of 0-4 mm represent the normal range, and that neonates whose measurements exceed these values should be followed up.

Brain↗
PubMed1987

Abnormalities of the neonatal brain: MR imaging. Part I. Intracranial hemorrhage.

The authors prospectively evaluated 82 neonates, ranging in gestational age from 29 to 44 weeks postconception, with magnetic resonance (MR) imaging at 0.6 T. Twenty-two cases of hemorrhage in 15 infants were identified. Ultrasound (US) and computed tomography (CT) were superior to MR in the first few days after parenchymal hemorrhage, since at this time lesions were apparent on only T2-weighted images. After the first 3 days, MR was the single best modality because (a) hemorrhage on CT became imperceptible in the 2d week, whereas the high signal of hemorrhage on MR persisted for 2-11 weeks; (b) MR permitted rough dating of hemorrhage according to changes in signal intensity; and (c) MR was superior in identifying subdural or epidural hemorrhage. Because of the nonspecificity and restricted field of view of US and the inability of CT to depict hemorrhage after 7-10 days, the authors conclude that MR significantly improves the detection of intracranial hemorrhage in neonates.

Cerebral Hemorrhage↗