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Biomedical subjects

D A Stringer

Publications and source records attributed to D A Stringer.

At least 37 records · Page 2Linked to original sources
PubMed1993

Prepubertal ovarian cyst formation: 5 years' experience.

OBJECTIVE: To document the frequency of ovarian cyst formation in the prepubertal female and to report on the clinical implications of these cysts. METHODS: We evaluated cases from a retrospective chart review of prepubertal females with ovarian cysts. RESULTS: Over a 5-year period, 1818 ultrasound studies were completed in prepubertal females, from which 99 patients were identified as having ovarian cysts. The majority (82 of 99, 83%) were small, unilocular cysts averaging 2-3 mm in diameter. The incidence of these small cysts ranged at 2-5% in females between birth and age 8. Large ovarian cysts (ie, greater than 2 cm in diameter) are rare in young girls over age 2, with most occurring within the first year of life. Of the 17 large ovarian cysts, two presented with torsion and both were complex on ultrasound examination. Five (29%) of the large ovarian cysts were treated conservatively and demonstrated regression on follow-up; these were unilocular cysts. Although functioning cysts resulting in precocious pseudopuberty are expected to be rare, we identified five cases (5%) in our series. CONCLUSIONS: Small, unilocular ovarian cysts less than 1 cm in diameter are found in prepubertal females with a frequency of 2-5% and are clinically insignificant. Ovarian cysts greater than 2 cm are rare. Unilocular ovarian cysts less than 5 cm may be followed conservatively with ultrasound surveillance until regression, without a major risk of torsion. Ovarian cysts associated with precocious pseudopuberty are generally larger than 2 cm and may be recurrent.

Child↗
PubMed1992

New concepts in imaging of the gastrointestinal tract in children.

This article highlights some of the significant recent advances in imaging of the pediatric gastrointestinal tract that have occurred over the last decade. The current roles of the newer imaging modalities, including ultrasound, computed tomography, and magnetic resonance imaging, are discussed and illustrated. Particular emphasis is given to antenatal evaluation, suspected gastric outlet obstruction, inflammation, and other causes of the acute abdomen. Enhancements in fluoroscopic techniques are outlined, including the use of the newer contrast agents as well as air reduction of intussusception. Continued good communication between the pediatric radiologist and pediatric surgeon is vital to improve the care to children with disorders of the gastrointestinal tract.

Abdomen, Acute↗
PubMed1991

T-cell lymphoma and mature nephroblastoma after synchronous bilateral Wilms' tumor.

A 15-year-old boy had lymphoblastic lymphoma of the left tonsil after being treated for bilateral Wilms' tumor (BWT) at 7 months of age. In addition, a fully differentiated Wilms' tumor was diagnosed in the remaining, partially nephrectomized left kidney. Development of second malignancies in patients with a history of BWT, as compared with those with unilateral Wilms' tumor, is discussed. A possible explanation for the concurrently diagnosed, fully differentiated Wilms' tumor in the remaining left kidney is suggested.

Humans↗
PubMed1991

Intussusception: barium or air?

At The Hospital For Sick Children, the use of air has recently replaced the use of barium in the reduction of intussusceptions. The purpose of this study was to review the results from 200 consecutive patients with intussusceptions, 100 patients treated with barium enema and 100 patients treated with air enema. The groups were similar with regard to sex, average and median ages, and presenting symptoms and signs. Successful reduction was achieved in 75% of episodes of intussusception treated with barium enema and 76% treated with air enema. Failure of either modality showed a high association with the presence of either a lead point or an ileoileal or ileoileocolic intussusception. Among those cases of unsuccessful reduction, operation was performed in all 59 cases; resection in 30 cases, manual reduction in 19, and spontaneous reduction was found in 10. There were three perforations during attempted reduction with barium and two with air. All perforations were treated by resection and primary anastomosis. There were 18 recurrent intussusceptions following barium enema reduction and nine following air enema reduction. Therefore, with the lower absorption of x-rays by air and the relatively inert nature of air (compared with barium in the event of a perforation), we feel that air enema is the treatment of choice in the initial management of intussusception.

Air↗
PubMed1991

Cardiac rhabdomyomata and megacystis-microcolon-intestinal hypoperistalsis syndrome.

Multiple cardiac rhabdomyomata were discovered on necropsy tissue review of a previously well child with megacystis-microcolon-intestinal hypoperistalsis syndrome, who died unexpectedly at home at 40 months of age. Multiple cardiac rhabdomyomata occur rarely and have not previously been reported with this syndrome. They are most frequently associated with tuberous sclerosis. The finding of multiple cardiac rhabdomyomata in this patient suggests the possibility that these two rare conditions may be associated. Putative gene loci for tuberous sclerosis have been assigned to the long arms of chromosomes 9 and 11 and it is possible that the cardiac rhabdomyomata seen in this patient are a serendipitous indicator of the location of the megacystis-microcolon-intestinal hypoperistalsis gene.

Chromosome Mapping↗
PubMed1991

Simple renal cysts in children: diagnosis and follow-up with US.

To assess the sonographic frequency of simple renal cysts in children, the authors retrospectively reviewed the results of abdominal sonographic studies of 16,102 children performed over a 5-year period between January 1, 1985, and December 31, 1989. Patients with abnormal renal function, dysplastic kidneys, or a family history of polycystic kidney disease were excluded from the study. The authors' review of the sonograms revealed 37 simple cysts in 35 patients (0.22%); the cysts were evenly distributed by age and sex and measured from 0.3 to 7.0 cm in maximum diameter. Sixteen cysts (43%) were in the upper pole of the right kidney. Follow-up sonographic studies of 23 cysts in 22 patients for up to 5 years showed no change in size in 17 cysts (74%). The largest cyst was drained percutaneously; all other cysts were managed conservatively. No patient showed deterioration of renal function. Therefore, the authors concluded that in a pediatric patient demonstrating normal renal function, no further intervention is necessary when a simple renal cyst is identified at sonography.

Adolescent↗
PubMed1991

Arteriopathy and coarctation of the abdominal aorta in children with mucopolysaccharidosis: imaging findings.

Eight children with mucopolysaccharidosis I (MPS I), representing 33% of all children with MPS I seen at our institution during an 18-year period, developed hypertension. Five of these hypertensive children also exhibited symptoms of aortic coarctation. The radiographic evaluation of four of these children with MPS I (three with Hurler syndrome, MPS I H, and one with Scheie disease, MPS I S) and arteriopathy affecting the thoracic aorta, abdominal aorta, and visceral and renal arteries is presented. Hypertension developed in all four children before they were 4 years old; three had differences between upper- and lower-extremity blood pressures. Irregular narrowing of the abdominal aorta with either multiple minor asymmetric wall lesions (n = 2) or abrupt concentric narrowing (n = 2) was present in all children as shown by aortography (n = 3), sonography (n = 3), MR imaging (n = 2), and/or autopsy (n = 1). A variety of other vessels also were involved, including the ascending aorta (n = 1) and vertebral (n = 1), axillary (n = 1), intercostal (n = 2), lumbar (n = 2), mesenteric (n = 3), renal (n = 2), and iliac arteries (n = 3). Autopsy in one child demonstrated thickened heart valves, narrowing of the coronary arteries, and irregularity of the aorta due to deposition of mucopolysaccharide material within the intima. Our series demonstrates various facets of the arteriopathy of MPS I as shown by sonography, MR imaging, and angiography.

Angiography↗
PubMed1990

The value of Doppler sonography in the detection of major vessel thrombosis in the neonatal abdomen.

Duplex spectral or color Doppler sonography demonstrated major abdominal vessel blocks affecting 18 vessels in 16 infants aged between 23 and 56 weeks postconceptional age. The portal vein was affected in 8 infants, the renal vein in 3, the renal vein and inferior vena cava in 1, the renal artery in 1, the inferior vena cava and hepatic vein in 1, and the aorta in 2 infants. Doppler sonography confirmed the grey-scale findings and often demonstrated the extent of vascular flow, providing functional information not available from the grey-scale scan. It facilitated the follow-up of thrombosis during therapy. Most important of all, in many instances it enabled a rapid and reliable specific diagnosis often not possible on the grey-scale study alone and hence altered patient management.

Abdomen↗
PubMed1990

Effects of cisapride in patients with cystic fibrosis and distal intestinal obstruction syndrome.

In a double-blind, placebo-controlled, crossover trial, we investigated the effects of the prokinetic drug cisapride in patients with cystic fibrosis and chronic recurrent distal intestinal obstruction syndrome (DIOS). After a baseline period, 17 patients (12.9 to 34.9 years; 12 boys) received, in random order, cisapride (7.5 to 10 mg) and placebo three times daily by mouth, each for 6 months. Gastrointestinal symptoms (flatulence, abdominal pain, fullness, abdominal distension, nausea, anorexia, heartburn, diarrhea, vomiting and regurgitation) were scored three times monthly and physical examinations assessed. At baseline and at each 6-month period, assessment included food intake for 7 days, 3-day stool collection, pulmonary function tests, and abdominal radiographs. During cisapride therapy compared with placebo, there were significant reductions in flatulence (p less than 0.005), fullness, and nausea (p less than 0.05). Patients with the worst symptom scores benefited most from cisapride. With cisapride, 12 patients felt better and three worse (p less than 0.05); physicians judged 11 patients improved and two worse (p less than 0.05). No side effects were noted. There were no significant differences between cisapride and placebo periods in nutritional status, x-ray scores, pulmonary function, food intake (fat, protein, calories), stool size and consistency, and fecal losses of fat, bile acids, chymotrypsin, and calories. For acute episodes of DIOS, intestinal lavage was needed 6 times in 4 patients during treatment with cisapride, and 11 times in 6 patients receiving placebo. In comparison with unselected patients with cystic fibrosis and pancreatic insufficiency who were receiving enzyme supplements and who had no distal intestinal obstruction, fecal fat losses (percentage of intake) were almost twice as high in the study group with DIOS (31.2 +/- 20.6% vs 16.2 +/- 17.6%; p less than 0.01). We conclude that in the dosage used, long-term treatment with cisapride appears to improve chronic abdominal symptoms in patients with cystic fibrosis and DIOS, but fails to abolish the need for intestinal lavage. Cisapride treatment had no effect on digestion and nutritional status of cystic fibrosis patients with pancreatic insufficiency.

Adolescent↗
PubMed1990

Malignant carcinoid within a recurrent sacrococcygeal teratoma in childhood.

Sacrococcygeal teratomas are uncommon tumors of childhood carrying a good prognosis if histologically benign and completely excised, especially if the coccyx is also excised. Carcinoids are also rare in children and only rarely associated with teratomas. We report the findings in a girl who had a malignant carcinoid within a recurrent malignant sacrococcygeal teratoma following its incomplete excision in the neonatal period. We believe that this is the first such case occurring in childhood.

Carcinoid Tumor↗
PubMed1990

The radiologic and endoscopic investigation and etiologic classification of gastritis in children.

In 11 children the endoscopic criteria for gastritis were correlated with radiologic and pathological findings. An etiologic classification is proposed. The diagnoses included gastric involvement by Crohn's disease (five children), eosinophilic gastroenteritis (one), diffuse varioliform gastritis (two), erosive gastritis associated with Campylobacter pylori infection (two) and idiopathic erosive gastritis (one). Eight of the nine double-contrast barium studies and only one of the three single-contrast examinations correlated with the endoscopic and histologic findings. In 10 children the endoscopic results correlated well with the biopsy findings.

Adolescent↗
PubMed1989

Duplex Doppler sonography for renal artery stenosis in the post-transplant pediatric patient.

Of 60 renal transplant patients who underwent 134 duplex Doppler sonograms, 38 had normal frequency shift profiles and 8 showed only minimal disturbances, within normal post-transplantation limits. Fourteen patients had hypertension and showed a very abnormal profile. In 3 of the 14 the hypertension was controllable medically, and the remaining 11 underwent angiography. Duplex Doppler sonography showed gross turbulence (spectral broadening, bidirectional flow) and high frequency shift confirmed on angiography to represent 50 to 75% main renal artery stenosis in 8 of these 11, and major renal intrahilar vessel stenosis in 2. In the remaining patient, no Doppler signal was found and 95% stenosis was present. In 1 patient with intrahilar stenosis, arterial signals detected in the renal veins indicated the presence of a post-biopsy arteriovenous fistula. One patient with main renal artery stenosis also had a fistula, which was masked by a 70% stenosis. All patients with angiographically proven renal artery stenosis had a distinctive abnormality of the Doppler arterial flow pattern.

Adolescent↗
PubMed1989

An assessment of sonography in the diagnosis and management of neonatal renal candidiasis.

The renal sonographic findings in six cases of neonatal candidiasis and 13 cases previously reported in the literature are reviewed. Focal and diffuse parenchymal changes and obstruction due to mycetoma formation were frequent features. In the current series the sonographic changes were found to bear an inconstant relationship to the probable time of onset of the infection. In addition, apparent sonographic deterioration occurred in neonates well after adequate antifungal treatment was initiated. In view of the potential toxicity of systemic antifungal therapy, sonographic renal parenchymal changes are not considered an adequate indication for either its initiation or its continuation.

Candidiasis↗
PubMed1989

Percutaneous aspiration, drainage, and biopsy in children.

Between 1983 and 1987, 44 infants and children had 50 percutaneous aspiration, drainage, and/or biopsy procedures under sedation and local anesthesia. Ultrasound occasionally supplemented by fluoroscopy was most commonly used as guidance. Results of all 17 aspirations without drainage helped in management. Eighteen of 25 aspirations with drainage were successful. The major clinical improvement was related to the initial decompression. Six of the eight biopsies were diagnostic. There were no complications or mortality. Our results show that percutaneous techniques can be performed safely and effectively in infants and children.

Adolescent↗
PubMed1989

Comparison of multi-view videofluoroscopy and nasopharyngoscopy in the assessment of velopharyngeal insufficiency.

Ratings and drawings of multi-view videofluoroscopy and nasopharyngoscopic studies of the velopharyngeal valve in 25 subjects with velopharyngeal insufficiency (VPI) were compared. The videofluoroscopic projections assessed were lateral, base, and Towne views. The Towne view was visually compared with flexible fiber optic nasopharyngoscopic studies in the same subjects. The Towne view was found to compare well with nasopharyngoscopic examination, and lateral view alone was found to be inadequate for the description of velopharyngeal movements.

Adolescent↗