Biomedical subjects
D H Jamieson
Publications and source records attributed to D H Jamieson.
H-type tracheoesophageal fistula.
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Local staging of Wilms' tumor--computerized tomography correlation with histological findings.
PURPOSE: The aim of this study was to assess the accuracy of computed tomography (CT) in the local staging of Wilms' tumor. METHODS: Twenty-six patients with unilateral, nonmetastatic Wilms' tumors were accrued over the period of 1990 through 1997. Preoperative CT staging was performed before surgical biopsy or excision. The abdominal CT images were reviewed and staged for local disease according to National Wilms' Tumour Study (NWTS) Group Staging V as either intrarenal disease (Stage I), local extrarenal extension amenable to complete local excision (Stage II), or advanced local disease (Stage III). Patients with metastatic (Stage IV) and bilateral disease (Stage V) were excluded from our study. Results were compared to histological findings. RESULTS: CT scan correctly staged 10 of 26 cases (38%) of Wilms' tumor. CT scan overstaged 12 of 16 (75%) localized renal disease (Stage I) and local extension (Stage II) tumors, and understaged 4 of 10 (40%) localized spread (Stage III) tumors. CONCLUSIONS: CT scan appears to have poor correlation to histological staging. Therefore, basing therapy solely on radiological imaging may lead to some patients receiving more intense therapy than necessary, whereas others do not receive sufficient therapeutic regimens. Histological assessment of the excised mass should remain the standard for staging Wilms' tumors.
Atelectasis on pediatric chest CT: comparison of sedation techniques.
BACKGROUND: A change in practice at our institution resulted in increased use of anesthesia for CT scan of the chest in children who required sedation. OBJECTIVE: To determine whether there is a difference in the frequency or severity of pulmonary atelectasis on CT scan in children sedated by anesthesiologists compared with children sedated by radiologists using intravenous pentobarbital. MATERIALS AND METHODS: Retrospective blinded review of 60 CT scans of the chest performed in 41 children. Forty-one studies in children sedated by radiologists (median age 29 months) were compared with 19 studies in children sedated by anesthesiologists (median age 25 months). RESULTS: Atelectasis sufficient to obscure pulmonary metastases was shown in 5 of 41 (12 %) radiology sedations and 13 of 19 (68 %) anesthesiology sedations (P < 0.01). Higher grades of atelectasis were recorded in children under anesthesia (P < 0.01). CONCLUSION: Atelectasis is more frequent and more severe in children undergoing general anesthesia compared with intravenous pentobarbital sedation. Consideration should be given to the use of forced inspiration in children anesthetized for CT scan of the chest.
Downhill esophageal varices.
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Interventional drainage of appendiceal abscesses in children.
OBJECTIVE: This study was undertaken to validate the outcome of interventional drainage and IV antibiotics for the treatment of appendiceal abscesses in children. MATERIALS AND METHODS: Between March 1991 and March 1995, 46 children with one or more intraabdominal appendiceal abscesses were seen at a tertiary care referral center. The children received IV antibiotics and underwent interventional drainage of their collections. All procedures were performed in the radiology intervention suite using IV sedation and, in one patient, a general anesthetic. All patients were followed up for at least 1 year. RESULTS: The 46 patients underwent 64 procedures. These included the insertion of 34 percutaneous drainage catheters, the insertion of 25 transrectal drainage catheters, and five needle aspirations. Four patients did not respond to their initial treatment and required surgery. One patient developed a colonic fistula that resolved spontaneously. CONCLUSION: Successful treatment of 42 patients (91%) justifies image-guided drainage and IV antibiotics as appropriate management for appendiceal abscesses in children.
Imaging gastrointestinal perforation in pediatric blunt abdominal trauma.
OBJECTIVE: To assess the role of imaging, in particular CT, in the early detection of GI perforation. SUBJECTS AND METHODS: In a 10-year period, 43 patients with surgically confirmed GI perforation were identified from hospital records; 22 of these had preoperative CT evaluation. Medical records and radiology were retrospectively reviewed and CT studies were particularly assessed for extraluminal air, free intraperitoneal fluid, bowel wall thickening, bowel wall enhancement, and bowel dilatation. During the study period an additional 12 trauma patients were identified who had CT studies demonstrating the above findings, but who had hypovolemic shock bowel or nondisrupting bowel injury without perforation evident. RESULTS: Extraluminal air was demonstrated in 47 % of the imaged perforations. There was one false-positive extraluminal air. Perforation was confirmed in patients who had all five of the above CT findings, but this was the case for only 18 % of patients with perforation. One or more of the five specified CT findings were present in all CT studies reviewed. No false-negative CT study was performed in the study period. CONCLUSION: Separating nondisrupting bowel injury from perforation is diagnostically difficult; however, CT remains a good modality for assessing GI perforation in pediatric blunt trauma, but it cannot replace diligent and repeated clinical evaluation of all potential perforation victims.
Imaging intracranial tuberculosis in childhood.
A morphologically based imaging review of intracranial tuberculosis in childhood is presented. The computed tomography and magnetic resonance features of parenchymal tuberculoma, tuberculous meningitis and meningeal/meniningocerebral tuberculoma are illustrated. Recent insight into the nature of tuberculoma necrosis and its magnetic resonance correlation is reviewed. Pathogenesis, relevant clinical background and the role of modern imaging is discussed.
Management of hemobilia and persistent biliary fistula after blunt liver trauma.
A 10-year-old girl had hemobilia and a biliocutaneous fistula after blunt abdominal trauma. Embolization of the right hepatic artery occluded the hepatic artery aneurysm, but the cutaneous biliary fistula persisted despite prolonged (8 months) conservative management including sphincter decompression with an endoscopically placed biliary stent. Roux-en-Y fistuloenterostomy eventually cured the bile leak.
Clinical and radiological features in three cases of pulmonary involvement from recurrent respiratory papillomatosis.
Clinical case reports of 3 children with recurrent respiratory papillomatosis who developed lung dissemination of the disease are presented. The radiological features of the primary pulmonary disease included papillomata in the distal airway and multiple, nodular lung lesions, both solid and cavitated. Changes secondary to pulmonary papillomatosis included atelectasis, infection and bronchiectasis. Respiratory papillomatosis involving pulmonary parenchyma is associated with a poor prognostic outcome. Early detection of such involvement and aggressive treatment of secondary infection are required to limit parenchymal damage.
A larval mosquito survey in northeastern Arkansas including a new record for Aedes albopictus.
An extensive larval mosquito survey was conducted in Craighead County in northeastern Arkansas in 1990-91. Nineteen species representing 8 genera were collected. Culex restuans was the most cosmopolitan species in relation to habitat utilization, being collected in 5 or 7 habitat types sampled. A major range extension of Aedes taeniorhynchus in Arkansas was documented as well as the first known collection of Aedes albopictus in the northeastern part of the state.
CT and MR in the management of advanced spinal tuberculosis.
In regions where tuberculosis is endemic, CT and MR are of limited use in making the initial diagnosis of spinal tuberculosis. Their optimum use is for monitoring the management of cases involving paralysis. CT best evaluates the integrity of posterior bony structures which provide spinal stability and MR best demonstrates the content and extent of the extradural mass that is causing the paralysis. Their use is illustrated by three recent cases.
High resolution CT of the lungs in acute disseminated tuberculosis and a pediatric radiology perspective of the term "miliary".
High resolution CT (HRCT) of the lungs in six children with acute disseminated tuberculosis was evaluated. There was a wide variation in the HRCT appearances. This covered differences in size, distribution and concentration of nodular opacities. Coalescence of nodules and the presence of interstitial thickening was variable. The recognition of acute disseminated tuberculosis is important for diagnosis and has prognostic implications. The use of the term "acute disseminated tuberculosis" rather than "military tuberculosis" is advocated.
Communicating bronchopulmonary foregut malformation associated with esophageal atresia and tracheo-esophageal fistula.
We report on two neonates who had esophageal atresia with a distal tracheo-esophageal fistula (type III) and a second fistula between the distal esophagus and an intralobular sequestrated lung segment. In both patients the bronchopulmonary foregut malformation became evident only when the entire esophagus was in continuity following primary repair and a contrast swallow was performed to evaluate the anastomotic site.