Biomedical subjects
Publications and source records attributed to D K Boal.
Diagnosis of spontaneous perforation of the bile ducts in infancy depends on the awareness of this rare condition. The purpose of this article is to report a new case of extra hepatic bile duct perforation, review the literature, and describe in detail the ultrasonographic findings.
Falciform ligament abscess resulting from an infected ventriculoperitoneal shunt has not previously been described. This unusual type of abscess should be considered in a patient with an infected ventriculoperitoneal shunt who presents with epigastric tenderness. Signs of peritonitis may not be present if the abscess is localized. Imaging studies such as ultrasound or CT scan may frequently establish the diagnosis.
Between 53 and 98 days of gestation 11 fetal lambs were subjected to unilateral ureteral ligation. In 8 fetuses re-exploration was performed 35 to 41 days after ligation. Chronic catheterization of the obstructed kidney, bladder and fetal vascular system was used for analysis of physiological data. Average creatinine clearance was 1.35 +/- 0.067 ml. per minute in the control kidney and 0.226 +/- 0.057 ml. per minute in the obstructed kidney after diversion. Free water clearance, osmolar clearance and fractional sodium excretions were not statistically significantly different in control and obstructed kidneys.
We have examined the trend in the incidence and mortality of intraventricular hemorrhage (IVH) in low birthweight infants from 1981 through 1984. During this time we admitted 407 infants in the first week of life with a birthweight less than or equal to 1500 gm in whom a cranial ultrasonogram or autopsy had been performed. Though the mean birthweight and gestational age, proportion of infants who were inborn, and percentage of infants requiring mechanical ventilation did not change over the 4 years, cesarean deliveries were performed more frequently (P less than .001). The overall incidence of IVH was 62% in 1981, 56% in 1982, 49% in 1983, and 58% in 1984, thus no significant trend was evident. Although the incidence of minor hemorrhages (grades I and II) remained relatively constant, there was a decrease in the incidence of grade III IVH (1981, 11%; 1984, 2%, P = .01). The incidence of grade IV hemorrhage did not change during the 4 years and ranged from 7 to 9%. Mortality rate for all infants weighing less than or equal to 1500 gm and for infants with a minor hemorrhage remained unchanged; however, the mortality rate for infants with a major hemorrhage (grade III or IV) tended to decrease (P = .07). We conclude that although some minor changes in the incidence and mortality have occurred, IVH continues to be a major problem in very-low-birthweight infants at our institution.
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A ureter entering a bladder diverticulum almost always has associated vesico-ureteric reflux but rarely obstruction. We present the clinical and radiologic data on a patient with an ectopic ureteral insertion into a bladder diverticulum, with associated obstruction but not vesico-ureteric reflux. Periureteral fibrosis secondary to chronic inflammation is thought to be the underlying cause.
The occurrence of pulmonary artery obstruction in an 8 day old infant as a complication of an aneurysm of a nonpatent ductus arteriosus is reported, together with the echocardiographic and angiographic findings. To relieve the obstruction, the aneurysm and an intrapulmonary thrombus were successfully removed with the use of cardiopulmonary bypass when the infant was 3 months old.
Real-time ultrasonography (US) of the infant hip provides an accurate image of anatomic relationships as well as valuable information concerning function. US clearly images the cartilaginous femoral head and enables accurate assessment of hip size, shape, and symmetry. The dynamic relationship of the cartilaginous head to the acetabulum is clearly defined, and instability, subluxation, and dislocation can be demonstrated. The size, shape, and position of the hip can be monitored with the infant in a spica cast, brace, or harness. Findings of 212 sonograms of infant hips were correlated with those of radiography, orthopedic examination, or both. There were no false-negative or false-positive results among infants with congenital hip dysplasia, and, to the authors' knowledge, US revealed anatomic details more accurately than any other currently employed imaging modality, including computed tomography.
Femoral neck stress fracture is extremely rare in childhood. We report a case of femoral neck stress fracture in an 11-year-old girl. Differential diagnosis and a brief review of the literature follow.
Autosomal dominant polycystic kidney disease is rarely diagnosed in infancy or childhood. The renal involvement is typically bilateral. We describe two children with ADPKD (autosomal dominant polycystic kidney disease) presenting with a unilateral renal mass. The value of a careful genetic history and the role of sonography will be discussed.
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This case report describes a child with biliary atresia and hypertrophic osteoarthropathy (HO), the second such case report of HO in a child with biliary atresia. Suggested pathogenetic mechanisms are discussed. Surgical intervention in the treatment of biliary atresia has clearly increased survival in affected children. The relationship between surgical intervention, either successful or unsuccessful, and hepatic HO remains speculative.
The lacuna magna is a congenital diverticulum embryologically arising from the dorsal aspect of the fossa navicularis. During a 1 year period, lacuna magna was diagnosed in five boys. Another 57 voiding cystourethrograms obtained in boys were reviewed retrospectively. Lacuna magna is demonstrable on properly performed voiding cystourethrography, but can be mimicked by pseudolesions created by improper radiographic technique. Clinical information, urographic evaluation, and methods of treatment are discussed.
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Sonography was performed on five children, ages 1 day-9 years, who had classic infantile polycystic kidney disease and on one child who had glomerulocystic renal disease. Microcystic involvement of the kidneys in infantile polycystic kidney disease results in renal enlargement, increased echogenicity of renal parenchyma but good transmission of sound through the kidney, and poor definition of renal borders on sonograms. The periportal involvement of the liver in the classic infantile polycystic kidney disease may lead to hepatic fibrosis and portal hypertension. Less typical features include asymmetric renal enlargement and macrocysts in the renal parenchyma.
With the increasing use of combined chemotherapy and radiotherapy in the treatment of certain types of malignancy, a clinically distinct type of esophagitis has been recognized as an undesirable side effect. It occurs with low doses (less than 2,000 rad) of mediastinal radiation in patients who simultaneously or sequentially receive either adriamycin or actinomycin D. Characteristic of this entity is "recall": recurrent episodes of esophagitis with each course of chemotherapy. The radiographic findings are nonspecific, ranging from subtle alterations in motility to severe damage with irreversible stricture formation. The primary differential diagnostic considerations are infectious processes. The radiographic spectrum, clinical aspects, and differential diagnoses in five patients are discussed.
Real-time ultrasound (US) is the imaging method of choice for diagnosis and follow-up of congenital dislocation of the infant hip (CDH). Clinical aspects and the role of imaging are reviewed. Technique and anatomy, both normal and abnormal, are illustrated, as well as, the use of sonography during treatment with Pavlik harness and spica cast. Correlation of ultrasound findings with clinical examination, other available imaging studies and long-term patient follow-up shows 100% sensitivity and 100% specificity for real-time US diagnosis of CDH.
We retrospectively reviewed the results of open or closed reduction for developmental dysplasia of the hip (DDH) in 49 children younger than 12 months old, who had 57 hip dislocations. Group A (18 hips) developed partial or complete avascular necrosis (AVN), and group B (39 hips) did not develop AVN. Thirty-eight hips were treated by closed reduction, and 17 had open reduction. One patient with bilateral hip dislocation initially had closed reductions followed by bilateral open reduction 3 months later. With the numbers available for study, there was no significant difference in the occurrence of AVN with respect to variables such as preliminary traction, closed versus open reduction, Pavlik harness use, and age at the time of operative intervention. However, the presence of the ossific nucleus before reduction, detected either by radiographs (p < 0.001) or ultrasonography (p = 0.033) was statistically significant in predicting AVN. Only one (4%) of 25 hips with an ossific nucleus developed AVN, whereas 17 (53%) of 32 hips without an ossific nucleus before reduction developed AVN. Our results suggest that the presence of the ossific nucleus before closed or open reduction for DDH may decrease the risk of AVN.