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Biomedical subjects

D Sirinelli

Publications and source records attributed to D Sirinelli.

At least 19 recordsLinked to original sources
PubMed2006

[Neurofibromatosis type 1 complications in the pediatric age: follow-up of a hundred cases].

UNLABELLED: Neurofibromatosis 1 (NF1) is a frequent genetic disease. Diagnostic criterias were established in 1988. The patients can exhibit various and unpredictable complications. OBJECTIVES: To check the efficiency of a coordinated follow-up in specialized multidisciplinary centers providing a higher quality of management and to have a better knowledge of the complications including their true frequencies. POPULATION AND METHODS: We report a serie of 100 NF1 children who were followed-up during 4 years in a specialized center at the Tours University Hospital. Three hospital check-up at 2-5, 6-7, 14-15 years of age were performed as well as an annual physical examination. RESULTS: In our serie, the mean age was 7.8 years old with a sex ratio of 1. The mean age at diagnosis was 3.8 years old and the main diagnosis criteria were the café-au-lait spots and the family history for 80% of the patients. The optic nerve glioma has a low frequency of 5%. Learning disabilities clearly represent the most frequent complication (46% of the patients). CONCLUSION: An early detection of these difficulties is a priority for the appropriate management of these children.

Adolescent↗
PubMed2006

[Sonographic cerebral sulcal pattern in normal fetuses].

PURPOSE: Define normal sulcation patterns and their chronological order of appearance on transabdominal ultrasound by comparing them with brain maturation references available in fetopathological studies and MRI findings. PATIENTS AND METHODS: By means of a prospective study, 158 normal fetal brains aged 21 to 34 gestational weeks have been analyzed with standardized data by transabdominal ultrasound in eleven different views using axial, coronal and sagittal orientation. RESULTS: The sequential development of cerebral sulci has been described according to the gestational age. This chronology was consistent with anatomo-pathologic references presenting a mean late period of one week and with MRI but without any late period. This study is available on the following website: CONCLUSION: This ultrasound study provides accurate landmarks and imaging features of normal fetal brain sulcation. The analysis and the knowledge of this sulcation provide better understanding of the brain cortex maturation and may be helpful in diagnosing brain diseases.

Brain↗
PubMed2006

[Pericochlear hypodensity on CT: normal variant in childhood].

PURPOSE: Evaluation of the prevalence of a pericochlear hypodensity on CT in children. Materials and methods. This study correlates the findings on temporal bone CT to the indications for CT (headache, trauma). Helical CT acquisitions using 0,5 mm, 0,6 mm or 0,75 mm slice thickness according to the material available, with multiplanar reconstructions. Only patients with significant pericochlear hypodensity, larger or equal to 0,4 mm, were taken into account, and the curvilinear or nodular nature of the lesion on axial and coronal sections was recorded. RESULTS: A pericochlear hypodensity was identified in nearly 40% of cases. There was no population predominence according to the indication for the CT. The curvilinear type was more frequent on coronal images, with unilateral and bilateral involvement being equally frequent. There was no significant difference according to the sex. Patients of all ages showed lesions, from newborns to adolescents, with increased frequency in childhood. CONCLUSION: This study confirms a high prevalence of pericochlear hypodensity in a paediatric population, without clinical correlation, which requires prudence when interpreting the significance of this CT sign commonly described in association with pericochlear otosclerosis and the pericochlear form of osteogenesis imperfecta.

Adolescent↗
PubMed2006

[Spasmodic torticollis caused by metoclopramide: a rare etiology of C1-C2 rotatory pseudoluxation in children].

Torticollis in children must always instigate a search for trauma. Many other etiologies can be found. The authors report a case of postmedicinal atlantoaxial rotatory pseudoluxation (AARP) occurring in a child. This child had fallen down in the morning with head trauma followed by headache. Clinically, a stiff neck with an irreducible right rotation of his neck, and an osteotendinous hyperreflexia were noted. There was a C1-C2 rotatory dislocation with no traumatic lesion on the cervical CT scan. After a few hours, the torticollis spontaneously reduced and then reappeared on the left side. This clinical fluctuation and the absorption of metoclopramide (Primpéran) started in the morning for acute gastroenteritis provided the diagnosis of AARP. This entity was confirmed by the good clinical and radiological follow-up and was caused by the substantial ligament laxity of the craniovertebral junction encountered in children. The analysis of medical imaging and the systematic search for a medicinal cause helped make the right diagnosis.

Cervical Vertebrae↗
PubMed2006

[The role of aortic morphology in the occurrence of hypertension in patients undergoing surgery for coarctation of the aorta before the age of 1 year].

OBJECTIVE: Hypertension on effort can be observed following surgical treatment of coarctation of the aorta even if the operation has been performed early and has been judged to be satisfactory. The pathophysiology of this hypertension has not been completely elucidated. The aim of our study was to look for a residual morphological anomaly of the aortic arch which might be responsible. METHODS: This was a retrospective study of patients aged over 10 years who had undergone surgery for coarctation of the aorta before the age of 1 year, consecutively between 1979 and 1993, and free from re-coarctation clinically or with Doppler. All of them had a blood pressure effort test on a cycling machine, echocardiography and an MRI of the thoracic aorta. RESULTS: 61 patients were included. Their median age was 15 years, 59% were male, 15% were hypertensive at rest and 56% on effort. With univariate analysis, only the average blood pressure (p=0.03) and the resting pulse pressure (p=0.001) were associated with hypertension on effort. With multivariate analysis the only factors that correlated independently with maximum arterial pressure on effort were the height of the patient (p=0.02) and the pulse pressure (p<0.0001). The surgical technique and the age at intervention were not associated with hypertension on effort (p=0.96 and 0.69 respectively). The diameter of the horizontal aorta and the aorta at the site of repair, measured on MRI, added to the diameter of the descending aorta at the diaphragm were not lower in patients with hypertension on effort (p=0.77 and 0.38). There were proportionally more Roman type aortic arches than Gothic types in patients with hypertension on effort, but this difference was not significant (p=0.18). CONCLUSION: In our study, the patients with hypertension on effort following correction of coarctation of the aorta did not display any residual obstruction at the level of the aortic cross on MRI. However, they had a resting pulse pressure that was significantly higher than the non hypertensive patients, reflecting an increase in the aortic wall rigidity.

Adolescent↗
PubMed2005

[Limb emergencies in children].

The three main categories of limb emergencies are trauma, infection and the painful hip. Conventional radiography is used as the initial screening imaging modality that can sometimes be complemented with sonography. Computed tomography and MRI are rarely needed. Familiarity with conditions specific to the pediatric population is essential to the diagnosis and management of these patients. Traumatic injuries in children involve growing bones with large cartilaginous component and biomechanical resistance different from that in adults. Lim infections in children are affected by the characteristic vascular supply to the metaphyseal-epiphyseal region, the intra-articular location of the metaphysis, and loose periosteal attachment. Limping (transient synovitis, Legg-Calvé-Perthes disease and slipped capital femoral epiphysis) is frequent cause of consultation and diagnosis relies on the patient's age and plain film findings.

Adolescent↗
PubMed2005

[Aortic diameter measurements on MRI follow-up of coarctation].

OBJECTIVE: During aortic coarctation follow-up, accurate diameter measurements using MRI are required. The purpose of this study was to compare the reproducibility of aortic measurements on axial and sagittal views using black blood (Fast-Spin-Echo) and three-dimensional Gadolinium-enhanced MR angiography. SUBJECTS AND METHODS: We studied 34 patients who underwent evaluation after surgical treatment in the first year of life. The aortic measurements were made at six thoracic levels. We calculated the mean difference between the two sequences, and used Bland and Altman method and the comparison to zero. RESULTS: With black blood, either on axial or sagittal views, aortic measurements were in agreement. Between two sequences, we considered as acceptable a mean difference of 0,5 mm with limits of agreement of +/- 3 mm. Difficulties were found for proximal ascending aorta measurements on all sequences. Using MR angiography, the highest agreement at the site of repair was on sagittal view, while the highest agreement at other sites was on axial views. CONCLUSION: Black blood sequence provides a better reproducibility for aortic measurements than native slices of MR angiography.

Adolescent↗
PubMed2003

[Staphylococcal pneumonia in a premature neonate: unusual transmission of nosocomial infection].

UNLABELLED: Late onset of neonatal infection could have been transmitted in prenatal period, but it is usually secondary to a postnatal transmission. CASE REPORT: A premature neonate developed staphylococcal pneumonia at 18 days of life. Genomic typing of the strains of Staphylococcus aureus obtained from the patient and from his mother (found in the endocervix culture 48 h before delivery) was identical. These strains were different from those isolated in other neonates colonised by S. aureus in the unit during at that moment. CONCLUSION: The observed case of staphylococcal pneumonia may correspond to a nosocomial infection secondary to a pre- or postnatal transmission of the agent by the mother.

Adult↗
PubMed2003

[Reduction of acute intestinal intussusception: when and how?].

After sonographic diagnosis, non-surgical therapy for intussusception in children uses pneumatic or hydrostatic (barium or water soluble) reduction. The purpose of this paper, in the light of our experience, is to answer the questions raised by general radiologists in emergency activity about the technique, indications, sedation and risks.

Acute Disease↗
PubMed2002

MRI morphometric study and correlation with cognitive functions in young adults shunted for congenital hydrocephalus related to spina bifida.

We studied the morphometric MRI findings and their correlation with cognitive functions in a population of 10 young adults shunted for congenital hydrocephalus related to spina bifida. Morphometric MRI analysis included measurement of the ventricular dilatation index, frontal and occipital parenchymal thickness and the size of the corpus callosum. The neuropsychological status was evaluated, notably to look for a discrepancy between verbal and performance skills, a finding which has previously been described in hydrocephalic children. We also investigated whether there was a correlation between cognitive function and cerebral morphometric indexes. In each case, MRI demonstrated the structural changes associated with the Chiari II malformation. The size of the lateral ventricles varied, ranging from important dilatation to small ventricles. Six patients had only partial development of the corpus callosum. All patients had a normal global IQ. In our population of young adults, we did not observe any discrepancy between verbal and visuospatial performances as has been described in children with hydrocephalus. We found no relationship between cognitive function and ventricle dilatation or parenchymal thickness or between the size of the corpus callosum and callosal transfer.

Adolescent↗
PubMed1999

Failure to demonstrate a direct caroticocavernous fistula due to arterialisation of the ipsilateral cavernous sinus.

We report a woman in whom a small direct caroticocavernous fistula (DCCF) was revealed after successful transarterial occlusion of a contralateral fistula which drained into both cavernous sinuses. We underline that a second smaller fistula can be masked by a contralateral larger one due to the lack of pressure gradient between the internal carotid artery (ICA) and arterialised blood in the ipsilateral cavernous sinus. We suggest that bilateral ICA angiograms should be performed before and after occlusion of all DCCF.

Aged↗
PubMed1999

MR assessment of the brain maturation during the perinatal period: quantitative T2 MR study in premature newborns.

The purpose of our study is to trace in vivo and during the perinatal period, the brain maturation process with exhaustive measures of the T2 relaxation time values. We also compared regional myelination progress with variations of the relaxation time values and of brain signal. T2 relaxation times were measured in 7 healthy premature newborns at the post-conceptional age of 37 weeks, using a Carr-Purcell-Meiboom-Gill sequence (echo time 60 to 150 ms), on a 2.35 Tesla Spectro-Imaging MR system. A total of 62 measures were defined for each subject within the brain stem, the basal ganglia and the hemispheric gray and white matter. The mean and standard deviation of the T2 values were calculated for each location. Regional T2 values changes and brain signal variations were studied. In comparison to the adult ones, the T2 relaxation time values of both gray and white matter were highly prolonged and a reversed ratio between gray and white matter was found. The maturational phenomena might be regionally correlated with a T2 value shortening. Significant T2 variations in the brainstem (p < 0.02), the mesencephalon (p < 0.05), the thalami (p < 0.01), the lentiform nuclei (p < 0.01) and the caudate nuclei (p < 0.02) were observed at an earlier time than they were visible on T2-weighted images. In the cerebral hemispheres, T2 values increased from the occipital white matter to parietal, temporal and frontal white matter (p < 0.05) and in the frontal and occipital areas from periventricular to subcortical white matter (p < 0.01). Maturational progress was earlier and better displayed with T2 measurements and T2 mapping. During the perinatal period, the measurements and analysis of T2 values revealed brain regional differences not discernible with T2-weighted images. It might be a more sensitive indicator for assessment of brain maturation.

Adult↗
PubMed1998

Iodixanol in paediatric excretory urography: efficiency and safety compared to iohexol.

BACKGROUND: Iodixanol (Visipaque, Nycomed Imaging AS, Oslo, Norway) is a new non-ionic and isotonic X-ray contrast medium. OBJECTIVE: To assess its safety and efficacy for paediatric excretory urography. MATERIALS AND METHODS: A three-centre trial in which 72 patients were randomised into three parallel groups: iodixanol 270 mgI/ml, iodixanol 320 mgI/ml and iohexol 300 mgI/ml (Omnipaque, Nycomed Imaging, Oslo, Norway). Doses ranging from 1 to 3 ml/kg never exceeded 50 ml. Pulse rate and blood pressure were recorded before, during, and after the examination. Adverse events, including injection associated discomfort, were recorded during and up to 24 h after the examination. The diagnostic quality of the urograms was assessed on a four-level scale. RESULTS: No serious adverse event occurred in any of the three groups. One patient who was given iodixanol 270 mgI/ml, three who received iodixanol 320 mgI/ml, and one who received iohexol 300 mgI/ml experienced transient adverse events. More than 80 % of the urograms in all three groups were rated "good" or "excellent". CONCLUSION: Iodixanol, either 270 mgI/ml or 320 mgI/ml, is well tolerated and efficacious for excretory urography in children.

Adolescent↗