PubMed Health⌕ Search

Biomedical subjects

G A Mandell

Publications and source records attributed to G A Mandell.

At least 19 recordsLinked to original sources
PubMed1999

Cost-effective imaging approach to the nonbilious vomiting infant.

OBJECTIVE: To develop a cost- and time-effective algorithm for differentiating hypertrophic pyloric stenosis (HPS) from other medical causes of emesis in infants referred from community-based pediatricians and family practitioners to the imaging department of a tertiary children's care facility. METHODS: Eighty-nine vomiting infants (22 females, 67 males) between the ages of 11 and 120 days (mean, 43.5 days) had received nothing by mouth for at least 1 hour before the study. Each child was assessed for duration of vomiting, status of body weight, time and volume of last ingestion, and time of last emesis. A #8 French (Sherwood Medical, St Louis, MO) nasogastric feeding tube was placed in the child's stomach. The contents were aspirated and measured to determine likelihood of HPS. An aspirated volume >/=5 mL implicated gastric outlet obstruction, and ultrasonography (US) was performed. If this study was positive for HPS, the patient was referred for surgery. If US was negative, an upper gastrointestinal series (UGI) was performed. An aspirated stomach contents volume <5 mL suggested a medical cause for the emesis, and UGI was performed. Pediatric surgeons with no knowledge of the volume results palpated the abdomens of 73 of 89 infants (82%). RESULTS: Twenty-three of 89 patients (25%) had HPS. The aspirate criteria for HPS had a sensitivity of 91%, a specificity of 88%, and an accuracy of 89%. Of the false-positive studies (total = 8), six were related to recent significant ingestion (within 2 hours of the study), and two were attributable to antral dysmotility. The surgeons palpated the mass in 10 of 19 patients (53%). Sensitivity and specificity were 53% and 93%, respectively. Only 6 of 89 infants (7%) required both US and UGI to determine the etiology of the nonbilious vomiting. By performing the UGI in 66 patients, it was also found that 14% had slow gastric emptying and 79% had gastroesophageal reflux. Eighty-one percent of the gastroesophageal reflux was significant. CONCLUSION: The volumetric method of determining the proper imaging study is cost- and time-effective in the evaluation of the nonbilious vomiting infant for pyloric stenosis. If US was performed initially in all patients referred for imaging, two studies would have been performed in 68 of 89 patients (76%) to define the etiology of the emesis. Because we used the volumetric method, 62 fewer imaging studies were performed, representing a savings of $4464 and 30 hours of physician time. If children are given nothing by mouth for 3 to 4 hours before gastric aspiration, the specificity of the volumetric method improves to 94%, and the accuracy improves to 96%.

Algorithms↗
PubMed1998

Nuclear medicine in pediatric orthopedics.

In this presentation, the common clinical pediatric problems (appendicular growth aberrations, hip pain, back pain, some aspects of trauma, and inflammatory and infectious processes that can be addressed by nuclear imaging will be discussed. The accurate interpretation of bone scintigraphy in the evaluation of pediatric orthopedic conditions depends on the use of appropriate radiopharmaceuticals and imaging techniques specific for the pediatric population, a knowledge of physiologic changes in the growing skeleton, as well as the different disease processes peculiar to each age bracket. The physes (growth-plates) will be discussed in detail because they are the most active portion of the pediatric skeleton. Their activity (potential for growth) can be altered by physiologic, developmental aberrations (varus and valgus) and pathologic conditions (trauma, infection, etc.).

Adolescent↗
PubMed1998

Bone scintigraphy in the detection of chronic recurrent multifocal osteomyelitis.

UNLABELLED: In this study, we describe the importance of the whole-body bone scan in diagnosing the multifocality of chronic recurrent multifocal osteomyelitis (CRMO) and in distinguishing it from unifocal acute hematogenous osteomyelitis. MATERIALS: The medical records and two-phase, whole-body bone scans of 14 patients (mean age 10.5 yr) with the diagnosis of CRMO, were retrospectively reviewed. The diagnosis of CRMO was based on bone biopsy in 9 patients and clinical course/laboratory findings in 5. Bone scans were evaluated for geographic and anatomic locations of their lesions. Correlative radiographs of areas of abnormal uptake were performed to assess the radiographic appearance of the lesions. RESULTS: The presentation of the disease was localized to one painful, tender and swollen periarticular site 86% of the time. The number of lesions detected by bone scan varied from 1-18 (mean 6). Most lesions were metaphyseal, proximal or distal tibial lesions. Purely sclerotic or mixed (sclerosis and lysis) lesions were found on radiographs. Bilateral lesions were seen in 64% of patients. Biopsies were negative for organisms in all patients and exhibited subacute or chronic histologic changes in most instances. Complications of chronic hyperemia included marked overgrowth (5), diffuse demineralization (1), angular deformity (1) and length discrepancy (1). CONCLUSION: The identification of the multifocal configuration of the disease process by two-phase (soft-tissue and delayed) whole-body bone scintigraphy results in appropriate diagnosis and therapy of CRMO. Additional sites for possible bone biopsy become apparent for exclusion of other diagnoses. Supportive (nonsteroidal, anti-inflammatory medication) instead of antimicrobial therapy can be initiated with significant cost savings.

Bone and Bones↗
PubMed1997

The use of the salivagram in the evaluation of severe and chronic aspiration.

Chronic salivary aspiration may be responsible for a significant percentage of pneumonia in the neurologically impaired child. The radionuclide salivagram (RS), a simple investigative study, can document salivary aspiration as the source of pulmonary contamination. The purpose of this study was to determine if the results of the RS would accurately identify children with severe and chronic salivary aspiration who would benefit from laryngotracheal separation (LTS). We reviewed 30 records of children with chronic aspiration pneumonitis who underwent LTS between 1988 and 1996. We recorded the number of inpatient days required for respiratory infections before and after LTS. This number was compared with the number of inpatient days for respiratory infection from children (n = 27) who underwent the RS during a ten-month period but who were never referred for LTS. Fifteen children who underwent LTS had a preoperative RS. The RS documented salivary aspiration in 11 of these children. Aspiration was effectively controlled by LTS for this group. There were three studies that failed to show either aspiration or progression of the Technetium 99m sulfur colloid (Tc 99m SC) into the esophagus This finding was felt to represent significant swallowing dysfunction and, therefore, was also considered a positive finding. There was a significant difference in the number of inpatient days for children who had a negative RS and were never referred for LTS when compared with the number of inpatient days for those children who had a positive RS and were referred for LTS. We feel that the RS is an effective tool to document salivary aspiration as the source of recurrent pneumonia. A modification of the technique and interpretation of RS is suggested.

Child↗
PubMed1997

Imaging techniques in childhood arthritis.

Technological advances in imaging have given physicians caring for children with arthritis a greater opportunity to detect abnormalities early in the course of a disease and better methods for monitoring chronic changes. Indications for using radiography, bone densitometry, nuclear medicine, ultrasound, CT scanning, and MR imaging are discussed in this article. In this era of managed care, the practicing clinician is urged more than ever to consult with the radiologist in selecting the study or sequence of studies to be used in particular case. In this way, evaluation can be limited to the most effective strategy from both the clinical and cost perspectives.

Adolescent↗
PubMed1997

Economic issue in pediatric nuclear medicine: cortical scanning of acute pyelonephritis.

Pediatric nuclear medicine, in order to survive, must be innovative in finding ways of competing with other pediatric imaging subspecialties for the health care dollars. Newer radiopharmaceuticals and imaging methods that are time-effective in answering clinical problems and cost-effective in attracting the health care providers are ways of accomplishing this difficult task. Renal cortical scanning for the diagnosis of acute pyelonephritis is presented as an example of an existing nuclear medicine study that is accurate and cost-effective, but has not yet taken a major place in the imaging armamentarium. In this discussion, the cortical scan is endorsed as the primary imaging tool for children presenting with acute urinary infection.

Acute Disease↗
PubMed1996

Hypervitaminosis A as a complication of treatment for neuroblastoma.

A case of hypervitaminosis A (HVA) as a complication of therapy for stage-IV neuroblastoma is presented. The patient was randomized to a trial of 13-cis -retinoic acid (a vitamin A-related compound) after completing routine chemotherapy. This acid was given as a means of maturing potential minimal residual disease. A routine follow-up bone scan revealed areas of increased activity, initially along the midshaft of the right ulna and subsequently bilaterally, which were ultimately found to be due to HVA. Hypervitaminosis A has not been previously reported in this setting, and awareness of the condition is important in centers where this treatment is contemplated.

Adrenal Gland Neoplasms↗
PubMed1994

Effects of different techniques of endotracheal epinephrine administration in pediatric porcine hypoxic-hypercarbic cardiopulmonary arrest.

OBJECTIVE: To compare three endotracheal epinephrine instillation techniques in a pediatric porcine hypoxic-hypercarbic cardiopulmonary arrest model. DESIGN: Prospective, randomized, laboratory comparison of three instillation techniques. SETTING: Large animal research facility at a children's hospital. SUBJECTS: Thirty-six preadolescent anesthetized and paralyzed Yucatan swine (mean weight 10.0 +/- 1.9 kg) with apnea-induced hypoxic and hypercarbic cardiopulmonary arrest. INTERVENTIONS: After 8 mins of cardiopulmonary arrest and 1 min of cardiopulmonary resuscitation (CPR), 500 micrograms (51 +/- 9 micrograms/kg) of radiolabeled endotracheal epinephrine was administered by direct injection (n = 17), injection via feeding catheter (n = 10), or via monitoring lumen built into the sidewall of the endotracheal tube (n = 9). CPR was resumed and continued for 5 mins. If resuscitation occurred, monitoring was continued for 1 hr. Outcome variables included successful resuscitation, pulmonary distribution, heart rate, mean arterial pressure, plasma radiolabeled epinephrine counts, and total plasma epinephrine concentrations. Analysis by Fisher's exact test, one-way analysis of variance and Pearson's phi coefficient was performed. MEASUREMENTS AND MAIN RESULTS: Successful resuscitation occurred in 31% of all pigs with no difference between groups (p = .69). Bilateral distribution occurred in 39% with no difference between groups (p = .25). No correlation was noted between successful resuscitation and distribution (p = .65). HR, mean arterial pressure, plasma radiolabeled epinephrine counts, and total plasma epinephrine concentrations showed significant changes over time within groups, but no difference between groups at any time point. Adherence of the epinephrine dose to the endotracheal tube was < or = 1.5% in all cases. CONCLUSIONS: Instillation of 50 micrograms/kg of endotracheal epinephrine by three different techniques during pediatric porcine asphyxial arrest does not affect resuscitation rate, pulmonary distribution, hemodynamic response, or plasma exogenous and total epinephrine concentrations. No correlation was found between successful resuscitation and bilateral distribution. Therefore, currently recommended cumbersome endotracheal epinephrine instillation techniques may offer no resuscitation advantage over commonly used direct injection in this setting.

Animals↗
PubMed1994

Innominate artery compression of the trachea: relationship to cervical herniation of the normal thymus.

PURPOSE: To document the possible association of segmental tracheomalacia in the thoracic inlet with the combination of a large thymus and normal innominate artery. MATERIALS AND METHODS: Eight infants with symptoms of innominate artery compression of the trachea were studied. The diagnostic approach included observation of posterior tracheal displacement and focal tracheal collapse at fluoroscopy, ablation of the right radial pulse by rigid endoscopic pressure, and compression of the anterior tracheal wall by the innominate artery at magnetic resonance imaging. RESULTS: Six patients had relief of symptoms with either thymectomy and innominate artery reimplantation (n = 4) or subtotal thymectomy and innominate artery suspension (n = 2). The ratio of the sagittal diameter of the thymus to the sagittal diameter of the thoracic inlet was significantly (P < .0009) higher in the symptomatic patients (0.58 +/- 0.03) than in age-matched control subjects (0.35 +/- 0.08). CONCLUSION: Crowding of the thoracic inlet by cervical herniation of an enlarged but normal thymus may contribute to the development of tracheomalacia and the symptoms of innominate artery compression.

Brachiocephalic Trunk↗
PubMed1993

Scintigraphy of spinal disorders in adolescents.

Bone scintigraphy in adolescents is useful in helping to differentiate between developmental (atypical lumbar Scheuermann disease), infectious (discitis, osteomyelitis), neoplastic (osteoid osteoma, osteoblastoma), and traumatic (occult fractures, spondylolysis, pseudoarthrosis) disease of the spine. Double-phase (blood pool, delayed images) scintigraphy can characterize the pattern (i.e., linear in fracture, ovoid in nidus of osteoid osteoma). Single-photon emission computed tomography (SPECT) can be helpful in detecting the subtle presence of stress reaction (spondylolyses) not noted on routine planar scintigraphy and radiography. Bone scintigraphy is most beneficial when correlated with other imaging modalities in refining the diagnosis of spinal diseases.

Adolescent↗