Biomedical subjects
Publications and source records attributed to H Carty.
Infantile myofibromatosis is a rare condition which usually presents in childhood. It has a wide spectrum of disease activity, ranging from a solitary cutaneous nodule, through to a multicentric form with widespread visceral involvement. We present four cases which demonstrate the diversity of this condition and its radiological findings, together with a review of the literature.
Three cases of septic arthritis of the hip are presented. In each case, radionuclide bone scanning, using 99Tcm diphosphonate (MDP), demonstrated complete photopenia of the femoral head. All three cases resulted in avascular necrosis and subsequently had a poor clinical outcome with a reduced range of movement and radiographic epiphyseal deformity. Complete photopenia in the presence of suspected sepsis requires urgent referral with a view to exploration and decompression.
We describe three cases of traumatic myositis ossificans in which fractures occurred through a mature, quiescent ossification mass. None of the fractures reactivated the original pathological process, no callus was formed and union did not occur. The nonunion became painless over a period of months. This unusual late complication of myositis ossificans seems to require only symptomatic treatment by temporary splintage and subsequent mobilisation. We could find no previous report of a similar case.
The purpose of this study was to determine the value of a baseline CT head scan in the assessment of patients who subsequently presented with symptoms which may have been due to shunt complications (such as blockage or infection). In all these patients the shunt had been inserted in the treatment of hydrocephalus. We conclude that the presence of a baseline scan does not add to the interpretation of CT scans done when the patient presents with symptoms of possible shunt malfunction.
Calcaneal fractures in very young children are thought to be rare. We report on seven calcaneal fractures in children under the age of 36 months in the absence of a history of significant injury. In five cases plain radiology was normal, but the diagnosis was reached using scintigraphy. We suggest that this is not such a rare injury, and that wider use of scintigraphy will assist in making the diagnosis. The prognosis of this injury is excellent.
A criterion for successful hydrostatic reduction of intussusception is reflux into the terminal ileum. In our practice, absence of reflux into the terminal ileum is not an indication for laparotomy if the radiographic appearances suggest edema of the ileocecal valve. The aim of this study was to validate our approach. We reviewed the case notes of patients with a diagnosis of intussusception (n = 107; age 11.74 +/- 1.48 months; mean +/- SEM) treated from 1987 to 1991. Eleven required primary laparotomy for peritonitis. Ninety-six patients who had a contrast enema were studied. Edema of the ileocecal valve was defined as a persistent filling defect in the cecum after apparently complete hydrostatic reduction, without reflux of contrast into the distal small bowel. In 59 patients hydrostatic reduction was successful: 11 (18.6%) had edema of the ileocecal valve and no reflux contrast into the terminal ileum (group B). All improved clinically after the enema and needed no further treatment. In 37 patients hydrostatic reduction of the intussusception was unsuccessful and an operation was performed: 26 (70.3%) required manual reduction of the intussusception (group C) and 11 (29.7%) underwent bowel resection (group D). None of the patients with edema of ileocecal valve required further treatment or developed recurrent intussusception. In none of the patients who had an operation was the intussusception found to have been reduced by the contrast enema. There were no deaths.(ABSTRACT TRUNCATED AT 250 WORDS)
A retrospective review of 15 patients presenting over a 15-year period with large ovarian tumours is reported in whom the presenting complaint was gross abdominal swelling. Histological confirmation of all the tumours was obtained. There were three serous cystadenomas, two mucinous cystadenomas, one Brenner tumour, three benign juvenile granulosa cell tumours--two not menstruating, three benign teratomas--one not menstruating, one malignant teratoma--not yet menstruating, one malignant embryonic carcinoma and one hydatid disease. All the patients are currently well. The radiological findings are described and some of the marked differences in the radiological appearances of adult and paediatric ovarian masses are illustrated.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A persistent focal abnormality was observed in 157 (16%) electroencephalograms undertaken in 964 consecutive children with epileptic and non-epileptic seizures seen over one year. CT head scans were performed in 121 (77%) of the 157 children with a focus on the EEG; 26 (21%) showed an abnormality, and 21 (81%) of the abnormalities were localised. There was no difference in the proportion of abnormal scans associated with a delta or slow wave focus compared with a spike or sharp wave focus. An abnormal scan was uncommon after a single seizure. In only two patients (1.7% of all scans) did the findings on CT alter or greatly influence subsequent management.
Pyogenic sacroiliitis is considered to be an uncommon infection, which is often diagnosed late because of poor localization of symptoms and normal plain radiographs at presentation. Nine cases aged between 20 months and 14 years who presented with sacroiliitis over a 7 year period are reviewed retrospectively. Isotope bone scanning is a useful technique in establishing early diagnosis and its relationship to other diagnostic imaging modalities is discussed. By routinely obtaining views of the entire pelvis in children presenting with hip pain and a limp, pyogenic sacroiliitis may be detected more frequently.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Strangulation has been postulated as one cause of cerebral hypoxia in child abuse. This report describes the finding of necklace calcification in an infant with rib fractures and a metaphyseal fracture and an admission of a shaking injury. The calcification is likely to represent fat necrosis as the result of strangulation.
Explore the source record for details and available documents.
Stress fractures reported in the medical literature almost exclusively affect young athletes, military recruits and patients with metabolic bone disease. The classification of stress-induced bone injury is somewhat confused and includes "fatigue" stress fractures which occur in previously normal bones and "insufficiency" stress fractures which occur in bones weakened by various causes. Femoral stress fractures in children are extremely rare, and we report 5 cases in young patients who sustained their injuries during the course of normal play activities. It is well-known that these lesions can simulate malignant lesions; however, we believe that careful review of the radiographs in the context of the clinical history can in many cases lead to the correct diagnosis being made and obviate the need for further intervention.
Patients (n = 181) with the irritable hip syndrome were reviewed. Four of these were found to have Perthes disease and 3 cases had septic arthritis. Ultrasonography provides accurate information as to the presence or absence of an effusion in children with an irritable hip syndrome. The likelihood of a positive result is higher in the early course of the disease process (i.e. within 3 days). Bone scanning, if done routinely will help in the early diagnosis of Perthes disease. Recurrence of the symptoms occurred in 18% of patients and most of them were within 12 months of the first onset of symptoms.