Biomedical subjects
Publications and source records attributed to H Carty.
A study of isotope scanning in children with irritable hip syndrome has demonstrated its role as a discriminator between Perthes disease and transient synovitis. Three children with normal radiographs had Perthes changes on scanning and went on to develop X-ray changes. An anatomical and pathological basis for the scan abnormalities is suggested.
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One of the rarer causes of intestinal obstruction in the neonatal period is segmental dilatation of the ileum. The case histories, radiological and histological details of four patients are presented together with a short review of the literature.
Presenting radiographs of 30 children with spondylolisthesis and spondylolysis were reviewed. A 67% incidence of spina bifida occulta was noted, a 13-fold increase of the incidence in the normal population, and a mechanism whereby this may precipitate a spondylolysis is given. The value of the spinous process rotation sign on AP radiographs and facet joint mal-alignment on oblique radiographs in paediatric practice was assessed, and the incidence was 39% and 56% respectively, compared with 92% and 91% in adult practice. Reasons for the reduced incidence are suggested. Oblique radiographs provided further diagnostic information only in the absence of a spondylolisthesis. Follow-up radiographs showed further slip in only five patients. The one constant factor in these five patients was the presence of a spina bifida occulta, indicating the necessity for close observation of such patients with a spondylolisthesis during the adolescent growth spurt. 99Tcm MDP bone scans were performed in three patients, in whom 4 of 5 spondylolyses were shown to have a high uptake. One lesion subsequently became of low uptake as symptoms subsided. Bone scanning in spondylolisthesis needs further evaluation but the finding of increased bone activity suggests a healing process. Spondylolysis is a differential diagnosis to be considered in a positive scan for evaluation of back pain.
Following pin fixation of the femoral neck, extrusion of a pin tip into the joint space cannot be excluded with conventional bi-plane radiography. A per-cervical pin was allowed to extrude from the head of a dried femur. Anteroposterior and lateral photographs and roentgenograms of this preparation, simulating corresponding intra-operative radiology, demonstrated misleadingly that the pin tip was wholly within the head. Careful intra-operative and post-operative screening is considered important to detect unwanted joint penetration and so avoid avascular necrosis and late degenerative change.
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99mTechnetium-labeled dimercaptosuccinic acid (99mTc-DMSA) scanning provides superior quality images of renal parenchymal detail, which makes it highly sensitive for the diagnosis of pyelonephritic scarring. Unlike most other imaging techniques, radionuclide scanning is not affected by bowel gas or bony structures overlying the kidneys. This makes it particularly useful in children. Furthermore, renal scarring can be demonstrated by 99mTc-DMSA even before the classic gross anatomic and radiologic changes are present. The use of 99mTc-DMSA scanning in over 300 children has demonstrated its benefits and advantages over standard radiographic techniques.
A prospective study, followed by a retrospective audit, was made of the radiographs and clinical features of 225 consecutive neonates with abdominal distension presenting during a period of 4 years. More than one major cause for the distension was found in a third of cases. Excluding cases of ano-rectal atresia, diagnostic difficulties were encountered in 31% of cases and, occasionally, the diagnosis was revised several times as investigations proceeded. Neuhauser's sign of 'bubbly' meconium is unreliable, being found in cases of meconium ileus, ileal atresia, Hirschsprung's disease and necrotising enterocolitis. Concomitant small-bowel atresia should be suspected in all cases of meconium ileus; intestinal malrotation should be considered in association with duodenal and intestinal atresias. In the absence of an obvious anatomical defect, it is difficult to differentiate between the various causes of functional obstruction by radiological means alone and all such infants should be referred to a specialised centre for intensive investigation and treatment. Very often, the skills of a neonatologist, paediatric surgeon and, especially, an experienced pathologist will be required in addition to those of the radiologist.
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The radiological features of three cases of pulmonary actinomycosis in children are presented. Two of the cases had the classical roentgen features of chronic consolidation with overlying rib periostitis. The third had non specific consolidation but demonstrated extension through the diaphragm. Two of our cases were mentally subnormal children in institutional care. Their pulmonary pathology is almost certainly attributal to poor dental hygiene, a constant problem in this group of children. Hence, although pulmonary actinomycosis is rare in the general populus, we suggest it might be suspected more often in the subnormal group when chronic consolidation is present.
The various artefacts that may be encountered in phlebograms and which may be confused with thrombus are described. Methods of avoiding these pitfalls are discussed. the conclusions are based on over 2500 phlebograms carried out for suspected deep vein thrombosis.
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