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J F de Campo

Publications and source records attributed to J F de Campo.

15 recordsLinked to original sources
PubMed2003

Is informed consent necessary for paediatric computed tomography?

Computed tomography (CT) is a valuable examination in children, but the lifetime cancer mortality attributed to CT radiation in children is an order of magnitude higher than in adults. Therefore, it is important that radiologists and referring clinicians ensure that parents are fully informed of the radiation risks, the appropriateness of the examination is considered and imaging protocols are tailored to reduce the radiation burden.

Adult↗
PubMed1995

Voiding cystourethrography in boys: does the presence of the catheter obscure the diagnosis of posterior urethral valves?

OBJECTIVE: In voiding cystourethrography, the urethral catheter may or may not be left in place during voiding. The main argument for removing the catheter is that the diagnosis of posterior urethral valves may be missed because the catheter can hold open the valve, efface it, and render it invisible. However, if the catheter does not prevent the diagnosis of urethral disease, it is preferable to leave it in place. The catheter makes it possible to repeat the procedure easily if necessary, and using it to drain the bladder provides information about ureteric obstruction in the presence of vesicoureteric reflux. Accordingly, the purpose of this study was to determine whether leaving the urethral catheter in place throughout voiding cystourethrography affects the efficacy of the procedure for the diagnosis of posterior urethral valves. MATERIALS AND METHODS: Three radiologists reviewed the preoperative voiding cystourethrograms obtained in 48 boys who ranged in age from 1 day to 10 years old (mean, 1.5 years). All patients had a diagnosis of posterior urethral valves made at cystoscopy, which was used as the gold standard. The voiding cystourethrogram was obtained with a catheter in place during voiding in 28 (58%) of the 48 boys, without a catheter in 17 (35%), and with and then without a urethral catheter during the voiding phase of the study in three (6%). RESULTS: Posterior urethral valves were detected on 25 (89%) of the 28 voiding cystourethrograms obtained with a urethral catheter in place and in 15 (88%) of the 17 voiding cystourethrograms done without a urethral catheter. The five children in whom posterior urethral valves had been diagnosed by cystoscopy but were not detected on voiding cystourethrography had no dilatation of the posterior urethra nor any other evidence of obstruction; these were possibly false-positive cystoscopic diagnoses. CONCLUSION: Our results show that a urethral catheter does not obscure posterior urethral valves in boys and need not be removed routinely during the voiding phase of voiding cystourethrography.

Child↗
PubMed1995

Sonographic measurement of renal enlargement in children with acute pyelonephritis and time needed for resolution: implications for renal growth assessment.

OBJECTIVE: Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements. SUBJECTS AND METHODS: In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography. RESULTS: Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days. CONCLUSION: Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.

Acute Disease↗
PubMed1994

Risk factors in the development of early renal cortical defects in children with urinary tract infection.

OBJECTIVE: Defects seen on early cortical scintigrams of the renal cortex in children with urinary tract infection may represent acute inflammatory change or established scar. The purpose of this study was to determine the relationship between these defects and age, sex, the presence and grade of vesicoureteral reflux, and infective organism in a cohort of children examined after their first proved urinary tract infection. SUBJECTS AND METHODS: We prospectively examined 193 consecutive patients less than 5 years old who were seen at the ambulatory pediatric department during a 3-year period and had a first proved urinary tract infection. Children with obstructed or solitary kidneys were excluded. All patients were imaged with scintigraphy of the renal cortex and radiographic voiding cystourethrography within 15 days of diagnosis. The association of age, sex, the presence and grade of vesicoureteral reflux, and infective organism with a defect (acute pyelonephritis or a renal scar) seen on a cortical renal scan was studied. RESULTS: The prevalence of cortical defects was greater in the kidneys of patients less than 2 years old (96/290, 33%) than in older children (16/96, 17%) and greater in those with vesicoureteral reflux (41/92, 45%) than in those without it (71/294, 24%). Vesicoureteral reflux was absent in 63% (71/112) of kidneys with a cortical defect. No association with sex or infective organism was established. As well as having a greater prevalence of cortical defects, 145 (75%) of the 193 urinary tract infections included in the study were in children less than 2 years old. The kidneys of these younger patients also had a greater severity and prevalence of vesicoureteral reflux (74/290, 26%) than did those of older children (18/96, 19%). CONCLUSION: Early cortical defects are associated with an age less than 2 years and vesicoureteral reflux. However, the association of early defects with the presence and grade of vesicoureteral reflux is confounded by the declining prevalence and severity of reflux with age. A significant proportion of cortical defects occur in the absence of vesicoureteral reflux, and the contribution of reflux to scar formation might be less than previously considered.

Age Distribution↗
PubMed1990

Computed tomographic assessment of vertebral bone mineral in childhood.

Quantitative computed tomography (QCT) was used to assess trabecular bone mineral concentration in the vertebrae of 132 children, 45 with suspected disorder of bone mineralisation, 54 with thalassaemia and 37 controls. The range for bone mineral concentration in controls, expressed as equivalent K2HPO4 concentrations, was 90-190 mg cm-3. Abnormally low values were seen in all untreated children with idiopathic juvenile osteoporosis, 3/9 steroid recipients, and three patients with osteogenesis imperfecta. Abnormally high values were seen in 10/14 chronic renal failure patients. Comparison of the single and dual-energy methods showed that the single energy method, which has a lower radiation dose and is less prone to error from movement artifact, is satisfactory in most paediatric applications.

Bone Diseases↗
PubMed1989

Gas reduction of intussusception.

Efforts to improve the non-surgical management of childhood intussusception centre around (a) reassessment of selection criteria used to ensure as many children as possible have the advantage of hydrostatic reduction, and (b) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the authors to evaluate this technique over an 18 month period using our previously reported technique of oxygen at 2 litres/minute and a pressure of 80 mm Hg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks for gas reduction using our current selection criteria and had primary surgery. The overall success rate considering all cases of intussusception managed at our institution over this period was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of complications and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction has replaced traditional barium reduction at our institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts that results will improve further.

Barium Sulfate↗
PubMed1988

Differentiating bacterial from viral pneumonias in children.

58 paediatric patients with pneumonia, in whom an etiological agent had been isolated, were reviewed. The patients were designated to have either viral or bacterial pneumonia on the basis of proposed clinical and radiological criteria. These presumed diagnoses were then compared to the microbiologically proven diagnosis. When clinical features suggested a bacterial infection the chance of isolating a bacteria as opposed to a virus was 18%. Was radiological features suggested a bacterial infection the chance of isolating a bacteria as opposed to a virus was 30%. Thus the commonest cause of "bacterial" clinical and radiological features is a viral infection and the proposed criteria do not allow differentiation of bacterial from viral pneumonia.

Bacterial Infections↗
PubMed1988

Ultrasound of primary hepatic tumours in childhood.

Ultrasound scans of 18 children with primary hepatic tumours were reviewed to assess the accuracy of ultrasound in determining hepatic origin, extent, resectability, and histology. Using basic landmarks, ultrasound correctly predicted extent and resectability in 72% of patients. Accuracy would be increased by more detailed scanning to determine segmental and lobar landmarks. Hepatoblastoma demonstrated a characteristic appearance of a well-defined hyperechoic mass. Other tumour types showed some overlap in ultrasound appearances. Ultrasound examination overestimated the incidence of obliteration of the IVC lumen, and such patients require inferior venacavography to assess the true status of the cava preoperatively.

Bile Duct Neoplasms↗
PubMed1988

Intussusception: clinical prediction of outcome of barium reduction.

Patients with intussusception who have necrotic bowel requiring bowel resection or who are at major risk of perforation from attempted hydrostatic reduction may be better managed without barium reduction. Ideally, the clinician would like to identify such patients at presentation. Two groups of patients, representing the extreme ends of the intussusception treatment spectrum were investigated in order to highlight the clinical features of patients in whom an attempted barium reduction is not justified. A group of 200 patients who had successful and safe hydrostatic reduction was compared with 104 patients who ultimately required bowel resection. Four features were found to be indicators of an increased likelihood of resection: age 3 months or less, or greater than 2 years, duration of symptoms greater than 24 h, presence of small bowel obstruction on plain radiology, and clinical assessment of dehydration greater than 5%. The validity of these features as prognostic indicators was assessed by applying them to all patients who had attempted barium reduction to see how they predicted patient outcome. In isolation, each feature was found to be compatible with a safe and successful hydrostatic reduction. The rate of resection was increased in patients with multiple adverse features and in these patients the enema technique may require modification. Patients with three or four adverse features had an unacceptably high incidence of gangrenous bowel requiring resection and a low likelihood of successful hydrostatic reduction. It is believed that attempts at reduction are not appropriate in these patients.

Barium Sulfate↗
PubMed1988

Comparison of oxygen and barium reduction of ileocolic intussusception.

Reports that gas reduction of ileocolic intussusception has a better success rate than traditional barium reduction prompted us to evaluate this technique and to compare the results with our previous experience with barium. Our method of intussusception reduction uses oxygen at a flow rate of 2 l/min and with a maximum pressure of 80 mm Hg. The results of 65 consecutive patients with 69 episodes of intussusception over a 9-month period were retrospectively reviewed. For eight episodes, gas enema was not used, including six patients who had barium reduction during the introduction of the gas technique and two patients in whom no intussusception was seen during gas enema were excluded. In the remaining 61 episodes, six patients were considered to be unacceptable risks for attempted therapeutic reduction with either oxygen or barium, according to our current criteria, and had primary surgery. Enemas with oxygen were attempted in 55 cases and were successful in 40 (73%). If all 61 cases with confirmed intussusception are included, the overall success rate with oxygen was 66%. We had greater success with oxygen than with barium (73% vs 53%), although identical pressures were used and the number of severely ill patients referred for therapeutic enema (90% vs 60%) had increased. The change in the referral pattern reflects the adoption of less conservative criteria for excluding patients from having therapeutic enema. No complications have occurred to date. We have had greater success with the use of oxygen than with that of barium, and have had no complications. Therefore, at our institution, oxygen has superseded barium for the therapeutic reduction of ileocolic intussusception.

Administration, Rectal↗