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Biomedical subjects

J G Blickman

Publications and source records attributed to J G Blickman.

At least 19 recordsLinked to original sources
PubMed2006

Colonic duplications: clinical presentation and radiologic features of five cases.

Diagnosis of colonic duplication can pose a potential problem even for those familiar with gastro-intestinal tract duplications in general but unaware of the condition due to its rarity and its apparently bimodal clinical presentation. In this report of five cases of surgically proven pediatric colonic duplication, we illustrate how the condition manifests clinically and describe the imaging features in an attempt to illustrate this bimodal presentation of the condition. The possible etiology, associated congenital anomalies and modes of clinical presentation are reviewed based on literature review as well as on our own experience.

Abnormalities, Multiple↗
PubMed2006

The role of imaging studies in pancreatic injury due to blunt abdominal trauma in children.

BACKGROUND: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma. METHOD: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma. RESULTS: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts. CONCLUSION: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions.

Abdominal Injuries↗
PubMed2005

[Feasibility of MRI imaging in patients with breast cancer].

Three women aged 45, 37 and 56 underwent MRI imaging of the breast for: breast-cancer screening, pre-operative staging and for monitoring the response on chemotherapy. Breast cancer at an early stage for which breast-saving surgery was possible was discovered in the first woman. In the second woman, the tumour was larger than was seen with mammography or ultrasound and other tumour sites were seen, leading to a more extensive treatment plan. In the year thereafter no metastases were found. In the third woman the response to chemotherapy was monitored. 8 months after therapy she appeared to have skeletal metastases. Mammography and ultrasound are the most commonly used modalities in breast imaging. Over the past few years MRI has been making an increasingly large contribution to the screening, staging and follow-up of patients with breast cancer. MRI can be an important supplementary study but its exact role still needs to be defined.

Adult↗
PubMed2004

Current imaging concepts in pediatric osteomyelitis.

The diagnosis of osteomyelitis remains a difficult diagnostic dilemma. In this article, which is particularly aimed at those whose practice does not include a large paediatric population, we review the pathophysiology of paediatric osteomyelitis and contrast it with the available imaging modalities. We examine the role of the radiologist as well as the usefulness of each modality. Secondly, we review the different clinical scenarios such as acute, subacute and chronic, as well as specific forms of osteomyelitis; the latter includes subacute chronic ostemyelitis, toxic synovitis, spondylodiscitis as well as the congenital inflammatory disorders such as rubella and syphylis. The most useful imaging findings to look for and their significance are assessed and we evaluate their usefulness in each case. Close cooperation between clinicians and imagers remains the key to early and adequate diagnosis of paediatric osteomyelitis.

Arthritis, Infectious↗
PubMed2002

Airway changes in children with mucopolysaccharidoses.

OBJECTIVE: To assess the CT findings of the airway in children with mucopolysaccharidoses (MPS). MATERIAL AND METHODS: The study included 13 patients (9 boys, 4 girls; age range 2-17 years; mean age 9.2 years) with MPS: 6 with Hunter syndrome, 3 with Maroteaux-Lamy syndrome, 2 with Sanfilippo syndrome, 1 with Hurler/Scheie syndrome and 1 with Morquio syndrome. CT of the airways was done in the axial section with 3-mm collimation from the oropharynx at the level of C3 to the base of the lung. The shape of the vocal cords and trachea at the level of T1 was evaluated. The tracheal surface area (TSA) at the level of T1 was measured both in patients and in age-matched subjects. RESULTS: CT showed an abnormality of the vocal cords in 7 of the 13 patients. Six patients had an abnormal shape and 7 had an inhomogenous density. The abnormalities included elliptical (5 of 6) and star-shaped (1 of 6) cords. Eight of 13 tracheas were also abnormal, either U-shaped (6 of 8) or worm-shaped (2 of 8). The TSA was significantly smaller in patients (79.6+/-28.9 mm2) than in control subjects (138.1+/-50.1 mm2). The TSA of those < or =9 years was 61.4+/-15.2 mm2 as compared with 99.9+/-23.5 mm2 for the control group. The TSA of patients > or =11 years was 107.1+/-25.3 mm2 as compared with 187.6+/-32.0 mm2 for the control group. CONCLUSION: Significant changes in the shape of the vocal cords and trachea in patients with MPS were found. The most common abnormal configuration of trachea was the U-shape. The TSA was smaller in patients with MPS than in controls. The airway changes may be due to abnormal submucosal storage of substances such as keratan or dermatan sulfate.

Adolescent↗
PubMed2001

Radiographic resolution of lymphocytic interstitial pneumonitis (LIP) in children with human immunodeficiency virus (HIV): not a sign of clinical deterioration.

BACKGROUND: The literature and anecdotal evidence associate the resolution of radiographic findings of lymphocytic interstitial pneumonitis (LIP) with a decline in immune and clinical status of human immunodeficiency virus (HIV) infected children. OBJECTIVE: As our clinical impression was the opposite, we sought to elucidate this contradiction. MATERIALS AND METHODS: Of 52 pediatric patients infected with the HIV currently being followed at our institution, 20 (38.5%) carried the diagnosis of LIP and 13 (65%) of these have had complete resolution of radiographic findings of LIP. We retrospectively reviewed the chest radiographs, CD4 counts, and clinical history of these 13 patients. RESULTS: Of the 13 patients who had resolution of radiographic findings, 11 (84.6%) had no significant change in CD4 count at the time of resolution and remained clinically stable during a mean follow-up period of 32 months. Two patients (15.3%) developed severe CD4 lymphocytopenia at the time of resolution of LIP, but clinically remained stable. None of these 13 patients had a recurrence of LIP, even with subsequent increases in CD4 count. CONCLUSION: We suggest that in contradiction to previously published data, resolution of LIP on chest radiographs is not an indicator for poor prognosis for the HIV-infected pediatric patient.

CD4 Lymphocyte Count↗
PubMed2000

World Wide Web program for optimizing and assessing medical student performance during the radiology clerkship.

RATIONALE AND OBJECTIVES: The purpose of this study was to adapt the technology of the World Wide Web to the teaching and evaluation of medical students participating in the radiology clerkship at our institution. MATERIALS AND METHODS: Teaching modules were placed on a local intranet site. One hundred two student evaluations were conducted online as a standardized, written- and image-based test that was administered both before and after the clerkship. The computer-delivered test consisted of 40 standardized questions that were sorted by category (based on American College of Radiology code criteria) and randomly administered from a pool of 200 potential questions. Scores from before and after the clerkship were analyzed statistically to evaluate the effectiveness of the educational program and the student performance. Student case presentation scoring and clerkship administration tasks were also evaluated both before and after implementation of the modules during the first 12 months of this project (July 1997 to July 1998). RESULTS: A statistically significant (P < .001) improvement in test performance was found in 102 consecutive students, and all 102 students (100%) preferred the digital-testing format. The amount of time needed to tabulate the teacher evaluation, grade the test, and score the oral presentations decreased substantially with the digital system. CONCLUSION: An intranet-based method of evaluating students in an ongoing fashion allows for additional growth in content and ease of use during the radiology clerkship.

Attitude to Computers↗
PubMed2000

The virtual course: delivery of live and recorded continuing medical education material over the Internet.

OBJECTIVE: Our objective was to deliver live and recorded lectures from a continuing medical education course, including the representations of original slides, over the Internet, using streaming audio media. CONCLUSION: The streaming audio media, an emerging technology, not only delivers large lectures over the Internet using commercially available PCs and modems, but also allows review at any time by individuals with access to the Web. An interactive conference of continuing medical education curriculum can thus be delivered and continuing medical education credit earned without leaving home.

Education, Distance↗
PubMed1998

Fluoroscopic examination in the neonatal intensive care unit using an inverted C-arm.

Fluoroscopic studies can be performed in the Neonatal Intensive Care Unit (NICU) using a portable C-arm. The C-arm is inverted so that the infant lays directly on the image intensifier. In all our cases, the images obtained were of good enough quality to allow for prompt diagnosis and management of the patient's condition. Furthermore, measured entrance doses were lower using the inverted C-arm than they were using conventional fluoroscopy.

Fluoroscopy↗
PubMed1998

Meta analysis of the relationship between tuberous sclerosis complex and renal cell carcinoma.

The association of angiomyolipoma with tuberous sclerosis complex (TSC) patients is well recognised. Some literature has suggested that patients with TSC are at increased risk of renal neoplasm, particularly since angiomyolipomas can be locally invasive and demonstrate tumor like neovascularity on angiography. In an attempt to place in context one case of metastatic renal cell carcinoma in a patient with TSC a meta analysis of the literature was performed. One pediatric patient with TSC and metastatic renal cell carcinoma was evaluated. Reviews and case reports of TSC and renal cell carcinoma and related imaging findings were identified by searching the MEDLINE database, the 'bibliography of reviews' in Index Medicus, personal files and the reference lists from all identified reviews. Individual cases suitable for review in the available literature from 1922 through 1993 comprised the data base. The data base was analysed with the method of proportions and unpaired two-tailed Student's t-test for different populations. A cumulative summary of the literature amassed 107 additional cases from 62 reports over 71 years. Our case is the 17th case, to our knowledge, of renal cell carcinoma in TSC. Analysis of the distribution of characteristics and incidence of; renal cysts, renal cell carcinoma, and lymph node involvement demonstrate no increased risk of renal cell carcinoma in patients with TSC (P = NS). Though anecdotal evidence has suggested a relationship between TSC and renal cell carcinoma, meta analysis of cases of coincident TSC renal complex, cystic changes, angiomyolipoma and renal cell carcinoma implies an identical, though small, risk of malignancy in TSC patients as compared with the normal population.

Adolescent↗
PubMed1996

A study of level of lesion, associated malformations and sib occurrence risks in spina bifida.

Neural tube defects remain the most serious common birth defect and, despite considerable progress in understanding these malformations, the etiology of most cases remains unknown. It has been proposed that the cause may vary with the type and location of the malformation but, if these variables are to be studied, a rigorous classification of cases is required. This has become more important as birth prevalence has fallen, mainly due to prenatal diagnosis and elective termination of pregnancy, and future studies will increasingly require collaboration between centres. In this study we have combined data from Ottawa, Ontario, and Boston, Massachusetts, in an attempt to examine the effect of level of spina bifida on sib occurrence rates and the rates of associated malformations, and to compare the level of lesion when determined radiographically with that recorded on the clinical chart. Malformations appeared to be more frequent with thoracic spina bifida and were more often associated with additional vertebral anomalies. Significant differences were found between the upper level of lesion recorded in the clinical file and that visible radiographically. Sib recurrences were too few for statistical comparison, but the data suggest a higher rate among sibs and more distant relatives of propositi with upper level lesions. There was not evidence to support a greater than expected concordance for level of lesion between sibs.

Boston↗
PubMed1996

Can clinical parameters help reliably predict the onset of acute intracranial hemorrhage in infants receiving extracorporeal membrane oxygenation?

PURPOSE: To determine whether clinical parameters can be used to help predict the onset of acute intracranial hemorrhage (ICH) in infants receiving extracorporeal membrane oxygenation (ECMO). MATERIALS AND METHODS: The authors retrospectively reviewed cranial sonograms and intensive care unit data for 53 neonates treated with ECMO for intractable cardiorespiratory insufficiency. Thirty-nine boys and 14 girls were treated between February 1988 and June 1993. Gestational age ranged from 34 to 43.5 weeks (mean, 39.2 weeks). Birth weights ranged from 2,200 to 4,650 g (mean, 3,310 g). Multiple clinical variables were subjected to statistical analysis. RESULTS: There were 38 patients without ICH, 10 with early ICH (within 72 hours after cannulation), and five with late ICH (more than 72 hours after cannulation). Analysis with bivariate scatterplots revealed almost complete overlap in the clinical parameters for patients in these three categories. Thus, use of individual variables to predict acute ICH was impractical. CONCLUSION: No clinical parameters helped adequately distinguish patients who developed ICH from those who did not.

Acute Disease↗
PubMed1996

Radiographic appearance of follicular bronchitis in children.

OBJECTIVE: The purpose of this study was to present the first radiographic description of a newly described disease in children, follicular bronchitis. MATERIALS AND METHODS: We retrospectively reviewed the medical history and radiographs of eight children with biopsy evidence of follicular bronchitis. RESULTS: All eight infants had findings on initial radiographs that were consistent with viral inflammatory disease. The clinical features of follicular bronchitis started by 6-8 weeks old and peaked between about 2 and 3 years old. After several months of the disease, the infants' radiographs showed a more obvious interstitial pattern. When these children were approximately 3 years old, the radiographic findings began to return to normal. Four children have been followed up for at least 8 years. By that age, the clinical symptoms of respiratory disease have disappeared. All four children tested after they were 8 years old had abnormal results of pulmonary function tests. CONCLUSION: The combination of unique clinical features associated with the radiographic appearances we describe should allow radiologists to suggest the diagnosis of follicular bronchitis.

Bronchitis↗
PubMed1995

Intracolonic pressure measurements during hydrostatic and air contrast barium enema studies in children.

PURPOSE: To prospectively evaluate intraluminal pressure changes in the colon of children undergoing conventional hydrostatic (barium and water-soluble contrast material) and air contrast barium enema studies. MATERIALS AND METHODS: Dynamic intracolonic pressure was measured in 26 children undergoing hydrostatic barium (23% wt/vol) enema studies, air contrast barium enema studies, or water-soluble contrast material enema examinations. Measurements were obtained with a measuring device capable of recording rapid changes in pressure. Pressure measurements were obtained with the contrast reservoir system open (contrast material was free to run through the tubing into the patient's colon) and closed (tube was clamped). RESULTS: The colonic pressures during the filling phase with liquid contrast material were equal to those elsewhere at the same level with the hydrostatic system. Mean pressure ranged from 30 to 50 mm Hg with peaks of more than 100 mm Hg during Valsalva maneuvers. During air contrast barium enema studies, sharp pressure increases and rapid swings in the intracolonic pressure occurred during and after manual insufflation of air. CONCLUSION: During conventional hydrostatic barium enema studies, intracolonic pressures remain low. During air insufflation, there were intermittent high, sharp pressure peaks.

Adolescent↗
PubMed1995

Autosomal recessive polycystic kidney disease: long-term sonographic findings in patients surviving the neonatal period.

OBJECTIVE: We studied the sonographic findings and the changes in renal function seen on long-term follow-up of children who had the initial diagnosis of autosomal recessive polycystic kidney disease made in the neonatal period. MATERIALS AND METHODS: The case records and sonograms of 14 children with biopsy evidence of autosomal recessive polycystic kidney disease were evaluated. Nine children who survived the neonatal period were followed up for a mean of 13 years (range, 5-19 years) after diagnosis and form the basis of this study. Serial changes in renal size, echogenicity, and function were assessed sonographically. The imaging findings were compared with those described in published reports. RESULTS: The sonographic findings showed that five of the nine children had a decrease in renal size, and three had stable renal size over a minimum follow-up period of 5 years. Only one of the nine survivors showed progressive increase in renal size. All had increased cortical echogenicity and large kidneys. Three patients showed a subjective change in renal echogenicity over time. A change in the echogenic pattern to one that resembles autosomal dominant polycystic kidney disease was noted with no evidence of increase in size of the kidneys. None of the surviving children had renal stones or massively enlarged kidneys. The renal function of seven of the nine survivors has remained stable with creatinine clearance nearly normal (> 60 ml/min/1.73 m2), and there was no correlation between renal size and renal function. CONCLUSION: In patients with autosomal recessive polycystic kidney disease who survive the neonatal period, kidney size as seen on sonograms does not continue to increase despite the patients' linear growth and maintained normal renal function. Rather, a decrease in kidney size and change in echogenicity occurs, producing a pattern that is similar to that seen on sonograms of patients with autosomal dominant polycystic kidney disease but without the marked increase in kidney size that occurs in that entity. This changing cystic pattern on follow-up sonograms may be the reason that previous descriptions of the sonographic findings in cases of autosomal recessive polycystic kidney disease have varied and why a decrease in size may not herald deteriorating renal function.

Biopsy↗
PubMed1995

Pseudomembranous colitis: CT findings in children.

A spectrum of nodular haustral thickening and an accordion pattern have been reported as specific features of pseudomembranous colitis (PMC) in adults. A retrospective review of nine patients with PMC was performed to assess whether this spectrum of CT findings also occurred in children. In four girls and five boys, CT scans were performed within 3 days of a positive stool toxin assay for Clostridium difficile. Documented CT abnormalities included nodular haustral thickening, the accordion pattern, colonic wall thickening, ascites, and pericolonic edema. These results were then correlated as to their impact on the clinical outcome. Circumferential colon wall thickening was identified in 7/9 (78 %) patients (mean thickening 14.5 mm). Nodular haustral thickening was identified in 4/9 (44 %) and the accordion pattern in 2/9 (22 %). Other findings included pericolonic edema in 3/9 (33 %) and ascites in 1/9 (11 %). Wall thickening was confined to the left colon and rectum in 2/9 (22 %), to the right colon in 2/9 (22 %), and involved the whole colon in 3/9 (33 %). Although CT findings associated with PMC in children may be suggestive for this diagnosis, CT is less specific than laboratory and clinical findings.

Child↗