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Biomedical subjects

J J Fairhurst

Publications and source records attributed to J J Fairhurst.

16 recordsLinked to original sources
PubMed2002

Doppler ultrasonography to aid diagnosis of orbital capillary haemangioma in neonates.

PURPOSE: To illustrate the use of Colour Doppler Ultrasonography to aid the differential diagnosis of orbital masses in neonates. METHODS: Three cases are reported of neonates presenting with undiagnosed orbital masses as isolated findings, causing lid swelling and proptosis and prompting a differential diagnosis of an orbital vascular lesion, rhabdomyosarcoma or other tumour. Colour Doppler Ultrasonography in expert hands using a small footprint linear 10-5 transducer proved an atraumatic, rapid and accurate way of confirming a vascular lesion at the first clinic visit. This reassured the family and ophthalmologist alike, and obviated the need for biopsy or cross sectional imaging requiring anaesthetic. All three lesions were orbital capillary haemangiomas with characteristic ultrasonographic findings. RESULTS: Illustrations are provided to illustrate the features of the capillary haemangiomas when visualised with Colour Doppler Ultrasonography. CONCLUSIONS: The use of ultrasonography in very young infants can help exclude malignancy, without the need for cross sectional imaging or biopsy under anaesthetic. However, close observation remains mandatory. Repeat scanning is easily performed with no adverse effects, in potential contrast to other imaging modalities.

Diagnosis, Differential↗
PubMed2002

Diagnostic value of the chest radiograph in asymptomatic neonates with a cardiac murmur.

AIM: To establish the diagnostic accuracy and diagnostic usefulness of the chest radiograph in asymptomatic neonates with cardiac murmurs. PATIENTS AND METHODS: The chest radiographs of 68 asymptomatic neonates with cardiac murmurs were analysed retrospectively. The radiographs were anonymized and then evaluated for the presence or absence of cardiac disease by six radiologists, three who regularly interpret neonatal chest radiographs and three who do so infrequently. The eventual diagnosis for each neonate and the impact of the chest radiograph and original report on patient management were established by review of the clinical case notes. RESULTS: The results for each observer were expressed in 2 x 2 contingency tables and statistical analysis was performed using Fisher's exact test. The radiologists who were experienced in reporting neonatal chest radiographs achieved statistically significant results (P=0.003, P=0.002 and P=0.007) compared with those who were less experienced (P=0.13, P=0.16 and P=0.09). Review of the case notes established that the chest radiograph and original report did not influence clinical management in any of the 68 cases studied. CONCLUSIONS: Radiologists who frequently report neonatal chest radiographs achieve high accuracy in differentiating cardiac from non-cardiac disease. However, inaccuracies are unavoidable as radiological evidence of cardiac disease is often not present. A false-positive result could cause undue anxiety while a false-negative report could result in the omission of further investigations. Furthermore, a chest radiograph is unlikely to provide the definitive diagnosis. Chest radiographs did not appear to influence patient management in this study and cannot be recommended in the initial evaluation of the asymptomatic neonate with a heart murmur.

Diagnostic Errors↗
PubMed1999

Colonic wall thickening is related to age and not dose of high strength pancreatin microspheres in children with cystic fibrosis.

OBJECTIVE: Colonic fibrosis causing stricture is a recently described complication in cystic fibrosis (CF). Studies have suggested that ultrasound evidence of bowel thickening predicts this complication and that it is prevalent among children receiving large doses of high-strength pancreatin preparations. We performed ultrasound studies on our patients to look for evidence of bowel wall thickening or early stricture. METHOD: Detailed colonic ultrasounds were carried out in 33 children with CF including 25 who had been receiving high-strength pancreatin (Creon 25,000) continuously for 3 years at the time of study. RESULTS: Median lipase intake was 19 330 U/kg/day (range 0-59 880 U/kg/day) and median protease intake was 387 U/kg/day (range 0-1170 U/kg/day). The combined thickness of mucosa, sub-mucosa and muscle layers was measured in ascending, transverse and descending colon using a 7.5 MHz transducer. Measurements were also made in nine healthy controls. There was no relationship between enzyme dosage and colon thickness but simple regression identified a significant relationship (P < 0.001) between age and maximum colon thickness in all three areas. The colon of CF children was up to 50% thicker than in controls. CONCLUSIONS: Thickening of the order described elsewhere did not occur among any of the children studied. The results suggest that the most important factor determining the thickness of the CF colon is age.

Adolescent↗
PubMed1998

The role of magnetic resonance imaging in the investigation of spinal dysraphism in the child with lower limb abnormality.

A review of magnetic resonance imaging (MRI) performed to exclude the presence of spinal dysraphism in children presenting with lower limb pathology is unrewarding in the absence of abnormal neurology. Over a 5-year period, 29 children ages 2 weeks to 15 years with a mean age of 6 years presenting with lower limb abnormalities were referred for MRI of the spine to exclude an occult neurologic cause for the deformities. More than one limb abnormality, for example pes cavus and limb length discrepancy, was present in 93% of the children, and 11 children had severe or recurrent talipes equinovarus deformity. Only two children (7%), both of whom had abnormal limb neurology, had abnormal MRI scans. In the absence of a demonstrable neurologic deficit in the lower limb, there appears to be no advantage in requesting MRI of the spine in children presenting with lower limb abnormality.

Child↗
PubMed1995

Wessex regional radiology audit: barium enema in colo-rectal carcinoma.

In the first Wessex regional radiology audit, a retrospective comparison of pathology and radiology reports was made to determine rates of demonstration and reporting of colo-rectal carcinoma on barium enema. Barium enema films were analysed by peer review in cases of discrepancy. The standard set was 100% demonstration and 100% diagnosis of colo-rectal carcinoma on a barium enema undertaken in the 12 months preceding histological diagnosis. The carcinoma demonstration rate was 97% and carcinoma reporting rate 85%. Of 1351 patients with carcinoma, 557 had a barium enema in the preceding 12 months. Four hundred and seventy-one enema reports satisfactorily recorded the malignant lesion (85%). The reasons for non-reporting of a carcinoma were failure to demonstrate the lesion (18 cases, 3%), failure to perceive a demonstrated lesion (23 cases, 4%) and failure to analyse a perceived lesion (45 cases, 8%). Any improvement in demonstration cannot be estimated, but 94% of carcinomas should be reported when improved reporting techniques are instituted and the audit loop is closed.

Adenocarcinoma↗
PubMed1994

Subcutaneous granuloma annulare: four cases and review of the literature.

Subcutaneous granuloma annulare (SGA) produces benign nodules in otherwise healthy children. The histology of the lesions may be indistinguishable from rheumatoid nodules. However, in children the lesion of SGA is not accompanied by connective-tissue disease. We report 4 patients with SGA. There were three girls and one boy ranging in age from 4 to 15 years. All the children presented with a solitary lesion on the lower limb. A cutaneous lesion was also present in case 4. In only one patient (case 4) was there a history of trauma. There was no relevant past medical history. Routine laboratory tests were normal (including ESR and auto-immune profile). A computed tomography (CT) scan with intravenous contrast was performed in all patients. The CT features were those of soft tissue masses of variable attenuation and enhancement with inconsistent infiltration into surrounding fat. There appear to be no specific CT features which distinguish this benign lesion from a more sinister one. Excisional biopsy was performed in all cases. In children, SGA should be included in the differential diagnosis of soft-tissue masses, particularly in the lower extremity.

Adolescent↗
PubMed1993

Madelung's deformity masquerading as a bone tumour.

Madelung's deformity has classical clinical and radiological appearances; it is well recognised by both radiologists and orthopaedic surgeons. In this paper we report on two Madelung's deformities demonstrated on wrist radiographs that were misinterpreted as bone tumours, the patients having presented with unrelated trauma. Two further cases demonstrating similar features are illustrated. The radiological diagnosis of Madelung's deformity and its differential diagnosis is discussed.

Bone Diseases, Developmental↗
PubMed1993

Effective dose during screening monitored intussusception reduction.

A retrospective survey of 58 intussusception reductions in 55 patients is presented. During the period studied, the department changed from the use of barium to air as a reduction medium. The reduction rates were 86% with air (37 procedures) compared to 67% with barium (21 procedures). The complication rates were similar. The use of a dose-area product meter enables effective dose to the patient to be assessed. The median effective dose to the patient is 55 microSv, and the 75 percentile dose is 75 microSv. A table to estimate effective dose to the patient during the procedure is presented. This study confirms previously quoted advantages of pneumatic reduction over hydrostatic reduction of intussusception but finds no significant difference in dose between air and barium reduction. We believe that it should be possible to submit the patient to a dose of 75 microSv or less during intussusception reduction under screening control.

Air↗
PubMed1991

Bladder capacity in infants.

Bladder capacity was measured at micturating cystourethrography and normal ranges were established for children up to 1 year of age. Bladder capacity was compared with patient weight and distance from first lumbar to third lumbar vertebrae (L1 to L3). The simplified formula--Capacity (mL) = 7 x weight (kg)--was shown to give a reliable estimate of the expected bladder capacity in infants independent of age; this is useful in those infants whose weight lies outside the normal range for their age. Similarly, a formula was deduced relating expected bladder capacity to the measured L1 to L3 distance on an anteroposterior radiograph, which is of potential use to radiologists.

Body Weight↗
PubMed1987

Duplex ultrasound assessment of femorodistal grafts: correlation with angiography.

Fifty-eight grafts have been assessed using duplex scanning and ankle brachial pressure indices. This assessment is compared with the findings by angiography. Eighteen grafts were occluded and 40 patent. Duplex scanning defined graft status with a greater accuracy than pressure indices. Pressure indices alone would not differentiate "satisfactory" grafts from those with localised, haemodynamically significant disease. Only 55% of those grafts with localised stenoses demonstrated a fall of greater than 0.2 in ankle brachial pressure index after exercise. When the information obtained using pressure indices and duplex scanning was combined non-invasive assessment had a sensitivity of 86% and specificity of 94% for detection of localised, haemodynamically significant disease in patent grafts. Haemodynamically significant disease, as defined by angiography, can be detected and localised with duplex scanning complementing the use of pressure indices in graft assessment.

Aged↗