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Biomedical subjects

L J Abernethy

Publications and source records attributed to L J Abernethy.

At least 19 recordsLinked to original sources
PubMed2003

Retrograde embolisation of varicocele in the paediatric age group: a review of 10 years' practice.

OBJECTIVE: To review the 10 years' practice of retrograde embolisation of varicoceles in the paediatric age group. PATIENTS AND METHODS: 40 boys (age range, 6-16 years), with varicocele diagnosed both clinically and sonographically, were referred to the radiology department for embolisation. Data of these patients were collected and analysed retrospectively. Patients' age, side, treatment, complications, and outcome were noted. The follow-up ranges from 2 months to 6 years (mean, 1.1 years). RESULTS: In 24 patients (60%), embolisation was successful at the first attempt and 11 procedures (27.5%) were technical failures; 4 patients (10%) after venography were considered non-embolisable. One patient (2.5%) is yet to be seen in the clinic. Recurrence occurred in 4 patients (10%) of whom 3 had successful repeat embolisation. One patient with a recurrent varicocele did not wish further treatment. Out of the 11 failures, 5 underwent repeat embolisation with success in 3 patients and failure in two. Four patients had successful surgical ligation and 2 patients were treated conservatively. All who were non-embolisable were treated successfully by surgery. Our overall success rate was 65% (n = 26). CONCLUSIONS: These results suggest that embolisation is valuable as a first line of treatment for paediatric varicoceles provided a skilled interventional radiologist is available. This procedure is less invasive, avoids general anaesthetic, involves minimal postoperative pain, and allows an earlier return to normal activities. However, 35% of patients did eventually require conventional surgery for primary failure of embolisation or late recurrence.

Adolescent↗
PubMed2002

Magnetic resonance venography in assessing venous patency after multiple venous catheters.

BACKGROUND/PURPOSE: Venous thrombosis is a well-recognised complication of central venous catheters (CVC). The aim of the study was to assess the value of magnetic resonance venography (MRV) in assessing venous patency in children with suspected venous thrombosis. METHODS: Contrast studies through the CVC (linogram) and Doppler ultrasonography were the initial investigations performed in children with suspected CVC-related thrombosis. Two-dimensional gated inflow and phase contrast MRV also was performed to assess the extent of venous thrombosis and to locate patent veins for replacement CVC. When the MRV identified a suitable patent vein, the CVC was reinserted by direct venous cut down or the percutaneous method under a general anaesthetic. RESULTS: A total of 25 children (median age, 5 years; range, 2 months to 17 years) who had multiple CVC insertions (median, 3; range, 1-9), underwent MRV for suspected venous thrombosis. Of 10 patients in whom the catheter was completely occluded, MRV identified extensive thrombosis of the central veins in 6. In 7 other children the linogram showed adherent thrombus at the tip of the CVC only. In 5 of these 7 children MRV showed extensive thrombosis of the vein in which the catheters were placed. Doppler ultrasonography diagnosed thrombotic occlusion of the neck veins in 7 children. The MRV studies showed more extensive thrombosis in 4 of these 7 patients. Additionally, MRV showed thrombosis of the intrathoracic veins in 11 patients who had patent neck veins on ultrasound scan. MRV identified a patent vein for reinsertion of CVC in 22 of 25 children. At operation, venous patency was confirmed in 20 patients (91%). CONCLUSION: MRV in children with suspected CVC-related thrombosis is more accurate than Doppler ultrasonography, and contrast studies for defining the extent of venous thrombosis. MRV correctly shows venous anatomy and patency for reinsertion of CVC.

Adolescent↗
PubMed2002

Quantitative magnetic resonance imaging of the brain in survivors of very low birth weight.

BACKGROUND: Children who survive very low birth weight (VLBW) without major disability have a high prevalence of learning difficulty, attention deficit, and dyspraxia. AIMS: To determine whether learning difficulty in children with VLBW is associated with structural brain abnormalities. METHODS: A total of 87 children (aged 15-16 years) with a history of VLBW (<1500 g) and eight age matched full term controls have been studied with detailed magnetic resonance brain scans. Volume measurements of the caudate nuclei and hippocampal formations were made. RESULTS: Scans in 42.5% of the children showed evidence of perinatal brain injury. There was no significant difference in IQ, dyspraxia, or attention deficit between children with qualitatively normal and abnormal scans. However, quantitative volumetric analysis showed that children with a low IQ had smaller volume measurements for the right caudate nucleus and left hippocampus, and a smaller hippocampal ratio (left volume:right volume) than those with normal IQ. CONCLUSION: Data suggest that learning disorder, attention deficit, and dyspraxia in children who survive VLBW do not correlate with conventional markers of perinatal brain injury, and may be related to global brain growth and the development of key structures, such as the caudate nuclei and hippocampal formations.

Adolescent↗
PubMed2000

Orbital abscess masquerading as a rhabdomyosarcoma.

Although orbital cellulitis is the most common cause of acute-onset proptosis with inflammatory signs in a child, the clinician should always be alert to the possibility of rhabdomyosarcoma. We describe an unusual presentation of acute-onset nonaxial proptosis of the left orbit without sinus disease or systemic toxicity in a 6-year-old boy. Our clinical differential diagnosis included orbital cellulitis, metastatic disease, capillary haemangioma, lymphangioma with cyst, ruptured dermoid cyst, and orbital rhabdomyosarcoma. Only after orbital biopsy and subsequent microbiologic confirmation were obtained was a diagnosis of chronic orbital abscess tenable. Features in our patient included paucity of symptoms and signs of inflammation. This case illustrates the difficulty in differentiating a chronic orbital infection from orbital rhabdomyosarcoma on the basis of clinical, laboratory, and orbital imaging findings. Possible causes of this unusual presentation are discussed.

Abscess↗
PubMed1999

Cranial magnetic resonance imaging and school performance in very low birth weight infants in adolescence.

AIM: To determine whether neurological deficits are associated with structural anomalies of the brain in very low birthweight (VLBW) infants with subsequent learning disorders but without cerebral palsy, or whether other factors, such as poor early growth, are responsible. METHODS: Eighty seven VLBW infants and eight term controls who had been examined at school between the ages of 12 and 13 years, had cranial magnetic resonance imaging (MRI) scans at 15-17 years of age. RESULTS: Thirty seven (42.5%) of the VLBW children had abnormalities reported on their scans (two porencephaly, 28 periventricular leucomalacia, 24 ventricular dilatation, and 15 thinning of the corpus callosum). No significant differences in intelligence quotient, motor clumsiness, or frequency of attention deficit / hyperactivity disorder were observed between those children with MRI lesions and those with normal scans. Quantitative measurements showed the VLBW infants had smaller brains, and a relatively smaller corpus callosum compared with controls. No association between brain measurements and school performance was observed among the VLBW infants. CONCLUSIONS: The difficulties experienced by VLBW children at school are unlikely to be the result of perinatal brain injury, but they might to be attributable to the effects of poor postnatal growth.

Adolescent↗
PubMed1998

Imaging of the pituitary in children with growth disorders.

Magnetic resonance imaging reveals the anatomy of the pituitary and hypothalamus with unique detail. The clinical and biochemical investigation of short stature in childhood may be difficult and complex; magnetic resonance imaging of the pituitary is a non-invasive technique which can help to clarify the diagnosis of growth hormone insufficiency and to determine its cause. Most cases of growth hormone insufficiency have previously been considered to be idiopathic; in about 60% of these children, magnetic resonance imaging shows a characteristic structural abnormality which has been termed pituitary stalk interruption syndrome. The most important role of magnetic resonance imaging is in the diagnosis of destructive lesions of the hypothalamic-pituitary axis which may initially present with growth failure.

Child↗
PubMed1998

Abscess after appendicectomy in children: the role of conservative management.

BACKGROUND: Intra-abdominal abscess remains a significant cause of morbidity following appendicectomy. In children, little emphasis has been placed on the non-invasive management of this complication using antibiotic therapy alone. This study reviews the experience of a paediatric surgical department in managing abscess arising after appendicectomy. METHODS: Hospital records of all children undergoing appendicectomy between January 1992 and January 1997 were reviewed retrospectively. RESULTS: Some 1024 children underwent appendicectomy over a 5-year period. Twenty three patients (2.2 per cent) developed abscesses after appendicectomy. Non-operative management with intravenous or oral antibiotics alone was successful in 21 patients, with complete clinical and radiological resolution of the abscess. Drainage of the septic collection was performed in only two patients: by laparotomy (n=1) and by the transrectal route (n=1). CONCLUSION: Antibiotic therapy alone is an efficacious and safe first-line treatment modality in children who develop this complication. Drainage of an abscess developing after appendicectomy is rarely necessary in children.

Abdominal Abscess↗
PubMed1998

Intra-arterial calcium stimulation test in the investigation of hyperinsulinaemic hypoglycaemia.

OBJECTIVE: To investigate the use of a calcium infusion test in the diagnosis and localisation of insulin secreting tumours in children. PATIENTS: Three patients with persistent hypoglycaemia of infancy (PHHI). PROCEDURE: During planned selective coeliac and mesenteric arteriography, serial samples were taken from a catheter in the right hepatic vein for insulin measurement following the injection of calcium gluconate. RESULTS: In all three children, selective intra-arterial calcium stimulation produced a significant rise in plasma insulin and was of value in localising the pancreatic abnormality in one child. In vitro studies on islets of Langerhans isolated from this patient following partial pancreatectomy showed unresponsive intracellular calcium signalling of the cells when stimulated with high extracellular concentrations of glucose and potassium or with sulphonylurea drugs (tolbutamide), but normal responsiveness to increasing extracellular calcium concentrations. CONCLUSIONS: The findings suggest a functional abnormality of the calcium channel in PHHI and provide a rationale for the reported efficacy of channel blocking drugs in this condition. The role of selective intra-arterial calcium stimulation in the diagnosis of hyperinsulinaemic hypoglycaemia in childhood warrants further investigation.

Calcium↗
PubMed1997

Normal MR appearances of the posterior pituitary in central diabetes insipidus associated with septo-optic dysplasia.

Magnetic resonance (MR) imaging of the pituitary in children with central diabetes insipidus usually shows absence of the normal high signal within the posterior gland. The high signal of the normal posterior pituitary is thought to be due to the presence of intra- cellular storage granules of vasopressin. MR imaging has been advocated as a useful investigation to aid in the distinction between central diabetes insipidus and other causes of thirst and polydipsia. We report the case of an infant with central diabetes insipidus in association with septo-optic dysplasia in whom MR imaging showed normal appearances of the posterior pituitary. The mechanism of central diabetes insipidus in this case may be related to a failure of hypothalamic function affecting osmoreception, rather than to a deficiency of vasopressin. Normal MR appearances of the pituitary do not exclude central diabetes insipidus in infants with midline cerebral malformations.

Abnormalities, Multiple↗
PubMed1991

Measurement of caudate nucleus area--a more accurate measurement for Huntington's disease?

Caudate nucleus atrophy occurs in Huntington's disease and methods of measuring this have been described using axial CT, but these are indirect and lack sensitivity. We measured caudate nucleus area (blind to the subjects' clinical state) in 30 subjects with or at risk of Huntington's disease, and in 100 normal age matched controls. Fifteen subjects with established symptomatic Huntington's disease, 3 with early symptoms, and 3 presymptomatic subjects (2 showing a high probability for the Huntington's disease gene on genetic testing, and one who has since developed symptoms) were correctly identified. Three normal (gene negative) family members were also correctly identified. Outcome is awaited in 6. CT caudate area measurement is simple and reproducible and we have found it to be a useful confirmatory test for Huntington's disease.

Adolescent↗
PubMed1990

Ultrasound assessment of the position of the tongue during induction of anaesthesia.

Tongue position was assessed in 15 female patients at induction of anaesthesia with either thiopentone or propofol. A video recording of a midline sagittal section of the tongue was made using an ultrasound transducer placed below the chin, and representative figures analysed by an observer who was not aware of the patient's state. In 11 satisfactory recordings, the tongue movement was inconsistent in direction and not more than 8 mm in the anterior tongue and 6 mm in the posterior tongue. The movements detected did not suggest that the tongue is likely to be an important cause of airway obstruction on induction of anaesthesia.

Adult↗
PubMed1989

Fibromuscular dysplasia of the renal artery in a child: detection by Doppler ultrasound and correction by percutaneous transluminal angioplasty.

We describe the case of a fourteen-year old girl with hypertension, in whom renal arterial stenosis was identified by Doppler ultrasound examination, with subsequent demonstration of typical features of fibromuscular dysplasia by selective renal arteriography. Percutaneous transluminal balloon angioplasty was performed, and a sustained improvement in renal arterial flow was confirmed by follow-up Doppler ultrasound examinations.

Adolescent↗