Biomedical subjects
Publications and source records attributed to M B Nogrady.
Several recent articles have described a third branchial cleft sinus as a route of infection in deep neck abscess. This article describes two children whose presentation and clinical course were secondary to a third branchial cleft sinus.
To evaluate the role of ultrasonography in the investigation of childhood urinary tract infections (UTI), 240 patients aged 2 days to 15 years with a first-documented UTI were examined first by sonography, then by intravenous urography (IVU), and when indicated by voiding cysto-urethrogram (VCU). According to the results of these examinations, the patients were divided into three groups. In Group 1 (71 patients), abnormal sonographic findings were confirmed by the radiographic studies. Patients in Group 2 (51 patients) had discrepancies between sonographic and radiographic findings, the most important of which concerned the assessment of vesico-ureteric reflux (VUR). In Group 3 (118 patients), sonographic and subsequent radiographic investigations were normal. Although ultrasonography can sometimes detect VUR, major reflux can be missed by sonography alone. In young children at risk for reflux nephropathy, ultrasound examination of the urinary tract must be accompanied by a VCU or isotope cysto-urethrogram.
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Three children presented with unilateral and asymmetric renal enlargement and clinical and laboratory evidence of acute poststreptococcal glomerulonephritis. This asymmetry resolved at the same time as the nephritis. Angiographic evidence of absence of renal artery stenosis was available in one case. Angiography was not performed in the other 2 cases. The authors suggest that the differential diagnosis of unilateral acute renal inflammation (swelling of the kidney, prolonged nephrogram, calyceal distortion, poor concentration of contrast medium) should include acute glomerulonephritis. Extensive radiological evaluation is probably not necessary unless asymmetry persists.
A group of girls is described with recurrent urinary tract infections characterized by predominantly lower tract symptoms. Clinical, laboratory, and radiography findings during the period of follow-up are presented. Infection persisted in most patients over several years. Response to medical and surgical treatment was unsatisfactory. The mean interval between the initial and most recent radiological study was 6 1/2 years. No case of renal parenchymal scarring was seen.
The roentgenologic diagnosis and differentiation of mediastinal neurogenic tumors are possible on the chest roentgenogram as a rule. The soft tissue mass may be ill-defined and the tumor "ghost-like" in the case of primary neuroblastoma, but it is usually obvious in ganglioneuroma and metastatic disease. The presence of calcifications differentiates neurogenic tumors from other posterior mediastinal tumors of childhood. They are common in primary and rare in secondary disease. Rib erosions and displacement are striking in neuroblastoma (after a few months of age), more subtle in ganglioneuroma, and absent with secondary involvement. In 3 out of 7 posterior mediastinal neuroblastomas the diagnosis and treatment were delayed, as the adjacent rib changes were not appreciated for some time. "Dumbbell" shaped tumors are usually associated with vertebral changes and myelography is indicated even in the absence of neurologic deficit. Thoracic deformity and disability subsequent to laminectomy, radiation therapy, or both, are present in all survivors.
Thirteen infants and children with adenovirus type 7 infection proved by virus isolation are described. High fever, cough and dyspnea were the most frequent findings; in infants under 1 year of age wheezing was common. Four patients required artificial ventilation. Lobar collapse, consolidation and hyperinflation were frequent radiologic findings. None of the symptoms responded to antibiotic therapy or bronchodilator drugs. Three patients died (mortality rate of 23%). Pathologic findings were compatible with adenovirus type 7 pneumonia, and were characterized by a necrotizing bronchitis and bronchiolitis, patchy alveolar fibrinopurulent exudate and hyaline membrane formation. Some intra-alveolar epithelial cells showed strikingly abnormal nuclei and rare typical halo-outlined intranuclear inclusions were seen. Only one of eight survivors had evidence of significant chronic chest disease.
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