Biomedical subjects
Publications and source records attributed to M Grünebaum.
The bone changes in infants with copper deficiency are typified by osteopenia and the symmetrical appearance of sickle-shaped metaphyseal spurs. Four examples are demonstrated and the differential diagnosis is extensively discussed.
Traumatic oesophageal perforation may occur during the intensive care of premature infants due to trauma of the laryngoscope blade, to traumatic intubation with an endotracheal tube or to forced passing of a nasogastric tube. Over a four-year period, three infants of 787 admitted to a neonatal intensive care unit were diagnosed as having this complication. The careful analysis of the position of the nasogastric tube in relation to surrounding structures can be an early clue to the diagnosis of this condition.
The paradoxical movement of the mediastinum, in relation to the respiratory cycle, is a valuable fluoroscopie sign in the evaluation of partial obstruction of air-flow through the trachea or larynx. Its recognition in the presence of the normal chest radiograms together with the clinical history of aspiration, is of importance in the diagnosis of a foreign body located above the tracheal bifurcation. The pathophysiology and the radiographic manifestations of this phenomenon are described. Various etiologies are discussed in which this sign is also seen. The experience with 18 pediatric patients is presented and 3 cases are outlined in details.
Congenital syphilis is re-emerging in modern society. The pediatric radiologist may contribute to its early diagnosis. A case of unusual bone involvement with fracture of the olecranon and facial bone lesions is described; the condition had to be differentiated from the "battered child syndrome". The problem of congenital syphilis as an infectious disease versus bone dystrophy is also discussed.
A two year old boy, admitted for evaluation of failure to thrive was found to have multiple paraspinal masses and a widened spinal canal. The masses proved to be lateral meningoceles, present varying degrees at every thoracic and lumbar level.
Roentgenograms of the chest, hip, or hand performed for a variety of reasons, may provide findings indicative of hypothyroidism even before there are any clear clinical signs of the disorder. It is stressed that the alertness of the roentgenologist and/or the physician is an important factor in discovering mild changes of the disease. We present such roentgenologic findings and illustrative cases of patients who were examined because of repeated respiratory tract infections, suspected hip joint dislocation and, sluggish behavior.
Long-term follow-up of leiomyomas in the oesophagus is discussed from the radiological point of view. It is the authors' impression that surgical intervention is not a matter of urgency in the treatment of these tumours as their tendency to undergo malignant change is very rare. Nine cases of leiomyoma of the oesophagus were followed for periods ranging from 1 to 15 years. None showed malignant degeneration.
It has recently been shown that hypothyroidism complicates cystinosis. The radiographic bone changes of hypothyroidism (retarded skeletal age) cannot be detected while the patient has overt rickets, since the secondary ossification centers are not ossified. When the rickets is treated and the secondary ossification centers fail to appear (the skeletal age remains retarded), then the diagnosis of hypothyroidism should be suspected. After treatment with thyroid hormone is begun and a growth spurt occurs, rickets that has been controlled may reactivate. The previous doses of vitamin D will no longer be adequate because of the patient's growth spurt.
Two children with cystitis presented with multiple filling defects in the urinary bladder. They were proven to be cases of cystitis glandularis with proliferative changes of the bladder epithelium. The radiographic findings are described and the differential diagnosis from neoplasms is outlined.
The conventional excretory urogram may provide valuable information in the diagnosis of polyarteritis nodosa. A finding of imprints on the ureteral wall or a nodular appearance of the ureter simulating a string of pearls would seem to be pathognomonic for this disorder. Two cases with these manifestations are presented and the differential diagnosis is discussed.
Twenty-nine children (23 girls, 6 boys) with precocious puberty were treated with cyproterone acetate for various periods of time ranging from 6 months to 3 years 4 months. They received an oral dose ranging from 70-150 mg/m2 per day, or an intramuscular depot injection once a fortnight or once a month at a dose ranging from 107-230 mg/m2. Both forms of therapy were found to suppress the signs of sexual maturation, but the oral form proved to be superior. Only the younger patients with a bone age under 11 years showed a beneficial effect upon linear growth and bone maturation. No side effects were noted, but additional advantageous effects upon behaviour and sociability were. It is concluded that at present cyproterone acetate by mouth is the drug of choice in the treatment of precocious puberty. The treatment should be initiated as early as possible to attain maximum benefit.
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Echinococcosis of the lung should always be kept in mind when evaluating masses seen in the chest radiograms of children, since the disease is not a rarity. The radiological signs and its differential diagnosis are considered, emphasizing the possibility of the masking of a hydatid cyst by a superimposed pneumonia. The importance of verifying the presence of echinococcosis before deciding on puncture of the lung is stressed.
Tumor-like proliferative lesions were discovered on cystourethrography and cystoscopy in two children, one with severe bacterial urinary tract infection and the other with painless terminal hematuria. Histologically, these lesions were characterized by inflammatory infiltration and proliferative changes of the bladder epithelium. Appropriate treatment, including antibiotics, resulted in complete disappearance of the bladder lesions in both patients. The development of such lesions is related to the potential for nonneoplastic proliferation and metaplasia of the bladder epithelium and is considered to be the result of irritation associated with infection or other chemical and physical factors. The known malignant potential of such bladder pathology indicates a need for careful, long-term follow-up in such patients, including children.
Both lung pathology and bowel distension are seen simultaneously on radiographs in familial dysautonomia. These are constant findings even in the absence of acute disease. One may thus speak of a "chest-abdomen sign" in this entity. Cases with this sign are presented in illustration and the differential diagnosis is discussed.
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