Biomedical subjects
Publications and source records attributed to M Grunebaum.
MRI can be used in the diagnosis of anterior horn infection and for assessing the extent of disease. There are no specific MRI signs to differentiate between the various possible pathogens. This is demonstrated in the present case of poliomyelitis, in which MRI of the spine played an important role in establishing the diagnosis.
Fracture-separation of the distal humeral epiphysis in neonates is difficult to diagnose radiologically because the cartilaginous epiphysis is radiolucent. We report a case in which fracture-separation of the distal humeral epiphysis in a neonate was diagnosed with the help of ultrasonography, which provided a clear delineation of the injury.
OBJECTIVE: The purpose of the study was to determine predictors of missed appointments for psychiatric consultations among patients in a general medical clinic. METHODS: The charts of 180 patients consecutively referred for psychiatric consultations at a university-affiliated primary care clinic were reviewed. Ninety patients missed appointments for these consultations. Parametric and nonparametric tests were used to compare patients who missed and did not miss appointments on demographic and clinical variables, as well as measures related to patients' interactions with the clinic and the referring clinician. RESULTS: Logistic regression analysis revealed three significant predictors of missed appointments. Patients with mild distress and those with significant resistance to seeing a psychiatrist were more likely to miss appointments, as were those who had to wait longer between the referral and the appointment date. CONCLUSIONS: The results suggest that shortening the wait for a psychiatric consultation, reserving consultation for more severe cases, and working to reduce patients' resistance to consultation will reduce the number of missed appointments.
We reviewed the cases of eight patients (thirteen hips) with Gaucher disease who had had osteonecrosis of the femoral head and had been managed with bed rest and non-weight-bearing with crutches only in the symptomatic stage of the bone crisis. The mean age of the patients at the onset of the first crisis in each hip was ten years (range, six to fourteen years). The mean age at the most recent follow-up examination for the six living patients (ten hips) was twenty-three years (range, nineteen to thirty-three years). The Mose rating was good for one hip, fair for two, and poor for seven. Despite the over-all unfavorable radiographic ratings, the six patients were asymptomatic and did not need assistance with daily activities. There is no known treatment that effectively prevents the development of deformities of the femoral head. Thus, we recommend symptomatic management for osteonecrosis of the femoral head in Gaucher disease with bed rest and analgesics followed by non-weight-bearing on the involved limb, if it makes the patient more comfortable, during the symptomatic stage of bone crisis.
To evaluate the incidence of abnormal intracranial findings in children with central precocious puberty, 62 children (51 girls, 11 boys) were examined by computerized tomography and/or magnetic resonance imaging (MRI) of the brain. Forty-four had normal examinations; 18 (11 girls, 7 boys) showed intracranial pathologies, including hamartoma of the tuber cinereum (8 cases), parenchymal loss (3 cases), hypothalamic-chiasmatic lesions (2 cases), lesions of the corpus callosum (2 cases), suprasellar cyst (1 case), and pineal cyst and mesiotemporal sclerosis (1 case each). Based on the correlation between the clinical and the imaging results of this series, the authors recommend MRI as the imaging method of choice in the investigation of precocious puberty.
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A preterm infant with a rare association of a multicentric hepatic hemangioendothelioma (MHH) and a large brain hemangioma is described. The imaging investigations and their findings are discussed. It is recommended that whole-body radionuclide imaging with 99mTc-labeled red blood cells is employed immediately following ultrasonography to confirm the suspected diagnosis of MHH and to detect other unsuspected hemangiomas.
The prevalence of bronchiectasis (BR), in general, is decreasing, yet the disease can produce significant morbidity in children. In the pediatric age group the classical investigation by bronchography implies general anaesthesia, thus carrying an additional risk of complications. CT has proved highly accurate in the diagnosis of BR in adults. It is also considered a reliable modality for the diagnosis of BR in children. This conclusion was reached by analysing the radiographic and the CT findings in 40 children with the clinical suspicion of BR in 25 of whom the CT examination was positive. Nine patients of this last group had bronchography as well. There was complete correlation in the diagnosis and location between the CT and the bronchographic findings. Thus, it seems that the occurrence of this disease is still high in the pediatric population in the appropriate clinical and radiological setting. The imaging evaluation of BR should include chest radiographs, computerized tomography and, if surgery is planned, bronchography as well.
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The bubble sign (BS) in the gasless abdomen of the newborn is a helpful clue in the diagnosis of an upper gastrointestinal obstruction. The already swallowed air serves as the natural contrast agent. The single, double and triple BS are described in view of 23 cases indicating the level of the obstruction, and its differential diagnosis is discussed. The presence of BS in the gasless abdomen of the newborn is an indication for surgery until proved otherwise. With the increasing experience by ultrasonography, this modality should be considered as the first bed-side procedure when suspecting upper gastrointestinal obstruction, and then be confirmed by radiograms.
The signals obtained from mediastinal cystic lesions in children by magnetic resonance imaging (MRI) have been analysed. The advantages and pitfalls in establishing the final diagnosis by MRI are compared to the conventional radiographic technique and to computed tomography.
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We report on a boy with Dubowitz syndrome and hypoparathyroidism from which he recovered, only to redevelop it at 6 years. He also had a submucous cleft palate and cineradiographic studies showed velopharyngeal insufficiency. Although a submucous cleft palate is a well-known manifestation of Dubowitz syndrome, velopharyngeal insufficiency has not been previously described.
Cortical thickening and/or periosteal reaction in long bones of children and adolescents continue to present a diagnostic difficulty for the pediatric radiologist. A history of physical activity points to the possibility of stress fracture, nevertheless bone malignancy or chronic inflammatory changes have to be excluded. The MRI findings in recent cases of stress fractures were confusing. An extensive metadiaphyseal abnormal signal from the medullary cavity was observed. Only the meticulous correlation between the various imaging modalities established the correct diagnosis. Stress fractures can occur in a normal bone that is subjected to repeated trauma, with the strain being less than that which causes an acute fracture. Localized pain is the presenting symptom. This kind of fracture is encountered in adolescents who are often involved in competitive physical exercise. The conventional radiographic examination shows the evidence of the fracture repair rather than the fracture itself: localized periosteal reaction and endosteal thickening. A radiolucent cortical fracture-line is usually not demonstrated. The radiologic appearance can be problematic in the pediatric age and necessitates differentiation from osteomyelitis or bone malignancy. The diagnostic investigation includes multidirectional bone radiographs. Tcm99 polyphosphate bone scintigraphy and computerized tomography. Recently MRI has been added to the diagnostic armamentarium. This paper presents the experience gained in the diagnosis of pediatric stress fractures which were investigated and followed up by MRI. It was found that this modality did not contribute to the establishment of the final diagnosis of stress fracture.
Two unrelated families are presented, each with 2 affected offspring with bifid femur, absent tibia, and ectrodactyly. The healthy parents are consanguineous. It is postulated that this combination of malformations is causally heterogenous with both autosomal dominant and autosomal recessive modes of inheritance; hence, it is established as a developmental field defect.
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