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Biomedical subjects

N B Wright

Publications and source records attributed to N B Wright.

At least 19 recordsLinked to original sources
PubMed2005

The role of magnetic resonance imaging in the assessment of suspected extrinsic tracheobronchial compression due to vascular anomalies.

AIMS: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of children with suspected extrinsic tracheobronchial compression due to vascular anomalies. METHODS: Retrospective case note review in a tertiary referral centre. Twenty nine children who underwent dynamic laryngotracheobronchoscopy (DLTB) and were found to have a clinical suspicion of extrinsic tracheobronchial compression were evaluated. All subsequently underwent thoracic MRI within 10 days. The findings on endoscopy were compared to those of MRI, and where performed, echocardiography, aortography, and surgery. RESULTS: There were 17 males and 12 females (mean age 5 months, range 28 weeks gestation to 60 months). The most common presenting features were stridor and cyanotic episodes. MRI showed abnormalities in 21 patients. There were five vascular rings (three double aortic arches and two right aortic arches) and 11 cases of innominate artery compression. Other vascular anomalies noted included aberrant right subclavian artery and aneurysmal left pulmonary artery. Echocardiography was generally found to be unhelpful in the diagnosis of extra-cardiac vascular abnormalities. Angiography was subsequently conducted in eight children; findings agreed with those shown on MRI. Surgery was performed on all five vascular rings, one innominate artery compression, and one aneurysmal left pulmonary artery. Surgical findings were also compatible with the preoperative MRI. CONCLUSIONS: This study shows the successful use of MRI as the initial imaging modality in endoscopically suspected extrinsic vascular compression of the upper airway. It enables accurate delineation of vascular anomalies and, unlike aortography, is non-invasive and does not require the use of contrast media.

Airway Obstruction↗
PubMed2003

Endocrine status in patients with optic nerve hypoplasia: relationship to midline central nervous system abnormalities and appearance of the hypothalamic-pituitary axis on magnetic resonance imaging.

We here: 1) describe the phenotypic spectrum, including magnetic resonance imaging (MRI) appearances of the pituitary stalk and anterior and posterior pituitary [H-P (hypothalamic-pituitary) axis], in children with optic nerve hypoplasia (ONH) with or without an abnormal septum pellucidum (SP); and 2) define endocrine dysfunction according to the MRI findings. Medical records of 55 children with ONH who had been assessed by ophthalmology and endocrine services were reviewed. All had MRI of the brain and H-P axis. Forty-nine percent of the ONH patients had an abnormal SP on MRI, and 64% had a H-P axis abnormality. Twenty-seven patients (49%) had endocrine dysfunction, and 23 of these had H-P axis abnormality. The frequency of endocrinopathy was higher in patients with an abnormal SP (56%) than a normal SP (39%). Patients were divided into four groups based on SP and H-P axis appearance: 1) both normal; 2) abnormal SP and normal H-P axis; 3) normal SP and abnormal H-P axis; and 4) both abnormal. The frequency of multiple pituitary hormone deficiency was highest (56%) in group 4, lower (35%) in group 3, and even lower (22%) in group 2. Precocious puberty was most common in group 2. None of the patients in group 1 had endocrine dysfunction. Thus, SP and H-P axis appearances on MRI can be used to predict the likely spectrum of endocrinopathy.

Adolescent↗
PubMed2002

Iodixanol in paediatric gastrointestinal imaging: safety and efficacy comparison with iohexol.

Iodixanol (Visipaque) is a dimeric, non-ionic iodinated contrast medium that is isotonic with blood at all clinically relevant concentrations. Iodixanol was compared in a randomized, double blind, parallel group, phase III multicentre trial with a monomeric, non-ionic contrast medium, iohexol (Omnipaque), at two concentrations assessing safety, tolerability and radiographic efficacy during contrast enhanced gastrointestinal radiography examinations of children. 154 children entered the trial; 152 formed the safety population and 147 the efficacy population. All examinations were performed following standard departmental practice. Children were assigned into either a high or low concentration group (iodixanol, 150 mgI ml(-1) and 320 mgI ml(-1) vs iohexol, 140 mgI ml(-1) and 300 mgI ml(-1)). The primary outcome measure for efficacy was the overall quality of visualization, which was assessed using a 100 mm visual analogue scale (VAS). The secondary efficacy variables assessed were quality of contrast opacification, mucosal coating and overall quality of diagnostic information. Safety evaluation involved patient follow-up for at least 48 h. Taste acceptance was also assessed. There was no statistically significant difference between the two contrast media with regard to the primary and secondary efficacy variables assessed, although higher ratings were observed for iodixanol. The 100 mm VAS score overall was 86 mm for iodixanol and 82 mm for iohexol (95% confidence interval -2.56, 10.42). The frequency of adverse events was lower for patients receiving iodixanol. Adverse events, mainly diarrhoea, occurred in 12 patients (16.2%) in the iodixanol group and 28 patients (35.9%) in the iohexol group. This reached statistical significance (p=0.006). Overall, iodixanol is well suited for examinations of the gastrointestinal tract, giving good efficacy results and fewer adverse events than iohexol.

Adolescent↗
PubMed2001

Magnetic resonance imaging in the diagnosis and management of choroid plexus carcinoma in children.

BACKGROUND: Choroid plexus carcinoma (CPC) is a rare tumour occurring in childhood. The MRI features are not well described. OBJECTIVE: To characterise the MRI features of CPC in children and to describe the role of MRI in post-surgical management. MATERIALS AND METHODS: The pre- and post-operative MRI examinations of five children with histologically proven CPC treated at this hospital were reviewed. RESULTS: The tumour was supratentorial in two patients and infratentorial in three patients. Pre-operative MRI showed heterogeneous enhancing tumours with irregular margins, parenchymal invasion and surrounding oedema. Cystic change within the tumour was present in all patients. Curvilinear signal voids were seen in two patients and punctate signal voids in one. All patients had hydrocephalus. In one patient a fourth-ventricular metastasis was present at diagnosis. In all cases, surgical resection was incomplete. Follow-up found long-term survival in one patient who had been treated with chemotherapy and further surgery. CONCLUSION: The MRI characteristics of CPC are nonspecific, but intraventricular location with tumour heterogeneity, parenchymal invasion and oedema may be useful features in diagnosis. MRI is valuable in the initial diagnosis, surgical planning and follow-up of children with these rare tumours.

Brain↗
PubMed2001

Imaging in epilepsy: a paediatric perspective.

Assessment of a child with epilepsy involves a number of key stages, the most crucial being clinical evaluation where the presence of seizure activity and seizure type is identified. Subsequent imaging is not required in all children. In those selected for further investigation, imaging techniques are broadly divided into structural and functional studies. MRI currently provides the best structural data, with nuclear medicine and specialized MR techniques giving supportive functional information. CT now has a much diminished role. This review highlights the role of different imaging modalities in the investigation of childhood epilepsy, as well as some of the practicalities of imaging children, and areas where recent advances have been made. It is hoped that the overview and information provided will help both the specialist and the general radiologist make informed decisions regarding how to best image a child with epilepsy.

Adolescent↗
PubMed1999

Removal of orthopedic implants in children: morbidity and postoperative radiologic changes.

One hundred twenty-one procedures for the removal of metalwork performed on 110 children aged 1-15 years is reported, with a focus on postoperative morbidity and radiographic skeletal changes. The removals were for a variety of acute and chronic pediatric orthopedic conditions. The level of postoperative morbidity was lower than in adult study groups with only one refracture (0.9%). Only four removals were considered to be difficult. All patients had a postoperative radiograph taken. The skeletal response to the fixation device was assessed by measuring the degree of cortical assimilation of the implant. Dynamic compression plating was compared with third tubular fixation. Overall cortical indentation was 7.3% in the third tubular group and 41.6% in the dynamic compression plating group; similar results were found in forearm fracture and hip osteotomy subgroups (P < 0.01, Wilcoxon unpaired test). The degree of indentation was related to the length of time for which the plate was left in situ. It is postulated that plates with high stress-rising characteristics are incorporated with growth and should both be removed early and have strictly limited indications for their use.

Adolescent↗
PubMed1997

Isolated H-type recto-vaginal fistula associated with a vulval abscess.

Recto-vaginal fistula is well known to occur in association with imperforate anus. We describe the case of an isolated "H-type" recto-vaginal fistula with no other anorectal abnormalities. The patient presented at 2 months of age with a vulval abscess and passing faeces per vaginum. Unilateral renal agenesis was also seen in this patient. We are unaware of any previous reports in the English-language literature of this isolated abnormality.

Abscess↗
PubMed1996

Antenatal and neonatal renal vein thrombosis: new ultrasonic features with high frequency transducers.

The ultrasonic appearances of two infants with renal vein thrombosis (RVT) are described. One infant presented in the neonatal period and one antenatally. Consistent with previous reports, one or both kidneys were enlarged, with a generalised increase in echogenicity and vascular or perivascular streaking compatible with interlobular and arcuate vessel occlusion. Using high frequency transducers (7. 0-10 MHz), we identified new features during the course of the disease. The apex of the renal papilla became hypo-echoic and there was a ring of reduced echogenicity around the affected pyramids 1-2 weeks after the acute phase. These features correlate with the known pathophysiological course of RVT, but have not been previously described using ultrasound. The features are illustrated and the mechanism is discussed.

Adult↗
PubMed1995

Intrathoracic rib.

The intrathoracic rib is a rare anomaly. Despite this, it has distinctive radiological features which should enable a confident diagnosis to be made from the chest radiograph alone. Its importance lies in recognising it as a benign lesion and limiting further investigation appropriately. We present an 11-year-old girl with an intrathoracic rib found incidentally on a chest radiograph.

Child↗
PubMed1995

Osteogenic sarcoma of the neural arch.

Osteogenic sarcoma arising in the spine, and in particular the neural arch, is rare. We present the case of a 4-year-old girl with an osteogenic sarcoma arising in the left transverse process of the second lumbar vertebra. The child received chemotherapy and delayed surgical excision was performed following a favourable response. The radiological features and differential diagnosis are discussed.

Child, Preschool↗
PubMed1995

Ultrasound in children with osteomyelitis.

Ultrasound (US) is a proven method of identifying subperiosteal abscess formation in osteomyelitis, but its precise role in the management of children with the condition is contentious. We reviewed nine children in whom US was used in the management of long bone osteomyelitis, including ribs. US was helpful in confirming the presence of a subperiosteal abscess in those children with an appropriate history and localizing signs. In these circumstances a bone scan is unnecessary. Problems were encountered when US failed to identify a subperiosteal abscess, because of the early stage of the disease process, and in multifocal abnormalities. In these circumstances a bone scan should still be performed.

Abscess↗
PubMed1994

The swollen leg and primary lymphoedema.

Children who present with unilateral or bilateral swelling of the legs are often suspected of having a deep venous thrombosis. The incidence of deep venous thrombosis in children is low and lymphoedema may be a more appropriate diagnosis. Lymphoedema can be primary or secondary. In childhood, primary lymphoedema is more common and may be seen associated with other congenital abnormalities, such as cardiac anomalies or gonadal dysgenesis. Primary hypoplastic lymphoedema is the most often encountered type. It is more common in girls, especially around puberty, and is typically painless. Atypical presentations produce diagnostic confusion and may require imaging to confirm the presence, extent, and precise anatomical nature of the lymphatic dysplasia. This article describes four patients presenting with limb pain and reviews the clinical features and imaging options in children with suspected lymphoedema.

Adolescent↗
PubMed1994

Ultrasound findings following laparoscopic cholecystectomy.

This study was set up to find the incidence of fluid collections in asymptomatic patients following laparoscopic cholecystectomy. Patients had an ultrasound scan on the first postoperative day and approximately 1 week later. Seven of 25 patients (28%) had a total of nine collections on the first postoperative day. Five had resolved by the follow-up scan and two patients developed new collections by the 1 week scan. None of the patients had significant postoperative symptoms. We emphasize the high incidence of ultrasonically detectable fluid collections in asymptomatic patients following laparoscopic cholecystectomy, encourage caution in attributing postoperative morbidity to such findings, and suggest that repeat scanning may be helpful in patient management.

Abdomen↗
PubMed1993

Myxoid liposarcoma of the porta hepatis in childhood.

Liposarcoma in childhood is rare. A case of a myxoid liposarcoma arising at the porta hepatis is reported in a 3-year-old boy with initial favourable response to surgery combined with radio- and chemotherapy. Fatal recurrence occurred at age 15 years. The radiological and sonographic findings of liposarcomas are reviewed.

Child, Preschool↗