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Nurith Hiller

Publications and source records attributed to Nurith Hiller.

17 recordsLinked to original sources
PubMed2006

Is non-operative intussusception reduction effective in older children? Ten-year experience in a university affiliated medical center.

Ileo-colic intussusception in older children is frequently caused by a pathological lead point. Therefore, in many cases, no attempts at hydrostatic or air reduction are performed in non-pediatric hospitals. This study summarizes our experience in management of intussusception in children aged 3 years or older, in order to determine its efficacy and safety in this age group. We retrospectively reviewed medical records and radiological images of 26 cases of intussusception in 24 children older than 3 years admitted to our hospital over a 10-year period. In one child no attempt of reduction was made. Three children underwent unsuccessful imaging-guided reduction and an underlying tumor was identified at surgery and resected. In 18 cases air reduction was successful and no pathological lead point was discovered. In four children hydrostatic or air reductions failed. Manual reduction was performed, with no predisposing cause found. No complications were observed in any of our patients. Older age is not a contraindication for imaging-guided intussusception reduction attempt. Most of these patients can benefit from such an attempt, thereby avoiding surgery.

Child↗
PubMed2006

Chronicle of a death foretold: a case of catastrophic vascular Behcet's disease.

A 20-year-old man with Behcet's disease characterized by recurrent arterial aneurysms presented with a new aortic root aneurysm. This patient previously had aneurysms of the coronary arteries and vein, as well as ruptured renal artery aneurysm. Chronic maintenance immunosuppressive therapy was recommended due to the catastrophic nature of the disease, which the patient refused to take. The patient died shortly after admission. This case demonstrates the unique catastrophic natural history of vascular Behcet's disease with recurrent life-threatening arterial events, and this case stresses the therapeutic dilemma of maintenance immunosuppressive therapy in selected patients.

Adult↗
PubMed2006

Spleen rupture secondary to anticonvulsant hypersensitivity syndrome.

Anticonvulsant hypersensitivity syndrome (AHS) is a rare complication associated with the use of anti-epileptic medications. The syndrome's main symptoms are cutaneous eruptions, fever, hepatitis, and lymphadenopathy. We describe a 23-year-old woman who developed AHS 2 months after starting phenytoin therapy. She presented with fever, orofacial edema, skin rash, and lymphadenopathy. Four days after admission, she developed agonizing epigastric pain with diffuse epigastric tenderness. An abdominal CT scan demonstrated splenomegaly with a large, hypodense area involving the upper half of the spleen, consistent with splenic rupture. She was managed medically in an effort to avoid splenectomy. There are no other documented cases of spleen rupture linked to AHS. A possible mechanism is the alteration of lymphocytic function due to the accumulation of cytotoxic metabolites and infiltration of the spleen with lymphocytic cells, distending the capsule and predisposing it for rupture. We believe that the case presented here should increase awareness of the potentially life-threatening complications associated with AHS.

Journal Article↗
PubMed2005

Partial duplication of the scapula.

We report an extremely rare case of partial scapular duplication. Mild shoulder area deformity in a newborn prompted further evaluation that included radiography, ultrasonography and spiral CT. These revealed an additional bone in the area of the left shoulder, above the humerus and lateral to the scapula. The accessory bone articulated with the upper part of the glenoid and caused caudal displacement of the humeral head. However, it did not restrict the normal range of motion in the shoulder joint.

Diagnosis, Differential↗
PubMed2005

Sonographic detection of radiographically occult fractures in paediatric ankle injuries.

BACKGROUND: In some paediatric ankle injuries, the clinical picture is suggestive of a fracture despite negative three-view radiographs. OBJECTIVE: To determine the effectiveness of high-resolution US to differentiate radiographically occult fractures from sprains. MATERIALS AND METHODS: During a 12-month period, children aged 5-13 years who had sustained an acute ankle injury suspicious of a fracture on clinical examination, but with negative radiography, were referred for high-resolution US. Follow-up radiographs were obtained after 2-3 weeks. RESULTS: A total of 20 children were examined. In 13, US did not reveal a fracture; small fractures were detected in 7. All patients with negative US studies had negative follow-up radiographs. In six patients with positive US the follow-up radiographs demonstrated a periosteal reaction. In one child in whom a fracture line identified by US was in the depth of the lateral malleolus, the follow-up radiograph demonstrated an area of increased bone density. CONCLUSIONS: US is effective for the detection of radiographically silent fractures of the paediatric ankle. It may be used as an adjunct to radiography in clinically suspicious, but radiographically negative ankle injuries.

Adolescent↗
PubMed2005

Computed tomographic features of tuboovarian abscess.

OBJECTIVE: To describe the spectrum and frequency of computed tomographic (CT) features in tuboovarian abscess (TOA) in order to increase the utility of computed tomography in diagnosing this condition. STUDY DESIGN: Search of our hospital registry found 22 patients diagnosed with TOA who underwent pelvic tomography between the years 1998 and 2001. A retrospective review of their CT scans was performed, and the CT features of TOA were recorded. Clinical signs and symptoms were also summarized. RESULTS: All 22 patients presented with lower abdominal pain. Additional clinical signs of TOA, such as a palpable abdominal mass (23%), vaginal discharge (27%) and fever (36%), were less common. On tomography the majority of TOAs were unilateral (73%) and multilocular (89%) and had fluid density (95%) and a thick, uniform, enhancing wall (95%). Other common CT findings were thickening of the mesosalpinx (91%) and infiltration into pelvic fat (91%). Less common CT findings included bowel thickening (59%), thickening of the uterosacral ligaments (64%) and pyosalpinx (50%). Ascites, lymphadenopathy, peritoneal involvement and hydronephrosis were uncommon findings on tomography. CONCLUSION: Computed tomography is a useful imaging modality in the diagnosis of TOA, especially in cases that are clinically indeterminate. Recognition of the spectrum of CT findings and their frequency can result in improved CT diagnosis of this disease.

Abscess↗
PubMed2005

The value of electrocardiography-gated multi-slice computed tomography in the evaluation of patients with chest pain.

BACKGROUND: Multi-detector spiral computed tomography with retrospective electrocardiography-gated image reconstruction allows detailed anatomic imaging of the heart, great vessels and coronary arteries in a rapid, available and non-invasive mode. OBJECTIVES: To investigate the spectrum of findings in 32 consecutive patients with chest pain who underwent CT coronary angiogram in order to determine the clinical situations that will benefit most from this new technique. METHODS: Thirty-two patients with chest pain were studied by MDCT using 4 x 1 mm cross-sections, at 500 msec rotation with pitch 1-1.5, intravenous non-ionic contrast agent and a retrospectively ECG-gated reconstruction algorithm. The heart anatomy was evaluated using multi-planar reconstructions in the axial, long and short heart axes planes. Coronary arteries were evaluated using dedicated coronary software and the results were compared to those of conventional coronary angiograms in 12 patients. The patients were divided into four groups according to the indication for the study: group A--patients with high probability for coronary disease; group B--patients after CCA with undetermined diagnosis; group C--patients after cardiac surgery with possible anatomic derangement; and group D--symptomatic patients after coronary artery bypass graft, before considering conventional coronary angiography. RESULTS: Artifacts caused by coronary motion, heavy calcification and a lumen diameter smaller than 2 mm were the most frequent reasons for non-evaluable arteries. Assessment was satisfactory in 83% of all coronary segments. The overall sensitivity of 50% stenosis was 74% (85% for main vessels) with a specificity of 96%. Overall, the CTCA results were critical for management in 18 patients. CONCLUSIONS: Our preliminary experience suggests that CTCA is a reliable and promising technique for the detection of coronary artery stenosis as well as for a variety of additional cardiac and coronary structural abnormalities.

Adult↗
PubMed2004

The use of ultrasound for the diagnosis of spinal hemorrhage in a newborn.

We present a case of an unusually large spinal epidural hematoma in an infant after a total breech extraction, which was diagnosed by high-resolution ultrasonography. The lesion appeared unusually large, homogeneous, and isoechoic to the spinal cord. This case demonstrates the ability of ultrasound to diagnose the nature of the lesion, its exact location and full extent. Magnetic resonance imaging was used in this case only as a secondary modality to demonstrate the hemorrhagic nature of the lesion.

Extraction, Obstetrical↗
PubMed2003

Primary ALK positive anaplastic large cell lymphoma of the pancreas.

Here we present an unusual case of anaplastic lymphoma kinase positive anaplastic large cell lymphoma (ALCL), appearing as a primary tumor of the pancreas which invaded into the adjacent duodenal wall, causing upper gastrointestinal bleeding. After complete resection of the tumor (Whipple's operation), the patient received 4 cycles of CHOP chemotherapy. Currently, 2 years after diagnosis the patient still remains lymphoma free. Primary ALCL of the pancreas is very rare and has only been reported on one previous occasion. Nevertheless, lymphoma should be considered in the differential diagnosis of pancreatic tumors and an attempt to obtain tissue diagnosis is always necessary before continuing with radical surgery, especially in young patients.

Adult↗
PubMedDate not supplied

Thoracic manifestations of Behçet disease at CT.

Behçet disease is a multisystemic and chronic inflammatory disorder of unknown cause that is characterized by recurrent oral and genital ulcerations, ocular manifestations, and additional clinical manifestations in multiple organ systems. Behçet disease involving the chest can manifest as a wide spectrum of abnormalities. Although conventional chest radiography is commonly used for initial assessment, spiral computed tomography can demonstrate the entire spectrum of thoracic manifestations of Behçet disease, including abnormalities of the vessel lumen and wall, perivascular tissues, lung parenchyma, pleura, and mediastinal structures. Aneurysms of the pulmonary arteries, with or without thrombosis, are a typical manifestation of Behçet disease. Other manifestations include thrombosis, vasculitis, hemorrhage, infarction, and inflammation. Familiarity with these manifestations can be useful in the diagnosis of Behçet disease, helping to determine the cause of symptoms in patients who present with hemoptysis and guide the choice of appropriate therapy.

Adolescent↗