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Biomedical subjects

P E Burrows

Publications and source records attributed to P E Burrows.

At least 55 records · Page 3Linked to original sources
PubMed1996

Magnetic resonance venography of congenital vascular malformations of the extremities.

Contrast angiography can demonstrate the vascular components of a vascular malformation, but can be technically challenging in small patients with complex venous anomalies. We reviewed the role of magnetic resonance venography (MRV) in the evaluation of children with predominantly low-flow, vascular malformations of the extremities. MRV (2D time-of-flight technique) and magnetic resonance (MR) imaging examinations were performed in ten young patients with congenital predominantly low-flow vascular malformations of the extremities. MR imaging was used to characterize and determine the extent of the malformations, and MRV to evaluate the deep and superficial venous channels. In all patients, MRV studies were reviewed in conjunction with contrast angiograms, considered the gold standard, to confirm the findings. All significant channel anomalies seen with contrast angiography were identified with MRV. In addition, MRV demonstrated some veins that were not intentionally opacified during contrast studies. MRV demonstrates both the superficial and deep conducting veins, whereas contrast angiography is a more directed study, evaluating only those channels intentionally opacified. Together, MR imaging and MRV data can non-invasively form the basis for determining the prognosis and choosing the individual treatment of congenital vascular malformations of the extremities.

Adolescent↗
PubMed1996

MR imaging of hepatic hemangiomas of infancy and changes seen with interferon alpha-2a treatment.

The purpose of this study was to describe the appearance on magnetic resonance (MR) imaging of hepatic hemangioma, and how the appearance changes in infants who have received interferon alpha-2a (IFN) treatment. We retrospectively studied 16 MR examinations in seven infants (mean age 3.2 months; range 5 days to 13 months) who were symptomatic with hepatic hemangiomas. Five of these seven patients had MR examinations both before and after treatment with IFN. In six of the seven patients, the hepatic hemangiomas were multicentric; they were usually discrete, well-defined nodules, best seen on T2-weighted images as high intensity lesions. One patient had a large solitary heterogeneous lesion. They all exhibited fast flow (seen as flow voids on spin-echo images and high signal intensity structures on gradient-recalled echo images) and enlarged hepatic arteries and veins. There was enlargement of the proximal abdominal aorta with distal tapering. Treatment was followed by accelerated regression of the hemangiomas in size and number and variable shrinkage of the enlarged vessels. As the tumor nodules regressed, they were replaced by normal-appearing hepatic parenchyma; neither fat nor fibrosis was detected by MR imaging.

Female↗
PubMed1996

Venous malformation of the pediatric airway.

OBJECTIVE: To evaluate the management of venous malformations of the pediatric airway, including diagnostic criteria and response to sclerotherapy and laser photocoagulation. DESIGN: Case series analysis of eight patients diagnosed with venous malformations of the upper airway. SETTING: Academic, tertiary care, children's hospital. PATIENTS: Eight patients (3 female, 5 male) with congenital venous malformations of the upper airway. INTERVENTION: Each patient underwent an individualized treatment regimen of sclerotherapy, laser photocoagulation and/or surgery. RESULTS: The combination of sclerotherapy and laser photocoagulation appears to cause gradual regression of the malformation. Five of the eight patients will require further therapy; two patients remain tracheotomy dependent. CONCLUSIONS: Extensive venous malformations of the pediatric airway require staged therapy, with a combination of sclerotherapy and photocoagulation. Long-term follow-up is essential because of the natural history of these lesions.

Adult↗
PubMed1996

Hepatic vascular anomalies in infancy: a twenty-seven-year experience.

OBJECTIVE: Infantile hemangioma and arteriovenous malformation (AVM) of the liver have a similar presentation but a different natural history, and therefore require different treatment. This study was undertaken to clarify differential diagnosis and management of these two biologically distinct vascular disorders. STUDY DESIGN: We retrospectively analyzed the records of 43 children with hepatic vascular anomalies treated during the past 27 years. RESULTS: Ninety percent were hemangiomas (n = 39); 10% were AVM (n = 4). Infants with AVM or large solitary hemangioma had hepatomegaly, congestive heart failure, and anemia as presenting symptoms at birth. Multiple hepatic hemangiomas manifested at 1 to 16 weeks of age with the same clinical triad, plus multiple cutaneous lesions (19/23). The mortality rate after treatment of hepatic AVM was 50% (2/4). The mortality rates after treatment of liver hemangiomas were as follows: resection of solitary lesions, 20% (2/10); embolization, 43% (3/7); corticosteroids, 30% (3/10); and interferon alfa-2a, 15% (2/13). CONCLUSION: Solitary hepatic hemangioma cannot always be distinguished from hepatic AVM without radiologic studies. Multiple hepatic hemangiomas are differentiated from hepatic AVM by coexistence of multiple cutaneous hemangioma and by radiologic imaging. We recommend combined embolization and surgical resection for hepatic AVM and for solitary symptomatic hemangioma, if drug therapy fails. Pharmacologic treatment is used for symptomatic multiple liver hemangiomas. Embolization allows interim control of heart failure. A decreased mortality rate after interferon alfa-2a therapy is encouraging.

Arteriovenous Malformations↗
PubMed1996

Interpreting the results of pediatric central venous catheter studies.

Radiographic evaluation of central venous catheters (CVCs) with contrast material is a commonly performed procedure in pediatric radiology, but the criteria for interpreting the results of such studies are not well described in the literature. Careful evaluation of the images from a contrast material-enhanced CVC study frequently demonstrates a cause of CVC malfunction. In a series of 166 contrast-enhanced CVC studies performed in children, 112 studies (67%) demonstrated abnormal results. The most common abnormalities were mural thrombus, catheter tip thrombus, catheter tip against the vessel wall, and sleeve thrombus. Other causes of catheter malfunction include reservoir thrombus, catheter break, and catheter malposition. When catheter malfunction is due to catheter thrombus formation, the patient is usually treated with urokinase (bolus injection or infusion). Short catheters that ended in the innominate or subclavian vein had a much higher frequency of abnormalities than longer catheters that ended in the superior vena cava or right atrium.

Catheterization, Central Venous↗
PubMed1996

Acquired cerebral arteriovenous malformation in a child with moyamoya disease. Case report.

The authors report a unique case involving a 2-year-old child with idiopathic moyamoya disease who presented with cerebral infarctions and seizures. On initial evaluation, computerized tomography (CT) showed a left parietal infarct and angiograms demonstrated early moyamoya disease with no evidence of arteriovenous malformation (AVM). Approximately 9 years later, angiography and magnetic resonance (MR) imaging revealed an AVM centered on the same region of the left parietal lobe. Angiographic, CT, and MR images are presented that demonstrate the progression of moyamoya disease and de novo development of the AVM in the infarct site. The possible role of angiogenesis in the etiology of acquired AVMs and moyamoya disease is discussed.

Cerebral Angiography↗
PubMed1995

The cerebral ventricles: a computer-based interactive tutorial.

The computer-based tutorial, "The Cerebral Ventricles," enables the user to review the anatomy, imaging, and common pathologic conditions of the human cerebral ventricular system. The program runs on a workstation that includes a laser videodisk player and a videodisk with 21,000 still images plus motion sequences. By using a mouse to select specific portions of the anatomic diagram depicting the ventricles, the user can review different planes of normal gross anatomy, corresponding computed tomographic and magnetic resonance images of normal anatomy, images of gross specimens of different pathologic entities, and corresponding radiologic images. The motion sequences portion of the program shows reconstructed three-dimensional images of ventricular anatomy and helps the user gain a greater understanding of the complex anatomy as seen from all angles. Subprograms provide more detailed information about anatomic relationships, disease entities, and bibliographic references. "The Cerebral Ventricles" assists radiologists in gaining a greater understanding of the ventricles so that an appropriate differential diagnosis of an intraventricular lesion can be offered when such masses are encountered in clinical practice.

Cerebral Ventricles↗
PubMed1995

Posttraumatic arterial priapism in children: management with embolization.

PURPOSE: To evaluate selective embolization for management of posttraumatic priapism in preadolescent boys and color Doppler sonography for diagnosis of the causative lesion and for planning embolization. MATERIALS AND METHODS: Five preadolescent boys with posttraumatic priapism underwent selective angiography and embolization. Color Doppler sonography was performed in the last three patients. RESULTS: Selective angiography showed an intracavernosal arteriovenous fistula in two patients, pseudoaneurysm of the cavernosal artery in two patients, and asymmetric cavernosal arterial flow in the other patient. After successful embolization, detumescence was achieved in all patients. Color Doppler sonography enabled localization and characterization of the lesion causing the priapism in the three patients. CONCLUSION: Angiography with selective embolization is a safe and effective method to correct posttraumatic priapism in children. Color Doppler sonography is a valuable preangiographic study, as it allows for characterization and localization of the causative lesion and obviates diagnostic cavernosal aspiration.

Aneurysm, False↗
PubMed1994

Neonatal superficial cerebral arteriovenous malformations.

The purpose of this report is to determine the role of various imaging modalities, and the outcome of early intervention in neonates with high flow pial arteriovenous malformations (AVM). This report describes 4 neonates with pial AVM associated with congestive cardiac failure, and reviews previous reports. Among the 4 infants in our series, 3 underwent early surgical resection of the AVM, complete in 2 and partial in 1. One infant suffered hemorrhagic infarction postoperatively and has a mild deficit on clinical follow-up; the other 2 patients had no worsening of mild neurologic deficits after surgery, and subsequent development has been normal. The fourth infant had absent deep venous drainage and died from intracranial hemorrhage following transvenous embolization. A single vessel arteriogram in 1 infant led to underestimation of the lesion and unexpected findings at surgery. Complete angiographic study is important in planning treatment, as the vascular anatomy of the lesions may be complex. Cranial ultrasound is useful in early diagnosis, but may miss the superficial lesions. Untreated infants with pial AVM have a poor prognosis due to cardiac failure or progressive cerebral ischemia and neurologic regression. This series illustrates the benefits of complete angiographic investigation and early treatment.

Cerebral Angiography↗
PubMed1994

Magnetic resonance imaging of the iliofemoral arteries after balloon dilation angioplasty of aortic arch obstructions in children.

BACKGROUND: We wished to determine the nature and incidence of changes in the iliofemoral arteries after balloon dilation angioplasty (BDA) for aortic arch obstruction in children and to determine the reliability of gradient magnetic resonance imaging (MRI) in their detection. METHODS AND RESULTS: Sixty-three children, including 62 with and 1 without arch obstruction, underwent MRI of the iliofemoral vessels. Of these, 36 patients had undergone transfemoral BDA (7 after previous transfemoral diagnostic catheterization), 12 had undergone diagnostic transfemoral catheterization but not BDA, and 15 had no history of femoral arterial catheterization. The iliofemoral arteries were normal on MRI in all 15 children without catheterization. Among the 36 children who had undergone BDA, the ipsilateral iliofemoral artery was normal in 15, mildly narrowing in 7, and severely stenotic or occluded in 14 (39%), including 6 of 9 patients treated for acute femoral artery thrombosis and 8 with no history of femoral artery thrombosis. Two patients had documentation of progressive obstruction. Six patients had concordant conventional angiography. There was a significant correlation between the number of balloon catheters used for the angioplasty and severe occlusive changes. Nine of 19 patients who had undergone diagnostic transfemoral catheterization had severe obstructive changes on MRI; 8 of 9 weighed < 10 kg at catheterization. CONCLUSIONS: Obstructive lesions of the iliofemoral arteries are common after transfemoral BDA of arch obstructions (58%) and can be reliably evaluated with gradient MRI. Catheter size and manipulation are the main contributing factors.

Adolescent↗
PubMed1993

Retrobronchial vertical vein in totally anomalous pulmonary venous connection to the innominate vein and its specific occurrence in right isomerism.

Recently, a case of right isomerism with totally anomalous pulmonary venous connection (TAPVC) to the innominate vein through a vertical vein that ascended in the mediastinum posterior to the left-sided main bronchus was encountered. This retrobronchial vertical vein that has not been described previously in patients with TAPVC to the innominate vein prompted the performance of a retrospective analysis of 44 cases with TAPVC to the innominate vein in which angiography had been performed. The 44 cases consisted of 36 patients with situs solitus, 7 with right isomerism, and 1 with left isomerism. The spatial relation of the vertical vein to the adjacent pulmonary artery and main bronchus could be defined in 41 cases. The vertical vein was retrobronchial in 4 of 5 cases with right isomerism in which the location of the vertical vein could be defined with certainty. No case with situs solitus or left isomerism was associated with a retrobronchial vertical vein. In all 4 patients with a retrobronchial vertical vein, angiographic evidence of obstruction of pulmonary venous drainage was present, and was due to an extrinsic bronchial compression in 2 and to an intrinsic narrowing of the vertical vein in 2.

Abnormalities, Multiple↗
PubMed1993

Pulmonary blood supply by a branch from the distal ascending aorta in pulmonary atresia with ventricular septal defect: differential diagnosis of fifth aortic arch.

A patient with pulmonary atresia and a ventricular septal defect is described in whom an arterial branch from the distal ascending aorta supplied segments of both lungs. The branch is considered to represent a persistent fifth aortic arch. The possible morphogenesis and differential diagnosis of a communication between the ascending aorta and the pulmonary artery in pulmonary atresia with ventricular septal defect are discussed.

Adolescent↗
PubMed1993

Cystic retrocerebellar malformations: unification of the Dandy-Walker complex and the Blake's pouch cyst.

Twenty-six cases of developmental retrocerebellar cyst (RCC) formation are studied with respect to determining the usefulness and anatomic relevance of separate terms currently in use, including Dandy-Walker complex, Dandy-Walker malformation, Dandy-Walker variant, mega-cisterna magna (MCM), and Blake's pouch cyst. An anatomic and embryological continuum between Dandy-Walker complex and Blake's pouch cyst is proposed. A method for the useful assessment of RCC is outlined. The patency or closure of the aqueduct is crucial to the evaluation and management of hydrocephalus associated with RCC formation.

Arachnoid Cysts↗
PubMed1993

Comparison of sedation regimens for pediatric outpatient CT.

The purpose of this study was to compare the concurrent use of chloral hydrate (CH), intramuscular Nembutal (IMN) and intravenous Nembutal (IVN) for sedation. Data was collected on all pediatric outpatients requiring sedation for CT over a 2.5-year period. During this period, 2178 outpatients required sedation of whom, 1324 (60.8%) received IMN, 710 (32.6%) IVN and 110 (5%) CH. The overall success rate was 97% and was similar in all three groups. IVN however, produced better-quality sedation than IMN or CH. The IVN group received a significantly lower dose of Nembutal than the IMN group (p = 0.001). Patients receiving IVN had a significantly lower induction time (p = 0.0001) and total examination time (p = 0.001) than IMN or CH. There was an increased occurrence of desaturation in patients sedated with IVN, especially in those with airway obstruction. IVN sedation permits faster, more efficient and better-quality sedation for outpatient CT scanning than IMN or CH in patients requiring intravenous contrast but may not be appropriate for departments that perform relatively few sedations or lack proper resuscitation facilities.

Ambulatory Care↗