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Biomedical subjects

Peter J Strouse

Publications and source records attributed to Peter J Strouse.

31 records · Page 2Linked to original sources
PubMed2003

CT of renal lymphoma in children.

OBJECTIVE: The purpose of this study was to determine the incidence and to describe the CT findings of renal lymphoma in children. CONCLUSION: Renal lymphoma was seen in 11 children, most commonly due to non-Hodgkin's lymphoma (n = 10, 91%) and Burkitt's subtype (n = 5, 45%). Multiple bilateral masses were the most common CT appearance. Less common presentations included focal solitary masses or an engulfing mass. Retroperitoneal lymph node enlargement and other organ involvements were common associated findings. Five of six patients with renal involvement at initial diagnosis have had cures or remissions. Therefore, renal involvement at the time of initial diagnosis with lymphoma does not portend a poor prognosis.

Adolescent↗
PubMed2003

CT findings and temporal course of persistent pulmonary interstitial emphysema in neonates: a multiinstitutional study.

OBJECTIVE: The purpose of this study was to evaluate the CT appearance, management, and temporal course of persistent pulmonary interstitial emphysema in neonates. MATERIALS AND METHODS: Criteria for inclusion in the study group included neonates with a history of prematurity who required ventilation for lung disease, development of hyperexpanded radiolucent lung lesions after typical radiographic findings of pulmonary interstitial emphysema, and CT documentation of lung abnormalities. Radiographs and CT scans were reviewed for the anatomic distribution, appearance, and presence of classic lines or dots within a radiolucent mass. We compared the management (surgical vs nonsurgical) and the temporal course in nonsurgical cases for patients in the United States and patients outside the United States. RESULTS: From seven institutions, we identified 17 patients who had persistent pulmonary interstitial emphysema with CT documentation. On CT, all lesions consisted of hyperexpanded cystic radiolucencies. Distribution was single-lobe in nine patients (left upper lobe, n = 5; left lower lobe, n = 3; right middle lobe, n = 1), multilobar in eight patients, and bilateral in six patients. Fourteen patients (82%) showed the characteristic line-and-dot pattern. All patients were initially treated conservatively; nine eventually underwent surgical resection with confirmation at pathology. Of 10 patients who underwent nonsurgical treatment for at least 1 year, lesions resolved in four patients, decreased in size in three asymptomatic patients, and enlarged in three patients, with eventual resection in two. Surgical resection was performed in 89% (8/9) of patients treated in the United States and in 13% (1/8) of patients treated outside the United States. CONCLUSION: Our study found that 82% of patients with persistent pulmonary interstitial emphysema had characteristic CT findings (central lines and dots surrounded by radiolucency). Although most patients in this series eventually underwent surgical resection, initial treatment can be conservative. The decision to perform surgery may have reflected the local medical culture.

Child, Preschool↗
PubMed2002

The effect of screening sonography on the positive rate of enemas for intussusception.

BACKGROUND: The referring physicians at our institution used the enema as a diagnostic test in children with suspected intussusception. OBJECTIVE: To determine the change in rate of positive enema findings performed for suspected intussusception with the intervention of screening ultrasound (US). MATERIALS AND METHODS: Since October 1995, 224 children (mean age 2.2 years) with suspected intussusception were referred for enema examination. In January 2001, US was introduced as a screening test for intussusception. Enemas were performed for all children with positive US findings and were offered for those with negative US findings if clinical suspicion persisted. RESULTS: Before 2001, 184 children underwent enema with intussusception documented in 40 (22%). Since January 2001, 40 children have been seen with suspected intussusception (12/40 positive or 30%). Two directly underwent enema (1/2 positive); 38 children underwent US. In 12 of 38 children, the US finding was positive, and an intussusception was found at enema examination in 11 of 12. In 26 cases, the US finding was negative. Seven of the 26 children with a negative sonogram finding had an enema, which was also negative. Nineteen enemas were canceled. With a screening US, the positive rate for enemas is now 58% (11/19). We know of no case of intussusception missed at US. CONCLUSION: Screening US has decreased unnecessary enemas for clinically suspected intussusception, increasing positive findings from 22% to 58%. This has in turn reduced children's exposure to radiation.

Barium Sulfate↗
PubMed2002

Horseshoe adrenal gland in association with asplenia: presentation of six new cases and review of the literature.

BACKGROUND: Asplenia syndrome is a form of heterotaxy characterized by bilateral right-sidedness. Congenital fusion of the adrenal glands ("horseshoe adrenal gland") is a less common feature of asplenia syndrome, most instances of which have been found at autopsy. PURPOSE: To present clinical and imaging features of infants diagnosed with asplenia syndrome and horseshoe adrenal gland. MATERIALS AND METHODS: Six infants with asplenia syndrome were identified as having a horseshoe adrenal gland. Medical records and imaging studies were reviewed to determine clinical presentation, associated anomalies, and outcome. The literature was reviewed for prior reports of horseshoe adrenal gland. RESULTS: Horseshoe adrenal gland was identified in five infants by sonography and one by CT, the latter confirmed by autopsy. In all cases, the horseshoe adrenal gland was pre-aortic. Besides features of asplenia syndrome, one infant also had associated vertebral anomalies and bilateral renal agenesis. Including the current cases, of 65 reported cases of horseshoe adrenal gland 34 (52%) were associated with asplenia, 24 (37%) with neural tube defects, 19 (29%) with renal anomalies, and 2 (3%) with Cornelia de Lange syndrome. Horseshoe adrenal gland has not been reported with polysplenia syndrome. CONCLUSIONS: Horseshoe adrenal gland is a less common manifestation of asplenia that may be demonstrated by imaging. Horseshoe adrenal gland may be a differentiating feature between asplenia and polysplenia.

Adrenal Glands↗
PubMed2002

Autosomal dominant stapes ankylosis with broad thumbs and toes, hyperopia, and skeletal anomalies is caused by heterozygous nonsense and frameshift mutations in NOG, the gene encoding noggin.

Although fixation of the stapes is usually progressive and secondary to otosclerosis, it may present congenitally, with other skeletal manifestations, as an autosomal dominant syndrome-such as proximal symphalangism (SYM1) or multiple-synostoses syndrome (SYNS1), both of which are caused by mutations in NOG, the gene encoding noggin. We describe a family that was ascertained to have nonsyndromic otosclerosis but was subsequently found to have a congenital stapes ankylosis syndrome that included hyperopia, a hemicylindrical nose, broad thumbs and great toes, and other minor skeletal anomalies but lacked symphalangism. A heterozygous nonsense NOG mutation-c.328C-->T (Q110X), predicted to truncate the latter half of the protein-was identified, and a heterozygous insertion in NOG-c.252-253insC, in which the frameshift is predicted to result in 96 novel amino acids before premature truncation-was identified in a previously described second family with a similar phenotype. In contrast to most NOG mutations that have been reported in kindreds with SYM1 and SYNS1, the mutations observed in these families with stapes ankylosis without symphalangism are predicted to disrupt the cysteine-rich C-terminal domain. These clinical and molecular findings suggest that (1) a broader range of conductive hearing-loss phenotypes are associated with NOG mutations than had previously been recognized, (2) patients with sporadic or familial nonsyndromic otosclerosis should be evaluated for mild features of this syndrome, and (3) NOG alterations should be considered in conductive hearing loss with subtle clinical and skeletal features, even in the absence of symphalangism.

Abnormalities, Multiple↗
PubMed2002

Non-contrast thin-section helical CT of urinary tract calculi in children.

BACKGROUND: Non-contrast thin-section helical CT has gained acceptance for the diagnosis of urinary tract calculi in adults, but experience with the technique in children is limited. PURPOSE: To evaluate the utility of non-contrast thin section helical CT for the diagnosis of urinary tract calculi in children. MATERIALS AND METHODS: Radiology databases at three pediatric institutions were searched to identify all pediatric patients evaluated by "renal stone" protocol CT scans (no oral or intravenous contrast, scans covering the entire urinary tract obtained in helical mode with narrow collimation (< 5 mm)). CT scans were reviewed for the primary finding of urinary tract calculi, for secondary signs of acute urinary tract obstruction and for evidence of alternative diagnoses. Medical records were reviewed to determine clinical presentation and to confirm the eventual diagnosis. RESULTS: One hundred thirty-seven scans of 113 children (mean age: 11.2 years) were studied. Thirty-eight of 94 examinations (40%) performed on 82 children for acute pain and/or hematuria showed ureteral calculi. Alternative diagnoses were suggested by CT on 16 scans (17%). Twenty-eight scans were performed on 10 asymptomatic children with known calculus disease confirming renal stone burden on 21 scans (75%) and persistent ureteral calculi on 6 scans (21%). Upper tract calculi were demonstrated on 10 of 15 scans (67%) performed to evaluate for calculi in patients with known non-calculus genitourinary tract abnormalities. CONCLUSIONS: Non-contrast thin section helical CT is a useful method to diagnose urinary tract calculi in children. Radiation dose in this retrospective study may exceed the lowest possible radiation dose for diagnostic accuracy. Further research is needed to optimize CT imaging parameters, while maintaining diagnostic accuracy and minimizing radiation dose.

Adolescent↗
PubMed2002

Magnetic resonance angiography of the pediatric abdomen and pelvis.

Although abdominal and pelvic vascular disease is much less common in children than in adults, MR angiographic techniques widely used in adults can also be readily applied in the pediatric population with suspected vascular disease. MR techniques, equipment, and image analysis software are in a continual state of development and refinement. Given the advantages of MR angiography (i.e., its absence of ionizing radiation, capability to obtain images without iodinated contrast material, and limited invasiveness), the applications of MR angiography in the pediatric abdomen and pelvis are likely to continue to increase.

Abdomen↗
PubMed2002

Magnetic resonance imaging of the pediatric knee.

Magnetic resonance imaging (MRI) is an excellent modality for imaging the pediatric knee because of its superb soft-tissue contrast, multiplanar capability, and lack of ionizing radiation. The knee is the most common joint imaged by MRI in the pediatric population. The majority of studies are performed on older children or adolescents with pain and/or known trauma. There are variations of injury and patterns of injury that are unique to children. The knee of a child also may be studied by MRI for other indications, including tumor, inflammatory disease, and developmental abnormalities. It is important to have a systematic approach to analysis of the knee MR images. Analysis should include individual attention to bones, articular cartilage, muscles and tendons, soft tissues, neurovascular bundle, joint space, fluid collections, ligaments, and menisci.

Adolescent↗
PubMed2002

Focal pyomyositis of the perisciatic muscles in children.

OBJECTIVE: The purpose of this report is to describe the role of MR imaging in the diagnosis of focal pyomyositis surrounding the sciatic nerve in children. CONCLUSION: In the absence of joint effusion on sonography, MR imaging should be considered in pediatric patients who present with a febrile illness and incapacitating pelvic pain.

Acute Disease↗
PubMed2002

Computed tomographic diagnosis of unsuspected pyelonephritis in children.

OBJECTIVE: To emphasize the utility of computed tomography (CT) in the diagnosis of pyelonephritis in children with complex comorbidities. METHODS: We retrospectively reviewed the CT imaging studies and medical records of 12 patients (8 girls, 4 boys; aged 2-18 years [mean 8.6 yr]) who did not have a classic presentation of pyelonephritis but were diagnosed by CT. All patients had fever at clinical presentation, and pyelonephritis was not suspected in any case. Two children had negative urine cultures before imaging. RESULTS: All 12 patients had wedge-shaped areas of hypoattenuation on CT, 7 bilaterally; 10 had enlargement of an involved kidney; 5 had perinephric fat stranding; and 3 had focal abscesses. CONCLUSIONS: Although classic and uncomplicated pyelonephritis is a clinical diagnosis that does not require imaging, sometimes the presentation may be equivocal and the diagnosis unsuspected. Pyelonephritis is one of several potential sources of fever that can be simultaneously evaluated using CT. Using. CT, the unsuspected diagnosis of pyelonephritis can be made and therapy initiated before the urine culture is positive.

Adolescent↗
PubMedDate not supplied

Aggressive hepatic angiomyolipoma in a child.

Angiomyolipoma is a tumor of the kidney and, more rarely, the liver, which histologically consists of smooth muscle cells, adipose cells, and abnormal blood vessels in varying proportions. This tumor is generally benign and resection is curative, but here the authors present the case of a 14-year-old girl with an unusual primary hepatic angiomyolipoma that recurred following resection and behaved aggressively. Despite stabilization with a number of novel therapies, the child ultimately died of progressive disease.

Adolescent↗
PubMedDate not supplied

Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine.

BACKGROUND: Neonates receiving parenteral nutrition (PN) are at risk for PN-associated cholestasis (PNAC); however, no preventive factors for PNAC have been clearly identified. Despite reports suggesting that taurine may prevent PNAC in neonates, such an effect of taurine has not yet been definitively demonstrated. We determined whether taurine supplementation reduces the incidence of PNAC in premature or critically ill neonates. METHODS: This study was part of a prospective, randomized, multi-institutional trial designed to assess cholecystokinin vs placebo as a potential preventive therapy of PNAC. Taurine supplementation of PN varied between institutions. The presence or absence of taurine in PN was analyzed by multivariate analysis, with a primary outcome measure of serum conjugated bilirubin (CB) as a measure of PNAC. RESULTS: Taurine reduced PNAC in premature infants (estimated maximum CB [95% confidence interval] 0.50 mg/dL [-0.17 to 1.18] for those receiving taurine, vs 3.45 mg/dL [1.79-5.11] for neonates not receiving taurine, approaching significance, p = .07). Taurine significantly reduced PNAC in infants with necrotizing enterocolitis (NEC; estimated maximum CB 4.04 mg/dL [2.85-5.23], NEC infants receiving taurine, vs 8.29 mg/dL [5.61-10.96], NEC infants not receiving taurine, p < .01). There were too few neonates with surgical anomalies to evaluate the effect of taurine in this group. CONCLUSIONS: Within specific subgroups of neonatal patients, taurine supplementation does offer a very significant degree of protection against PNAC. Patients with NEC or severe prematurity are most likely to benefit substantially from taurine supplementation.

Bilirubin↗