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Biomedical subjects

R A Kaufman

Publications and source records attributed to R A Kaufman.

At least 55 records · Page 3Linked to original sources
PubMed1986

Patterns of liver injury in childhood: CT analysis.

Forty-eight consecutive cases of liver injury diagnosed by CT in hemodynamically stable children were analyzed retrospectively for anatomic location, type of injury, associated nonhepatic injuries, and complications. It was found that the right lobe was involved in 83% of all injuries, and that the posterior segment of the right lobe was injured most often. Right-sided injuries were usually superficial and simple, while left-sided injuries were more likely to be deep and complex. Significant complications were associated with deep, complex, perihilar injuries. Retroperitoneal blood collections were noted around the adrenal, in a distribution not previously described. Injuries of the hepatic dome were most characteristic and were often associated with injuries of the lung base, kidney, ribs, and pneumothorax.

Adolescent↗
PubMed1986

Blunt liver injury in childhood: evolution of therapy and current perspective.

One hundred eighty-eight consecutive children with serious blunt abdominal or multisystem trauma were evaluated between August 1981 and July 1985. Of the 188 patients, 53 (28%) were found to have hepatic parenchymal injuries and are the basis of this report. Four of the 53 (8%) underwent emergency laparotomy for exsanguinating hemorrhage; two patients died, both of hepatic vein lacerations, and two are alive and well after right hepatic lobectomy. Forty-nine (92%) of the children with liver injuries did not require operation for hemorrhage. Four of these 49 patients developed serious complications; hemobilia occurred in one patient and bile peritonitis occurred in three. The one case of hemobilia was resolved without surgery. One child underwent a delayed operative biliary tract reconstruction that was successful. The other two children required a combination of debridement and drainage procedures. Fifty-one of the 53 children (96%) are currently alive without morbidity related to their liver injuries. Both children who died had multiple trauma including central nervous system injuries and had exsanguinating hemorrhage that required emergency laparotomy at initial evaluation. There were no children with "late" hemorrhage and none who developed septic complications. Nonoperative management of most childhood blunt abdominal trauma is possible. Widespread use of abdominal computerized tomography scanning has made this approach practical. This large series of consecutive liver injuries from a large pediatric trauma center illustrates the advantages and the risks of a selective but primarily nonoperative approach to liver trauma in children.

Alanine Transaminase↗
PubMed1985

Cholangitis associated with Cryptococcus neoformans.

A 15-yr-old girl presented with complaints of right upper quadrant pain and jaundice. Elevation of serum alkaline phosphatase, signs of protal hypertension, and computed tomographic scan findings suggested a diagnosis of primary sclerosing cholangitis. However, cultures of the bile and of the common bile duct specimen obtained during a surgical procedure grew Cryptococcus neoformans. Treatment with amphotericin B was begun. An episode of upper gastrointestinal bleeding, however, led to the hepatorenal syndrome, and the patient died before antifungal therapy was completed. At autopsy, active sclerosing cholangitis associated with cryptococci involved the common bile duct. We suggest that opportunistic infection of the biliary tree should be considered in pediatric patients with presumed primary sclerosing cholangitis.

Adolescent↗
PubMed1985

Stubbed finger osteomyelitis.

Forceful hyperextension of the distal phalanx may result in a Salter II fracture. Due to the anatomic relationship of bone and nail, a 'stubbed finger' injury may result in an inapparent compound fracture. When nail bedding is associated with a distal phalangeal fracture, antibiotics should be instituted.

Adolescent↗
PubMed1985

Osteomyelitis of the head and neck: sequential radionuclide scanning in diagnosis and therapy.

Sequential technetium and gallium scans of the head and neck were used to confirm the diagnosis of osteomyelitis and as an important therapeutic aid to delineate the transformation of active osteomyelitis to inactive osteomyelitis in 11 cases involving sites in the head and neck. Illustrative cases are presented of frontal sinus and cervical spine osteomyelitis and laryngeal osteochondritis.

Adult↗
PubMed1985

Normal pituitary stalk size in children: CT study.

A retrospective study was undertaken of 1005 normal contrast-enhanced head computed tomographic (CT) scans in children to determine normal standards for pituitary stalk diameter, basilar artery diameter, and their ratio for age and gender. The pituitary stalk enlarges with age, and girls have larger stalks than do boys after age 8. The pituitary stalk-to-basilar artery ratio is easily estimated visually. Ratios greater than or equal to 1 are unusual in normal children. A ratio greater than or equal to 1 should prompt direct measurement of the stalk and comparison with age-matched normal values. If the stalk measurement is greater than 2 SD above the age-matched mean, it is presumably abnormal and deserves further evaluation for numerous possible pathologic conditions including histiocytosis X, pituitary adenoma, hypothalamic lesions, Rathke cleft cysts, metastases, sarcoidosis, hypothyroidism, and infection.

Adolescent↗
PubMed1984

Blunt hepatic injury and elevated hepatic enzymes: a clinical correlation in children.

During a recent prospective nonrandomized comparison of noninvasive imaging techniques in 100 children with suspected major blunt abdominal injury, an interesting subset of patients was defined. Of 95 hemodynamically stable patients, 44 were found to have immediate elevation of hepatic enzymes (SGOT, SGPT greater than 30 IU). Nineteen of these children (43%) were subsequently shown to have significant liver injuries. No child with a liver injury had normal enzymes on admission. The level of enzyme elevation (SGOT chi 890 +/- 142 IU, SGPT chi 536 +/- 105 IU) in those with liver injuries is significantly greater than those without injury (SGOT chi 273 +/- 44 IU, SGPT chi 115 +/- 19 IU) (P less than or equal to 0.0001 SGOT. P less than or equal to 0.0001 SGPT). Our study has allowed definition of a group of children who are at significant risk for liver injury based on immediately available serum determinations of GOT and GPT. We have begun to use this information in our institution to select children for further noninvasive imaging. We recommend that these studies be obtained emergently in all children with suspected upper abdominal trauma.

Alanine Transaminase↗
PubMed1984

Calcification associated with terminal defects of the upper extremity.

Four children who had calcifications associated with terminal defects of the upper extremity are reported. A review of the literature has revealed no previous report. Moreover, an examination of the radiographs of 65 children who had terminal defects of the upper limb failed to show any such calcifications. The exact cause of this association remains unknown.

Arm↗
PubMed1984

Upper abdominal trauma in children: imaging evaluation.

One hundred consecutive children with serious blunt upper-abdominal injury were evaluated prospectively to assess the accuracy and usefulness of emergency computed tomography (CT) compared with liver-spleen scintigraphy and sonography. Ninety-five hemodynamically stable patients were imaged. The results of this 20-month study indicate that CT has fewer false negatives and false positives than scintigraphy or sonography, that CT is useful in abdominal trauma, and that CT provides the most information of any single diagnostic imaging test commonly available.

Abdominal Injuries↗
PubMed1983

Characteristics of extrafocal radiation and its potential significance in pediatric radiology.

Extrafocal radiation was investigated using four different rotating-anode radiographic units currently employed in a pediatric hospital. It was found to exhibit significant penetration, with an effective energy only slightly lower than that of the primary radiation. The percentage of extrafocal relative to focal radiation in pediatric procedures involving rare-earth screens ranged from 2 to 15%. The ratio of extrafocal to focal radiation tended to increase with increasing kVp, mA, and field size but was independent of focal spot size. Since extrafocal radiation may extend significantly outside of the primary collimated field, radiosensitive organs such as the gonads, thyroid, and eyes which are assumed to be shielded may actually receive as much as 25 mR per radiograph.

Child↗
PubMed1983

Childhood diskitis: computed tomographic findings.

The spectrum of computed tomographic findings in seven children with diskitis is reported. Paravertebral inflammatory masses, intraspinal (epidural) soft-tissue extension with thecal sac deformity, and psoas involvement with abscess were demonstrated in 7/7, 6/7, and 1/7 patients, respectively. Plain radiographic findings of disk space narrowing and vertebral end-plate destruction were confirmed by CT in all cases. Follow-up CT in two patients revealed persistent bone destruction despite resolution of soft-tissue inflammation and clinical abnormalities. CT proved most useful in the diagnosis of early and atypical cases. The CT spectrum of childhood diskitis may simulate other diseases, including neoplasm, tuberculosis, and disk herniation. While CT is not routinely indicated in typical childhood diskitis, it may confirm the diagnosis in those patients with atypical clinical presentation or nonspecific plain radiographs, and exclude other lesions in patients unresponsive to routine treatment.

Adolescent↗
PubMed1983

Ultrasonography and computed tomography in the evaluation of the acutely ill pediatric patient.

The use of diagnostic ultrasonography and CT in the investigation of the acutely ill pediatric patient has been steadily increasing because of the relative noninvasiveness of these imaging modalities and because of improvements in resolving capabilities and scanning speed of the latest equipment. In the examination of the pediatric patient, special emphasis must be given to immobilization, sedation, or both in those children too young or too ill to cooperate. Close monitoring and observation of the child throughout sedation is important and requires special personnel and equipment. The usual indications are the search for an abscess or occult infection, trauma, and acute renal failure. Because ultrasonography uses nonionizing radiation and is less expensive, it is usually the initial modality of choice for evaluating the pediatric patient. CT is reserved for situations in which greater anatomic detail and lack of compromise by the presence of bowel gas or bone are necessary. These situations include multiple abscess collections, particularly interloop abdominal abscesses, mediastinal masses and collections obscured by overlying lung, osteomyelitis, older patients with meningomyelocele and with spinal deformity when evaluating the urinary tract, and major multiorgan abdominal trauma.

Abdominal Injuries↗