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Biomedical subjects

R De Bruyn

Publications and source records attributed to R De Bruyn.

14 recordsLinked to original sources
PubMed2006

Perinatal renal venous thrombosis: presenting renal length predicts outcome.

BACKGROUND: Renal venous thrombosis (RVT) is the most common form of venous thrombosis in neonates, causing both acute and long term kidney dysfunction. Historical predisposing factors include dehydration, maternal diabetes, and umbilical catheters, but recent reports highlight associations with prothrombotic abnormalities. STUDY: Twenty three patients with neonatal RVT were analysed over 15 years. Predisposing factors, presentation, and procoagulant status were compared with renal outcome using multilevel modelling. RESULTS: Median presentation was on day 1: 19/23 (83%) had pre/perinatal problems, including fetal distress (14), intrauterine growth retardation (five), and pre-identified renal abnormalities (two); 8/18 (44%) had procoagulant abnormalities, particularly factor V Leiden mutations (4/18). Long term abnormalities were detected in 28/34 (82%) affected kidneys; mean glomerular filtration rate was 93.6 versus 70.2 ml/min/1.73 m2 in unilateral versus bilateral cases (difference 23.4; 95% confidence interval 6.4 to 40.4; p = 0.01). No correlation was observed between procoagulant tendencies and outcome, but presenting renal length had a significant negative correlation: mean fall in estimated single kidney glomerular filtration rate was 3 ml/min/1.73 m2 (95% confidence interval 3.7 to -2.2; p = 0.001) per 1 mm increase, and kidneys larger than 6 cm at presentation never had a normal outcome. CONCLUSIONS: This subgroup of neonatal RVT would be better termed perinatal RVT to reflect antenatal and birth related antecedents. Prothrombotic defects should be considered in all patients with perinatal RVT. Kidney length at presentation correlated negatively with renal outcome. The latter, novel observation raises the question of whether larger organs should be treated more aggressively in future.

Blood Coagulation Disorders, Inherited↗
PubMed2004

Cutaneous haemangioma: prevalence and sonographic characteristics of associated hepatic haemangioma.

AIMS: To determine the prevalence of hepatic haemangiomas (HH) occurring with multiple or large cutaneous haemangiomas (CH), and compare the ultrasound (US) characteristics of HH with morphology of concurrent CH. MATERIALS AND METHODS: Retrospective and prospective sonographic and clinical analysis was undertaken on 69 patients referred for US to exclude silent HH. This comprised 62 patients referred over 6 years with six or more CH or one large CH (#10878;5 cm) and seven patients referred over 1 year with three to five small CH. RESULTS: HH occurred in 45% miliary CH and 40% mixed small and large CH, but also in 12-14% of patients with one large or three or more small CH. None had HH progression. There was association between HH sonographic characteristics and CH number and morphology. CONCLUSION: Clinically silent HH occurred in nearly one in four of infants presenting overall with six or more small CH or large CH. Previous studies have documented HH mortality between 18 and 80%, although this was not shown in our study. Therefore, if clinical suspicion exists, US is indicated to enable early steroid treatment if significant HH are present.

Child↗
PubMed2003

Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions in children.

BACKGROUND/PURPOSE: Viscera stuck to the anterior abdominal wall from previous surgery risk injury during laparoscopic surgery. A prospective study was conducted to determine if these adhesions are detectable on ultrasound scan by showing a reduction in the normal visceral slide. METHODS: Patients undergoing laparoscopic procedure after a previous laparotomy underwent preoperative real-time ultrasound scan to observe if viscera slides freely under the abdominal wall. A reduction in slide was considered a positive sign of underlying adhesions. These findings were correlated with the operative findings. RESULTS: Anterior abdominal wall scans were performed on 17 children. Reduced visceral slide was seen in 10. Viscero-parietal adhesions were found in 9 of 10 patients. Visceral slide was reduced in a very localized area in 6 patients, and, in these, a loop of bowel (n = 3), liver and bowel (n = 2), or liver (n = 1) was adherent. In 4, reduced visceral slide was seen over a wide area. Extensive adhesions were found in 3 of 4. One renal transplant patient with peritonitis had a false-positive ultrasound scan. At laparotomy there were no adhesions. The peritonitis is thought to have prevented an adequate examination. Seven patients had normal visceral slide. Of these, 4 had no adhesions, but 3 children had flimsy omental adhesions. The sensitivity and specificity of visceral slide in predicting adhesions were 75% and 80%, respectively. CONCLUSIONS: Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions. Ultrasonographic mapping of the abdominal wall may be useful in selecting an adhesion-free site for trocar insertion in children with previous operations requiring laparoscopic procedures.

Abdominal Wall↗
PubMed2003

Evaluation of spinal ultrasound in spinal dysraphism.

AIMS: The aims of this study were to evaluate the role of spinal ultrasound in detecting occult spinal dysraphism (OSD) in neonates and infants, and to determine the degree of agreement between ultrasound and magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS: Eighty-five consecutive infants had spinal ultrasound over 31 months. Of these, 15 patients (age 1 day-7 months, mean 40 days; nine male) had follow-up MRI. Ultrasound and MRI findings were correlated retrospectively. RESULTS: Six out of 15 (40%) ultrasound examinations showed full agreement with MRI, seven of 15 (47%) had partial agreement, and two of 15 (13%) had no agreement. In the present series ultrasound failed to visualize: four of four dorsal dermal sinuses, three of four fatty filum terminales, one of one terminal lipoma, two of four partial sacral agenesis, three of four hydromyelia and one of 10 low-lying cords. CONCLUSION: Agreement between ultrasound and MRI was good, particularly for the detection of low-lying cord (90%). Therefore we recommend ultrasound as a first-line screening test for OSD. If ultrasound is abnormal, equivocal or technically limited, MRI is advised for full assessment.

Female↗
PubMed2002

Spinal ultrasound in infants.

This paper discusses the indications for spinal ultrasound, including its advantages and disadvantages compared with spinal MRI. The features and ultrasound findings both in normal infants and in those with spinal dysraphism are reviewed.

Humans↗
PubMed2000

Colloid cyst in ectopic thyroid gland.

A five year old girl presented with a mid-line neck swelling. At operation, a multiloculated cyst was excised with a portion of hyoid bone and a suprahyoid gelatinous tract extending into the base of the tongue. Histology revealed a benign colloid cyst with associated thyroid tissue. Post-operative investigations indicated severe hypothyroidism. The cystic nature of the lesion was misleading at operation and pre-operative thyroid ultrasonography (US) is recommended for all patients with suspected thyroglossal tract cysts (TGC).

Child, Preschool↗
PubMed1997

The natural history of the multicystic dysplastic kidney in children.

The objective of this study was to examine the natural history of the multicystic dysplastic kidney and the use of sonography for follow-up studies. A retrospective study was performed on 66 children with a radiological diagnosis of multicystic kidney. The change in size demonstrated on sonograms was examined. Adequate follow-up was available on 55 children over a period of 32 months (range 2-69 months). 40/55 of the kidneys underwent a reduction in size, including 22 which were no longer detectable by ultrasound. 10/55 kidneys showed an increase in size and 5/55 showed no change. Reduction in size occurred at a mean age of 84 weeks (range 20-120 weeks). In conclusion, most multicystic kidneys undergo partial or complete involution over the first 2 years of life. The mean size of the multicystic kidney at diagnosis is a poor predictor of eventual outcome.

Follow-Up Studies↗
PubMed1996

Primary vesicoureteric reflux--how useful is postnatal ultrasound?

The presence or absence of pelvicalyceal dilatation on postnatal ultrasound continues to appear within diagnostic algorithms to select patients for micturating cystourethrography (MCU) in the investigation of antenatally diagnosed hydronephrosis. Postnatal ultrasound findings were assessed in a population diagnosed as having antenatal hydronephrosis due solely to primary vesicoureteric reflux (VUR) to see whether this is justified. The postnatal ultrasound and MCU findings in 177 patients with primary VUR detected as antenatal hydronephrosis were reviewed retrospectively. A total of 132 (75%) were boys. Reflux was unilateral in 103 cases and bilateral in 74 (42%). Altogether 37% of boys and 33% of girls with a renal pelvic diameter of < or = 10 mm had grade III-V VUR. Calyceal and/or ureteric dilatation had specificities of 87-96% for grade III-V VUR, but sensitivities of only 37-54%. Fifty eight per cent of male and 75% of female renal units with grade III VUR and 17% of male units with grade IV-V VUR were normal on ultrasound. Approximately 25% of ultrasonically normal renal units had grade III-V VUR on MCU. Postnatal ultrasound criteria correlate poorly with the presence and degree of VUR in children with antenatally diagnosed hydronephrosis and should not be used to direct the use of cystography.

Female↗
PubMed1996

Sonographic standards for a single functioning kidney in children.

OBJECTIVE: We investigated the sonographic measurements of the functioning kidney of children who were born with a single functioning kidney. MATERIALS AND METHODS: In 56 children (0-6 years old) with one multicystic dysplastic kidney and one functioning kidney, the length of the functioning kidney was correlated with the child's age, weight, and body surface area. RESULTS: The mean length of the kidney was 51.0 mm in children 2 weeks old, 56.8 mm at 9 weeks, 62.8 mm at 23 weeks, 69.6 mm at 46 weeks, 71.7 mm at 63 weeks, 78.0 mm at 112 weeks, 79.6 mm at 172 weeks, 86.7 mm at 225 weeks, and 91.0 mm at 279 weeks. When these results were compared with existing sonographic standards for bilateral functioning kidneys, the single functioning kidneys were longer by a statistically significant amount. CONCLUSION: Compensatory hypertrophy of single functioning kidneys occurs in utero. In children of the ages we investigated, the size of single functioning kidneys exceeded established standards for the size of bilateral functioning kidneys.

Age Factors↗
PubMed1992

Duplex Doppler ultrasound in the investigation of occult nephropathy following haemolytic uraemic syndrome.

Duplex doppler ultrasound has been reported to be of value in the detection of raised vascular resistance, particularly in the renal tract. A prospective single blind study investigating the use of duplex Doppler ultrasound to measure resistive index (RI) in patients with impaired renal function and a history of diarrhoea-associated haemolytic uraemic syndrome (D+ HUS) was performed. There was considerable overlap in the range of RIs, with RIs greater than 70% in children with normal renal function and in those with renal impairment following D+ HUS. There was no significant difference in the mean RI between the groups studied. We feel that the RI is not of value in predicting the presence of occult nephropathy following haemolytic uraemic syndrome.

Child↗
PubMed1990

Neonatal hypothyroidism: comparison of radioisotope and ultrasound imaging in 54 cases.

Fifty-four neonates with congenital hypothyroidism identified by the North East and North West Thames Regional hypothyroid screening programme between January 1985 and December 1987 were investigated with radioisotope (Tc99m) and ultrasound scans of the thyroid before treatment with 1-thyroxine was commenced. Compared with the radioisotope scans, ultrasound identified normally sited thyroid tissue in only 7 out of 10 cases, and ectopic thyroid tissue in only 5 out of 26 cases. Three out of 18 cases with no isotope uptake in the neck appeared to have normally sited tissue on ultrasound scan. We conclude that in our hands ultrasound of the neck is of only limited value in the assessment of young infants with congenital hypothyroidism.

Congenital Hypothyroidism↗
PubMed1985

Isosexual precocious puberty in girls.

This paper reviews the clinical findings, pituitary gonadotrophin reserve and plasma oestradiol, neurological findings and pelvic ultrasound appearance in 47 girls with precocious puberty starting before the age of 7 years. Of the 39 girls who had air encephalograms or cranial CT scans, 19 showed intracranial abnormalities (hamartomas 11; hydrocephalus 5; optic glioma 2; arachnoid cyst 1). There was no significant difference in the peak serum luteinizing hormone and follicle-stimulating hormone responses to intravenous gonadotrophin stimulating hormone in girls with and without intracranial lesions. Pelvic ultrasound examination showed development of the ovaries, uterus, and vagina similar to that seen in normal puberty. Treatment with cyproterone acetate (50-100 mg/day) in 26 girls resulted in arrest of breast development and suppression of menstruation, but a definite effect on growth was not documented.

Brain Diseases↗
PubMed1985

Transient sexual precocity and ovarian cysts.

Nine girls presenting under the age of 7 years with unsustained sexual precocity are described. Large ovarian cysts were detected by ultrasound in three and laparotomy in one. In two girls the symptoms resolved after surgical removal of the cyst; the other seven had spontaneous remission of symptoms, but in two of these transient breast development and bleeding recurred: further ovarian cyst formation was found in one of these patients. Endocrine studies performed before resolution of the cysts showed raised plasma oestradiol concentrations (64 to 440 pmol/l) in three girls and no appreciable rise in plasma luteinising hormone after gonadotrophin releasing hormone stimulation in two. We conclude that ovarian cyst formation with spontaneous resolution may cause transient sexual precocity in girls, and that ultrasound examination is an effective means of diagnosing and following these patients.

Breast↗