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Biomedical subjects

R Howman-Giles

Publications and source records attributed to R Howman-Giles.

At least 73 records · Page 4Linked to original sources
PubMed1991

The 'cold hip' sign on bone scan. A retrospective review.

The "cold hip" sign on bone scan is often seen in patients referred with irritable hip. This sign is due to fluid in the hip joint under pressure causing impaired perfusion of the structures within the joint capsule. In a retrospective review, 22% of patients with this sign on bone scan were found to have septic arthritis at surgery. This fact would appear to justify surgical drainage or aspiration of any hip showing this sign on scan. An attempted follow-up study through the medical records was incomplete because of the short follow-up on most patients. The possibility that temporary impairment of blood supply to the head of the femur causes long-term damage to the hip is unanswered on this study, and a long-term recall follow-up study is underway.

Arthritis, Infectious↗
PubMed1991

Infantile hepatic haemangioma: investigation and treatment.

Infantile hepatic haemangiomas are benign tumours which tend to regress in late infancy. We describe five infants with hepatic haemangioma, three of whom developed congestive cardiac failure. Technetium-99m labelled red blood cell scan was useful in the diagnosis and follow-up of the lesion. The three symptomatic infants were treated with prednisone (2 mg/kg per day) for 2 months in addition to digoxin and diuretics. Significant clinical improvement occurred within 3 weeks in each case. We conclude that the red blood cells scan is a good non-invasive diagnostic test and recommend corticosteroids as initial management for symptomatic infantile hepatic haemangiomas.

Diagnostic Imaging↗
PubMed1991

Myocardial infarction in childhood: clinical analysis of 17 cases and medium term follow up of survivors.

Between 1979 and 1989 17 patients aged two months to 12 years with acute myocardial infarction of any cause (other than after cardiac surgery) were seen at a children's hospital. Eight died from three days to three years after diagnosis (overall mortality 47%). The nine survivors, now aged 2-17 years, have been followed for one to 10 years (mean follow up five years) after infarction. The commonest causes of myocardial infarction in this series were anomalous origin of left coronary artery from the pulmonary artery (six patients (35%] and Kawasaki disease (five patients (27%]. The main symptoms of acute myocardial infarction were dyspnoea, vomiting, and difficulty feeding. Diagnosis was made in all patients by electrocardiography and confirmed by echocardiography, cardiac catheterisation, or at operation. All survivors were symptom free with excellent exercise capacity. The left ventricular ejection fraction in survivors ranged from 21% to 66%, and only one child was on regular cardiac medications. There were no cases of late sudden death. Twenty four hour Holter monitoring performed on survivors was normal (seven) or showed minor abnormalities only (one), suggesting that serious arrhythmia is rare after paediatric myocardial infarction. Myocardial infarction in children had a high early mortality; however, the incidence of serious arrhythmia was low in the survivors, who had a good exercise tolerance even when the left ventricular ejection fraction was low.

Cardiac Catheterization↗
PubMed1989

Imaging paediatric endocrine disorders.

Disorders of growth and development, including delayed and precocious puberty may be idiopathic, constitutional or due to a disorder of one of several endocrine systems including the hypothalamic-pituitary system, the adrenal and the thyroid. Sonography is of great importance in the classification of precocious puberty in children. Skeletal maturation assessment is useful to evaluate the severity of the growth disorder and to monitor subsequent therapy. Magnetic resonance imaging and computed tomography are essential in the study of the pituitary and central nervous system. MRI has special advantages in the imaging of the hypothalamic-pituitary region. The thyroid gland and its function are still best imaged with radionuclide scintigraphy. Sonography can play a complementary though less important role. Hypoparathyroidism, pseudohypoparathyroidism and pseudopseudohypoparathyroidism although rare are more common in children than primary hyperparathyroidism. Valuable clues as to the presence of these conditions can be gained by examination of the plain radiographs. Confirmation of their diagnosis still rests with the biochemical and endocrine profile.

Diagnostic Imaging↗
PubMed1988

Liver disease and common-bile-duct stenosis in cystic fibrosis.

To determine the incidence of common-bile-duct lesions and their relation to liver disease in cystic fibrosis, we performed hepatobiliary scanning in 50 of 61 patients with cystic fibrosis who had hepatomegaly, abnormal liver function, or both and in 31 of 92 patients with cystic fibrosis who did not have hepatomegaly or abnormal liver function. Ninety-six percent of the patients with liver disease had evidence of biliary tract obstruction, which was defined cholangiographically as a stricture of the distal common bile duct in the majority of cases. All the patients without liver disease had normal intrahepatic and common-duct excretion of tracer. Abdominal pain was significantly more common in patients with common-duct obstruction (P less than 0.001), and enlarged gallbladders occurred only in such patients. Since fasting levels of serum bile acids were elevated in nearly half these patients, irrespective of the severity of their liver disease, serum bile acids may be markers of the severity of the common-duct lesion. We conclude that strictures of the distal common bile duct are common in patients with cystic fibrosis and liver disease. This association requires further study, since surgical relief of common-duct obstruction may prevent or ameliorate the hepatic complications of cystic fibrosis.

Adolescent↗
PubMed1987

Pulmonary aspiration studied by radionuclide milk scanning and barium swallow roentgenography.

We have examined the use of radionuclide milk scanning to detect aspiration and have compared the clinical features of patients with demonstrated aspiration with those of patients in whom aspiration was not demonstrated. One hundred twenty children underwent radionuclide milk scanning for three different clinical indications, namely, respiratory tract symptoms (n = 56), gastroesophageal (GO) reflux (n = 20), and near-miss sudden infant death syndrome (SIDS) (n = 44). Ninety-eight (82%) of the 120 patients had a GO reflux demonstrated on the radionuclide milk scan. The incidence of aspiration was high in the respiratory (23%) and near-miss SIDS groups (20%) but low in the GO reflux group (5%). Only four of the 19 patients with an aspiration-positive scan had an aspiration-positive barium swallow film. The clinical symptoms and signs of those patients with aspiration-positive results were not significantly different from those of patients in whom aspiration was not demonstrated. We conclude that radionuclide milk scanning is more sensitive than barium swallow roentgenography in detecting aspiration; however, the clinical significance of such aspiration is undetermined. In view of the high incidence of GO reflux demonstrated in the absence of aspiration by the use of radionuclide milk scanning, the sole finding of GO reflux in a child with respiratory tract symptoms should not be taken as presumptive evidence that aspiration is contributing to those symptoms.

Adolescent↗
PubMed1987

Volume expansion diuretic renal scan in urinary tract obstruction.

The diuretic renal scan is used to differentiate the obstructed dilated urinary system from the nonobstructed dilated system. The technique, however, has a false-positive and indeterminate rate of 10%-15%. This usually is due to variables such as the degree of dilatation of the pelvicalyceal system or ureter, the degree of bladder distention, the diuretic dose, and the state of hydration. We developed the volume expansion diuretic renal scan (VEDRS) to overcome these variables and to improve the accuracy of the technique. Twelve patients who had obstructive patterns on the diuretic renal scan were evaluated. Ten patients were shown to be dilated but not obstructed. Two patients were confirmed as obstructed. This technique improves the accuracy of the diuretic renal scan.

Adolescent↗
PubMed1986

Renal subcapsular rim sign. Radionuclide pattern.

The renal cortical rim sign is a radiological term describing the thin peripheral nephrogram of 2-4 mm thick which is from the peri-renal capsular collateral circulation in an otherwise nonfunctioning kidney. Radionuclides are used frequently in the estimation of renal function. A neonate with renal vein thrombosis demonstrated a rim sign on renal scan with Technetium DTPA. The rim sign on renal scan can be differentiated from severe hydronephrosis or multicystic kidney both of which may have a peripheral thin cortex which functions late on the renal scan. The rim sign in renal vein thrombosis was best visualized during the early blood pool phase when there was a considerable amount of radioactivity in the blood pool.

Humans↗
PubMed1984

A radionuclide method of evaluating shunt function and CSF circulation in hydrocephalus. Technical note.

A simple technique for the evaluation of shunt function and cerebrospinal fluid (CSF) circulation in hydrocephalic patients is described. The method utilizes clearance rates of a radionuclide tracer injected into the lateral ventricle via an indwelling frontal catheter which is separate from the shunt apparatus. This permits an accurate assessment of drainage of ventricular CSF via the shunt, or the patency of normal or alternative CSF pathways where the shunt is malfunctioning.

Cerebrospinal Fluid↗
PubMed1984

The arrest of treated hydrocephalus in children. A radionuclide study.

A prospective study was made of the incidence of arrest of treated non-neoplastic hydrocephalus in 30 neonates and infants over a 5-year period. Radionuclide assessment of shunt function and cerebrospinal fluid (CSF) dynamics was carried out at intervals over this period, using a method that allowed injection of the radionuclide into the ventricular system independent of the shunt apparatus. The radionuclide scanning results were correlated with computerized tomography and clinical findings. Of 24 patients still available for analysis at the end of 5 years, four patients showed restoration of CSF circulation independent of the shunt apparatus and, in three of these, the shunt has either been clipped or clipped and removed without any ill effects. Clinical details of these three patients are provided. Two initially had communicating hydrocephalus, and one had probable aqueduct stenosis.

Cerebrospinal Fluid Shunts↗
PubMed1984

Multifocal pyomyositis. Diagnosis on technetium-99m MDP bone scan.

Pyomyositis is a bacterial infection of skeletal muscle occurring in the absence of trauma or a primary site of infection. The condition is rare in temperate climates. The diagnosis is often difficult to make and frequently delayed since the suppurative process is confined by the tense overlying muscle and fascia. The bone scan is very useful in differentiating underlying osteomyelitis and septic arthritis. An 11-year-old boy is described who presented with multifocal pyomyositis in the elbow region and thigh. Lateral blood pool images suggested infection with liquefaction within the muscles without evidence of osteomyelitis.

Bone and Bones↗
PubMed1983

Milk antibodies in pulmonary inhalation.

To determine the association between inhalation and increased circulating milk antibodies, the presence of milk precipitins and haemagglutinating titres of antibody to casein and lactalbumin were determined in a series of 100 children studied by radionuclide 'milk scan' and/or barium swallow for possible milk inhalation. Sixty-five were investigated because of reflux and/or inhalation (REFLUX), while 35 were evaluated after near-miss sudden infant death (SID). Inhalation was demonstrated in 23/65 Reflux and 9/35 Sid patients. The incidence of milk precipitins was 22% (5/23) of the REFLUX with demonstrable inhalation, 12% (5/42) of the REFLUX without demonstrable inhalation, 0% (0/23) SID and 2% (21/1005) of an unselected series of hospital patient sera. The incidence of milk precipitins was increased in cases with demonstrated inhalation and lower respiratory tract symptoms. Determination of antibody titres to casein and lactalbumin did not provide additional benefit in the diagnosis of milk inhalation. Detection of milk precipitins can provide additional support to the diagnosis of milk inhalation.

Animals↗
PubMed1982

Evaluation of CSF shunt patency by means of technetium-99m DTPA.

Evaluation of 192 cerebrospinal fluid shunts was performed using 1 mCi of technetium-99m DTPA which was injected into the shunt tubing. This was found to be a safe, simple method of evaluating shunt patency. No complications were noted with this procedure, nor was there any documented case of infection related to the injection of the isotope. The sensitivity of the test for evaluation of patency was 97%, specificity 90%, and accuracy 93%. Various patterns of tracer clearance are noted and discussed. The role on this test as an aid in making management decisions is detailed.

Adolescent↗