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Biomedical subjects

R I Markowitz

Publications and source records attributed to R I Markowitz.

At least 37 records · Page 2Linked to original sources
PubMed1995

Bronchiectasis in children.

Bronchiectasis (BR) is a descriptive term for abnormal, irreversibly dilated, and often thick walled bronchi, usually associated with inflammation. Causes are varied but include cystic fibrosis, aspiration, post infectious airway obstruction, immune abnormalities, immotile cilia, posttransplantation states, and congenital bronchial lesions. Although BR is uncommon in children, it causes significant mortality when present. Following a period of presumed decline due to antibiotics and vaccines, BR may increase in prevalence because of AIDS, organ transplantation complications, and changing patterns of childhood immunization. As with adults, high resolution CT (HRCT) is the most useful imaging tool for diagnosis and evaluation of bronchiectasis in children.

Age Factors↗
PubMed1994

Ultrasonographic evaluation of the elbow in infants and young children after suspected trauma.

Fractures and epiphyseal injuries in the region of the elbow are uncommon in infants and young children, but they can be very difficult to diagnose and delineate accurately. In addition to plain radiography, invasive or costly procedures such as arthrography and magnetic resonance imaging traditionally have been used to evaluate these injuries. We used high-resolution real-time ultrasonography to evaluate a suspected injury of the elbow in seven infants and one ten-year-old child. Three of the infants had a physeal separation, two had a supracondylar fracture, and two had no skeletal injury. The child had an avulsion fracture of the lateral epicondyle of the humerus and an effusion in the joint. The ultrasonographic findings were confirmed by arthrography in three patients, by open reduction in one, and by follow-up radiographs in all. None of the ultrasonographic studies were performed with the patient under general anesthesia. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the unossified epiphysis about the elbow of infants and young children; to demonstrate dislocations, fractures, and physeal separations; to identify a hinge of soft tissue at the site of a fracture; to identify interposition of soft tissue between fracture fragments; and to aid in the planning of closed and open reductions.

Arthrography↗
PubMed1993

Fractures in young children. Distinguishing child abuse from unintentional injuries.

OBJECTIVE: To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. DESIGN: Case series. SETTING: Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). PATIENTS: Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse registry. OUTCOME MEASURE: Each case was rated, by means of predefined criteria and a consensus of two clinicians and two pediatric radiologists, on a seven-point scale from "definite child abuse" to "definite unintentional injury." A middle rating of "unknown" was used if there was not enough information to reach a consensus. RESULTS: Of the 253 fractures in 215 children that were identified, we categorized 24.2% as abuse, 8.4% as unknown, and 67.4% as unintentional injuries. Fractures that were considered likely due to abuse were (1) fractures in children whose caretakers reported either a change in the child's behavior, but no accidental event, or a minor fall, but the injury was more severe than expected; (2) fractures of the radius/ulna, tibia/fibula, or femur in children less than 1 year of age; or (3) midshaft or metaphyseal fractures of the humerus. Linear fractures of the parietal bone were the most common skull fractures, whether due to abuse or unintentional injuries. CONCLUSION: In young children with fractures, child abuse is common. By comparing fractures due to abuse and those due to unintentional injuries, we obtained empiric evidence to help clinicians and radiologists correctly examine children with such serious injuries.

Accidental Falls↗
PubMed1993

Sonography of the knee in normal and abused infants.

Sonography of an infant's knee is relatively easy and can show the non-ossified cartilage and adjacent soft tissues with great clarity. The normal anatomic features are characteristic and easy to learn and recognize. In abused infants, sonograms can confirm subtle or questionable radiographic abnormalities. In infants with metabolic bone disease, detection of occult fractures of the epiphyses is clinically important. Metaphyseal abnormalities due to neonatal ricktes should not be mistaken as signs of child abuse.

Child Abuse↗
PubMed1993

Three-dimensional CT diagnosis of myositis ossificans of the sacrospinous ligament.

We present the case of a 4-year-old female with a complex fracture of the left hemipelvis who, on follow-up CT imaging, developed new ossific densities within the peripelvic soft tissues of the contralateral side. Three-dimensional surface reformations of the pelvis demonstrated myositis ossificans along the course of the right sacrospinous ligament, thus elucidating unsuspected ligamentous injury and implying prior instability.

Child, Preschool↗
PubMed1993

Pulmonary tuberculosis in children.

TB is no longer the scourge it once was, but it remains an important cause of morbidity and mortality worldwide. Fueled by increasing poverty, homelessness, immigration, drug abuse, declining prevention programs, and the HIV epidemic, its incidence in the United States has increased dramatically. The complex natural history of pulmonary TB in children is reflected in its varied radiographic manifestations. Strict distinction between "adult" and "childhood" patterns of TB should be avoided (Fig 16). In general, adenopathy is the footprint of childhood primary pulmonary TB, with or without a readily apparent primary parenchymal focus or pleural effusion. Infants and young children are more likely to present with adenopathy only than their older counterparts. The pediatric tracheobronchial tree is particularly susceptible to compression by surrounding nodes, producing segmental atelectasis, or less commonly, obstructive emphysema. Self-limited lymphohematogenous dissemination is the rule, but actual miliary disease is the exception. Pediatric postprimary TB, when it occurs, is usually observed in adolescents. It is characterized by parenchymal disease with an anatomic bias for the upper lung zones. Proper image interpretation is inextricably dependent on an understanding of the pathogenesis of this fascinating and often baffling illness whose appearance widely varies depending on host age and immunity as well as the virulence of the organism itself.

Adolescent↗
PubMed1992

CT differentiation of benign and malignant lung nodules in children.

The superiority of computed tomography (CT) for detection of lung nodules has been documented and attempts have been made to distinguish benign from malignant lesions in adults. We attempted to characterize lung nodules in 12 children with solid malignant tumors (aged 8 months to 17 years) in an effort to differentiate benign from metastatic disease. All scans were performed at 10-mm contiguous intervals on a GE 9800 CT scanner. The scans were retrospectively viewed by two pediatric radiologists independently and without knowledge of the pathological findings. All biopsies were done via open thoracotomy. The CT findings were correlated with pathology results. Twelve children had 13 nodules biopsied. Six of these showed malignancy, two showed inflammatory changes, and two had a reactive subpleural lymph node. In three children, no abnormality was found and a biopsy was not obtained. One child had a metastatic nodule in one lung, and a simultaneous inflammatory nodule in the other. The radiologists agreed with each other on the CT interpretation in 11 of 13 surgically explored areas. They correctly predicted malignancy in four cases and correctly excluded it in two cases. However, they were simultaneously incorrect in five instances. Our conclusion is that, contrary to reports in adults, a tiny nodule may be either benign or malignant. Malignancy cannot be separated from benign disease by CT established criteria.

Adolescent↗
PubMed1992

Sonography of the elbow in infants and children.

High-resolution real-time sonography of the musculoskeletal system of infants and young children is being used with increasing frequency, in part because of the inability of plain film radiography to visualize unossified cartilage. Real-time sonography now plays an important role in the evaluation of infantile hip dysplasia, as well as in the identification and aspiration of joint effusion. The purpose of this essay is to illustrate clinical situations in which sonography of the elbow is helpful.

Cellulitis↗
PubMed1991

Multiple collaterals to hepatic infantile hemangioendotheliomas and arteriovenous malformations: effect on embolization.

Hemangioendotheliomas and arteriovenous malformations (AVMs) of the liver often cause congestive heart failure in babies, but embolization of the hepatic artery is not always effective. Six newborns and infants (four with hemangioendotheliomas and two with AVMs) underwent abdominal aortography, hepatomesenteric arteriography, and angiography of arterial and portal collateral vessels prior to embolization of the hepatic artery for heart failure (n = 5) and portal hypertension (n = 1). In addition, extrahepatic arteries were embolized in one patient and a portal vein branch in another. Extrahepatic arterial collaterals from the superior mesenteric, intercostal, phrenic, and adrenal arteries were seen in five patients; portal vein connections, in two patients. Embolization was therapeutically most effective in the baby with the least collateral supply and in the two patients in whom arterial collaterals or portal venous connections were embolized. Angiographic documentation and possibly embolization of collateral flow is required to improve treatment planning and success in these severely ill patients.

Angiography↗
PubMed1991

Normal splenic size in infants and children: sonographic measurements.

The purpose of this study was to establish guidelines for normal splenic size at different ages by using a simple and reproducible sonographic method. Two hundred thirty patients, from neonate to 20-year-old, had sonography because of abdominal and/or pelvic problems unrelated to the spleen. Findings on sonograms of the liver and kidneys were normal in all cases. Splenic size was measured by obtaining a coronal view that included the hilum, while the patient was breathing quietly. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) was measured and correlated with age, height, and weight. The following guidelines are proposed for the upper limit of normal splenic length based on this simple, easy to use, one-measurement technique: splenic length no greater than 6.0 cm at 3 months, 6.5 cm at 6 months, and 7.0 cm at 12 months, 8.0 cm at 2 years, 9.0 at 4 years, 9.5 cm at 6 years, 10.0 cm at 8 years, 11.0 cm at 10 years, 11.5 cm at 12 years, 12.0 cm at 15 years or older for girls, and 13.0 cm at 15 years or older for boys. Twenty-two patients with known abnormalities of the spleen were randomly selected and their splenic lengths compared with the proposed guidelines; in each case, the length of the spleen exceeded the upper limit of normal for that age. Normal values of a single measurement of the greatest longitudinal diameter of the spleen, from the dome to the tip measured at the hilum in the coronal plane, were obtained in patients from newborn to 20 years old.

Adolescent↗
PubMed1991

Long-bone fractures in young children: distinguishing accidental injuries from child abuse.

While testifying in child abuse cases, physicians have been frustrated by the lawyer who asks, "Doctor, how did this injury happen?" The medical records and radiographs of 215 children younger than the age of 3 with fractures evaluated by a pediatric service during a 5-year period were retrospectively reviewed in an attempt to elucidate the mechanism of childhood fractures. Based on these reviews, two clinicians and two pediatric radiologists rated the likelihood that the fracture was either accidental or due to child abuse. Long-bone fractures were strongly associated with abuse. This report focuses on the 39 children with either humeral or femoral fractures. Fourteen children had humerus fractures. Eleven were considered to be the result of child abuse, and 3 the result of accidents. The latter 3 were supracondylar elbow fractures in children who fell from a tricycle, a rocking horse, or downstairs. Humerus fractures other than supracondylar fractures were all found to be due to abuse. There were 25 femur fractures. Nine were found to be from abuse, 14 were found to be from accidents, and 2 could not be rated. Sixty percent of femur fractions in infants younger than 1 year of age were due to abuse. Although it is taught that femur fractures in young children are inflicted unless proven otherwise, in this study it was found that femur fractures often are accidental and that the femur can be fractured when the running child trips and falls.

Accidental Falls↗
PubMed1990

Partial splenectomy for symptomatic splenic hamartoma.

Lower pole splenectomy with preservation of residual splenic function was successfully performed in a 3-year-old boy with a symptomatic splenic hamartoma. Following resection, several of the patient's constitutional symptoms resolved. This is the first reported case of a splenic hamartoma treated by partial splenectomy.

Child, Preschool↗
PubMed1990

Blunt abdominal trauma resulting in intestinal obstruction: when to operate?

The overall approach to blunt abdominal trauma resulting in hematoma and intestinal obstruction has been variable and controversial. Recent reports recommend conservative nonoperative management. We reviewed six cases of duodenal and jejunal hematomas resulting from blunt trauma of which five resolved with nasogastric decompression and parenteral nutrition. The average hospital stay was 16 days (10-23 days), and total parenteral nutrition days were 9 days (4-16 days). Upper gastrointestinal series (UGI) demonstrated partial bowel obstruction in all five cases. In contrast, the sixth case was a restrained passenger who had evidence of complete bowel obstruction on UGI series, which failed to resolve after 18 days of conservative management. Laparotomy revealed jejunal and colonic strictures with fibrosis, which were successfully resected. We recommend that based on radiologic documentation of persistent high-grade obstruction, as well as the clinical course, patients whose obstructions do not resolve by 10 to 14 days ought to be further investigated and operative intervention considered. This approach may facilitate an earlier diagnosis of complications, reduce length of hospitalization and days on parenteral nutrition, as well as to expedite the proper management.

Abdominal Injuries↗
PubMed1989

Pulmonary venous collaterals secondary to superior vena cava stenosis: a rare cause of right-to-left shunting following repair of a sinus venosus atrial septal defect.

We describe a case of unusual pulmonary vein-to-vein collateral formation leading to systemic desaturation years following surgical repair of a sinus venosus atrial septal defect and partial anomalous pulmonary venous return from the right lung. At surgery, a single right upper lobe pulmonary vein branch was left draining high into the superior vena cava (SVC), resulting in a small left-to-right shunt. SVC obstruction developed at the site of the ASD repair and elevated venous pressure above the obstruction caused retrograde flow into the unincorporated pulmonary vein. Pulmonary vein-to-vein collaterals formed between this unincorporated vein and an adjacent pulmonary vein that had been surgically diverted to drain into the left atrium, resulting in a right-to-left shunt within the right lung. Normal pulmonary veins drain multiple bronchopulmonary segments, thus providing potential collateral pathways. Balloon angioplasty of the SVC stenosis successfully relieved the obstruction and abolished the right-to-left intrapulmonary shunt.

Angioplasty, Balloon↗