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Biomedical subjects

R Towbin

Publications and source records attributed to R Towbin.

At least 19 recordsLinked to original sources
PubMed1992

Interventional procedures in pediatrics.

Pediatric intervention has grown substantially over the last 20 years. Interventionalists now work closely with surgeons and other physician groups to diagnose and treat a wide variety of pediatric disease processes. Using image guidance and intravenous sedation in most instances, the interventionalist performs vascular and nonvascular procedures such as embolotherapy, abscess drainage, dilation of strictures, biopsy, and percutaneous nutritional procedures, to name a few. It is my hope that the current and future techniques will lead to improved, more effective, and safer methods for treating sick children of all ages.

Angioplasty, Balloon↗
PubMed1991

Comparison of iohexol with barium in gastrointestinal studies of infants and children.

This study evaluates iohexol as a contrast agent in the gastrointestinal tract in children. In the first part of the study, iohexol in concentrations of 180 and 300 mg l/ml was compared in double-blind manner with barium. Sixty-four patients were studied. No significant difference in changes of blood pressure and pulse rate was found between the three groups of patients studied. Diarrhea was significantly more common in the children receiving iohexol than in children receiving barium. The diarrhea was not due to previously identified high-risk factors in the children, nor was it due to concurrent medication. When image quality was assessed in each anatomic region of the gastrointestinal tract, fewer nondiagnostic ratings occurred with barium than with iohexol. With barium, fewer ratings of poor mucosal coating and slightly fewer ratings of suboptimal contrast density occurred. The second part of the study was an open evaluation of iohexol 180 mg l/ml in 18 patients in whom barium was clinically contraindicated. Three of 53 assessments were nondiagnostic. Mucosal coating was poor in 6%, and contrast density was suboptimal in 8% of patients. The results of this study indicate that barium is the preferred contrast agent for routine evaluation of the gastrointestinal tract in children. Good-quality images can be obtained, however, with iohexol in concentrations of 180 or 300 mg l/ml, and iohexol is an excellent contrast agent for evaluation of the gastrointestinal tract in those patients in whom barium is relatively or absolutely contraindicated.

Adolescent↗
PubMed1991

Instability of the cervical spine after decompression in patients who have Arnold-Chiari malformation.

Stability of the cervical spine was studied in two groups of children who had myelomeningocele. Group I consisted of twenty children who had an Arnold-Chiari Type-II malformation in whom a suboccipital craniectomy (partial occipital craniectomy through the suboccipital route) and cervical laminectomy was done to decompress the brain stem. The average duration of follow-up in this group (excluding one patient) was 4.7 years (range, 2.3 to 10.4 years) after the operation. Group II consisted of twenty children who had myelomeningocele but had not had an operation for decompression. Lateral radiographs of the cervical spine in flexion and extension showed no instability between the occiput and atlas or between the atlas and axis in either group. In contrast, translation between the second and third cervical vertebrae averaged four millimeters in Group I and one millimeter in Group II (p less than 0.01), and angulation between the third and fourth cervical vertebrae averaged 17 degrees in Group I and 6 degrees in Group II (p less than 0.01). Nineteen of the twenty patients in whom a suboccipital craniectomy and cervical laminectomy (Group I) had been done had instability of the cervical spine.

Arnold-Chiari Malformation↗
PubMed1988

Arterial occlusions in neonates: use of fibrinolytic therapy.

For neonates with ischemia of an extremity or extensive thrombosis of the aorta after umbilical artery catheterization, prompt recognition and management decisions are necessary. The cases of eight infants with symptomatic thrombosis who were treated with fibrinolytic agents were retrospectively reviewed to study means of diagnosis and response to therapy. Peripheral thrombosis was seen in two otherwise healthy infants; fibrinolytic therapy produced complete lysis in one and partial lysis in the other. The six infants with central thrombosis presented with low Apgar scores and multiple clinical problems; umbilical catheters were already in place. To assess the clot, real-time sonography was performed in all six patients, and umbilical arteriograms were obtained in five. Fibrinolytic therapy produced complete lysis of clot in five of the six infants. The one death occurred in a premature infant in whom a large intracranial hemorrhage developed 6 hours after institution of therapy.

Aorta, Abdominal↗
PubMed1987

Radiographic characteristics of skull fractures resulting from child abuse.

Radiographic characteristics of skull fractures in 39 cases of documented child abuse were compared with skull fractures in 95 cases of accidental injury to determine if differential features could be identified. All children were less than 2 years old. Emergency room and hospital records for these patients were also reviewed. The results of this study show that clinical features did not provide any clues as to whether the children had been injured by abuse or by accident. However, it was found that multiple fractures, bilateral fractures, and fractures crossing sutures occurred significantly more often in abuse cases than in accidental injury. When such fractures are present, abuse should be suspected.

Accidents↗
PubMed1986

Low grade pelviureteric junction obstruction with normal diuretic renography.

We report five patients with normal diuretic renograms who underwent Whitaker pressure perfusion testing. They were found to have normal pressure at low flow rates (2-4 ml/min) and an abnormally elevated pressure at high flow rates (8-10 ml/min). Because of persistent symptoms, two patients underwent surgery, while the other three have been followed up. Our findings indicate that a negative diuretic renogram in a well hydrated patient with good renal function may not rule out low grade obstruction. Renal pelvic perfusion at low flow rates as well as high flow rates is recommended to determine better the function of the pelviureteric junction.

Adolescent↗
PubMed1986

Postseptal cellulitis: CT in diagnosis and management.

Thirteen orbital computed tomographic (CT) scans were obtained in 12 patients with postseptal (orbital) cellulitis. Sinus radiographs, which were also obtained, were not helpful in diagnosis or management. The location and extent of the inflammatory process was accurately demonstrated with axial CT scans in all cases. A protocol using CT in the management of postseptal cellulitis is proposed.

Adolescent↗
PubMed1986

Value of CT scan in the diagnosis of temporal bone diseases in children.

CT scan of the temporal bone has become a frequently ordered test for diagnosis of temporal bone pathology. We retrospectively examined our experience with CT scans of the temporal bones in 124 consecutive children from January 1983 to September 1984 in an attempt to assess its usefulness in diagnosis and treatment of ear disease in children. Patients were divided into six categories according to their pre-scan diagnosis, (trauma, congenital aural atresia, dizziness, facial nerve paralysis, middle ear disease, congenital sensorineural hearing loss) and CT findings were compared to data found by physical examination, by otologic studies such as audiogram and BSER, by other x-ray studies and ultimately compared to findings at surgery when applicable. CT was found to be instrumental in diagnosing middle ear disease; gave necessary preoperative information in children with aural atresia; delineated most temporal bone fractures; ruled out gross inflammatory, neoplastic, or traumatic etiologies in dizzy patients and in facial nerve abnormalities; and provided anatomic information about the inner ear in patients with sensorineural hearing loss. In our group of patients with sensorineural hearing loss, a 6.8% incidence of anatomic malformations was found by CT. However, CT had major limitations in stapes and oval window areas, especially in cases of perilymph fistulas. CT use was also limited in children because of the difficulty in achieving projections that require active patient cooperation.

Adolescent↗
PubMed1986

Interventional genitourinary radiology in children: a review of 61 procedures.

Forty-nine children underwent 61 interventional uroradiologic procedures. These included percutaneous nephrostomy, internal ureteral stenting, ureteral stricture dilatation, perirenal abscess drainage, and percutaneous removal of renal calculi. Of the 61 procedures, 60 (98%) were technically successful. Of the 60 successful procedures, 24 (40%) were considered "definitive," 33 (55%) favorably "altered the course," and 3 (5%) "failed" to have any beneficial effect. Technical success at minimal risk can be achieved in even the smallest patients by modifying equipment and by attending to the special needs of the pediatric patient.

Adolescent↗
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↗
PubMed1985

Granulocytic sarcoma (chloroma): CT manifestations.

Nests of granulocytic tumor cells in patients who have myelogenous leukemia are termed chloromas. Eight cases of chloroma seen on CT were reviewed. Lymph nodes, subcutaneous tissues, peritoneum, pleural space, pelvis, and portal hepatis were involved. Two patients exhibited chloroma as the sole manifestation of their disease during bone marrow remission. The extracranial appearance of chloroma on CT is that of small, nonenhancing, nodular densities that resemble lymphoma. Cranial involvement is characteristically in the orbit. The central nervous system appearance is variable, however, and high attenuation masses may occur that mimic lymphoma, hematoma, and metastatic neuroblastoma. The recognition of these lesions is important, since radiation, not chemotherapy, is often the preferred treatment for localized chloroma.

Adolescent↗
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↗
PubMed1985

Vascular dysplasia in a child with tuberous sclerosis.

Tuberous sclerosis is characterized by the development of hamartomas in many organs, particularly the brain, skin, heart, and kidney. We report a child with typical features of this disease who also had a severe generalized vascular dysplasia of both muscular arteries and veins and an abdominal aortic aneurysm in association with obliterative dysplasia of the aortic vasa vasorum. This is the first report of such a widespread vascular abnormality in association with tuberous sclerosis. This case along with several reports of more isolated vascular abnormalities in these patients indicates that vascular dysplasia represents another manifestation of the generalized tendency to hamartoma formation seen in this disorder.

Aorta↗
PubMed1983

Abscess drainage with CT and ultrasound guidance.

The technique of catheter drainage of abscesses, while appearing to be a departure from standard surgical tenets, in reality adheres to accepted principles of abscess management. In properly selected candidates, most abscesses are adequately and safely drained by catheter. Catheter drainage has the advantages of avoidance of general anesthesia, less morbidity, and lower cost when compared with that of surgical drainage. Since catheter drainage does not preclude surgical drainage, in appropriate candidates percutaneous drainage should be considered initially for definitive therapy. Ultrasonography and CT have become the preferred methods of detecting abdominal abscesses and also of guiding percutaneous catheter drainage. Real-time sonography has the advantages of being inexpensive, "portable," and able to provide simultaneous imaging during catheter placement. CT provides greater accuracy in guiding drainage of small, deep abscesses, more accurate delineation of the extent and location of the collection, and better definition of the relationship of abscesses to bowel and blood vessels.

Abdomen↗
PubMed1979

Antrochoanal polyps.

The antrochoanal polyp, a benign solitary polypoid lesion, usually arises in a maxillary sinus, opacifying and enlarging the sinus cavity without bone destruction. It passes through the ostium of the sinus into the choana, and from there into the posterior nasopharynx. The soft tissue mass does not erode or destroy contiguous soft tissue or bony structures. In this sequence of events, its radiologic findings are characteristic. Five case reports are presented, and the differential diagnosis is discussed.

Child↗
PubMed1979

Neonatal traumatic proximal femoral epiphysiolysis.

Traumatic proximal femoral epiphysiolysis is a rare event. Early recognition and management are important to minimize sequelae. Evaluation should include plain roentgenograms and arthrography. Treatment should be conservative with open reduction reserved only for severe cases.

Birth Injuries↗