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Biomedical subjects

S Andronikou

Publications and source records attributed to S Andronikou.

At least 19 recordsLinked to original sources
PubMed2007

Esophageal stent improves ventilation in a child with a broncho-esophageal fistula caused by Mycobacterium tuberculosis.

The deployment of an esophageal stent to aid in the ventilation of a child who had developed an acquired broncho-esophageal fistula caused by Mycobacterium tuberculosis (MTB) is described. The 12-month-old boy presented with respiratory failure requiring ventilation. The air leak via the fistula led to inadequate mechanical ventilation. The deployment of the stent resulted in successful ventilation, closure of the fistula, and eventual successful treatment.

Bronchial Fistula↗
PubMed2006

Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review.

OBJECTIVE: Cerebral palsy (CP) is associated with prenatal, perinatal and postnatal factors. This is a retrospective case-control study aiming to determine the frequency of CP and examine risk factors for CP among infants cared for in the Neonatal Intensive Care Unit (NICU) covering Northwest Greece. DESIGN AND PATIENTS: All neonates who were admitted to the NICU during the period 1989-2003 inclusive, and subsequently developed CP, were enrolled in the study, with matched controls. The incidence of CP was evaluated according to gestational age (GA): GA<34 weeks (group A) and GA>34 (group B), and study period: 1989-1996 (period I) and 1997-2003 (period II, during which intrauterine transfer and prenatal steroids were used). RESULTS: CP was diagnosed in 78 children, 55 in group A and 23 in group B. The incidence of CP increased significantly with decreasing GA. Survival without CP increased significantly in children of GA<34 weeks during period II. The main factors associated with CP, identified by multivariate analysis, were (odds ratios, confidence interval), for group A: being small for gestational age (SGA) (2.5, 1.2-4.5) and patent ductus arteriosus (PDA) (3.4, 1.3-9.2) in period I, periventricular leucomalacia (PVL) (27, 4.8-209), prolonged rupture of membranes (PROM) (5.6, 1.8-18) and duration of mechanical ventilation (1.1, 1.05-1.2) in period II, and for group B: SGA (3.6, 1.3-9.9), neonatal transfer (3.06, 1.2-7.6), duration of mechanical ventilation (1.1, 1.06-1.25) and sepsis-meningitis (4.3, 1.2-16). CONCLUSION: Improvement in survival without CP was observed in infants of GA<34 weeks during the later period of the study, and risk factors for CP in preterm infants depended on the study period. PVL, PROM and PDA were the most powerful independent predictors of CP in children of GA<34 weeks and SGA, neonatal transfer and sepsis/meningitis in children of GA>34 weeks.

Case-Control Studies↗
PubMed2005

Diagnostic accuracy of chest radiography in detecting mediastinal lymphadenopathy in suspected pulmonary tuberculosis.

OBJECTIVE: To estimate the diagnostic accuracy of chest radiography in the detection of chest lymphadenopathy in children with clinically suspected pulmonary tuberculosis. METHODS DESIGN: Prospective cross sectional study. SETTING: A short stay ward in a children's hospital in South Africa. PATIENTS: Consecutive children under 14 years of age admitted with suspected pulmonary tuberculosis. DIAGNOSTIC TEST: Antero-posterior and/or lateral chest x rays interpreted independently and blind to the reference standard by three primary care clinicians and three paediatricians, all with a special interest in tuberculosis. Reference standard: Spiral chest computed tomography (CT) with contrast injection. RESULTS: One hundred children (median age 21.5 months) were enrolled. Lymphadenopathy was present in 46 of 100 reference CT scans and judged to be present in 47.1% of x ray assessments. Overall sensitivity was 67% and specificity 59%. Primary care clinicians were more sensitive (71.5% v 63.3%, p = 0.047) and less specific (49.8% v 68.9%, p<0.001) than paediatricians. Overall accuracy was higher for the paediatricians (diagnostic odds ratio 3.83 v 2.49, p = 0.008). The addition of a lateral to an antero-posterior view did not significantly increase accuracy (diagnostic odds ratio 3.09 v 3.73, p = 0.16). Chance adjusted inter-observer agreement (kappa) varied widely between viewer pairs, but was around 30%. CONCLUSIONS: Detection of mediastinal lymphadenopathy on chest x ray to diagnose pulmonary tuberculosis in children must be interpreted with caution. Diagnostic accuracy might be improved by refining radiological criteria for lymphadenopathy.

Child, Preschool↗
PubMed2004

The height of the pituitary in preterm infants during the first 2 years of life: an MRI study.

Pituitary secretory activity is different in premature and full-term infants. The height of the pituitary is a marker of its secretory activity. Our purpose was to use MRI to measure height of the pituitary of premature infants and to compare it with full-term controls. The height was measured on a midline sagittal T1-weighted image in 86 premature infants (gestational age 26-36.9 weeks, mean 32.3+/-2.85 weeks, corrected age 0.33-2 years, mean 0.76+/-0.42 years) and in 70 age- and sex-matched full-term controls. The children were was divided into four age groups: A: > or =0.5 years; B: 0.51-1.0 year; C: 1.01-1.5 years; and D: 1.51-2.00 years. The gland was significantly (P<0.01) higher in the preterm infants than in the controls (3.88+/-0.61 vs 3.31+/-0.64 mm). In the preterm group no significant difference was found between children small or appropriate for gestational age or between those with and without periventricular leukomalacia. Pituitary height by age group was: A: 3.71+/-0.57, B: 3.81+/-0.56, C: 4.09+/-0.68; and D:4.45+/-0.57 mm; statistically significant (P<0.01) differences were found between groups A and D and B and D. The pituitary is thus higher in premature than in full-term controls and shows a trend to increase after the first year of corrected-age life.

Case-Control Studies↗
PubMed2004

Lack of association of birth size with polymorphisms of two imprinted genes, IGF2R and GRB10.

Little is known about the determinants of birth size variability among individuals. Maternal and nutritional factors have been studied, but familial clustering suggests genetic factors as well. As a first step in testing this hypothesis, we examined common sequence variants in IGF2R and GRB10, two genes involved in the regulation of growth and subject to parental imprinting. The IGF2R gene was scanned with five polymorphisms spanning the coding and 3'-UTR for possible association with birth size in a set of 97 normal newborns in Greece. In addition, a silent SNP in GRB10 exon 2 was similarly tested as an exploratory first step. Birth weight and length were compared between groups of newborns divided according to which allele they had received from heterozygous parents. No significant differences were found between alleles in either gene, examined either by parental origin or in aggregate. Thus, we found no evidence that IGF2R variants modulate intrauterine growth within the normal range. If such variants exist in GRB10, they are not in linkage disequilibrium with the marker studied.

Alleles↗
PubMed2003

MRI measurements of the pons and cerebellum in children born preterm; associations with the severity of periventricular leukomalacia and perinatal risk factors.

Our purpose was to measure the size of the pons and cerebellum in preterm babies with periventricular leukomalacia (PVL), and to study their relationship with the severity of PVL and with perinatal risk factors. We examined 33 premature children, mean gestational age 31 weeks, range 26-36 weeks with PVL on MRI, and 27 full-term controls. On MRI at 0.4-5.5 years (mean 1.4 years) we measured the area of the corpus callosum and vermis, the anteroposterior diameter of the pons and the volume of the cerebellum. The area of the corpus callosum was used as a marker of white matter loss and PVL severity. All regional brain measurements except that of the vermis were significantly lower in patients than controls: corpus callosum (mm(2)): 239.6+/-92.5 vs 434.8+/-126.8, P <0.01; pons (mm): 14.8+/-3.0 vs 17.9+/-1.4, P <0.01]; cerebellum (cm(3)): 68.2+/-31.6 vs 100.6+/-28.3, P <0.01; vermis (mm(2)): 808.1+/-292.2 vs 942.2+/-246.2, NS. Significant reduction in the area of the vermis: 411.3+/-203.3 vs 935+/-252.6 mm(2); cerebellar volume: 16.3+/-12.5 vs 96.6+/-20.2 mm(3); and the diameter of the pons: 10.1+/-2.2 vs 17.5+/-1.3 mm ( P<0.01) were observed in seven children with gestational age < or =28 weeks, severe hypotension and large patent ductus arteriosus (PDA). There was a significant correlation between the duration of mechanical ventilation and the size of the vermis, pons and cerebellum (R=-0.65, -0.57 and -0.73, respectively, P <0.01).

Case-Control Studies↗
PubMed2002

An enteric duplication cyst of the pancreas causing abdominal pain and pancreatitis in a child.

A rare case of a gastric duplication in the tail of the pancreas in a child presenting with recurrent abdominal pain and evidence of pancreatic calcification suggesting pancreatitis was cured by excision of the cyst and adjacent pancreas. Congenital causes of pancreatitis are rare, but are curable with surgery. These lesions are often misdiagnosed, and patients may be subjected to inappropriate surgery. Imaging is sensitive in the detection of such lesions, but the lack of specific features necessitates an index of suspicion. Similar cases have been described previously, but the pancreatic tail is rarely involved.

Abdominal Pain↗
PubMed2002

Congenital mesoblastic nephroma associated with polyhydramnios and hypercalcemia.

Congenital mesoblastic nephroma (CMN) can present with atypical clinical and imaging findings. A premature male neonate was born to an 18-year-old woman after 33 weeks' gestation, which was complicated by polyhydramnios and placenta abruptio. A right abdominal mass was diagnosed antenatally. From the 1st day of life, the newborn had hypercalcemia with initially normal parathormone levels and polyuria for the first hours of life and normal urine output afterwards. Ultrasonographic study and magnetic resonance imaging of the abdomen showed at the upper pole of the right kidney a heterogeneous, solid, poorly defined mass, partially surrounded by a subcapsular fluid collection mimicking malignant rhabdoid tumor of the kidney. Surgical resection revealed a CMN of mixed, classic, and in areas, cellular type. One year after the resection, the patient is asymptomatic and normocalcemic. In conclusion, CMN may present with atypical clinical and imaging findings, necessitating an extensive work-up in order to exclude highly malignant renal tumors of the neonatal period.

Adolescent↗
PubMed2002

Organophosphate poisoning complicated by a tachyarrhythmia and acute respiratory distress syndrome in a child.

A 9-year-old child presented with documented organophosphate insecticide poisoning. His course was initially complicated by a tachyarrhythmia with QT-interval prolongation that responded promptly to intravenous magnesium. However, following partial recovery, he developed progressive acute respiratory distress syndrome characterized by irreversible fibrosis and obliteration of the lung parenchyma.

Child↗
PubMed2001

Bronchial mucoepidermoid tumour in a child presenting with organomegaly due to secondary amyloidosis: case report and review of the literature.

Childhood bronchial mucoepidermoid tumours (BMET) are rare. A 12-year-old boy with hepatosplenomegaly underwent liver biopsy which diagnosed amyloidosis. Chest radiograph and CT, performed for recurrent respiratory symptoms, identified a left lower lobe tumour, which was subsequently excised. Histology showed a BMET. A literature review reveals 51 reported cases of BMET in children. Common presenting symptoms include fever, cough and recurrent pneumonia. Diagnosis is often delayed and patients with recurrent respiratory symptoms should undergo CT or bronchoscopy. The association between amyloidosis and BMET in this case is unique and has not been previously described, but may be coincidental.

Amyloidosis↗
PubMed2001

Extended hepatic resection with transplantation back-up for an "unresectable" tumour.

Liver transplantation (LT) for malignancy has had disappointing long-term results due to tumour recurrence. Ex-vivo dissection and auto-transplantation have had poor results when the tumor was obstructing bile ducts. Advances in liver surgery have made extensive liver resection safer, but cases of "unresectable" tumours due to site and size still present. A 10-year-old boy was referred with jaundice due to a 6 x 8-cm central (segment 4) tumour shown on biopsy to be a fibrolamellar hepatocellular carcinoma. Ultrasound (US) and Computed Tomography also showed dilatation of intrahepatic bile ducts in both lobes. Angiography showed a large tumour mass supplied by the left branch of the hepatic artery, a low take-off of a right branch of the hepatic artery, and a very displaced but patent portal vein. The initial surgical consensus was that the tumour was unresectable. The patient was listed for LT with the plan of first attempting resection with a liver graft-in-waiting. An extended left hepatectomy was performed under total vascular exclusion with resection of the tumour, which had extended from segment 4 into surrounding segments 1, 3, 5, and 8. Intraoperative US assisted in planning the resection. The right hepatic vein, artery, and the right branch of the portal vein could be preserved and a Roux loop was anastomosed to a markedly dilated segment 6 and 7 intrahepatic duct for bile drainage. Vascular exclusion time was 30 min. The patient made a good recovery without major complications. Jaundice and bile-duct dilatation resolved. On follow up at 5 years there was no recurrence. The liver graft-in-waiting gave the surgical team confidence to proceed with an extensive resection beyond a "point of no return" and allowed good clearance of the disease and avoidance of LT with all the long-term consequences of immunosuppression. This mandates that extensive hepatic surgery in children should be carried out in centres that have a facility for LT should the need arise.

Carcinoma, Hepatocellular↗
PubMed2001

An unusual complication of retrosternal colon interposition successfully managed by median sternotomy and revision retrosternal pull-through.

An unusual complication of a retro-sternal colonic interposition is described where the redundant retro-sternal section of the graft underwent mesentericoaxial volvulus and infarction 3.5 years after the initial procedure. Access to the graft was obtained via a median sternotomy. At a second procedure the residual distal colon was used to reconstitute the interposition graft via the retro-sternal route without a repeat sternotomy with an excellent outcome. Graft redundancy is an avoidable complication of colon interposition provided certain technical steps in the operation are adhered to. Median sternotomy afforded safe access to the retro-sternal problem with good healing and long-term outcome.

Child, Preschool↗