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Biomedical subjects

S Bruce Greenberg

Publications and source records attributed to S Bruce Greenberg.

10 recordsLinked to original sources
PubMed2006

Ductus arteriosus aneurysm with community-acquired methicillin-resistant Staphylococcus aureus infection and spontaneous rupture: a potentially fatal quandary.

We present the case of a 6-month-old previously healthy girl who presented with high fever, labored breathing, and an enlarged cardiac silhouette on her chest radiograph. Comprehensive evaluation discovered a ductus arteriosus aneurysm and pericardial effusion with methicillin-resistant Staphylococcus aureus bacteremia. Despite pericardiocentesis and appropriate intravenous antibiotics, there was rapid enlargement of the aneurysm and accumulation of echogenic material within the ductus arteriosus aneurysm. Infected aneurysm rupture was identified during emergency surgery. This infant also had vocal cord paresis, a likely complication of the surgery. The clinical course, diagnosis, and treatment of this patient are discussed. Infection of a ductus arteriosus or an infected ductal arteriosus aneurysm is a rare and potentially fatal clinical entity. In the era of increasing community-acquired methicillin-resistant S aureus infections, this is a diagnosis that requires a high index of suspicion.

Aneurysm↗
PubMed2006

Cardiopulmonary bypass for adults with congenital heart disease: pitfalls for perfusionists.

The fixed incidence of congenital heart defects and improved survival have resulted in increasing numbers of adults with congenital heart disease (CHD) who have undergone complex repairs and/or palliations. Eventually, there will be more adults with CHD than children. They will require cardiac surgical interventions associated with progression of their CHD or for age-related disease, such as coronary revascularization. During bypass, anatomical shunts may exist within or without the heart. Left-to-right shunts can result in dramatically lower systemic blood flow than pump flow due to 'steal', while pulmonary edema ensues due to excessive pulmonary flow. Right-to-left shunts carry risks of massive air embolism and double or triple venous cannulation may be necessary. Cannulation of composite reconstructed aortas may be difficult, risking dissection or aortic obstruction, and double arterial cannulation may be indicated. Aberrant coronary arterial and venous anatomy may .preclude adequate myocardial preservation with common techniques and can be complicated by aortic insufficiency. Valves and conduits may exhibit failure. Conventional monitoring, such as central venous oximetry, may be misleading. Monitoring, such as serial lactate measurement, near-infrared spectroscopy and transcranial Doppler blood velocity, offer advantages for such patients. The perfusionist needs to be aware of such conditions as much congenital aberrancy may present unexpectedly during cardiac surgery.

Adult↗
PubMed2006

Spine bone densitometry in asthmatic children treated with high dose corticosteroids: correcting for racial discrepancies.

PURPOSE: Our hypothesis is that the use of standards based on Caucasian children will under-estimate the incidence of abnormal bone density in African American children. MATERIALS AND METHODS: Eighty-two African American and 80 Caucasian asthmatic children classified as high-dose inhaled corticosteroid users comprised the study population. Bone mineral density measurements were compared to reference standards, based on Caucasians, to calculate Z-values. Regression analysis was used to compare Z-values derived from the race-specific and Caucasian standards for 32 African American children. The derived regression analysis equation was then applied to the entire African American population to determine the incidence of abnormal bone density. RESULTS: The asthmatic Caucasian mean spine bone density was significantly less than the normal standards (p < .001), but the African American mean spine bone density was not, despite the high-dose steroid use. Using the Caucasian standards, Caucasians were significantly more likely to have abnormal bone density detected (p < 0.015). Regression analysis of the 32 children with available race specific standards resulted in the following equation: Z African American= Z Caucasian-0.86. The number of African Americans with abnormal bone density detected using the regression equation was not significantly different than the Caucasian children (p > 0.12). CONCLUSIONS: Asthmatic African Americans treated with high-dose inhaled corticosteroids had denser bones than Caucasians. Caucasian standards can be adjusted using a regression equation.

Absorptiometry, Photon↗
PubMed2005

Big help for small hearts.

The ACH Heart Center is a comprehensive, full-service resource for infants and children with congenital and acquired heart disease. UAMS physicians and nurses and ACH nurses and staff are here to care for these children both directly and by providing support to pediatricians and primary care physicians within Arkansas and the surrounding states.

Arkansas↗
PubMed2004

Gadolinium-enhanced magnetic resonance angiography of right ventricle to pulmonary artery shunts following Norwood 1 palliation in infants.

The classic Norwood I palliation for the treatment of hypoplastic left-heart disease includes an atrial septectomy, neoaorta creation, and a systemic-to-pulmonary artery shunt. The Norwood I palliation has been modified by the use of a right ventricle-to-pulmonary artery shunt instead of a traditional systemic-to-pulmonary artery shunt. Right ventricle-to-pulmonary artery shunts were non-invasively imaged in four infants using gadolinium-enhanced magnetic resonance angiography. Diagnostic MR angiograms were performed in all infants throughout the length of the shunt and were useful in the detection of shunt patency, stenosis, and aneurysm. Associated surgical conduits and shunts were also evaluated. All findings were verified by subsequent conventional angiography or surgery.

Arteriovenous Shunt, Surgical↗
PubMed2004

Gadolinium-enhanced magnetic resonance angiography in neonates and infants suspected of caval or aortic thrombosis.

BACKGROUND: Gadolinium-enhanced magnetic resonance angiography (MRA)is a well-established technique in older children and adults. No studies have focused on its use in neonates and small infants. OBJECTIVE: Our objective was to study the use of gadolinium-enhanced MRA in neonates and infants suspected of caval or aortic thrombosis. MATERIALS AND METHODS: Gadolinium-enhanced MR angiography was performed on seven neonates and small infants for the evaluation of caval or aortic thrombosis. Gadolinium-DTPA at a dose of 0.3 mmol/kg (minimum dose 1 ml) was injected using a power injector (0.2 ml/s). Contrast-enhanced MRA was performed using a 3-D, fast, radiofrequency spoiled gradient-echo sequence (TR/TE: 4.8/1.1, flip angle 45 degrees , matrix 256 x 128, slice thickness 2.6 mm interpolated to 1.3 mm, FOV variable, NEX=1.0). RESULTS: Diagnostic-quality angiograms were obtained in all seven neonates. Superior vena cava thrombosis was identified in two neonates, and abdominal aortic thrombosis was present in one neonate. CONCLUSION: It is practical to perform gadolinium-enhanced MRA in neonates weighing as little as 600 g for the detection of caval or aortic thrombosis.

Aorta, Abdominal↗
PubMed2004

Magnetic resonance flow analysis of classic and extracardiac Fontan procedures: the seesaw sign.

BACKGROUND: Energy inefficiencies lead to Fontan procedure failures. Our purpose was to quantify energy inefficiencies of various Fontan procedures using flow analysis. MATERIALS AND METHODS: The study included 12 patients with Fontan operations; 7 with classic trans-atrial flow and five extra-cardiac Fontans. Flow analysis was used to determine the systolic and diastolic flow in the superior vena cava and inferior venous circulations (IVC, right atrium or conduit). Retrograde flow fractions were calculated. Inferior venous flow analysis was obtained in 12 patients and superior vena cava in 9 patients. RESULTS: A seesaw pattern (augmented inferior venous flow during diastole and augmented superior vena cava flow in systole) was present in five of seven patients with trans-atrial Fontan procedures, but no patient with an extra-cardiac Fontan procedure. Significant retrograde flow occurred in the superior vena cava in three children with trans-atrial Fontan procedures (retrograde flow fractions of 15-22%). Inferior venous flow occurred predominantly during diastole in five of seven children with trans-atrial Fontan procedures. Retrograde flow occurred in all seven children with the retrograde flow fractions ranging from 9 to 37% (mean 25%). Extracardiac Fontan flow was characterized by continuous balanced flow during systole and diastole. The association of the seesaw pattern with trans-atrial Fontan procedures was statistically significant (p = 0.028). CONCLUSIONS: Classic trans-atrial Fontan procedures are characterized by energy inefficiency creating a seesaw flow pattern of forward and reverse flow. Extra-cardiac Fontan procedures are more energy efficient. Magnetic resonance imaging is useful in detecting flow inefficiencies in patients palliated by the Fontan procedure.

Adolescent↗
PubMed2003

All-terrain vehicle injuries in children: injury patterns and prognostic implications.

BACKGROUND: All-terrain vehicle (ATV) accidents are common in children. Our purpose was to identify imaging patterns associated with ATV injuries in children. PATIENTS AND METHODS: The study group comprised 141 consecutive children admitted to a tertiary pediatric hospital following ATV accidents. Medical records were evaluated for demographics and patient outcome. All imaging studies were reviewed and abnormalities cataloged. RESULTS: Extremity fractures were the most common injuries in our study, occurring in 38% of patients. Lower extremity fractures were more common than upper extremity fractures. Partial foot amputation, an unusual injury, was present in three children. Torso injuries were present in 22% of the children. Pulmonary contusions, but not abdominal injuries, were significantly associated with long-term disability or death (p=0.01). Brain injuries occurred in 19% of the children and were significantly associated with death or long-term disability (p=<0.001). No association of brain injury and skull fracture was present. CONCLUSIONS: A wide variety of injuries were identified in children with ATV accidents. Partial foot amputation, an unusual injury, was identified in three children. Brain injuries and lung contusions detected by computed tomography were associated with long-term disability and death. Radiologists need to be aware of injuries associated with ATV accidents.

Adolescent↗
PubMed2003

RadioGraphics: a Web-based model for radiology resident self-education.

RATIONALE AND OBJECTIVES: The residency review committee (RRC) for diagnostic radiology of the Accreditation Council for Graduate Medical Education mandates core competencies including computer-aided applications in medicine. The purpose of this review was to evaluate the use of RadioGraphics' on-line CME to satisfy the RRC requirements. MATERIALS AND METHODS: Twenty radiology residents at a university training program read the same four articles in the on-line version of RadioGraphics. Before reading each article, the residents took the associated CME pre-test and, after completing the article, the CME post-test. Each resident completed a survey to evaluate the quality of the resident experience using RadioGraphics' CME on-line program after completing the four articles and tests. RESULTS: The combined mean scores of all four articles pre-test and post-test scores were 5.6 and 9.3. Significant improvement in the test scores was determined by a student t-test (P < .001). Fourteen residents agreed and one resident disagreed with the statement that the modules were time effective. Nineteen of 20 residents agreed with the statement that valuable information for future practice was gained and that they would continue to use RadioGraphics for CME in the future. All of the residents agreed with the statement that the experience satisfied the residency's requirement to teach computer skills appropriate for ongoing learning. CONCLUSION: RadioGraphics' on-line CME an effective method to teach residents skills required by the RRC.

Internship and Residency↗