Combined hypertrophic pyloric stenosis and duodenal web in Down syndrome: sonographic and radiographic diagnosis.
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Down Syndrome↗
Biomedical subjects
S C Kao
Publications and source records attributed to S C Kao.
Unusual orbital presentations of dural sarcoidosis.
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Adult↗
Silicone intubation with tissue glue anastomosis in the treatment of congenital nasolacrimal duct obstruction.
BACKGROUND AND OBJECTIVE: To evaluate the advantages of tissue glue application for the anastomosis of silicone intubation in congenital nasolacrimal duct obstruction. PATIENTS AND METHODS: Patients with congenital nasolacrimal duct obstruction were treated with silicone intubation with the aid of tissue glue for end-to-end anastomosis. The recurrence rate, complications, and the need for general anesthesia at tube removal were recorded. RESULTS: The silicone tubes for all 18 eyes studied were removed smoothly on an outpatient basis. Early extrusion was noted in 3 eyes. No recurrence of epiphora was noted in any eye after more than 6 months of follow-up. CONCLUSION: Tissue glue anastomosis is a beneficial modification that avoids the need for general anesthesia during stent removal in children and allows removal to be easily performed in an outpatient clinic.
Anastomosis, Surgical↗
Exfoliation syndrome.
Increasing pathophysiologic evidence indicates that exfoliation syndrome, a systemic process involving various visceral organs, frequently manifests itself first in the eyes as exfoliation of the lens and glaucoma. Exfoliation syndrome occurs when several tissues synthesize an abnormal basement membrane protein. This protein may obstruct the trabecular meshwork in the eye and cause glaucoma. We present a case of exfoliation syndrome associated with angle-closure glaucoma in a 57-year-old male patient from Taiwan. After peripheral iridectomy and topical antiglaucoma medications, intraocular pressure in both eyes was well controlled in the range of 15 to 20 mmHg. The mechanism of the glaucomatous optic neuropathy in this patient was probably caused by chronic angle-closure glaucoma superimposed with the exfoliation syndrome.
Antihypertensive Agents↗
Staged operation for Graves' ophthalmopathy.
A four-staged operation is currently the most effective treatment available in the management of stable Graves' ophthalmopathy. This report describes the results of four-staged therapy in 51 patients with Graves' ophthalmopathy. Stage I, orbital decompression: 58 orbits in 32 patients underwent orbital decompression, with an average retroplacement effect of 4.2 +/- 2.2 mm (mean +/- SD). This procedure is effective to restore vision and correct the proptosis due to Graves' ophthalmopathy. Careful intraoperative titration of the retroplacement effect during orbital decompression is very important to achieve successful results. Stage II, strabismus surgery: 24 patients underwent strabismus surgery, including 11 with previous decompression surgery and six with previous simultaneous decompression and strabismus surgery. The overall success rate was 87% and previous decompression or strabismus surgery had no influence on the final results. Stage III, fissure width adjustment: 28 patients (45 eyes) received fissure width adjustment. Various procedures were performed and we found Müllerectomy with levator muscle stripping to be the most useful procedure for fissure width adjustment. The average improvement of fissure height was 3.1 +/- 1.8 mm. The rate of overall satisfactory results was 89%. There were five patients who received Staged IV cosmetic procedures with satisfactory results. Graves' ophthalmopathy is a chronic disease that needs thorough cooperation between doctor and patient. Careful evaluation of clinical parameters and individualized surgical goals are the keys to success.
Adult↗
Urinary tract tuberculosis: a 10-year experience.
Ninety-seven patients with urinary tract tuberculosis were reviewed from January 1983 to December 1993 at our hospital. Aside from two cases of military tuberculosis and three cases with coexisting active pulmonary tuberculosis, most urinary tract infections developed from a previous primary lung infection. Patients usually exhibited local symptoms. Fever, weight loss and anorexia were uncommon. Eighty-nine percent of the patients had abnormal urinalysis (hematuria and/or pyuria). Eight percent of the patients also had genital involvement, whereas 38% of these patients had normal intravenous pyelogram and urinalysis. Pyelograms disclosed abnormalities in 94% of the 97 patients and most revealed late changes, which were correlated with higher incidence of azotemia and anemia noted at diagnosis. Chemotherapy is the mainstay of treatment and at least three antituberculous drugs are required for initial therapy due to high drug resistance rate. Reconstructive surgery is warranted to salvage renal function. Except 6 patients run into maintenance hemodialysis, the renal functions of all patients remained stable during the period of follow-up, either receiving chemotherapy alone or combined surgery. Renal calcification may not represent inactive process, which requires further evaluation.
Adult↗
Therapeutic responses to corticosteroids in Graves' ophthalmopathy.
To elucidate the therapeutic responses to corticosteroids and prognostic factors in the treatment of Graves' ophthalmopathy, 23 patients with Graves' ophthalmopathy were treated with intravenous methylprednisolone 0.5 g daily for 3 days, followed by prednisolone 40 mg daily. Dosage was reduced gradually to 10 mg daily over 4 weeks. The symptoms and signs of the eyes were recorded. Orbital computed tomography and urinary glycosaminoglycan excretion testing were performed before treatment. We observed the effectiveness of treatment at 6 months as the endpoint of this study and classified the response as good or poor. We compared the differences in parameters between these two groups. The results showed that 12 (52%) out of 23 patients had a good response, and three (25%) of those with a good response recovered completely. Corticosteroid therapy dramatically improved lacrimation, reduced soreness and congestion of the eyes and ameliorated exophthalmos, lagophthalmos and extraocular muscle movement. Four (36%) of the 11 patients with a poor response had rebound of symptoms and/or signs after the dosage of prednisolone was decreased. Those with a good response were usually younger, and enlargement of the extraocular muscle was also milder than in those with a poor response. This study demonstrated that corticosteroid therapy is effective in Graves' ophthalmopathy and that extraocular muscle size demonstrated by orbital computed tomography is a prognostic factor of therapy.
Adrenal Cortex Hormones↗
Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology.
To determine the practice pattern regarding nonoperative treatment of simple meconium ileus, a survey was sent to directors of 66 pediatric radiology departments in the USA and Canada. Thirty-nine responses were received reporting 1,236 patients. A wide variation of enema techniques and contrast media were used. While the success rate did not correlate with osmolality, mode of administration, catheter size, or perforation rate, there was a significantly higher overall success rate with the use of Gastrografin versus non-Gastrografin (p < 0.00076) and the use of additives such as Tween-80 and Mucomyst versus techniques without additives (p < 0.00001). Perforation did not correlate with success rate, osmolality, or type of contrast medium. The only two instances of rectal perforations were associated with the use of balloon-tip catheter.
Canada↗
Utility of Tc-99m mebrofenin scintigraphy in the assessment of infantile jaundice.
Technetium-99m mebrofenin hepatobillary excretory patterns were assessed in 36 infants with hyperbilirubinemia. Phenobarbital was administered to 22 patients before imaging. Final diagnoses included: intrahepatic cholestasis (14 patients), neonatal hepatitis (nine patients), biliary atresia (eight patients), alpha-1-antitrypsin deficiency (two patients), Alagille's syndrome (two patients), and cystic fibrosis (one patient). No patient with biliary atresia showed bowel activity by 24 hours. Of the 28 infants without biliary atresia, 23 (82%) had bowel activity visualized by 6-8 hours and 26 (90%) had bowel activity by 24 hours. Two had no bowel activity at 24 hours: one had cystic fibrosis and one had neonatal hepatitis. Of the 26 patients with bowel visualization, the time to visualize bowel did not differ between patient groups with and without phenobarbital induction. All of the patients with hepatitis, including those with marked dysfunction, showed good hepatic uptake. Mebrofenin scintigraphy is an important imaging technique in the diagnostic evaluation of infants with hyperbilrubinemia. In addition to biliary atresia, intrahepatic cholestasis due to cystic fibrosis and severe neonatal hepatitis may also cause bowel nonvisualization up to 24 hours. The results of this study suggest phenobarbital induction may not be needed when Tc-99m mebrofenin scintigraphy is used for the assessment of infantile jaundice.
Aniline Compounds↗
Tracheomalacia before and after aortosternopexy: dynamic and quantitative assessment by electron-beam computed tomography with clinical correlation.
To correlate the dynamics of tracheal collapse with clinical upper airway obstruction before and after aortosternopexy, seven boys and three girls (mean age, 10 months) underwent dynamic evaluation of the trachea by electron-beam computed tomography (EBCT). The site, extent, and severity of collapse were correlated with symptomatology and details of operative procedure. When > 50 % area collapse was used as the criterion for tracheomalacia, segmental involvement occurred above the aortic arch in all patients, extending to the aortic arch level in only four. Tracheomalacia involved two or fewer 8-mm levels in seven patients and more than two levels in three. Eight patients underwent one aortosternopexy procedure, resulting in clinical improvement in six and correlating well with EBCT findings. Of the remaining two patients who had single aortosternopexy and did not show clinical and radiographic improvement, one required operative repair of a vascular ring and the other continued to have recurrent respiratory tract infections. On the basis of EBCT findings, two patients required additional innominate arteriopexies: one improved, and the other remained symptomatic, requiring tracheostomy. EBCT is a noninvasive modality that allows preoperative diagnosis of tracheomalacia. More importantly, the operative decision and technique are guided by an objective and quantitative assessment of tracheal collapse.
Aorta, Thoracic↗
Gastric adenocarcinoma metastatic to the testes in Peutz-Jeghers syndrome.
Peutz-Jeghers syndrome is associated with an increased frequency of gastrointestinal and extraintestinal malignancies. Ultrasound, CT, and MRI findings of testicular metastases from gastric adenocarcinoma in a boy with Peutz-Jeghers syndrome are presented.
Adenocarcinoma↗
Relationship of eye movement to computed tomographic findings in patients with Graves' ophthalmopathy.
To elucidate the relationship between eye movement and computed tomographic findings, 101 patients with Graves' ophthalmology were studied. Eye movements were scaled 0 to 3 according to movability. Extraocular muscle width and area were calculated from the largest portion of each muscle from the orbital coronal CT sections. Muscle widths were measured manually and muscle areas were calculated by a digitizer. The width and area of each rectus muscle were significantly correlated with limitation of eye movement. The muscle widths and areas were also significantly correlated to each other (r = 0.91 to 0.77, p < 0.001). Limitations of supraduction and abduction from enlargement of the inferior and medial rectus muscles were the most common clinical findings (46.5% and 39.6%, respectively). In conclusion, this study establishes a relationship between limitation of eye movement and extraocular muscle enlargement. Calculation of the width from the largest portion of the muscle manually from orbital coronal section is a simple method for clinical assessment of the severity of extraocular muscle involvement.
Adolescent↗
Ultrafast computed tomography of the chest.
Improvements in scan speed and resolution are changing the role of the pulmonary imager. An understanding of airway mechanics and blood flow physiology is required to take full advantage of the new technology. Assessment of regional airflow and blood flow provides information that is currently unavailable from clinical tools.
Adult↗
MR of fetal central nervous system abnormalities.
PURPOSE: To investigate whether MR can provide additional information on fetuses with central nervous system abnormalities as demonstrated by ultrasonography. METHODS: Fetal MR examinations were studied prospectively in 22 pregnant women whose fetuses showed evidence of anomalies on ultrasound performed in the High-Risk Obstetric Clinic. RESULTS: In 19 of 22 cases, postpartum confirmatory diagnoses were obtained by MR or CT examinations, autopsy, or surgery. In general, the image quality of MR is comparable with that of ultrasound. However, in six of 22 cases (27%), MR provided additional information that altered the ultrasound diagnosis; these included cases of infarction, diastematomyelia, normal hemimegalencephaly with early myelination, Dandy-Walker variant, and lipoma. All of these cases had postpartum confirmation. The additional information changed the treatment in three of six patients (no intervention or elective abortion). CONCLUSIONS: In certain situations MR can add valuable information to that obtained by sonography in the evaluation of the fetal central nervous system.
Central Nervous System↗
Radiotherapy in the management of thyroid orbitopathy. Computed tomography and clinical outcomes.
OBJECTIVE: We investigated the long-term outcome of patients with thyroid orbitopathy treated with orbital radiotherapy using quantitative clinical measurements and orbital computed tomographic morphometric changes. DESIGN: Patients who had undergone orbital radiotherapy for thyroid orbitopathy at least 1 year previously were retrospectively recalled for follow-up examination and computed tomography. Controls were patients with similar disease activity but who had not undergone radiotherapy. SETTING: Subspecialty clinic in a university teaching hospital. PATIENTS: Twenty-one patients (42 orbits) who underwent radiotherapy and six clinically comparable patients who had not undergone radiotherapy (12 orbits). INTERVENTION: Standardized, super-voltage, orbital radiotherapy. MEASUREMENTS: Five clinical indexes of orbitopathy and six computed tomographic indexes were examined for interval changes. RESULTS: The orbital computed tomographic muscle-diameter index enlargement ratio did not change in either group (radiotherapy group, 1.54 to 1.51, not significant; nonradiotherapy group, 1.37 to 1.36, not significant). The mean (+/- SEM) number of muscles with low-density areas increased in both groups (radiotherapy group, 1.1 [+/- 1.9] muscles per orbit; P < .001). Soft-tissue signs improved significantly with lesser improvements in extraocular muscle function in both groups. Proptosis, visual acuity, and intraocular pressure rise on upgaze did not improve significantly in either group. CONCLUSIONS: No changes in muscle size measured with computed tomography were found in either patients undergoing radiotherapy or patients not undergoing radiotherapy after long-term follow-up. Clinical indexes of thyroid orbitopathy, especially soft-tissue signs, improved on follow-up, but this was not influenced by the method of treatment.
Adult↗
Pentoxifylline inhibits the proliferation and glycosaminoglycan synthesis of cultured fibroblasts derived from patients with Graves' ophthalmopathy and pretibial myxoedema.
Excessive amounts of glycosaminoglycans accumulate in the extraocular muscles of patients with Graves' ophthalmopathy and in the affected skin of patients with pretibial myxoedema. It is widely accepted that fibroblasts are the sources of glycosaminoglycan synthesis. Pentoxifylline, an analogue of the methylxanthine theobromine, inhibits the proliferation and certain biosynthetic activities of fibroblasts derived from normal human skin and from skin of patients with some fibrotic disorders. Our objective was to determine whether pentoxifylline has similar effects on fibroblasts derived from patients with Graves' ophthalmopathy and pretibial myxoedema and could serve as a candidate for the treatment of these manifestations. Fibroblasts from the extraocular muscles of two patients with Graves' ophthalmopathy and normal extraocular muscles of two subjects with strabismus, as well as the affected skin of two patients with pretibial myxoedema were cultured in vitro in the presence and absence of pentoxifylline to assay its effect on the proliferation of fibroblasts and their production of glycosaminoglycans. In subconfluent fibroblast cultures, pentoxifylline treatment caused a dose-dependent inhibition of serum-driven fibroblast proliferation. In confluent fibroblast cultures both in the presence and absence of serum, exposure to pentoxifylline similarly resulted in a dose-dependent inhibition of glycosaminoglycan synthesis for all these different kinds of fibroblasts. These findings may form the rationale for a clinical trial using pentoxifylline for the treatment of Graves' ophthalmopathy and pretibial myxoedema.
Adult↗
Octreotide and Graves' ophthalmopathy and pretibial myxoedema.
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Adult↗
Contrast enema diagnosis of necrotizing enterocolitis.
Contrast enema was performed in a select group of 126 neonates with ambiguous diagnosis of necrotizing enterocolitis (NEC). Enema findings were compared with that on plain abdominal radiographs (AXR) and the clinical outcome. Thirty-one of the 34 patients with a discharge diagnosis of NEC were interpreted to have a positive contrast enema, and 91 of the 92 patients without a discharge diagnosis of NEC were interpreted to have a negative contrast enema. The AXR was interpreted as positive in 57 patients and as negative or indeterminate in 69. Not a single case of perforation was produced. Judicious use of contrast enema can improve specificity of diagnosis in cases with discordant clinical and plain radiographic findings.
Barium Sulfate↗