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Biomedical subjects

S D John

Publications and source records attributed to S D John.

At least 19 recordsLinked to original sources
PubMed2000

Is the open-mouth odontoid view necessary in children under 5 years?

OBJECTIVES: Questionnaires (984) were submitted to pediatric radiologists to determine how often odontoid fractures were missed on lateral views and detected on open-mouth odontoid views in children under 5 years. Other questions relating to imaging protocols of the odontoid also were included, and there were 432 respondents. RESULTS: Of these, 161 respondents indicated that an open-mouth odontoid view was not routinely included in their imaging protocol. CONCLUSIONS: There was considerable variability on how the problem of imaging of the odontoid was addressed, but overall there were enough data to begin to consider the concept that the open-mouth odontoid might not be needed in patients under 5 years of age if a lateral view is normal.

Child, Preschool↗
PubMed1999

Upper tibial hyperextension fractures in infants: another occult toddler's fracture.

We describe the radiographic findings associated with occult upper tibial fractures in infants and young children and offer an explanation for the underlying mechanism from which they result. These fractures tend to be subtle, just as the classic spiral tibial fracture originally described by Dunbar et al. (1964, J Can Assoc Radiol 15: 136-144). The fracture we describe results from a hyperextension injury to the knee, and the knowledge of the mechanism of injury, the subtle radiographic findings, and the findings on physical examination allow one to diagnose this fracture with confidence. Otherwise, it easily can go undetected.

Child, Preschool↗
PubMed1999

Trends in pediatric emergency imaging.

Abdominal pain, respiratory infections, and skeletal trauma are among the most common reasons for imaging infants and children in the emergency department. The types of pathology and the imaging findings for the various causes of these conditions often differ significantly from those seen in adults with similar symptoms. Although radiographs remain the primary imaging tool, ultrasound, helical CT, and MR imaging play an increasingly important role in solving diagnostic problems in emergency pediatrics. This article highlights some of the common diagnostic dilemmas and discusses current trends in the use of advanced imaging in pediatric patients.

Abdomen, Acute↗
PubMed1998

Ciprofloxacin as a therapeutic modality in pediatric burn wound infections: efficacious or contraindicated?

BACKGROUND: Food and Drug Administration regulations state that ciprofloxacin hydrochloride may cause arthropathies. For this reason, such therapy is contraindicated in the pediatric population. However, several studies in children with cystic fibrosis have found the drug to be efficacious. Our hypothesis was that ciprofloxacin treatment is justified in the case of multiresistant organisms in burn populations. DESIGN: During a 4-year period (January 1, 1993, to December 31, 1997) we treated 56 of our pediatric burn patients with ciprofloxacin when cultures proved resistant to other antibiotics. The burn area was 65% of the total body surface area. The average patient age was 8.4 years. Of the 56 patients who received ciprofloxacin, 50 received the recommended dose. Biopsy specimens were assessed for quantitative bacteriology and antibiotic sensitivity. Radiologic review was conducted to examine for arthropathy. RESULTS: All patients showed unequivocal reduction in quantitative bacterial counts, and susceptibility to ciprofloxacin remained stable without the development of resistance. Of the 56 patients treated, 42 had a major reduction in their quantitative wound biopsies from 10(6) to less than 100 colonies per gram of tissue, while the remaining 14 were observed to have a 2- to 3-log decrease. No arthropathy was detected in any of the 56 patients receiving ciprofloxacin. Review of the patients' charts showed no documented adverse events associated with the use of ciprofloxacin. All patients survived their thermal injury and the complications associated with it without any untoward problems or complications of arthropathy. CONCLUSION: On the basis of these data, ciprofloxacin therapy in the treatment of immunosuppressed pediatric burn patients is efficacious and does not cause arthropathy.

Adolescent↗
PubMed1998

Fibromatosis colli of infancy: variability of sonographic appearance.

PURPOSE: We describe the variable sonographic appearances of fibromatosis colli, a disease that presents as a mass-like enlargement of the sternocleidomastoid muscle during the first 8 weeks of life. METHODS: Sonograms and records of 12 infants who presented with a sternocleidomastoid mass or torticollis before they were 12 weeks old were retrospectively reviewed for sonographic features (presence of a mass, diffuse muscle enlargement, and echogenicity), medical history, and follow-up data. RESULTS: Sonographically, 6 infants had only a mass in the sternocleidomastoid muscle, 2 had a mass with fusiform muscle enlargement, and 4 had only muscle enlargement. Five masses were hyperechoic, and 1 mass was of mixed echogenicity. The 2 masses associated with muscle enlargement were hypoechoic. Three cases of diffuse muscle enlargement were of mixed echogenicity, and 1 was hypoechoic. Unusual variations included (1) a mass split longitudinally into 2 components and (2) a diffusely enlarged muscle with a striated pattern of mixed echogenicity. Follow-up in 10 patients at 4 months and in 7 patients at 6 months showed clinical improvement. CONCLUSION: Fibromatosis colli usually appears sonographically as a hyperechoic mass or diffuse sternocleidomastoid enlargement of mixed echogenicity. Variations in its appearance should not prevent the correct diagnosis as long as the abnormality is intramuscular and adjacent soft tissues are normal.

Fibroma↗
PubMed1998

Hypercalcemia associated with dysgerminoma: case report and imaging findings.

Hypercalcemia associated with malignancy is rare in children. We report a case of hypercalcemia associated with ovarian dysgerminoma in a 13-year-old girl with renal medullary calcinosis and vascular calcifications. To our knowledge this is the first report of the imaging findings in this condition and only the fourth case report of hypercalcemia associated with dysgerminoma.

Adolescent↗
PubMed1997

Neck masses in infants and children.

Neck masses, both inflammatory and tumoral, are common in infants and children, and most are benign. This article examines the imaging characteristics of various neck masses in infants and children. Routine radiographs, ultrasound, CT scan, MR imaging, and nuclear scintigraphy are discussed.

Child↗
PubMed1996

The lungs in immature infants: how important is surfactant therapy in preventing chronic lung problems?

Seventy-five premature infants weighing between 600 and 3200 g were studied over a period of 1 year. All of the infants received surfactant therapy for hyaline membrane disease immediately after birth and, thereafter, up to four doses every 6 h. The roentgenographic findings in all patients were documented at birth and at 2 days, 7-10 days, and 21-28 days of life. Larger babies responded to surfactant therapy better than did smaller infants. The smaller infants, even after initial clearing, were prone to develop pulmonary edema and the bubbly lungs of bronchopulmonary dysplasia. These data suggest that small infants, while initially responding to surfactant therapy with clearing of their lungs, are still at considerable risk of developing chronic lung disease in the form of pulmonary edema and bronchopulmonary dysplasia. An explanation is offered for why this occurs; at the same time it is suggested that, in view of our findings and those in the literature, the problems of pulmonary edema and bubbly lungs be more clearly separated.

Birth Weight↗
PubMed1996

Primary intrathoracic lymphangioma masquerading as teratoma.

Two cases of cystic hygroma arising as a primary lesion in the chest are presented. Because of calcifications discovered on CT and because of the anterior location of the mass in both cases, teratoma was the first diagnostic consideration. However, after surgical removal, histologic study determined that both lesions were cystic hygromas with areas of scattered calcification probably secondary to hemorrhage. These cases are presented because of the remarkable similarity of their imaging features to those of teratoma.

Adolescent↗
PubMed1996

Improving detection of pediatric elbow fractures by understanding their mechanics.

Fractures around the elbow are among the most common fractures in children, but they can also be some of the most elusive to detect. Although elbow fractures result from a variety of stresses applied to the three bones constituting the elbow joint, hyperextension-rotation injuries with valgus or varus stress are the most common cause of elbow fractures. Less common are direct impact injuries to the posterior aspect of the elbow. Because all three bones and their articulations are morphologically different, the various traumatic forces applied result in distinctly different types of fractures in each of the bones. For example, hyperextension with vertical stress produces supracondylar fractures of the distal humerus, longitudinal linear ulnar fractures, and buckle fractures; hyperextension with valgus stress causes impaction fractions of the radial head and neck, transverse olecranon fractures, and medial epicondylar fractures, whereas varus stress produces Monteggia fractures, lateral condylar avulsion fractures, transverse olecranon fractures, and longitudinal linear ulnar fractures. Understanding these forces and their effects is important because it facilitates detection of the wide variety of fractures in their more subtle forms.

Adolescent↗
PubMed1996

A double-blind, placebo-controlled trial of decongestant-antihistamine for the treatment of sinusitis in children.

We studied the effectiveness of nasal decongestant-antihistamine in treating acute sinusitis in children. All subjects received oral amoxicillin for 14 days. Subjects randomized to the decongestant-antihistamine group received nasal oxymetazolone and oral syrup containing brompheniramine and phenylpropanolamine. Controls received placebo nasal saline and oral syrup. In both groups symptoms resolved quickly, and radiographs improved significantly. Responses to treatment were similar between the two groups. Water's radiographs of the maxillary sinuses proved reliable in the assessment of the degree of sinus involvement. We conclude that decongestant-antihistamine need not be given to the child with acute maxillary sinusitis.

Acute Disease↗
PubMed1996

Immature lung problems: can our nomenclature be more specific?

Since the advent of surfactant therapy for hyaline membrane disease, the problems associated with this condition have been greatly reduced in severity and morbidity. However, many premature infants who recover from the biochemical problem of surfactant deficiency still suffer from structural immaturity of the lungs. This aspect of lung immaturity centers primarily around pulmonary hypoplasia, for these infants, because they are immature, have fewer than normal alveoli and thus cannot accomplish adequate gas exchange. As a result, they are placed on long-term ventilator therapy, which renders them susceptible to problems associated with hypoxia, oxygen toxicity, and barotrauma. Over the last two decades, we have learned a great deal about the pathophysiology of these problems, and we believe that the terminology used to describe them may now be less than accurate. We suggest that the it be adjusted to more correctly reflect the problems seen in these infants.

Bronchopulmonary Dysplasia↗
PubMed1995

Bladder neck obstruction caused by a large simple ureterocele in a young male.

The most common clinical presentation of ureterocele is infection of the urinary tract. Much less common is obstruction of the bladder outlet by prolapse of the ureterocele into the urethra. Even less common is simple occlusion of the bladder outlet by a nonprolapsing ureterocele. We present such a case where a large, simple ureterocele in a young male led to such obstruction.

Child↗
PubMed1995

MR imaging of nasal masses.

Magnetic resonance (MR) imaging is useful in evaluating the wide spectrum of diseases that cause nasal masses. MR imaging is most helpful in (a) defining tumor margins and possible intracranial extension and (b) differentiating tumor (which has intermediate, heterogeneous signal intensity on T2-weighted images) from concurrent postobstructive sinusitis and other infectious or inflammatory masses (which have high, homogeneous signal intensity on T2-weighted images if the secretions are well hydrated). The analysis becomes more complicated in cases with desiccated and mixed composition secretions. MR imaging also allows characterization of very vascular tumors, which show flow voids or marked enhancement. Low signal intensity on T1-weighted images and marked low signal intensity on T2-weighted images are characteristic of fungal sinusitis, and fat within a nasal mass indicates a dermoid or epidermoid cyst. Idiopathic midline granuloma, Wegener granulomatosis, and "cocaine nose" manifest as predominantly destructive midline masses. Despite the advantages of MR imaging, computed tomography remains the preferred imaging modality for evaluating nasal masses that contain calcification or originate from bone or cartilage.

Diagnosis, Differential↗