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Biomedical subjects

S Heyman

Publications and source records attributed to S Heyman.

At least 55 records · Page 3Linked to original sources
PubMed1991

Use of Tc-99m MAA in determining the etiology of increasing cyanosis following SVC-PA anastomosis for the hypoplastic left heart syndrome.

The hypoplastic left heart syndrome, which characteristically presents in the first few hours of life with cardiovascular collapse, is treated by reconstructive surgery (Norwood's procedure) beginning in the neonatal period. If untreated, more than 95% of infants with this malformation die within the first month of life. The case described involves the development of increasing cyanosis 7 weeks following bilateral superior vena caval-pulmonary artery (SVC-PA) anastomosis in an infant born with a hypoplastic left heart (including aortic and mitral valve stenosis) and an anatomic variant of bilateral superior vena cavae. The use of Tc-99m MAA proved efficacious in quantitating the differential perfusion to each lung, establishing the site of a postoperative stenosis in an anastomotic channel, and documenting systemic perfusion, thus confirming the right-to-left shunt from the superior vena cava to the systemic circulation that resulted in increasing cyanosis.

Anastomosis, Surgical↗
PubMed1990

Bilateral deep venous thrombosis in protein S deficiency. Detection by radionuclide venography.

Patients with primary hypercoagulopathies often present with recurrent, spontaneous deep venous thrombosis and pulmonary embolism. An adolescent eventually diagnosed with protein S deficiency presented with unilateral deep venous thrombosis documented ultrasonographically. Scintigraphic studies showed no evidence of pulmonary embolism but revealed a complete absence of deep venous flow in both lower extremities, the pelvis, and the abdomen. Subsequent ultrasonography and CT scanning documented this marked thrombotic extension. Radionuclide scintigraphy may play an important role in the serial evaluation of primary hypercoagulable states, particularly when pulmonary scintigraphy is combined with bilateral, lower extremity venography.

Adolescent↗
PubMed1989

Nuclear imaging and clinical features of childhood reflex neurovascular dystrophy: comparison with adults.

Reflex neurovascular dystrophy (RND) is less common in children than in adults, and differences in onset, clinical course, response to treatment, and degree of disability suggest a different pathogenesis. We have assessed the usefulness of nuclear imaging in 15 children with RND who were evaluated from March 1983 to September 1985. Abnormal findings on 3-phase bone scans were observed in 14 children, with diffusely decreased bone uptake at the symptomatic site being the most common observation. This contrasts sharply with previous reports of diffusely increased uptake in most adults with RND.

Adolescent↗
PubMed1989

Changing concepts in management of primary obstructive megaureter.

The management of neonatal urinary tract dilatations represents one of the most challenging dilemmas in pediatric urology today. We have been confronted with 44 renal units in 35 neonates diagnosed as having primary obstructive megaureter during the last 6 years. Of these units 23 in 17 infants were diagnosed antenatally and 20 (87 per cent) have been managed without surgical intervention. Notably, 16 renal units were graded as moderate to severe megaureters by an excretory urogram. The decision to manage conservatively was based on the initial extraction of the 99mdiethylenetriaminepentaacetic acid renal scan (the extraction factor). This estimate of absolute renal function has been used to differentiate dilatations with obstructive implications for the renal parenchyma from those without. Significantly, expectant treatment has resulted in improvement of dilatation on sequential excretory urograms in 15 megaureters and none has shown a deterioration of function by renal scan. Similar diagnostic criterion also has resulted in conservative management for 12 of 21 additional neonatal megaureters seen during this period with symptoms or they were discovered serendipitously. Only 2 of these 12 megaureters required surgical correction. The neonatal primary megaureter appears in many cases to represent a different entity than those that commonly presented before the advent of antenatal and perinatal diagnosis.

Dilatation, Pathologic↗
PubMed1989

Hyperfiltration and renal disease in glycogen storage disease, type I.

A prospective study of 14 patients (ages 6 months to 33 years) with glycogen storage disease, Type I (GSD-I) was carried out in order to define the character and frequency of renal dysfunction. A marked increase in the glomerular filtration rate (GFR) was documented in virtually all subjects, with the mean GFR raised by approximately 50%, to the range of 170 ml/min/1.73 m2. While this constituted the only renal abnormality found in the younger patients, a significant increase in urinary albumin excretion was seen in three teen-aged individuals; three patients over 20 years of age exhibited frank proteinuria (2 to 8 g/day). Renal biopsy on two of the proteinuric subjects revealed focal and global glomerulosclerosis and interstitial fibrosis. Evaluation of factors known to cause an increase in GFR did not define the precise etiology for its elevation in GSD-I. These studies suggest that: (1) glomerular damage and chronic renal disease are common in older patients with GSD-I; (2) the renal injury appears to be specifically related to GSD-I and is not secondary to the treatment of the disease; and (3) the natural history of the renal lesion in GSD-I may be analogous to that seen in insulin-dependent diabetes, with a "silent" period where hyperfiltration is the only demonstrable renal abnormality, followed by evidence of increasing glomerular damage progressing from microalbuminuria to frank proteinuria.

Adolescent↗
PubMed1989

Ventilation/perfusion mismatch caused by positive pressure ventilatory support.

In a patient with lobar atelectasis who was on positive pressure ventilatory support, ventilation and perfusion images showed absent ventilation and normal perfusion (reverse mismatch) in the region of the atelectasis and normal ventilation and decreased perfusion (true mismatch) not caused by pulmonary embolism in another lung zone. We report this case to emphasize that the lung scan findings in patients on positive pressure ventilatory support be carefully interpreted for the diagnosis of pulmonary emboli.

Diagnosis, Differential↗
PubMed1989

Detection of pulmonary aspiration in children by radionuclide "salivagram".

The radionuclide "salivagram" was introduced to document the aspiration of oral secretions in patients who are at risk. Approximately one-third of patients studied had positive tests. A positive study does not necessarily imply that patients are at risk for aspiration after gastroesophageal reflux. However, sequential images of the lung fields after the oral radioactivity has cleared may be a sensitive technique for detecting aspiration in infants and children following reflux.

Adolescent↗
PubMed1989

Nondiaphyseal osteoid osteomas in the pediatric patient.

Nondiaphyseal osteoid osteomas lack the classic roentgenographic appearance of diaphyseal lesions. This may delay diagnosis and treatment. This paper reports on seven children with nondiaphyseal osteoid osteoma seen consecutively. Delay in making the diagnoses, once the children were examined by orthopedic surgeons, averaged six months. Absence of the classic roentgenographic appearance led to the delay in these cases. The difficulty in diagnosing the lesion on routine roentgenograms derives from the specific reaction to the lesion by cancellous bone as compared to cortical bone. Bone scans proved to be sensitive at locating a focal area of intense uptake but lacked the specificity to make the diagnosis. Computed tomography (CT) was quite specific at making the diagnosis and localizing the lesion for biopsy. How to differentiate between osteoid osteoma and osteomyelitis by CT is described. When osteoid osteoma is suspected in nondiaphyseal locations, CT is likely to aid in the diagnosis and localization of the lesion for biopsy.

Adolescent↗
PubMed1988

I-131 metaiodobenzylguanidine: diagnostic use in neuroblastoma patients in relapse.

Metaiodobenzylguanidine (MIBG) has been used for the detection and treatment of neuroectodermal tumors, including neuroblastoma. We report our experience with 131I-MIBG used diagnostically in neuroblastoma patients with relapse. Thirty-eight studies were performed in 26 patients. There were 24 children (range 3 months-14 years) and two adults. While the study was found to be both sensitive and specific for the presence of disease, there are instances of discordance. False-negative studies were found with a markedly anaplastic tumor and with two mature ganglioneuromas. A bone lesion was negative with 131I-MIBG, but positive on bone scan. A biopsy confirmed the presence of neuroblastoma. Caution should be exercised when scanning pretreated patients, and perhaps with newly diagnosed patients as well.

3-Iodobenzylguanidine↗
PubMed1988

Deterioration of renal function in a conjoined twin: lack of compensatory renal hypertrophy.

The renal function of conjoined twin girls was evaluated by radioisotopic, radiographic, and laboratory techniques. The smaller of the twins was shown to have severe impairment of renal function, but due to the "auto-dialysis" by her normal twin, she was able to maintain a normal BUN and creatinine. Compensatory hypertrophy was not found in the normal twin, despite renal failure and loss of renal mass in the smaller twin.

Diseases in Twins↗