Biomedical subjects
Publications and source records attributed to S Laurin.
An extralobar pulmonary sequestration in an infant was diagnosed by ultrasound. The sequestration appeared as an echogenic mass interpositioned between the liver and the right lung. The main feeding vessel of the sequestration was demonstrable. Ultrasound should be the first diagnostic modality used for evaluation of a supraphrenic chest mass seen on chest roentgenogram in childhood.
Whereas digital subtraction angiography (DSA) has been extensively used in adults, few reports have dealt with its application in children. We utilized DSA in 52 children, studying various vascular territories. Technically satisfactory studies were obtained in 89%. Motion artifacts is the foremost technical problem. Extremity DSA with arterial injection was highly successful in a number of cases. Thoracic vascular studies were also successful, as were studies of the head and neck, whereas renal and abdominal vessel studies were somewhat less successful. DSA with arterial injection may be expected to replace conventional angiographic studies in selected cases and appears to be an excellent screening method also in children.
The value of glucagon to facilitate hydrostatic reduction of childhood ileo-colic intussusception was tested in a series of 188 consecutive cases. Sixty-nine patients selected at random received 0.05 mg glucagon/kg body weight intramuscularly before attempts at reduction were started. The rate of successfully accomplished reductions was 84 per cent in the test group and 76 per cent in the control group (not significant). The time for accomplished reduction was approximately equal in the two groups. After 3 unsuccessful attempts at hydrostatic reduction patients in the control group received glucagon. The subsequent attempt at reduction proved successful in slightly more than every second case. No complications occurred. In general, glucagon was not found to improve the rate of employed reductions nor on the time necessary for reduction to take place. The investigation indicated, however, that there may be a limited benefit of adjuvant medication of glucagon. After two unsuccessful barium enemas glucagon administration is therefore recommended before a third attempt at reduction is performed.
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Diagnostical and therapeutical problems associated with supination-adduction injuries are presented. 457 ankle fractures were collected from a retrospective material of 919 children aged 0-18 years with fractures of the tibio-fibular shaft or the ankle. The ankle fractures were classified anatomically according to Salter and Harris and traumatologically according to Gerner-Smidt. 147 fractures were classified as due to supination-adduction, of which 128 had open growth plates. The first stage, a Salter-Harris type I, II, or III fracture through the lateral malleolus or only epiphyseal fracture without fracture through the growth plate, is easily overlooked and is probably more common than earlier registered. The stage II injury with, an addition, a vertical or oblique fracture of the medial malleolus sometimes continuing through the physis and metaphysis is often more easily recognized at the radiographical examination. The mean age of supination-adduction injuries is lower than for supination-eversion injuries. The supination-adduction injuries are the second most common type of ankle fractures in children (32%) only exceeded by injuries due to supination-eversion (39%). Early recognition of the fracture pattern of supination-adduction injuries is important as growth disturbance and joint problems are not uncommon when there is fracture through the medial malleolus. The need for correct diagnosis and treatment is stressed by the risk for late problems.
One hundred prematurely born infants were evaluated 2 to 15 months after birth with real-time ultrasound. Seventy of these had intracranial bleeding as demonstrated by ultrasound examination during the first days of life. Nine of 13 (69%) infants with single or multiple sites of hemorrhage but without intraventricular hemorrhage had normal ultrasound at the late follow-up, 3/13 (23%) had mild and only one (8%) severe ventricular dilatation. Fifteen of 57 (26%) infants with intraventricular hemorrhage had normal ventricles at follow-up ultrasound, 26/57 (46%) mild and 16/57 (28%) moderate or severe ventriculomegaly. Only 2 infants were shunted. Porencephalic cysts developed in 5 infants. The size of ventricles may either progress or regress after the early posthemorrhagic period. Real-time ultrasound is the modality of choice not only for the diagnosis of intracranial hemorrhage in premature infants but also for late follow-up examinations as long as the size of the fontanelle permits the performance of the examination.
In a retrospective study in children aged 0-18 years, 457 ankle fractures in children were classified traumatologically according to Gerner-Smidt or Lauge-Hansen. Anatomically, ankle fractures with open growth plates were classified according to the Salter-Harris classification. Pronation injuries constituted 18% of the ankle injuries and showed different fracture patterns. In total 83 pronation injuries were found. Of these, 52 showed open growth plates: 25 pronation-abduction, 23 pronation-eversion, and 4 pronation-dorsal flexion injuries. The pronation-abduction injuries were classified into two groups. In 15, a detachment of the deltoid ligament at the medial malleolus, visible on radiographs as a minimal fragment or transverse fracture of the medial malleolus, was found; seven showed in addition a fracture through the growth plate (Salter-Harris type I or II) or a metaphyseal fracture of the distal fibula. In 10, a physeal fracture through the distal tibia (Salter-Harris type I) was found. Of these, seven had in addition a metaphyseal fibular fracture. Pronation-eversion injuries showed in 21 cases a physeal-metaphyseal fracture (Salter-Harris type II) with an antero-lateral metaphyseal fragment (Stage I-II); 17 had in addition a metaphyseal fibular fracture (Stage III). A minimal posterolateral metaphyseal fragment of the distal tibia represents the fourth stage but could not adequately be separated from the third, so Stages III and IV were combined. Pronation-dorsal flexion showed a physeal-metaphyseal fracture in four cases with an anteriorly situated metaphyseal fragment (Stages I-II); one case also had a metaphyseal fracture of the distal fibula (Stage III). Pronation-eversion injuries showed frequently displacement and were more commonly treated by reduction than pronation-abduction and supination injuries including supination-eversion injuries of intra-articular type. However, complete reduction of pronation-eversion injuries with closed methods often proved difficult.
Progressive growth retardation and varus tilting were observed in a child with an ankle fracture of supination-adduction type initially treated by closed reduction and pinning. The patient was later operated with the Langenskiöld procedure. Preoperatively, roentgen stereophotogrammetric analysis showed decreasing growth rates especially medially in the distal tibia, radionuclide scintimetry manifested reduced activity on the injured side, and tomograms showed a bony bridge medially. The evidence of growth in the distal tibia indicated the existence of an osseofibrous bridge between the epiphysis and the metaphysis. This was also confirmed by the findings at the operation and partly by microscopical investigation of the removed osseofibrous bridge. Postoperative stereophotogrammetric analysis showed reduction of the varus position in two steps. Roentgen stereophotogrammetry permits early detection of a growth disturbance, and evaluation of the effects of therapy.
Following gastrectomy for locally advanced adenocarcinomas, three patients developed microangiopathic hemolytic anemia and renal failure shortly after completing courses of adjuvant chemotherapy with mitomycin and 5-FU. These complications progressed despite cessation of chemotherapy, and all three patients died of noncardiogenic pulmonary edema precipitated in two cases by blood transfusions. At autopsy, two patients had no residual carcinoma and all had a diffuse microangiopathy involving mainly the kidneys and lungs. There was intimal hyperplasia of many arterioles sometimes associated with complete occlusion of the lumen, prominent nuclear atypia in many capillary cells, and numerous capillary fibrin thrombi. Direct immunofluorescence studies revealed extensive fibrinogen-fibrin deposits in the vascular lesions. Chemotherapy-induced microangiopathic hemolytic anemia and renal failure may predispose patients to fatal episodes of noncardiogenic pulmonary edema that can be triggered by blood transfusions.
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Obstructive sleep apnea syndrome was every likely caused by an enlarged tongue in a 60-year-old man with acromegalia. The diagnosis was confirmed by polygraphic sleep recordings and by roentgenologic examination. The patient was treated with a tongue-reduction plasty which gave him good subjective relief and better sleep. A whole night polygraphic sleep recording showed a couple of hours of normal sleep without apneas or arousals. The last part of the night was, however, still disturbed by several apneas with concomitant arousals.
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Intraarticular fractures of the ankle in children known as the Tillaux and triplane fractures of the distal tibia are caused by supination-eversion. In order to determine the three-dimensional configuration of these fractures and the relation of the fracture to the growth plate and the joint, computed tomography (CT) was performed in one case with Tillaux fracture and in four cases with triplane fracture, besides conventional radiography and tomography. The Tillaux fracture showed two fragments. The triplane fracture consisted of two to four fragments representing three types of fracture, depending on type of investigation. Conventional radiographs could not differ between two and three fragment triplane fractures, whereas CT offered possibilities to register the epiphyseal and metaphyseal fractures in detail and the exact displacement of the fracture. In one case with a three fragment diagnosed by conventional tomography and CT, a four fragment fracture was revealed at operation. This patient had, in addition, a fracture through the anteromedial part of the growth plate without displacement. According to this and previous investigations, the Tillaux and triplane fractures represent at least five different anatomical pattern of intraarticular supination-eversion injuries.