Biomedical subjects
Publications and source records attributed to S Mahboubi.
The most sensitive indicators of an abnormal adrenal gland have been a change in the margin of the gland from concave or straight to convex, and the presence of calcification. Large adrenal glands that have preserved normal shape and in postintravenous enhancement show homogeneous increased density indicate hyperplasia.
This report describes our experience with 16 infants and children with a mean age of 7 months and a median age of 6 weeks with hepatic hemangioendothelioma. Fifteen patients presented with hepatomegaly. Seven had congestive heart failure and four had associated cutaneous lesions. Although diagnosis was clinically evident in 15 of the 16 patients, arteriography and computerized tomography (CT) were diagnostic. A variety of treatment approaches were used including radiation, resection, systemic steroids, hepatic artery ligation, angiographic embolization, and various combinations of these modalities. The following information was gained from this experience. CT with enhancement is as specific a diagnostic tool as hepatic arteriography. Angiographic and CT appearances do not correlate with prognosis. Most patients can be treated successfully with steroids; those who do not respond should have other approaches tried such as embolization or ligation. The angiographic appearance determines whether embolization therapy is worthwhile, as we found that hemangioendotheliomatosis with portal as well as hepatic arterial supply will not respond to embolization. The survival rate in this series was 80%.
In 30 adolescent patients with 36 structural curves undergoing posterior spinal arthrodesis using Cotrel-Dubousset (CD) instrumentation, computer tomography (CT) was performed to evaluate the change in rotation and in the sagittal plane. The average preoperative Cobb angle was 51.7 degrees, and improved to 18.7 degrees postoperatively, or 64.9%. The angle of rotation of the apical vertebra relative to the anterior midline of the body (RAML) improved from 27.9 degrees preoperatively to 21.5 degrees postoperatively (23.9%). The angle of rotation relative to the sagittal plane (RAsag) improved from 15.2 degrees preoperatively to 13.4 degrees postoperatively (14.3%). The kyphotic angle increased an average of 10.6 degrees in the 14 patients whose preoperative angle was less than 25 degrees. As measured by CT, CD instrumentation improves both the rotational and sagittal plane deformities better than that reported for other systems.
The essential aids in the evaluation of suspected blunt urinary tract injury are urinalysis and IVP. In 78 consecutive children who had IVPs because of trauma from January 1982 to March 1986, the following were evaluated: (1) the yield of IVP; (2) the correlations between IVP and hematuria, mechanism of injury, and associated clinical findings; and (3) the effect of IVP on patient management. Of the 26 children (33%) with abnormal IVP findings, 13 had congenital urinary tract anomalies only and 13 had urinary tract injuries (eight renal contusions, four renal lacerations with extravasation, and one bladder rupture). The number of RBCs per high-power field correlated with IVP evidence of injury (P less than .05). If only those patients with greater than or equal to 20 RBCs per high-power field had received IVPs, 42% of IVPs would have been avoided and no injuries or surgically correctable anomalies would have been overlooked. Urinary tract injury occurred significantly more often in patients with extremity fractures (P less than .05) and pelvic fractures (P less than .05). Mechanism of injury, admission to the hospital, and flank tenderness or hematoma were not associated with IVP evidence of trauma (P greater than .05), however. In four patients with trauma, results of IVP led to lengthened hospitalization or further diagnostic studies but did not result in surgery. Two patients in whom ureteropelvic junction obstruction was discovered incidentally had delayed corrective surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Accurate femoral-acetabular relationship was not possible until the advent of the computed tomography scan. Computed tomography scan allows visualization and measurement of femoral torsion, femoral head contour, soft tissue and bony impingements on the femoral head, acetabular configuration and femoral-acetabular relationship.
Hepatic hemangioma (hemangioendothelioma) is a rare but most common benign vascular tumor of the pediatric age group. Prompt diagnosis and treatment prevent complications. Familiarity with various CT patterns should facilitate correct diagnosis of hemangioendothelioma of the liver in infants and children and avert angiography.
Explore the source record for details and available documents.
There are many reports in the literature describing ultrasonic features of tubo-ovarian abscess. Computed tomography characteristics of these lesions are less frequently described. This presentation shares our experience with computed tomography findings in two girls, aged 6 and 14 years, with tubo-ovarian abscesses.
Combined gastric and pancreatic duplications are uncommon. Although patients usually present with symptoms of intestinal obstruction, gastrointestinal (GI) bleeding may occur if the duplication ulcerates and erodes into a neighboring hollow viscus. An upper GI series and barium enema are helpful in making a diagnosis. Combined duplications probably are produced during embryologic development by traction along a neuroenteric band between the stomach and pancreas. Simple surgical excision is the treatment of choice.
From 1974 to 1983 we treated 16 children between 1 and 16 years old for soft tissue sarcoma arising in the pelvis, bladder or prostate. An incisional biopsy was obtained in every patient. Each child then was treated with a combination chemotherapy program, incorporating vincristine, actinomycin D and cyclophosphamide with or without doxorubicin, cis-platinum and etoposide. Of the 16 patients 13 (81 per cent) also received radiation therapy. In 8 children with urinary obstruction or hematuria sarcomas arose in the bladder or bladder-prostate region, including 7 who had localized tumors and 1 who had lung metastases at diagnosis. The median tumor diameter in these patients was 5 cm. Of these 8 patients 3 eventually required total cystectomy and prostatectomy to eradicate persistent local tumor, and 6 are alive and remain free of recurrent sarcoma for 1 to 9 years after initiation of therapy. The 8 other children had a pelvic mass at diagnosis, which arose adjacent to but outside of the bladder or prostate, and 2 had lung metastases at diagnosis. The median tumor diameter in these patients was 15 cm. Only 3 of these 8 children are alive and remain free of sarcoma for 1 to 8 years after initiation of therapy. In only 1 of these children was complete tumor excision ever possible despite the use of local radiation therapy and aggressive chemotherapy. Sarcomas arising in the bladder-prostate region are found when relatively small, perhaps because they soon produce overt signs, and they appear to have a better prognosis than those arising in the retroperitoneum-pelvis outside the bladder. Better treatment strategies are needed for the latter group of tumors that often are locally uncontrollable.
Nine patients with choanal atresia or stenosis, ranging in age from two days to 6 years were evaluated by computer tomography (CT). The clinical, conventional radiographic and surgical findings were correlated with CT findings. In all patients, the complete anatomic abnormality and the thickness of the obstruction were better defined with CT than with a choanogram. Findings on CT included: thickening of the vomer, bowing of the lateral wall of the nasal cavity and fusion of bony elements in the choanal region. This information is essential in planning surgical correction.
We report a new method using computed tomography (CT) to measure femoral torsion more accurately in patients with cerebral palsy. The method involves CT scanning through the femoral head, the femoral neck at the region of the greater trochanter, and the femoral condyle.
Computed tomography examinations were performed on 74 patients who presented to the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania with a known or suspected diagnosis of primary or secondary soft tissue sarcoma. Focal masses were detected on computed tomography study in 59 patients. These masses were classified into three broad categories: centrally necrotic masses with a large predominantly liquefactive center and higher density periphery (29); multilocular, septated masses with distinct linear bands or striations (21); and miscellaneous masses (9). The miscellaneous category included six inhomogeneous and three homogeneous masses. The apparent density differences within these sarcomas were best appreciated on dynamic postcontrast scans. The computed tomography appearance of these sarcomas may be explained by the pathologic findings of cystic degeneration, extensive necrosis, central cavitation, focal hemorrhage, and myxoid changes.
In this study we have considered whether the lateral neck radiograph is useful in predicting the degree of airway obstruction, and whether supine and erect views are more useful than a single film. We evaluated the supine and erect lateral neck radiographs of 50 patients with upper airway obstruction due to enlarged tonsils and adenoids. Our results show that the supine radiograph, which is technically easier to perform, is entirely satisfactory for appraising the size of the tonsils and adenoids, but that neither view tells us much about the degree of airway obstruction during sleep.
Explore the source record for details and available documents.
Primary tumors of the esophagus are extremely rare in children. A common periesophageal mass in children is duplication. It constitutes only 0.5 to 2.5% of all esophageal lesions usually diagnosed in infancy or early childhood. Duplication of the esophagus may be diagnosed on examination by the emergency department (ED) physician when it produces symptoms or when it is inadvertently found on a chest radiograph. The duplication may produce acute gastrointestinal symptoms such as vomiting and dysphagia or respiratory symptoms such as cough, wheezing, or dyspnea. Currently the examination of choice for evaluation of esophageal duplication is a barium swallow. However, computed tomography (CT) has the advantage over conventional diagnostic procedures, since it demonstrates the cystic nature of the mass and its relationship to adjacent structures in a noninvasive manner. An esophageal duplication has a well-marginated spherical mass contiguous with the esophagus, with preserved surrounding fat planes, and numbers of 15 to 30 Hausenfield units (HU) on CT. We are reporting three cases of this anomaly as demonstrated by CT.
Association of imperforate anus and Hirschsprung's disease is rare, the incidence of both events occurring together would be one child out of every 25 million live births. A case of "cat-eye" syndrome with association of high imperforate anus and long segment Hirschsprung's disease is presented.
Explore the source record for details and available documents.