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Biomedical subjects

T J Spackman

Publications and source records attributed to T J Spackman.

At least 19 recordsLinked to original sources

Commercial research and development in times of financial restraint.

More than most other areas of medical practice, radiology depends on technology for the practice of its specialty, the effectiveness of its specialists, and the contribution it can make to medical care. Consequently, manufacturers of diagnostic imaging equipment and supplies have special importance to radiologists, and there has long been a productive interrelationship between those vendors and radiologists, resulting in rapid growth in the sophistication and effectiveness of diagnostic imaging products. Presumably because the market for imaging equipment and supplies is narrowing, in the past three years there has been some redirection of research expenditures away from pure research into applied research and product development, although absolute levels of research funding have not decreased. Understanding the theory of the firm provides an insight into how vendors might respond to changes in the size of the equipment market or the certainty of the market in the future. Because the research and development activities of these vendors are important to radiology practice, radiologists need to understand corporate behavior, just as managers of companies providing imaging equipment and supplies need to understand the requirements and concerns of their market. Finally, individuals and agencies that determine the ultimate reimbursement for diagnostic medicine should be mindful of the effect their decisions have on costs and efficiencies in this area, particularly the risk that the long-range effect on the cost and quality of medical care is quite different from that intended.

Commerce↗

A critical eye.

Explore the source record for details and available documents.

Quality of Health Care↗

A newly recognized profile in neonatal lung disease with maternal diabetes.

A radiographic pattern associated with respiratory distress, distinct from hyaline membrane disease and transient tachypnea of the newborn, is described in eight infants of diabetic mothers. The radiographic findings demonstrate a regional distribution of reticulogranular densities accompanied by increased lung volumes. Clinical features were gestationally mature infants in moderate respiratory distress with tachypnea, hypercapnia, and hypoxemia requiring supplemental oxygen, with steady improvement and uneventful recovery within 2 weeks. There was no bacteriologic evidence of infection or radiographic evidence of delayed lung fluid absorption. The mothers had mild diabetes. These features characterize a newly recognized entity in diabetes-related idiopathic lung disease of the newborn. Possible causative factors are discussed.

Female↗

Cockayne syndrome.

The diagnosis of Cockayne syndrome was established with the aid of cranial computed tomography (CT) in a child with growth deficiency, mental retardation, and neurologic findings which are typical for this rare childhood disorder. Calcification of basal ganglia and hydrocephalus ex vacuo are neuropathologic characteristics of Cockayne syndrome which may be present on CT as early as 3 years of age.

Child, Preschool↗

Congenital right diaphragmatic hernia. A case report and review of the literature.

Congenital right diaphragmatic hernia can present a difficult diagnostic problem. An illustrative case is reviewed in which the diagnosis was not considered during the initial hospitalization because chest radiographs were interpreted as showing an atelectatic and pneumonic process. Once suspected, the diagnosis was made by fluoroscopy, which showed an immobile right hemidiaphragm, and by liver scan, which demonstrated herniation of the liver into the right thorax. The tendency of congenital right diaphragmatic hernias to present after the neonatal period and to mimic pulmonary parenchymal disease is discussed. Several alternative means of diagnosis of right diaphragmatic hernias are reviewed.

Female↗

Multiple congenital anomalies associated with infantile achalasia.

Achalasia is rare in the pediatric age group, particularly in the neonate and young infant. The symptoms are often nonspecific and may not even suggest a primary esophageal disorder. This is a report of two cases of achalasia seen in neonates, both of whom has other unusual and exceedingly uncommon congenital abnormalities.

Abnormalities, Multiple↗

The usefulness of lateral neck roentgenograms in laryngotracheobronchitis.

To evaluate the usefulness of lateral neck roentgenograms when laryngotracheobronchitis (LTB) is the suggested diagnosis, three pediatric radiologists were asked to examine a series of lateral neck roentgenograms of subjects with LTB and controls. In six of the group with LTB, the roentgenograms were unreadable. Given adequate roentgenograms, the radiologists diagnosed or excluded LTB with a high degree of accuracy (sensitivity, 93%; specificity, 92%). However, their predictions of severity based on the roentgenograms showed a poor correlation with measures of clinical severity. The clinical severity of those with unreadable roentgenograms was significantly greater.

Bronchitis↗

Neonatal presentation of I-cell disease.

Two patients are described in whom the diagnosis of I-cell disease was established in early infancy. These patients lacked many of the clinical and radiographic features described in other children with this disorder. Differences between the neonatal and early childhood presentation of ICD are discussed.

Hip↗

The Dominican Republic conjoined twins: ischiopagus, tetrapus, omphalophagus.

Alta and Clara, the Dominican Republic conjoined twins (ischiopagus, omphalopagus, tetrapus) were evaluated prior to separation with plain films, vaginograms, arteriograms, intravenous pyelogram, barium enema, and upper gastrointestinal series with small bowel follow-through. The clear demonstration of their internal anatomy allowed the surgeons to plan the operative approach and to make a reasonable judgment regarding viability of each baby. Each twin had a semicircular pelvis which joined the other to form a complete ring. There were a few hepatic arterial twigs from Alta which crossed the midline, proving at surgery to be a small bridge of tissue connecting the two livers. Clara's superior mesenteric arteries supplied the majority of the small bowel. Portal venous drainage was separate for each twin. Each baby had two kidneys in normal position with the bladders laterally placed. Each bladder received one ureter from each twin. Two separate small bowels joined proximal to the single colon which terminated in an anus related to Clara's pelvic structures. Following separation, each baby did well. Their postoperative anatomy is described.

Dominican Republic↗

Ectopic vas deferens: a report of two cases and review of the literature.

Two new cases of ectopia of the urethral end of the vas are described, and six cases reported since 1949 are reviewed. Most cases had associated urinary tract abnormalities, often anomalies of renal position, and imperforate anus was the most frequent gastrointestinal anomaly. The most productive mode of radiologic evaluation was voiding cystourethrography. The two types of insertion and the associated urinary and gastrointestinal anomalies are analyzed on the basis of embryologic development.

Abnormalities, Multiple↗

Ureteritis cystica after treatment of cyclophosphamide-induced hemorrhagic cystitis.

A case is presented in which ureteritis cystica developed following formalin instillation for treatment of cyclophosphamide-induced hemorrhagic cystitis. It is not known whether this complication, not previously reported, is a result of the cyclophosphamide, the formalin, or a combination of both. Patients being considered for formalin instillation should be studied by cystography for evaluation of vesicoureteral reflux. Alternative methods to formalin instillation should be considered in patients with reflux.

Child↗

Tracheal agenesis.

Tracheal agenesis is a rare anomaly that produces neonatal respiratory distress and has been uniformly lethal to date. In this malformation the entire trachea is usually absent, air reaching the bronchi through a communication with the esophagus, and the lungs are normally formed. The diagnosis should be suspected in any infant in whom improved ventilation is obtained despite difficult intubation and abnormal tracheal tube placement. Coexistent cardiac, gastrointestinal, and genitourinary anomalies are common. The growth of the tracheoesophageal septum and the elongation of the dividing foregut are crucial phases in the morphogenesis of this malformation.

Abnormalities, Multiple↗

A renal lesion in asphyxiating thoracic dysplasia.

A boy with asphyxiating thoracic dysplasia was studied from age seven months until his death with congestive heart failure at age thirteen months. Aminoaciduria, phosphaturia, increased urate excretion, hyposthenuria, proteinuria, and metabolic acidosis were demonstrated at one year of age. Cardiopulmonary dysfunction and skeletal abnormalities were also studied during life. Cessation of linear growth, overgrowth of membranous bone with retardation of enchondral bone formation, and cartilaginous overgrowth of the chest were prominent findings. At autopsy, an unexpected hepatic fibrosis was discovered, along with renal and skeletal disorganization.

Bone and Bones↗