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V Rathaus

Publications and source records attributed to V Rathaus.

30 records · Page 2Linked to original sources
PubMed1996

Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma?

The evaluation of injured children with suspected blunt abdominal trauma (BAT) is clinically challenging. Computed tomography (CT) requires that patients be sedated, stable, and transportable, and even so, it is considered the diagnostic modality of choice for children with BAT. The authors questioned whether abdominal ultrasonography (US) performed during the initial assessment of the injured child is accurate enough to replace CT in the detection of intraabdominal injury. One hundred twenty-four children with BAT aged 2 to 14 years; (average, 8.3) were admitted to the authors' institution during 1992 and 1993. Some had associated injuries (head, 60; chest, 25; extremities, 15; pelvis, 5). The indications for US were pelvic, abdominal, or lower chest trauma, tenderness, or guarding; altered consciousness; microhematuria; and/or low hemoglobin/hematocrit values. Three patients underwent abdominal CT at the time of admission. For 121 children, an emergency US examination was performed using a 3.5-MHz transducer and a portable machine. The examination evaluated the kidneys, liver, and spleen for parenchymal injuries, and the subhepatic, subphrenic, and paracolic spaces and the pelvis for evidence of free peritoneal fluid. The presence of fluid and/or parenchymal injury was interpreted as a positive US result. Twenty-eight patients had positive US findings. Ten of these had a subsequent positive CT result, eight had a normal CT result, and 10 had a negative second US result. Eleven patients (with a total of 17 visceral injuries) were treated conservatively. One patient underwent emergency surgery for liver and caval injuries. Four patients required blood transfusions. Ninety-three of the 121(78%) had a negative US result. For one of these patients, a subsequent CT scan showed a minor subcapsular splenic hematoma, which resolved spontaneously. The authors conclude that US is sensitive in detecting free peritoneal fluid or visceral injuries and is an effective screening modality. It has replaced abdominal CT in 76% of our patients with suspected BAT. In view of the reliability, simplicity, low cost, and bedside availability of US, the authors suggest that this modality be used in the initial assessment and diagnosis of children with suspected intraabdominal injury from blunt trauma.

Abdominal Injuries↗
PubMed1996

Frequent involvement of the internal cuff segment in CAPD peritonitis and exit-site infection - an ultrasound study.

BACKGROUND: The extent of involvement of the subcutaneous Tenckhoff catheter tract in CAPD peritonitis and catheter-related infections is of major therapeutic importance. By definition, both peritonitis and exit-site infections do not involve the catheter tract. However, diagnosis of these infections as well as the more sinister tunnel infection is based mainly on clinical signs. METHODS: We examined the usefulness of ultrasound examination (US) of the catheter tract in delineating catheter-related (exit-site and tunnel) infections, and their relationship to each other and to peritonitis. CAPD patients with no evidence of peritonitis or catheter-related infections for 6 months prior to examination served as controls. US were performed by one of two experienced radiologists using the Acuson 128XP/10 scanner with a 7-MHz linear transducer. A positive US was defined as an area of hypoechogenicity (indicative of fluid collection) >2 mm in width along any portion of the catheter tract. Findings were localized into segments(S) as follows: S1, limited to external cuff; S2, intercuff segment adjacent to the external cuff; S3, intercuff segment adjacent to the internal cuff; S4, limited to the internal cuff; and S5, involvement extending throughout the catheter tract. RESULTS: Between March 1993 and January 1995, 39 CAPD patients, all with a double-cuff straight Tenckhoff catheter with the exit site situated above the point of entry into the peritoneum were studied. A total of 56 US were performed divided among 26 episodes of peritonitis, four tunnel infections, 13 exit-site infections,and 13 controls. There were 30 positive US distributed among 16 peritonitis, four tunnel, eight exit site infections and two control patients. The two positive controls went on to develop peritonitis within 1 month of the US. The majority of the US findings (13/16 in episodes of peritonitis and 5/8 exit site infections were localized to segment 4, that is, to the internal cuff region. Apart from a significant increase in width in all infected segments versus a normal tunnel, no differences in size were seen between peritonitis, exit-site, or tunnel infections, nor were there any differences in size and localization in these infections when comparing the offending organism (Gram-positive, negative, or culture negative). CONCLUSIONS: We conclude that peritonitis and exit-site infections are frequently accompanied by involvement of the catheter tract. The localization of infection to the internal cuff region in cases of exit-site infection probably occurred as a result of downward migration along the catheter tract. This supports the notion that ideally the exit site should be pointing caudally or that the peritoneal catheter have a swan-neck configuration. With regard to peritonitis, infection within the peritoneal cavity appears to extend and involve the internal cuff region. Thus both the internal and external cuffs do not seem to pose an effective barrier against the spread of infection.. Based on our data, we recommend that US be performed as a routine investigation in all cases of exit-site infection and in cases of refractory or relapsing peritonitis.

Adult↗
PubMed1995

Interrupted air column in the large bowel on plain abdominal film: a new radiological sign of intussusception.

Intussusception is a frequent cause of small bowel obstruction in infants and toddlers. Early confirmation and treatment are paramount. We have recognized a fairly consistent radiological finding in plain abdominal x-rays that had not been described previously. The study compares the x-ray findings of patients with proven intussusception with those of patients with colicky abdominal pain related to other causes. In association with the relevant symptoms, this "interrupted air column" in the large bowel should alert one to the possibility of intussusception.

Colic↗
PubMed1992

The bubble sign in the gasless abdomen of the newborn.

The bubble sign (BS) in the gasless abdomen of the newborn is a helpful clue in the diagnosis of an upper gastrointestinal obstruction. The already swallowed air serves as the natural contrast agent. The single, double and triple BS are described in view of 23 cases indicating the level of the obstruction, and its differential diagnosis is discussed. The presence of BS in the gasless abdomen of the newborn is an indication for surgery until proved otherwise. With the increasing experience by ultrasonography, this modality should be considered as the first bed-side procedure when suspecting upper gastrointestinal obstruction, and then be confirmed by radiograms.

Air↗
PubMed1992

Case report: unusual presentation of splenic hamartoma; computed tomography and ultrasonic findings.

Hamartomas of the spleen are rare benign tumours, which are usually asymptomatic, incidental findings at laparotomy or autopsy (Komakl and Gombas, 1976; Brinkley and Lee, 1981; Norowitz and Morehouse, 1989). There are a few well documented reports of symptomatic splenic hamartoma associated with haematological disturbances, marked splenomegaly or even spontaneous rupture that required an emergency operation (Iozzo et al., 1980; Morgenstern et al., 1984). We report a patient with splenic hamartoma who presented with splenomegaly and iron deficiency anaemia. Computed tomographic (CT) and ultrasound (US) evaluation demonstrated an inhomogeneous mass within the enlarged spleen. Malignant melanoma was mistakenly diagnosed by US-guided fine needle aspiration of the mass, and necessitated splenectomy. The final diagnosis was hamartoma of the spleen.

Diagnosis, Differential↗
PubMed1991

Transperineal ultrasound examination in the evaluation of prostatic size.

Eighty patients with benign prostatic hyperplasia underwent transperineal ultrasonographic evaluation of prostatic size and calculation of prostatic volume. In 10 patients transabdominal prostatic ultrasonography was also performed and the findings compared with those of transperineal examination. The estimated prostatic volume measured by transperineal ultrasonography was compared to the actual weight of the surgically removed gland. The correlation coefficient was 0.89 (P less than 0.0001). The transperineal and transabdominal ultrasonographic estimated volumes were also compared. The correlation coefficient was 0.92 (P less than 0.0001). No pain or discomfort were reported by the patients. Transperineal ultrasonography appears to be an accurate, fast and easy method to evaluate prostatic volume.

Humans↗
PubMed1986

[Anemia in primary hyperparathyroidism].

Among the complications associated with primary hyperparathyroidism, anemia has not been extensively studied. In order to assess the frequency of this anemia we make a retrospective study of the medical records of 62 patients with a primary hyperparathyroidism. In 40 of the 62 hyperparathyroidic patients the diagnosis was surgically proven (group 1) and in 22, typical laboratory changes were found (group 2). In all these cases no other causes of anemia, except hyperparathyroidism, could be found. The 2 groups were similar concerning age and sex. A normochromicnormocytic anemia was present in 11 patients in group 1 (24,5%) and in 7 in group 2 (31, 8%). This anemia was corrected after a successfull parathyroidectomy (parathyroid adenoma in all the operated cases). Anemia was correlated with neither Ca and P blood levels nor C1/P ratio. A significant inverse correlation was found between age and hemoglobin in anemic hyperparathyroidic patients. The etiopathogeny of this findings is discussed.

Adenoma↗
PubMedDate not supplied

Intestinal malrotation as an incidental finding on CT in adults.

BACKGROUND: Intestinal malrotation in adults is usually an incidental finding on computed tomography (CT). We present the CT findings of 18 adult patients with malrotation and discuss the clinical implications. METHODS: Abdominal scans of 18 patients (12 women, six men; age range = 15-79 years) with intestinal malrotation were reviewed. Special attention was directed to the location of the superior mesenteric vessels, the location of the small and large bowels, the size of the uncinate process, the situs definition, and additional anomalies. RESULTS: The malrotation was an incidental finding in all but one patient. The malrotation was type Ia in 17 patients and IIc in the one symptomatic patient. The superior mesenteric vessels were vertically oriented in 10, inverted in two, normally positioned in four, and mirror imaged in two cases with situs ambiguus. All patients had aplasia of the pancreatic uncinate process, five had a short pancreas, and two had a preduodenal portal vein. Fourteen patients had a normal situs and four had heterotaxia. Seven patients had polysplenia, six of which with associated inferior vena cava anomalies. CONCLUSIONS: Intestinal malrotation can be diagnosed on CT by the anatomic location of a right-sided small bowel, left-sided colon, an abnormal relationship of the superior mesenteric vessels, and aplasia of the uncinate process. Awareness of these abnormalities is necessary to diagnose this anomaly. It should be sought in patients with a situs problem, inferior vena cava anomalies, polysplenia, or preduodenal portal vein. Although usually an incidental finding, it is important to diagnose such a malrotation because it may cause abdominal symptoms. Also, knowledge of associated vascular anomalies is important when abdominal surgery is planned.

Adolescent↗
PubMedDate not supplied

Role of imaging in the diagnosis of acute appendicitis in children.

The aim of the study was to investigate the place of imaging in the diagnosis and treatment of acute appendicitis. The files of 2,427 children with suspected acute appendicitis were reviewed for clinical management and operative findings. The sample was divided into 3 groups at time of admission: (1) before diagnostic imaging was available in our department (1991-1994); (2) after the introduction of imaging studies on a random basis in equivocal cases (1995-1998); and (3) after a policy was formulated for ultrasound use in all equivocal cases followed by computed tomography if necessary (1999-2000). Results showed that the rate of misdiagnosis decreased from 13.2% in group 1 to 6.5% in group 2 and 6.1% in group 3. False-positive findings (normal appendix with positive scan) were noted in 16.7% of group 2 and 25% of group 3; false-negative findings (appendicitis at surgery with negative scan) in 23.8% and 9.5%, respectively. Computed tomography was performed in 8 children and prevented unnecessary surgery in 4 of them. We conclude that in equivocal cases of acute appendicitis, imaging studies performed by skilled operators can improve the accuracy of diagnosis, saving patients unnecessary surgery, and identifying other conditions that mimic appendicitis.

Abdomen, Acute↗