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Significance of intraarticular fluid without visible fracture in children
INTERNATIONAL ABSTRACTS
next 3 years radiologic union was shown to have occurred. The authors point out that presently accepted forms of treatment all have drawbacks: curretage is followed by a high recurrence rate, resection en bloc may be difficult and hazardous, and radiotherapy for a condition that may regress spontaneously is unacceptable. They feel that as long as the situation of the tumor is such that it does not threaten mechanical or functional failure, it is sufficient to observe progress in the hope of natural healing.--G.C. Bennet Significance of Intraarticular Fluid without Visible Fracture in Children. L.E. Swischuk, C.K. Hoyden, and M.C. Kupfer. Am J
469
453 siblings of whom five (11.1 per 1,000) had congenital hydrocephalus and nine (19.9 per 1,000) had neural tube defects. These data, together with those obtained from the literature, indicate that the etiology of the two conditions is probably the same in many cases, although there are unusual exceptions in special families, even apart from families with the sex-linked recessively inherited hydrocephalus. These findings suggest that parents of children with uncomplicated hydrocephalus should have adequate antenatal tests for the detection of neural tube defects as well as for hydrocephalus and may need similar prophylactic treatment as do parents of children with spina bifida and anencephaly.--Thomas A. Angerpointner
Roentgenol 142:1261-1262, (June), 1984. A prospective study of 128 pediatric patients with joint trauma and radiographic evidence of joint fluid without visible fracture yielded two groups for evaluation. Group 1 patients sustained mild injury and were instructed to return if symptoms worsened or persisted. Of 72 patients in this group, 18 returned but only 7 were felt to need repeat radiographs (65 patients without repeat studies). Group 2 sustained more severe injuries and had repeat radiographs at 10 to 14 days postinjury (63 patients with repeat studies). Injuries involved the elbow (46), wrist (5), knee (16), and ankle (61). Occult fractures occurred in 8 of the 63 patients undergoing repeat studies with the site incidence being 4 of 26 elbow, 2 of 3 wrist, 0 of 7 knee, and 2 of 27 ankle injuries. The authors feel this prospective study reveals a lower incidence of occult fractures in patients with radiographic signs of joint fluid but no visible fracture on initial radiographs. They recommend selective repeat radiographs in patients with more severe clinical injuries, persistent symptoms, or wrist injuries (67% incidence).--Randall W. Powell N E R V O U S SYSTEM Genetic Aspects of "Uncomplicated" Hydrocephalus and Its Relationship to Neural Tube Defects. K.M. Laurence. Z Kinderchir
39:96-99, (suppl 2) (December), 1984. Congenital hydrocephalus is a relatively uncommon abnormality in population surveys occurring in 4 to 10 births out of 10,000. In 30%, it is caused by aqueduct stenosis. The majority of cases have multifactorial etiologies, the genetic component, which is polygenic, rendering the developing fetus susceptible to largely unidentified environmental factors in early development. Some cases are caused by single gene defects. Family studies suggest that the risk to siblings of a child with uncomplicated congenital hydrocephalus, where the anatomical site is not specified, is about 1 in 50 (1 in 40 for males, 1 in 80 for females). With aqueduct stenosis, the risk to brothers of affected boys is 1 in 22; to sisters only 1 in 50. The risk to siblings of sisters is less. Probably less than 2% of uncomplicated cases have an X-linked basis and should be suspected if the special clinical features are present, there is more than one male sibling affected, or there are affected male relatives on the mother's side. Dandy-Walker's syndrome may be recessively inherited, and there are some other, very rare, monogenic causes for hydrocephalus. There is no obvious additional risk for neural tube defect. Nondirective genetic counseling should be given and should include not only the risk to family members but also the options for avoiding recurrences, and any prenatal diagnostic tests available, such as high precision ultrasonography and a serum alphafetoprotein estimation at about 16 weeks gestation. Amniocentesis for the identification of open neural tube defects is neither necessary nor justified.--Thomas A. Angerpointner The Family History of "Simple" Congenital Hydrocephalus. J.
Lorber. Z Kinderchir 39:94-95, (suppl 2) (December), 1984. A longitudinal study was performed on the family histories of 270 babies with uncomplicated congenital hydrocephalus. There were
Wandering Distal Ends of Ventriculo-Peritoneal Shunts. S. Prabhu,
W. Cochran, and A.F. Azmy. Z. Kinderchir 40:80-81, (April), 1985. Four unusual complications after ventriculo-peritoneal shunts for hydrocephalus are presented. Disconnection of the peritoneal catheter was followed by extrusion per rectum in three cases and migration to an open vaginal processus in another. Tubes were pulled out via the rectum in three cases and via an inguinal incision in the other. Neither techniques nor equipment seem to predispose to these complications.-- Thomas A. Angerpointner Sonographic Recognition of In Utero Intraventricular Hemorrhage.
J.P. McGahan, H.C. Haesslein, M. Meyers, et al. Am J Roentgenol 142:171-173, (January), 1984. The authors report the findings of an intraventricular bleed in a fetus at 34-weeks gestation with subsequent development of hydrocephalus. The latter prompted steroid therapy to enhance lung maturation and early delivery by C-section. A ventriculo-peritoneal shunt was placed, and at 6 months of age mild esotropia and mild hemiparesis are present. The authors believe this case represents the first documented case of in utero hemorrhage by sonography with confirmation postdelivery in a surviving infant.--Randall IV. Pewell Digital Myelography of Spinal Dysraphism in Infancy: Preliminary Results. P.D. Barnes, A.F. Reynolds, D.C. Galloway, et al. Am J
Roentgenol 142:1249-1252, (June), 1984. The authors present their results in four infants evaluated by digital myelography with the findings of simultaneous separation of bone and neural elements. The technique allows lower doses of metrizamide and lowers radiation dosage. CT scanning can be done immediately, using the findings from digital myelography as a guide. The authors describe their technique in detail and present their findings in two infants (lumbosacral myelomeningocele and sacral agenesis with tethered cord).--Randall W. Powell High Resolution Spinal Sonography in Infants. H. Kangarloos, R.H.
Gold, M.J. Diament, et al. Am J Roentgenol 142:1243-1247, (June), 1984. Real time spinal sonography in 27 infants aged 1 day to 3 months, yielded nine infants with abnormalities. The former included syringomyelia, cord hematoma, spina bifida with enlarged dural sac and tethered cord, lipomatous tissue at filum terminate with tethered cord (2), hemivertebrae (2), subcutaneous lipoma, and a sinus tract. The transverse real time sonogram detects osteochondral anomalies and asymmetry of the spinal column, while the longitudinal scan provides information about the spinal cord and its arteries. The authors illustrate normal anatomy and two anomalies.--Randall W. Powell
next 3 years radiologic union was shown to have occurred. The authors point out that presently accepted forms of treatment all have drawbacks: curretage is followed by a high recurrence rate, resection en bloc may be difficult and hazardous, and radiotherapy for a condition that may regress spontaneously is unacceptable. They feel that as long as the situation of the tumor is such that it does not threaten mechanical or functional failure, it is sufficient to observe progress in the hope of natural healing.--G.C. Bennet Significance of Intraarticular Fluid without Visible Fracture in Children. L.E. Swischuk, C.K. Hoyden, and M.C. Kupfer. Am J
469
453 siblings of whom five (11.1 per 1,000) had congenital hydrocephalus and nine (19.9 per 1,000) had neural tube defects. These data, together with those obtained from the literature, indicate that the etiology of the two conditions is probably the same in many cases, although there are unusual exceptions in special families, even apart from families with the sex-linked recessively inherited hydrocephalus. These findings suggest that parents of children with uncomplicated hydrocephalus should have adequate antenatal tests for the detection of neural tube defects as well as for hydrocephalus and may need similar prophylactic treatment as do parents of children with spina bifida and anencephaly.--Thomas A. Angerpointner
Roentgenol 142:1261-1262, (June), 1984. A prospective study of 128 pediatric patients with joint trauma and radiographic evidence of joint fluid without visible fracture yielded two groups for evaluation. Group 1 patients sustained mild injury and were instructed to return if symptoms worsened or persisted. Of 72 patients in this group, 18 returned but only 7 were felt to need repeat radiographs (65 patients without repeat studies). Group 2 sustained more severe injuries and had repeat radiographs at 10 to 14 days postinjury (63 patients with repeat studies). Injuries involved the elbow (46), wrist (5), knee (16), and ankle (61). Occult fractures occurred in 8 of the 63 patients undergoing repeat studies with the site incidence being 4 of 26 elbow, 2 of 3 wrist, 0 of 7 knee, and 2 of 27 ankle injuries. The authors feel this prospective study reveals a lower incidence of occult fractures in patients with radiographic signs of joint fluid but no visible fracture on initial radiographs. They recommend selective repeat radiographs in patients with more severe clinical injuries, persistent symptoms, or wrist injuries (67% incidence).--Randall W. Powell N E R V O U S SYSTEM Genetic Aspects of "Uncomplicated" Hydrocephalus and Its Relationship to Neural Tube Defects. K.M. Laurence. Z Kinderchir
39:96-99, (suppl 2) (December), 1984. Congenital hydrocephalus is a relatively uncommon abnormality in population surveys occurring in 4 to 10 births out of 10,000. In 30%, it is caused by aqueduct stenosis. The majority of cases have multifactorial etiologies, the genetic component, which is polygenic, rendering the developing fetus susceptible to largely unidentified environmental factors in early development. Some cases are caused by single gene defects. Family studies suggest that the risk to siblings of a child with uncomplicated congenital hydrocephalus, where the anatomical site is not specified, is about 1 in 50 (1 in 40 for males, 1 in 80 for females). With aqueduct stenosis, the risk to brothers of affected boys is 1 in 22; to sisters only 1 in 50. The risk to siblings of sisters is less. Probably less than 2% of uncomplicated cases have an X-linked basis and should be suspected if the special clinical features are present, there is more than one male sibling affected, or there are affected male relatives on the mother's side. Dandy-Walker's syndrome may be recessively inherited, and there are some other, very rare, monogenic causes for hydrocephalus. There is no obvious additional risk for neural tube defect. Nondirective genetic counseling should be given and should include not only the risk to family members but also the options for avoiding recurrences, and any prenatal diagnostic tests available, such as high precision ultrasonography and a serum alphafetoprotein estimation at about 16 weeks gestation. Amniocentesis for the identification of open neural tube defects is neither necessary nor justified.--Thomas A. Angerpointner The Family History of "Simple" Congenital Hydrocephalus. J.
Lorber. Z Kinderchir 39:94-95, (suppl 2) (December), 1984. A longitudinal study was performed on the family histories of 270 babies with uncomplicated congenital hydrocephalus. There were
Wandering Distal Ends of Ventriculo-Peritoneal Shunts. S. Prabhu,
W. Cochran, and A.F. Azmy. Z. Kinderchir 40:80-81, (April), 1985. Four unusual complications after ventriculo-peritoneal shunts for hydrocephalus are presented. Disconnection of the peritoneal catheter was followed by extrusion per rectum in three cases and migration to an open vaginal processus in another. Tubes were pulled out via the rectum in three cases and via an inguinal incision in the other. Neither techniques nor equipment seem to predispose to these complications.-- Thomas A. Angerpointner Sonographic Recognition of In Utero Intraventricular Hemorrhage.
J.P. McGahan, H.C. Haesslein, M. Meyers, et al. Am J Roentgenol 142:171-173, (January), 1984. The authors report the findings of an intraventricular bleed in a fetus at 34-weeks gestation with subsequent development of hydrocephalus. The latter prompted steroid therapy to enhance lung maturation and early delivery by C-section. A ventriculo-peritoneal shunt was placed, and at 6 months of age mild esotropia and mild hemiparesis are present. The authors believe this case represents the first documented case of in utero hemorrhage by sonography with confirmation postdelivery in a surviving infant.--Randall IV. Pewell Digital Myelography of Spinal Dysraphism in Infancy: Preliminary Results. P.D. Barnes, A.F. Reynolds, D.C. Galloway, et al. Am J
Roentgenol 142:1249-1252, (June), 1984. The authors present their results in four infants evaluated by digital myelography with the findings of simultaneous separation of bone and neural elements. The technique allows lower doses of metrizamide and lowers radiation dosage. CT scanning can be done immediately, using the findings from digital myelography as a guide. The authors describe their technique in detail and present their findings in two infants (lumbosacral myelomeningocele and sacral agenesis with tethered cord).--Randall W. Powell High Resolution Spinal Sonography in Infants. H. Kangarloos, R.H.
Gold, M.J. Diament, et al. Am J Roentgenol 142:1243-1247, (June), 1984. Real time spinal sonography in 27 infants aged 1 day to 3 months, yielded nine infants with abnormalities. The former included syringomyelia, cord hematoma, spina bifida with enlarged dural sac and tethered cord, lipomatous tissue at filum terminate with tethered cord (2), hemivertebrae (2), subcutaneous lipoma, and a sinus tract. The transverse real time sonogram detects osteochondral anomalies and asymmetry of the spinal column, while the longitudinal scan provides information about the spinal cord and its arteries. The authors illustrate normal anatomy and two anomalies.--Randall W. Powell