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Periosteal chondromas of the anterior tibial tubercle: Two cases
400
ABSTRACTS
of 44 girls with initial scars with no difference between the groups. All girls with progressive scarring had vesico-ureteric reflux compared with an overall incidence of vesico-ureteric reflux of 34% in the entire group. Vesico-ureteric reflux disappeared from 33 out of 81 ureters, and improved in 17 out of 81 ureters with no difference between the groups but disappearance of reflux occurred in only 17% of grade III reflux compared to 62% of grades I and II reflux. Treatment did not influence the growth of kidneys nor grades I and II of reflux. The conclusion from the study was that renal deterioration took place in 10% of the 208 girls, representing a total incidence of 1 in 500 of all schoolgirls and that antibiotic treatment had no influence on the emergence of symptoms, the clearance of vesico-ureteric reflux, kidney growth or the progression of kidney scarring.--J. G. Harvey Pneumopelvigraphy in Childhood. P. D. Lester and W. H.
Mc`41ister. Am J Roentgenol 131:607-612, (October), 1978.
A retrospective review of 150 infants and children undergoing pelvic pneumography revealed 118 females and 32 males being studied. Reasons for this study included the evaluation of precocious puberty, hirsutism, amenorrhea, Turner's syndrome, ambiguous and abnormal genitalia, suspected pelvic masses, mobile pelvic calcifications, intersex problems, unexplained abdominal pain, and to detect ~ontralateral open peritoneal sacs in patients with unilateral inguinal hernias. Complications included 1 bladder and 2 intestinal punctures with no adverse effects. The authors state that ultrasonography has decreased the indications for pelvic pneumography except for the evaluation of internal genital structures in infants and small children. Computed tomography may further decrease the need for this procedure.--Randall W. Powell Radiographic Findings in Ovarian Teratomas in Children.
M. J. Siegal, W. H. Mc`41ister, and G. D. Shackelford. Am J Roentgenol 131:613-616, (October), 1978. A retrospective review of radiographs of 21 patients with surgically confirmed ovarian teratomas revealed calcification in 15 patients (68%) and recognizable teeth in 6 (29%). In nine patients, the tumor was primarily intraabdominal in location. Calcifications were not present in the 2 primary malignant teratomas but were present in retroperitoneal metastases in 1 patient. In one patient, the calcifications migrated to different quadrants and at exploration a free floating cystic mass was found with the left ovary being absent. Other causes of migratory abdominal calcifications include amputated appendices epiploicae, omental deposits, mummified pieces of small bowel, various enteroliths, liquid calcification in a psoas abscess, gallstones, and omental or mesenteric cysts.--Randall W. Powell
MUSCULOSKELETAL SYSTEM Fractures of the Odontoid Process in Children. E, H. Sherk, A. C. Nicholson, and S. N. Chung. J Bone Joint Surg 60A:1901-1904, (October), 1978.
Eleven patients, under 7 yr of age, were studied for the natural history of odontoid fractures. The average age was three. There were 6 girls and 5 boys. No direct neurologic
lesions were associated with the fractures. The authors concluded that, with extension reduction and maintenance of the reduction, first with bedrest and ultimately with bracing, fracture healing will occur. There were no cases of nonunion, osteonecrosis, or growth disturbance.--Anthony H. Alter Vertebral Osteomyelitis in Children: Report of Four Cases.
R. Bolivar, S. Kohl, and L. K. Pickering. Pediatrics 62:549553, (October), 1978. Four children (aged 4 and 7 yr, 1 and 3 mo) were diagnosed as having vertebral osteomyelitis due to staphylococcus aureus. Presenting symptoms and signs were abdominal pain with tenderness and fever. Back pain was an uncommon symptom except as a late manifestation, and then only in one patient. The infection occurred in the low thoracic and lumbar spine. The diagnoses were based on x-ray changes, radionuclide imaging, and bacteriologic corroboration. The portal of entry of the organisms was not apparent except in one infant who also had pneumonic infiltrations due to staphylococcus. It is concluded that the symptoms and signs of vertebral osteomyelitis in children are often atypical and that there is need for prompt diagnosis, and aggressive treatment if orthopedic and neurologic sequelae are to be prevented.--Colin C. Ferguson The Spine in Osteogenesis Imperfecta. D. R. Benson, D. H.
Donaldson, and ,4. Millard. J Bone Joint Surg 60A:925929, (October), 1978. One-hundred and three patients with osteogenesis imperfecta had spinal x-rays available for study. Thirty-nine had straight spines with 7 curves of 0~ to 9~ (Cobb method), 10 had curves of 10~ to 19~ 14 curves from 20~ to 49 ~ 14 had curves from 50~ to 79 ~ and 9 had curves greater than 80~ Early progression of these particular curves were documented. Conservative bracing was ineffective in 8 of the 9 curves so treated. The authors conclude that because of the technical problems doing Harrington type fusions on this type of spine, the spine should be fused early before significant progression occurs, as progression is the rule. By fusing early, significant noncorrectible deformity may be prevented.--,4nthony H. Alter Periosteal Chondromas of the Anterior Tibial Tubercle: T w o Cases. S. G. Kirchner, H. Pavlov, R. M. Heller, and J.
J. Kaye. Am J Roentgenol 131:1088-1089, (December), 1978. A 6-yr-old boy and an 8-yr-old boy presented with masses beneath the left knee. X-rays revealed partially calcified masses in the soft tissue anterior to the proximal tibia in the area of the anterior tibial tubercle. Biopsies revealed periosteal or juxtacortical chondromas. Periosteal chondromas are relatively rare benign cartilaginous tumors seen in children and young adults usually in the tubular bones of the hands and feet. Characteristic radiologic features include a localized soft tissue mass that may contain cartilaginous calcification or ossification and cortical erosion with subjacent sclerosis. The differential diagnosis includes osteochondromas, fibrous cortical defect, cortical desmoid, chondrosarcomas, osteosarcomas, and synovial sarcomas. The two cases
ABSTRACTS
401
presented were atypical in location and radiographic presentation. Randall HI. Powell
Surgical Relief of Progressive Upper Limb Paralysis in Arnold-Chiari M a l f o r m a t i o n . A. Gol and L. Hellbusch. J
Neurol Neurosurg Psychiatr 41:433-437, (May), 1978. NERVOUS SYSTEM Avoidance of Anencephalic and Spina Bifida Births by Maternal Serum-Alphafetoprotein Screening. M. A. Gerguson-Smith, H. A. Rawlinson, H. M. May, H. A. Tait, J. D. Vince, A. A. M. Gibson, H. P. Robinson, and J. G. Ratcliffe.
Lancet 1:1330 1332, (June), 1978. The authors report a pilot study to determine the benefits and disadvantages of a national screening program for neural tube defects. Pregnant women (11,585) were screened for raised serum alphafetoprotein between 16 and 20 wk of gestation. Of affected pregnancies 93%, (anencephaly 100%, open spina bifida 81.2%) were detected. Of false positives, 75.2% were excluded by a repeat serum sample or by ultrasonography. Of pregnancies, 0.063% proceeded to amniocentesis and of these, 46.6% showed raised amniotic alpha-fetoprotein levels due to fetal abnormality. Fetal loss following amniocentesis occurred in 0.034% of all those screened. The birth of 81.4% of babies with open neural tube defects (96.3% anencephalic, 56.2% open spina bifida) could be avoided reducing the incidence of all neural tube defects in the sample screen from 4.9/1000 to 1.5/ 1000. The authors stress that (1) screening must be voluntary; (2) a high standard of ultrasonography is essential; and (3) effective organisation is required for diagnostic tests and counseling. J. G. Harvey Growing Fractures of the Skull. D. Kingsley, K. Till, and R. Hoave. J Neurol Neurosurg Psychiatr 41:312 318, (April),
1978. The authors report on 10 cases collected over 10 yr. Six of the patients sustained the injury within 6 mo of life. The defects formed rapidly, several within 2-3 mo after injury. Most commonly, the parietal bone was involved. The edges of the defects were usually thickened. The ipsilateral ventricle was usually dilated and in a number was associated with a porencephalic cyst. In two, the latter connected with an extra-cranial fluid-filled cavity. The nature of the lesions is still not understood. The defects are almost unknown after the first few years of life. The single most important etiologic factor is a dural tear. Brain injury occurs beneath the fracture. At the edges of the defect, the brain and meninges are adherent. In this series, there was considerable damage to the underlying brain but none had neurologic symptoms.-R. J. Brereton Subdural Hematoma and the Malfunctioning Shunt. A. H. Moussa and S. K. Sharma. J Neurol Neurosurg Psychiatr
The authors review the subject and previous literature. They report 2 patients, 1, a girl of 13 yr, the other a man of 46, and describe relief of symptoms and signs by various operations upon the cervical spine. The girl had hydrocephalus but neither patient had spina bifida. The problem of hydromyelia of the cervical cord and upper limb weakness is not rare in older children with spina bifida, and it is likely that at least some of these teenagers would benefit from the procedures described by these authors in this preliminary report.--R. J. Brereton Brain Abscesses in Infants and Children. Z. H. ldriss, L. T. Gutman, and N. M. Kronfol. Clin Pediatr 17:738-746,
(October), 1978. Forty-two children presented with brain abscesses with two being found at post-mortem. Twenty-five patients were treated at the American University Medical Center (Beirut) and 17 at the Duke University Medical Center. Ages ranged from 1 mo to 18 yr with 9 patients being less than 1 yr of age. Most presented with fever, headache, and vomiting, and less commonly, with other neurologic signs. The complex of otitis-mastoiditis-sinusitis and congenital cyanotic heart disease were the most common underlying disease processes. Six of the 9 patients less than 1 yr had meningitis and 3 had cyanotic heart disease. Staph aureus and anaerobic or microaerophilic streptococci represented 18 of the 34 cases from which bacteria were isolated. Sixteen (38%) patients recovered completely and 12 (29%) were left with residual neurologic deficits. Fourteen (35%) patients died, I0 of these presenting with drowsiness or coma. Prompt recognition, now aided by CT scans, antibiotic treatment, and prompt surgical drainage should lower the high mortality and morbidity.--Randall HI. Powell Squamous Cell Carcinoma Arising in a Meningomyelocele. J. M. Saksun and B. K. Fisher. Can Med Assoc J 119:739741, (October), 1978.
Squamous cell carcinoma developed in an untreated meningomyelocele of a 25-yr-old man. The lesion was biopsled and then treated by radiation therapy. Eight weeks after completion of treatment, the patient died of meningitis despite antibiotic therapy. The authors stress the need for careful observation of patients with chronic scars, ulcers, and areas of inflammation, and recommend early biopsy to detect malignant change in any such lesion which undergoes a significant change in appearance.--Colin C. Ferguson
41:759 761, (August), 1978. NEOPLASMS Of 30 consecutive children with hydrocephalus treated by shunt implant, 6 developed subdural hematoma. Four presented with a malfunctioning shunt. The diagnosis in all six was made by a CAT scan. Five of the six had low pressure Pudenz ventriculo-atrial shunts. Of the 6, 3 had the hematomas evacuated through burr holes and 1 died. Of the remaining three, none required treatment. It is thought that the low pressure valve was an important etiologic factor.--R. J. Brereton
Testicular Histology After Combination Chemotherapy in Childhood for Acute Lymphoblastic Leukemia. M. Lendon, 1. M. Hann, M. K. Palmer, S. M. Shalet, and P. H. Morris Jones. Lancet 2:439-441, (August), 1978.
A study of testicular histology in 44 boys treated with combination chemotherapy for acute lymphoblastic leukemia. Twenty-one boys were still being treated with cytotoxic drugs; 23 had completed the course of treatment at times
ABSTRACTS
of 44 girls with initial scars with no difference between the groups. All girls with progressive scarring had vesico-ureteric reflux compared with an overall incidence of vesico-ureteric reflux of 34% in the entire group. Vesico-ureteric reflux disappeared from 33 out of 81 ureters, and improved in 17 out of 81 ureters with no difference between the groups but disappearance of reflux occurred in only 17% of grade III reflux compared to 62% of grades I and II reflux. Treatment did not influence the growth of kidneys nor grades I and II of reflux. The conclusion from the study was that renal deterioration took place in 10% of the 208 girls, representing a total incidence of 1 in 500 of all schoolgirls and that antibiotic treatment had no influence on the emergence of symptoms, the clearance of vesico-ureteric reflux, kidney growth or the progression of kidney scarring.--J. G. Harvey Pneumopelvigraphy in Childhood. P. D. Lester and W. H.
Mc`41ister. Am J Roentgenol 131:607-612, (October), 1978.
A retrospective review of 150 infants and children undergoing pelvic pneumography revealed 118 females and 32 males being studied. Reasons for this study included the evaluation of precocious puberty, hirsutism, amenorrhea, Turner's syndrome, ambiguous and abnormal genitalia, suspected pelvic masses, mobile pelvic calcifications, intersex problems, unexplained abdominal pain, and to detect ~ontralateral open peritoneal sacs in patients with unilateral inguinal hernias. Complications included 1 bladder and 2 intestinal punctures with no adverse effects. The authors state that ultrasonography has decreased the indications for pelvic pneumography except for the evaluation of internal genital structures in infants and small children. Computed tomography may further decrease the need for this procedure.--Randall W. Powell Radiographic Findings in Ovarian Teratomas in Children.
M. J. Siegal, W. H. Mc`41ister, and G. D. Shackelford. Am J Roentgenol 131:613-616, (October), 1978. A retrospective review of radiographs of 21 patients with surgically confirmed ovarian teratomas revealed calcification in 15 patients (68%) and recognizable teeth in 6 (29%). In nine patients, the tumor was primarily intraabdominal in location. Calcifications were not present in the 2 primary malignant teratomas but were present in retroperitoneal metastases in 1 patient. In one patient, the calcifications migrated to different quadrants and at exploration a free floating cystic mass was found with the left ovary being absent. Other causes of migratory abdominal calcifications include amputated appendices epiploicae, omental deposits, mummified pieces of small bowel, various enteroliths, liquid calcification in a psoas abscess, gallstones, and omental or mesenteric cysts.--Randall W. Powell
MUSCULOSKELETAL SYSTEM Fractures of the Odontoid Process in Children. E, H. Sherk, A. C. Nicholson, and S. N. Chung. J Bone Joint Surg 60A:1901-1904, (October), 1978.
Eleven patients, under 7 yr of age, were studied for the natural history of odontoid fractures. The average age was three. There were 6 girls and 5 boys. No direct neurologic
lesions were associated with the fractures. The authors concluded that, with extension reduction and maintenance of the reduction, first with bedrest and ultimately with bracing, fracture healing will occur. There were no cases of nonunion, osteonecrosis, or growth disturbance.--Anthony H. Alter Vertebral Osteomyelitis in Children: Report of Four Cases.
R. Bolivar, S. Kohl, and L. K. Pickering. Pediatrics 62:549553, (October), 1978. Four children (aged 4 and 7 yr, 1 and 3 mo) were diagnosed as having vertebral osteomyelitis due to staphylococcus aureus. Presenting symptoms and signs were abdominal pain with tenderness and fever. Back pain was an uncommon symptom except as a late manifestation, and then only in one patient. The infection occurred in the low thoracic and lumbar spine. The diagnoses were based on x-ray changes, radionuclide imaging, and bacteriologic corroboration. The portal of entry of the organisms was not apparent except in one infant who also had pneumonic infiltrations due to staphylococcus. It is concluded that the symptoms and signs of vertebral osteomyelitis in children are often atypical and that there is need for prompt diagnosis, and aggressive treatment if orthopedic and neurologic sequelae are to be prevented.--Colin C. Ferguson The Spine in Osteogenesis Imperfecta. D. R. Benson, D. H.
Donaldson, and ,4. Millard. J Bone Joint Surg 60A:925929, (October), 1978. One-hundred and three patients with osteogenesis imperfecta had spinal x-rays available for study. Thirty-nine had straight spines with 7 curves of 0~ to 9~ (Cobb method), 10 had curves of 10~ to 19~ 14 curves from 20~ to 49 ~ 14 had curves from 50~ to 79 ~ and 9 had curves greater than 80~ Early progression of these particular curves were documented. Conservative bracing was ineffective in 8 of the 9 curves so treated. The authors conclude that because of the technical problems doing Harrington type fusions on this type of spine, the spine should be fused early before significant progression occurs, as progression is the rule. By fusing early, significant noncorrectible deformity may be prevented.--,4nthony H. Alter Periosteal Chondromas of the Anterior Tibial Tubercle: T w o Cases. S. G. Kirchner, H. Pavlov, R. M. Heller, and J.
J. Kaye. Am J Roentgenol 131:1088-1089, (December), 1978. A 6-yr-old boy and an 8-yr-old boy presented with masses beneath the left knee. X-rays revealed partially calcified masses in the soft tissue anterior to the proximal tibia in the area of the anterior tibial tubercle. Biopsies revealed periosteal or juxtacortical chondromas. Periosteal chondromas are relatively rare benign cartilaginous tumors seen in children and young adults usually in the tubular bones of the hands and feet. Characteristic radiologic features include a localized soft tissue mass that may contain cartilaginous calcification or ossification and cortical erosion with subjacent sclerosis. The differential diagnosis includes osteochondromas, fibrous cortical defect, cortical desmoid, chondrosarcomas, osteosarcomas, and synovial sarcomas. The two cases
ABSTRACTS
401
presented were atypical in location and radiographic presentation. Randall HI. Powell
Surgical Relief of Progressive Upper Limb Paralysis in Arnold-Chiari M a l f o r m a t i o n . A. Gol and L. Hellbusch. J
Neurol Neurosurg Psychiatr 41:433-437, (May), 1978. NERVOUS SYSTEM Avoidance of Anencephalic and Spina Bifida Births by Maternal Serum-Alphafetoprotein Screening. M. A. Gerguson-Smith, H. A. Rawlinson, H. M. May, H. A. Tait, J. D. Vince, A. A. M. Gibson, H. P. Robinson, and J. G. Ratcliffe.
Lancet 1:1330 1332, (June), 1978. The authors report a pilot study to determine the benefits and disadvantages of a national screening program for neural tube defects. Pregnant women (11,585) were screened for raised serum alphafetoprotein between 16 and 20 wk of gestation. Of affected pregnancies 93%, (anencephaly 100%, open spina bifida 81.2%) were detected. Of false positives, 75.2% were excluded by a repeat serum sample or by ultrasonography. Of pregnancies, 0.063% proceeded to amniocentesis and of these, 46.6% showed raised amniotic alpha-fetoprotein levels due to fetal abnormality. Fetal loss following amniocentesis occurred in 0.034% of all those screened. The birth of 81.4% of babies with open neural tube defects (96.3% anencephalic, 56.2% open spina bifida) could be avoided reducing the incidence of all neural tube defects in the sample screen from 4.9/1000 to 1.5/ 1000. The authors stress that (1) screening must be voluntary; (2) a high standard of ultrasonography is essential; and (3) effective organisation is required for diagnostic tests and counseling. J. G. Harvey Growing Fractures of the Skull. D. Kingsley, K. Till, and R. Hoave. J Neurol Neurosurg Psychiatr 41:312 318, (April),
1978. The authors report on 10 cases collected over 10 yr. Six of the patients sustained the injury within 6 mo of life. The defects formed rapidly, several within 2-3 mo after injury. Most commonly, the parietal bone was involved. The edges of the defects were usually thickened. The ipsilateral ventricle was usually dilated and in a number was associated with a porencephalic cyst. In two, the latter connected with an extra-cranial fluid-filled cavity. The nature of the lesions is still not understood. The defects are almost unknown after the first few years of life. The single most important etiologic factor is a dural tear. Brain injury occurs beneath the fracture. At the edges of the defect, the brain and meninges are adherent. In this series, there was considerable damage to the underlying brain but none had neurologic symptoms.-R. J. Brereton Subdural Hematoma and the Malfunctioning Shunt. A. H. Moussa and S. K. Sharma. J Neurol Neurosurg Psychiatr
The authors review the subject and previous literature. They report 2 patients, 1, a girl of 13 yr, the other a man of 46, and describe relief of symptoms and signs by various operations upon the cervical spine. The girl had hydrocephalus but neither patient had spina bifida. The problem of hydromyelia of the cervical cord and upper limb weakness is not rare in older children with spina bifida, and it is likely that at least some of these teenagers would benefit from the procedures described by these authors in this preliminary report.--R. J. Brereton Brain Abscesses in Infants and Children. Z. H. ldriss, L. T. Gutman, and N. M. Kronfol. Clin Pediatr 17:738-746,
(October), 1978. Forty-two children presented with brain abscesses with two being found at post-mortem. Twenty-five patients were treated at the American University Medical Center (Beirut) and 17 at the Duke University Medical Center. Ages ranged from 1 mo to 18 yr with 9 patients being less than 1 yr of age. Most presented with fever, headache, and vomiting, and less commonly, with other neurologic signs. The complex of otitis-mastoiditis-sinusitis and congenital cyanotic heart disease were the most common underlying disease processes. Six of the 9 patients less than 1 yr had meningitis and 3 had cyanotic heart disease. Staph aureus and anaerobic or microaerophilic streptococci represented 18 of the 34 cases from which bacteria were isolated. Sixteen (38%) patients recovered completely and 12 (29%) were left with residual neurologic deficits. Fourteen (35%) patients died, I0 of these presenting with drowsiness or coma. Prompt recognition, now aided by CT scans, antibiotic treatment, and prompt surgical drainage should lower the high mortality and morbidity.--Randall HI. Powell Squamous Cell Carcinoma Arising in a Meningomyelocele. J. M. Saksun and B. K. Fisher. Can Med Assoc J 119:739741, (October), 1978.
Squamous cell carcinoma developed in an untreated meningomyelocele of a 25-yr-old man. The lesion was biopsled and then treated by radiation therapy. Eight weeks after completion of treatment, the patient died of meningitis despite antibiotic therapy. The authors stress the need for careful observation of patients with chronic scars, ulcers, and areas of inflammation, and recommend early biopsy to detect malignant change in any such lesion which undergoes a significant change in appearance.--Colin C. Ferguson
41:759 761, (August), 1978. NEOPLASMS Of 30 consecutive children with hydrocephalus treated by shunt implant, 6 developed subdural hematoma. Four presented with a malfunctioning shunt. The diagnosis in all six was made by a CAT scan. Five of the six had low pressure Pudenz ventriculo-atrial shunts. Of the 6, 3 had the hematomas evacuated through burr holes and 1 died. Of the remaining three, none required treatment. It is thought that the low pressure valve was an important etiologic factor.--R. J. Brereton
Testicular Histology After Combination Chemotherapy in Childhood for Acute Lymphoblastic Leukemia. M. Lendon, 1. M. Hann, M. K. Palmer, S. M. Shalet, and P. H. Morris Jones. Lancet 2:439-441, (August), 1978.
A study of testicular histology in 44 boys treated with combination chemotherapy for acute lymphoblastic leukemia. Twenty-one boys were still being treated with cytotoxic drugs; 23 had completed the course of treatment at times