Treatment of overt isolated testicular relapse in children on therapy for acute lymphoblastic leukemia. A report from the Childrens Cancer Group.

Background: Fifty-seven children with acute lymphoblastic leukemia (ALL) receiving therapy who experienced overt isolated testicular relapse while in bone marrow remission were entered into a study that featured an intensive retreatment regimen.

Methods: The objective was to determine whether a change in chemotherapy and local irradiation would prevent subsequent marrow relapse and increase the survival rate. The regimens used (modified Berlin-Frankfurt-Munster or modified New York) delivered acceptable therapy based on analyses of toxicity data.

Beckwith-Wiedemann syndrome: development of nephroblastoma during the surveillance period.

Two children, with Beckwith-Wiedemann syndrome and hemihypertrophy who were followed by ultrasonography, developed a large nephroblastoma in the interval between two abdominal ultrasound examinations. The customarily suggested bi-annual examinations are not frequent enough and may give physicians and parents a false sense of security.

Jejunal atresia with 'apple peel' deformity. A report of eight survivors.

Jejunal atresia with an "apple peel" deformity is one of the most severe forms of intestinal atresia. Until quite recently, neonatal mortality rates as a result of this anomaly were high. Early diagnosis, appropriate surgery, and prolonged parenteral nutrition have led to a spectacular improvement of the survival rates.

Radiographic-endoscopic correlations in the examination of airway disease in children.

The results of radiographic examinations and flexible fiberoptic endoscopy (FFE) of the airways were correlated in 100 pediatric patients. For the diagnosis of laryngomalacia, tracheal stenosis and tracheal granulomas. FFE proved to be more accurate than radiography.

Chronic idiopathic intestinal pseudo-obstruction syndrome. Radiologic signs in children with emphasis on differentiation from mechanical obstruction.

The radiographic pattern of chronic idiopathic intestinal pseudoobstruction syndrome (CIIPS) in children includes: (a) manifestation of motility disorder, and (b) signs of bowel occlusion. The findings on plain films are identical to those of mechanical obstruction. However, when there is a clinical history of chronic symptoms of a disparity between the patient's clinical condition and the radiographic findings, opaque studies are indicated.

"Apple peel" atresia of the small bowel: prenatal diagnosis of the obstruction by ultrasound.

35-year-old woman developed polyhydramnios during her first pregnancy. Ultrasound confirmed this and showed high bowel obstruction. Delivery was uneventful, the infant was asymtomatic.

Wilms tumor, misdiagnosed preoperatively: a review of 19 National Wilms Tumor Study I cases.

This study establishes the difficulty in making specific diagnoses in children with retroperitoneal tumors when only excretory urograms are used in diagnosis. Complementary use of excretory urography and ultrasonography should make the number of preoperative errors less by separating cases of Wilms tumor from those with cystic disease. This investigation underscores the hazards inherent in the use of preoperative irradiation and chemotherapy, since some children with benign disease are likely to receive inappropriate therapy.

"Contrast buttle": a sign indicating perforation of the digestive tract.

Bubble formation outside the digestive tract that correlated with small perforations was observed in two infants during water-soluble contrast material studies using a 50% solution of Gastrografin in water. The causes of extraluminal bubbles are discussed; in vitro experiments demonstrated the mechanism of formation and the radiographic characteristics of the various types of bubbles. Extraluminal bubbles appearing during a water-soluble contrast material examination actually represent contrast bubbles.

Radiographic manifestations of bone marrow transplantation in children.

Radiographically detectable complications in 35 children after bone marrow transplant are reviewed. These complications are most frequently due to infection, chemoradiotherapeutic toxicity, and graft versus host disease (a transplant rejection phenomenon peculiar to bone marrow transplant patients). The pulmonary complications within the first 2 months are secondary to a form of interstitial lung disease.

Renovascular hypertension in children and adolescents.

Renovascular disease often leads to hypertension in children. The most frequent cause is fibromuscular dysplasia of focal type affecting main and peripheral arteries. Diastolic readings in excess of 110 mm Hg with normal serum creatinine and urinalysis are suggestive of renovascular disease.

Complete obstruction of the gastric antrum in children following acid ingestion.

We report on two children who experienced delayed complete obstruction of the gastric antrum following concentrated acid ingestion. Both patients required initial tube gastrostomy and subsequent antrectomy with intestinal reconstruction. Unlike the more common alkaline corrosives, ingested acids tend to spare the esophagus and gastric fundus.

Gray-scale ultrasonography of the normal female pelvis.

The pelvis was evaluated with gray-scale ultrasound in 45 normal females, important aspects of instrumentation, changes in scanning techniques, and pitfalls in the identification of various normal anatomical structures are described, and normal ranges of uterine size and ovarian volume are reported.

Obstruction of the airways by the heart and pulmonary vessels in infants.

It is well known that certain cardiovascular abnormalities, frequently compress the airways in infants [1]. Two additional cardiac mechanisms of airway obstruction are described in this paper: progressive compression of the bronchial tree by left sided cardiac enlargement and infantile cardiac asthma due to compression of the small airways by pulmonary venous congestion. Functional and reversible collapse of the trachea is a frequent finding in cardiac asthma.

Ileo-ileal intussusception in the newborn. Report of a radiologically diagnosed case.

Ileo-Ileal intussusception was demonstrated preoperatively in a newborn infant by gastrografin enema with deliberate reflux of the contrast material into the small bowel. An intraluminal filling defect and stretching of the mucosal folds were demonstrated. The indications and proper use of contrast enemas are discussed.

Pre and postoperative ventricular function in infants and children with right ventricular volume overload.

Hemodynamic and ventricular volume parameters were evaluated in 21 patients (24 studies) with total anomalous pulmonary venous return (TAPVR), 11 patients with secundum atrial septal defect (ASD), and eight patients who had complete correction of TAPVR or ASD. Right and left ventricular (RV and LV) volume parameters were calculated according to Simpson's rule and the area length methods, respectively. In infants with TAPVR, RV end-diastolic volume was larger than normal, but RV ejection fraction was significantly less than normal.

Fiberoptic endoscopy and upper gastrointestinal series: comparative analysis in infants and children.

Fiberoptic endoscopy is a new and highly efficient diagnostic tool which is being increasingly used in the pediatric age group. Its use in children requires general anesthesia, special facilities, and technical expertise. We have compared the results of upper gastrointestinal barium studies and fiberoptic endoscopy in 75 cases.

Assessment of velar and lateral wall movement by oral telescope and radiographic examination in patients with velopharyngeal inadequacy and in normal subjects.

Thirty-one patients referred to the Craniofacial Anomalies Clinic for speech evaluation were evaluated by endoscopy and cineradiographic examination (lateral and submentovertical projection). Movement of the velar and lateral walls was examined by both procedures in order to determine the accuracy of the endoscopy in assessing velopharyngeal movement. Cineradiography confirmed endoscopic observation in a large percentage of patients.