Professor Emeritus, Radiology - Pediatric Radiology
The most frequently occurring and important cause of gastric outlet obstruction in the neonate and young infant is infantile hypertrophic pyloric stenosis (IHPS). A reported association of IHPS and eosinophilic gastroenteritis  raises interesting questions about the possible etiologic relationship between the two entities. It is plausible that the observed sonographic pyloric muscular wall thickness in IHPS may in part be dependent on the degree and duration of an allergic gastroenteropathy. A recent report suggests that endoscopy may be a more reliable diagnostic method than sonography in the patient with evolving IHPS . Our recent experience with a patient with evolving IHPS supports the findings described in these prior reports.
View details for Web of Science ID A1995RF84300025
View details for PubMedID 7567248
We have presented an unusual case of chondroblastoma mimicking a malignant tumor. Retrospective review of radiographs obtained 19 years before the diagnosis gave us a unique opportunity to follow the natural history of this atypical lesion.
View details for PubMedID 2057799
Bronchopulmonary dysplasia is a chronic lung disease that often develops after mechanical ventilation in prematurely born infants with respiratory failure. It has become the most common form of chronic lung disease in infants in the United States. The long-term outcome for infants with bronchopulmonary dysplasia has not been determined.We studied the pulmonary function of 26 adolescents and young adults, born between 1964 and 1973, who had bronchopulmonary dysplasia in infancy. We compared the results with those in two control groups: 26 age-matched adolescents and young adults of similar birth weight and gestational age who had not undergone mechanical ventilation, and 53 age-matched normal subjects.Sixty-eight percent of the subjects with bronchopulmonary dysplasia in infancy (17 of the 25 tested) had airway obstruction, including decreases in forced expiratory volume in one second, forced expiratory flow between 25 and 75 percent of vital capacity, and maximal expiratory flow velocity at 50 percent of vital capacity, as compared with both control groups (P less than 0.0001 for all comparisons). Twenty-four percent of the subjects with bronchopulmonary dysplasia in infancy had fixed airway obstruction, and 52 percent had reactive airway disease, as indicated by their responses to the administration of methacholine or a bronchodilator. Hyperinflation (an increased ratio of residual volume to total lung capacity) was more frequent in the subjects with a history of bronchopulmonary dysplasia than in either the matched cohort (P less than 0.0006) or the normal controls (P less than 0.0004). Six of the subjects who had bronchopulmonary dysplasia in infancy had severe pulmonary dysfunction or current symptoms of respiratory difficulty.Most adolescents and young adults who had bronchopulmonary dysplasia in infancy have some degree of pulmonary dysfunction, consisting of airway obstruction, airway hyperreactivity, and hyperinflation. The clinical consequences of this dysfunction are not known.
View details for Web of Science ID A1990EP37600003
View details for PubMedID 2247118
Proper therapy for Hodgkin disease requires accurate staging of the disease. We compared the value of CT and lymphography with that of laparotomy for staging newly diagnosed Hodgkin disease in 46 children. The laparotomy revealed disease in one or more subdiaphragmatic sites in 46%. Correlation of the imaging studies with the laparotomy findings showed that lymphography has a greater sensitivity (80%) than does CT (40%) in detecting retroperitoneal lymph nodes. The sensitivity of CT in detecting splenic involvement was only 19%, presumably because of the small size of tumor deposits in involved spleens. Staging laparotomy altered the clinical stage in 37% of children, which resulted in a significant change of therapy in those patients. Although lymphography and, to a lesser degree, CT are useful for staging of Hodgkin disease, laparotomy continues to be the most important tool in choosing appropriate therapy for children with Hodgkin disease.
View details for Web of Science ID A1990DD80800022
View details for PubMedID 2110738
A dynamic probabilistic model based on hazard rate analysis, Monte Carlo modeling, and lead-time estimation techniques was developed to determine the optimal timing and frequency of chest radiography in the monitoring for relapse of children with treated Hodgkin disease. The analysis incorporates the performance characteristics of chest radiography, the natural history of the disease process, and therapeutic efficacy as a function of earliness of detection in the determination of optimal strategy. Examples of the model applied to the experiences of Stanford Medical Center and St. Jude Children's Research Hospital illustrate the utility of such a model in customizing an optimal monitoring strategy for a specific institution and clinical experience. The results suggest that monitoring protocols significantly overutilize chest radiography in the evaluation for recurrent Hodgkin disease in children.
View details for Web of Science ID A1989AQ83100016
View details for PubMedID 2781033
Lesch-Nyhan syndrome is a rare X-linked recessive disorder of purine metabolism associated with a virtually complete deficiency of the enzyme hypoxanthine-guanine phosphoribosyl-transferase (HPRT). The disease is characterized by hyperuricemia, self-multilation, choreoathetosis, spasticity, and mental retardation. The abnormalities of purine metabolism are present at birth and may lead to uric acid crystalluria and stone formation early in life. Radiographic findings described in Lesch-Nyhan syndrome include faintly radio-opaque stones on abdominal radiographs or, if renal disease is present, small kidneys with poor function on intravenous urogram. Radiolucent stones are usually composed of uric acid; however, several cases of xanthine and hypoxanthine-containing calculi in Lesch-Nyhan patients receiving allopurinl therapy have also been described. Oxypurine is the collective name for the compounds hypoxanthine, xanthine, and uric acid, and all may be radiolucent. We report a case of Lesch-Nyhan syndrome with presumed renal parenchymal oxypurine deposition demonstrated readily by ultrasonography but not detected on standard radiographs or intravenous urograms.
View details for Web of Science ID A1989AH35900039
View details for PubMedID 2671903
Juvenile xanthogranuloma is a benign histiocytosis of infancy and childhood characteristically involving the skin, the eye, and, rarely, the lungs, liver and mesothelial structures. This report documents the first known case of renal involvement which is demonstrated by ultrasound and computed tomography.
View details for Web of Science ID A1988M319300017
View details for PubMedID 3353152
Two patients with fibromatosis colli (congenital torticollis) presented with lytic lesions in the clavicle at the insertion of the fibrosed clavicular head of the sternocleidomastoid muscle. Biopsy of one lesion showed intraosseous fibrosis. These lesions are probably not uncommon but radiographs are rarely performed in uncomplicated cases.
View details for Web of Science ID A1983QW31300009
View details for PubMedID 6879213
View details for Web of Science ID A1983RJ04400003
A case is presented of massive air embolism complicating respiratory distress syndrome of the newborn. This uncommon complication of respiratory therapy has occurred only with high inflation pressures and has been uniformly fatal in this and all reported cases. Antemortem radiographs are necessary for accurate diagnosis.
View details for Web of Science ID A1977EF79100015
View details for PubMedID 336630
View details for Web of Science ID A1974R759900014
View details for Web of Science ID A1974T533200014