The Value of Color Doppler Ultrasonography for a Screening Method of Gastroesophageal Reflux Disease in Children with Chronic Respiratory Symptoms / 소아알레르기및호흡기학회지

PURPOSE: The relationship of gastroesophageal reflux(GER) to respiratory diseases has been recognized. Diagnosis of gastroesophageal reflux disease can be confirmed by 24 hour esophageal pH probe study and barium fluoroscopic esophagography. However, for 24 hour esophageal pH monitoring in children, patients should be admitted, and the fluoroscopic studies may have radiation exposure. The objective of this study was to determine the value of color Doppler(CD) ultrasonography as a screening test of gastroesophageal reflux disease in children. METHODS: Thirty-four CD ultrasonographic examinations were performed and compared to simultaneous 24 hour esophageal pH monitoring. The patients were aged 3 months to 10 years, mean age of 36 months. The CD study was performed over a period of 10 minutes after weight-related feeding. The CD ultrasonographic finding was staged in the following way: 1) normal : 0 reflux, 2) grade I : 1-3 refluxes, 3) grade II : 3-6 refluxes, and 4) grade III: >6 refluxes. RESULTS: Gastroesophageal refluxes were detected in 28 out of 34 patients on CD ultrasonography. Fifteen cases were classified as grade I, 12 cases as grade II, and 1 case as grade III. There was agreement in the diagnosis of reflux or no reflux between pH measurements and CD ultrasonography in 28 out of 34 patients(82%) patients. In the remaining six patients, pH measurements were positive for reflux, and color Doppler ultrasonography showed no reflux in two, while pH-metry were negative and CD showed reflux in four patients. Positive and negative predictive values of CD sonography compared with 24 hour pH monitoring were 85.7% and 66.7% respectively. CONCLUSION: We suggest that CD ultrasonography can be used as a useful and convenient screening method for outpatients suspected of reflux.

Clinical Significance of the Corpus Callosum in Cerebral Palsy

PURPOSE: To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. MATERIALS AND METHODS: Fifty-two children [30 boys and 22 girls aged between six and 96 (median, 19) months in whom cerebal palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebal palsy were classified as hemiplegia(n =14), spastic diplegia(n=22), or spastic quadriplegia(n=16), and according to the severity of motor palsy, the condition was also classified as mild(n=26), moderate(n=13), or severe(n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. RESULTS: Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p < 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p< 0.05). CONCLUSION: There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

Prenatally Diagnosed Cystic Neuroblastoma: A Case Report

Cystic masses of the adrenal gland are unusual in the fetus and most are secondary to hemorrhage. Cysticneuroblastoma is extremely rare, and in contrast to solid neuroblastoma, follows a benign course, is diagnosedearlier, and rarely presents with metastatic lesions(1-4). We report one case of cystic neuroblastoma diagnosedprenatally by ultrasound(US) and magnetic resonance(MR) imaging, and include a review of the literature.

Cranial Fasciitis in a Child: A Case Report

Cranial fasciitis is a rare fibroblastic tumor which shows a predilection for the scalp and skull of youngchil-dren. Histologically, cranial fasciitis is identical to nodular fasciitis which is typically found in theextremities of adults, though is unique in that it may present as an osteolytic lesion of the skull. We report acase of cranial fasciitis in a 20-month-old girl, describing the ultrasonography, CT and MRI findings.

An Association between Brain MRI and Neurologic Findings in Welders Exposed to Manganese Fume / 대한산업의학회지

This study was carried out to investigate the relationship between brain magnetic resonance imaging (MRI) and neurological findings in welders exposed to manganese fume. Thirty five welders from a bus manufacturing factory who were occupationally exposed to low dose manganese fume were examined. We collected the information on the demo graphic factors and welding careers. Laboratory investigations included blood and urine manganese concentration and blood chemistry. Brain MRI was checked, and high signal intensity of the globus pallidus was graded from 0 to 3 compared to the white matter of the frontal lobe. Neurologic examination wart carried out. The results were as follows ; 1. The mean age of workers was 48.3+/-5.7 years, mean duration of welding was 21.4 +/-5.6 Years. 2. On brain MRI, high signal intensity in the globes pallidus was observed in 27 workers (77.1%) Among them, 18 cases (66.7%) showed remarkably high signal intensity (grade 2) Mean concentration of blood manganese was higher in those with high signal intensity and correlated to the grade of high signal intensity (p=0.02) 3. On neurologic examination, no workers showed the finding of typical parkinsonism. But 11 workers (31.4%) showed subtle neurological abnormalities such as gait without associated arm movement, postural instability, intention tremor, and so on. Blood manganese concentration of neurologically abnormal group was 2.4+/-0.7 microgram/dL, which was significantly higher, compared to 1.8+/-0.7 microgram/dL of neurologically normal group (p=0.03). 4. Among 27 workers who showed high signal intensity on brain MRI, 10 workers (37%) were neurologically abnormal. Higher grade of signal intensity on globus pallidus showed higher rate of neurologic abnormality (p<0.05) Especially postural instability and gait without associated arm movement were prominent findings. These bindings suggest that high signal intensity on brain MRI might be associated with a prodromal sign of manganese intoxication. Careful neurologic examination should be tool lowed up on welders showing high signal intensity in the golbus pallidus of brain MRI.

US Characterization of Soft Tissue Hemangiomas of Extremities: Correlation with MR Signal Intensity

PURPOSE: To evaluate the US findings of soft tissue hemangiomas in extremities and to correlate the echo-pattern with MR signal characteristics of hemangiomas. MATERIALS AND METHODS: We retrospectively studied forty-two patients either with pathologically proven cases or with characteristic features of hemangiomas on MRI, US and plain film. Hemangiomas were divided into two types according to the locations;subcutaneous and intramuscular. Analytic points on US and MR findings were gross morphology of the mass, internal echo-pattern or signal characteristics. We correlated the echo-pattern with MR signal characteristics in hemangiomas. RESULTS: Subcutaneous hemangiomas revealed homogeneously anechoic mass on US, which were well correlated with MR signal characteristics' homogeneous low singnal intensity(SI) on Tl-weighted image(WI) and high SI on T2-WI. Intramuscular hemangiomas showed heterogeneously mixed echoic masses on US. An anechoic component on US corresponded to dilated vascular channels on MRI. The signal intensity of intramuscular hemangioma was less than that of subcutaneous fat on T1-WI and greater than that of fat on T2-WI. Both types of hemangiomas had tubular or lace-like appearance with interspersed fibrofatty septa. CONCLUSION: The echo-patterns in US were well associated with MR signal characteristics on MRI. Regarding US and MR features, intramuscular hemangiomas were different to subcutaneous hemangiomas.