Frequency of developmental dysplasia of hip detected by graf's ultrasonographic method in icteric newborns: a preliminary study

Limping is a debilitating problem that can be prevented by screening at risk newborns. Jaundice is a problem that brings approximately one fifth of newborns to hospital in early infancy. The aim of this study was to find out whether the newborns with physiologic jaundice are at an increased risk of developing developmental dislocation of hip and whether it is logical to screen these newborns with Graf's ultrasonographic method. Throughout a year, 320 icteric newborns [640 hips] that referred to Nemazee Hospital Neonatal Emergency Room for checking their bilirubin were screened by Graf's ultrasonographic method for developmental dislocation of hip [DDH]. Any newborn with other problems such as congenital anomalies were excluded form this study. Of the 640 hips, 21 newborns [3.28%] had a dysplastic hip [Class IIa] that needed follow up and 12 from them came back for follow up of hip ultrasongraphy, all of whom became normal [Class Ia] without treatment. Only 1 hip did have severe dysplasia [Class IIc] [.16%] that needed treatment at the time of discovery. The rate of DDH seems not to increase in the newborns with physiologic jaundice. It seems not to be logical to screen newborns with physiologic jaundice with Graf's ultrasonographic method, if screening is not cost-effective

Peri-operative high-dose V post-operative low dose steroid therapy in the management of biliary atresia: a preliminary report

The use of high-dose steroid therapy peri portoenterostomy may have a positive impact on the frequency of cholangitis and survival rate. A prospective study was conducted on two groups of patients [less than three months of age] suffering from biliary atresia from 1999 to 2005. The patients in group I [G I] were managed peri-operatively by high-dose methylprednisolone while the other group [G II] received low dose methylprednisolone only post-operatively [2mg/k/day for 1 month]. Infants in GI [n = 30] received methylprednisolone for 3 successive days before operation [10-8-6mg/kg/day], and 10 mg/k at the day of operation respectively. Thereafter the dose was tapered in the next successive 6 days by 8, 6, 5, 4, 3, and 2 mg/kg/day and continued for one month. Seventy two infants with biliary atresia were operated [39 girls and 33 boys]. Twenty-six of the 30 patients [86%] in G I became jaundice-free within 90 days after portoenterostomy while only seven [15%] of the 42 patients in G II had normal bilirubin [P < 0.0001]. Episodes of postoperative cholangitis in G I were 20% [6 of 30], and 53% [24 of 42] in G II [P < 0.005]. The difference in 3-year survival rate between the two groups is also remarkable: Eighty seven percent [26 of 30] in GI versus 29% [13 of 45] in G II [P < 0.005]. Death related to biliary atresia occurred in 1 [3.3%] patient in GI compared with 12 [29%] patients in G II [p < 0.005]. These results provide strong evidence that peri-operative high dose steroid therapy is not only safe in this patients population, but because of its anti-inflammatory and cholerrhetic effects has a positive impact on preventing recurrent cholangitis, and ultimately survival

Accuracy of CT scan in detection of benign or malignant nature of solitary pulmonary nodules in comparison with pathological results-A prospective study

Solitary Pulmonary Nodule [SPN] is one of the most common diagnostic problems in chest radiology because differentiation between benign and malignant nature of the lesions based on radiologic pictures may be difficult and sometimes impossible. Nowadays, CT scan is the most accurate imaging modality for diagnosis and characterization of pulmonary nodules. In this study, 131 patients were included in whom Preliminary chest x-ray revealed SPN, chest CT scan was the next imaging investigation in these patients. Chest CT Scan confirmed SPN in 103 patients. Of these patients, Fine Needle Aspiration [FNA] and surgical resection of the nodule were taken place in 69 and 27 patients respectively. Pathological results compared with CT scan findings. Considering CT characteristics of the lesions, results were in favor of malignancy in 27 patients and in other 61 patients, CT scan findings were consistent with benign process. Mentioned data disclosed sensitivity and specificity of CT scan in prediction of malignant SPN 81/8% and 86/3% respectively. CT scan as used in this study could be useful for determining benign or malignant nature of solitary pulmonary nodules. Rate of enhancement in the lesions following IV administration of contrast agent is the most important criterion to differentiate benign and malignant lesions