Roentgenographic features of acute nonobstructive appendicitis: a case report.

We document a case of acute nonobstructive appendicitis and critically evaluate the pertinent literature. Although undoubtedly a rare entity, nonobstructive appendicitis may occur and should be differentiated from a normal appendix by barium enema examination. Mucosal and intramural inflammatory abnormalities are described which permit the diagnosis of nonobstructive appendicitis.

Protection from radiation nephropathy by WR-2721.

The efficacy of WR-2721 pretreatment against radiation injury to the growing kidney was evaluated in the weanling mouse. Immediately following unilateral nephrectomy, animals received intraperitoneal injections of saline or WR-2721 (220 mg/kg). Thirty minutes later both nonprotected (saline-treated) control animals and protected (WR-2721-treated) animals received 1000-rad single-fraction radiation to the remaining kidney. Other animals received WR-2721 immediately following unilateral nephrectomy but no radiation. Animals were sacrificed at 3 and 24 weeks. Nonirradiated animals treated with WR-2721 only showed normal compensatory renal growth, body growth, and renal function at 24 weeks. The nonprotected, irradiated animals exhibited renal growth inhibition without body growth inhibition, and renal functional abnormalities including elevation of serum BUN and reduction of glomerular filtration rate. Pretreatment with WR-2721 prior to 1000 rad prevented the renal growth inhibition and functional abnormalities seen in the nonprotected irradiated animals. Within the observation period there were no differences in renal morphology by light and electron microscopy between protected and nonprotected groups; only mild glomerular and tubular abnormalities compatible with radiation injury were seen. WR-2721 can modulate renal radiation injury; however, the growth and functional protection is not well correlated with specific histologic change. The dose reduction factor for WR-2721 renal growth protection is between 1.16 and 1.2. WR-2721 may have future clinical utility by increasing radiation tolerance of the kidney.

Childhood diskitis: computed tomographic findings.

The spectrum of computed tomographic findings in seven children with diskitis is reported. Paravertebral inflammatory masses, intraspinal (epidural) soft-tissue extension with thecal sac deformity, and psoas involvement with abscess were demonstrated in 7/7, 6/7, and 1/7 patients, respectively. Plain radiographic findings of disk space narrowing and vertebral end-plate destruction were confirmed by CT in all cases. Follow-up CT in two patients revealed persistent bone destruction despite resolution of soft-tissue inflammation and clinical abnormalities. CT proved most useful in the diagnosis of early and atypical cases. The CT spectrum of childhood diskitis may simulate other diseases, including neoplasm, tuberculosis, and disk herniation. While CT is not routinely indicated in typical childhood diskitis, it may confirm the diagnosis in those patients with atypical clinical presentation or nonspecific plain radiographs, and exclude other lesions in patients unresponsive to routine treatment.

Sonographic diagnosis of cystic adenomatoid malformation in-utero.

Routine ultrasound examination at 30 weeks gestation revealed an intrapulmonary cystic mass in an otherwise normal fetus. Following delivery at term, the diagnosis of congenital cystic adenomatoid malformation of the right lung was confirmed, and an elective right middle lobectomy successfully performed at nine days of age.

John Caffey Award: chemotherapy-induced inhibition of compensatory renal growth in the immature mouse.

Minimal-lethal-doses (LD1/21) of Actinomycin-D (AMD), Vincristine (VCR), or Adriamycin (ADR) inhibited compensatory renal growth in unilaterally nephrectomized weanling mice. AMD transiently inhibited compensatory renal and body growth. VCR transiently inhibited kidney growth only, while ADR produced persistent kidney and body growth inhibition. 3H thymidine uptake was decreased at 5 days from controls with AMD and ADR, and increased at 14 days from controls with ADM, VCR, and ADR. Kidney DNA concentration was increased from controls at 3 days with AMD and at 8 and 14 days with ADR, but decreased from controls of 8 days with AMD and VCR. AMD and ADR inhibit compensatory renal growth and body growth in the immature mouse. VCR selectively inhibits renal growth. Renal growth inhibition with AMD, VCR, and ADR is related, in part, to a delay in the renal mitotic response to contralateral nephrectomy, and with AMD and ADR to generalized body growth supression. Chemotherapy injury to the growing mammalian kidney may be manifest as growth inhibition.

Ultrasonic renal volumetry in children: accuracy and simplicity of the method.

Renal length and volume were determined with B-mode ultrasonography and manual planimetry. The accuracy of the technique was prospectively evaluated in 11 children in whom concurrent sonograms and excretory urograms were obtained. Sonographic renal volume correlated better with urographic renal volume (r = 0.89) than did sonographic and urographic renal length (r = 0.78). The technique provides rapid, noninvasive measurement of renal length and volume, and can be used to follow renal growth patterns in children.

Pneumatosis pulmonalis: a complication of the idiopathic respiratory distress syndrome.

Interstitial emphysema of the lung is a well-recognized complication of the idiopathic respiratory distress syndrome. Its incidence has increased with the recent more aggressive therapy for this disease, and persistence of the emphysema in a large number of patients has been observed. This report describes the clinical complications, changes in the roentgenographic pattern, and, particularly, the characteristic morphologic findings in these patients, which delineate persistent pulmonary emphysema as a distinct entity.

Renal malposition associated with omphalocele.

Nine patients with omphalocele had abnormally positioned kidneys; in 8, the kidneys were more cephalad than normal, immediately subdiaphragmatic in position. In one patient the kidneys were more caudal than normal. This renal malposition should be recognized in order to avoid unnecessary imaging procedures in patients with omphalocele.

Radiation-induced inhibition of compensatory renal growth in the weanling mouse kidney.

Weanling mice were given 500, 1,000, 1,500, or 2,000 rads single-fraction renal irradiation immediately following unilateral nephrectomy and sacrificed 3 days or 3, 6, 12, or 24 weeks later. Inhibition of compensatory renal growth was related to both radiation dose and time following treatment; it was transient following 500 and 1,000 rads but persisted following 1,500 and 2,000 rads. Renal growth was inhibited more than body growth. These studies indicate that the weanling mouse kidney is more sensitive to radiation-induced inhibition of compensatory renal growth than adult mice or other rodents.

Retention cysts of Cowper's duct.

Retention cysts arising from obstructed Cowper's ducts are rare lesions of the anterior urethra. Five cases are reported, 3 in male infacts and 2 in young boys. In children and adults the cysts may cause dysuria, urinary frequency, or urinary retention. The etiology of Cowper's duct cysts remains uncertain, but both congenital and acquired cysts have been described. The radiographic findings are characteristic: a smooth, rounded filling defect is seen on the ventral wall of the proximal bulbous urethra during voiding cystourethrography. After fulguration of the cyst, urethrography may reveal reflux into a dilated Cowper's duct.

The medial pneumothorax.

The intrapleural air of a pneumothorax may largely collect medial to the anterior aspect of the lung in supine infants. The mechanical basis for this phenomenon is presented with supporting experimental evidence. This distribution of intrapleural air poses problems in recognition of the pneumothorax radiographically, in differentiation of the pneumothorax from pneumomediastinum, in estimation of the true volume of intrapleural air, and in the proper placement of drainage tubes. The importance of horizontal-beam lateral radiographs and of careful attention to the position of intrapleural tubes is emphasized, especially in supine, immobile newborns.

Diuresis and improved renal hemodynamics produced by prostaglandin E1 in the dog with norepinephrine-induced acute renal failure.

Unilateral acute renal failure was induced in dogs by renal artery infusion of norepinephrine. Renal hemodynamics and function were studied before and 5 days after norepinephrine infusion, and during subsequent renal artery infusion of prostaglandin E1. After norepinephrine, the infused kidney exhibited decreased urine volume, sodium excretion, and creatinine clearance. Cortical blood flow, determined with radioactive microspheres, also decreased. No redistribution of intracortical blood flow occurred. Arteriographically, proximal vessels were constricted and the cortical nephrogram density diminished. During prostaglandin E1 infusion, urine volume, sodium excretion, and cortical blood flow increased. Creatinine clearance did not change significantly. Blood flow was redistributed from the outer third to the inner third of the cortex. Proximal vessels were dilated and the cortical nephrogram density was enhanced. The apparent dissociation of cortical blood flow from creatinine clearance suggests that prostaglandin E1-induced diuresis and natriuresis result from a mechanism other than increased glomerular filtration.