[Rare acute disease pictures of the upper respiratory tract in children]. / Seltene akute Krankheitsbilder der oberen Atemwege bei Kindern.

The radiologist should recognize dangerous uncommon conditions such as epiglottitis and membranous croup by their pattern on conventional images. Subglottic narrowing, as from croup, is recognizable on lateral images by loss of the superior interface of trachea and vocal cords. A lateral image is important when an upper esophageal foreign body is seen on a frontal view.

Both Trevor and Ollier disease limited to one upper extremity.

A case is presented of a young boy in whom features of Trevor's dysplasia epiphysealis hemimelica and Ollier's enchondromatosis coexisted in a single extremity, the right upper. As Trevor disease consists of osteochondromas of epiphyses and their equivalents, such as carpal and tarsal bones, it is of interest that exostosis-like centers of the neck of radius and perhaps the proximal third metacarpal are present as well. Advanced maturation of selected centers was most marked at the right scaphoid. The child shows alignment abnormalities as a consequence of the varied lesions, including a varus of the right wrist. The coexistence of these varied osteochondromatous abnormalities in one extremity suggests a relationship in their etiologies.

Knee in early juvenile rheumatoid arthritis: MR imaging findings.

PURPOSE: To determine the magnetic resonance (MR) imaging findings in the knee in early juvenile rheumatoid arthritis. MATERIALS AND METHODS: MR imaging (1.5 T) was performed in the more symptomatic knee in 30 children with juvenile rheumatoid arthritis with a symptom duration 1 year or less. Conventional, fast spin-echo, three-dimensional gradient-echo, and gadolinium-enhanced T1-weighted images were assessed. Two radiologists independently read the images, and a third resolved disagreements. These images were compared with knee radiographs in 27 children. RESULTS: Mean maximal synovial thickness was 4.8 mm +/- 2.4 (SD). Mean synovial volume was 15.4 mL +/- 10.8. Suprapatellar joint effusions were seen in 26 (87%) of 30 knees, meniscal hypoplasia in 11 (37%) of 30 knees, and abnormal epiphyseal marrow in eight (27%) of 30 knees. Three knees had articular cartilage contour irregularity, fissures, and/or thinning. One knee had a bone erosion. Knee radiographs showed suprapatellar fullness in 78% of the knees, joint space narrowing in one knee, and no bone abnormalities. CONCLUSION: Synovial hypertrophy and joint effusions are the most frequent MR imaging findings of knees in early juvenile rheumatoid arthritis. Early in the disease, radiographically occult cartilage and bone erosions are uncommonly seen at MR imaging. The potential relationship of synovitis to cartilage abnormalities deserves further study.

H. Binga Dismond, MD--pioneer Harlem physician and much more.

All physicians hopefully have some interests beyond their specialty. Dismond exemplified a broad range of activities, including athletics, military service, poetry, multiple marriages, and socializing, as well as two specialties in medicine.

[Pediatric arthroses as a sequelae of enchondral damage. Examples of frostbite, Kashin-Beck disease, rat bites and other etiologies]. / Kindliche Arthrosen als Folge enchondraler Schädigungen. Am Beispiel von Erfrierungen, der Kashin-Beck-Erkrankung, Rattenbissen und anderen Ursachen.

PURPOSE: To review the similarities of the radiographic changes in frostbite, the Asian disease of Kashin-Beck, and long term growth damage from injury such as rate bite. MATERIALS AND METHODS: Radiographs and literature from subjects with these diagnoses were analyzed for the common features and differences. Included was an infant with hand changes 8 months after unwitnessed rat bites. RESULTS: Each condition revealed findings consistent with the hypothesis of localized damage to sites of enchondral ossification, including at acrophyses--the growth plates that are not between epiphysis and metaphysis, but instead lie at the margins of growth centers, including carpal and tarsal bones, and the non-epiphyseal ends of small tubular bones. DISCUSSION: The patterns observed support a final common pathway of damage in frostbite due to cold injury, Kashin-Beck disease (endemic in China) of unknown etiology, and damage from toxins associated, for example, with rat bite. In frostbite, the distribution is acral because of the site of exposure, while the distribution in Kashin-Beck is more diffuse and often less contiguous. In each condition, arthrotic sequelae may be expected in the natural course of follow-up. MRI may play a role in acute diagnosis that might modify the course of each disease.

Ebb and flow rickets in a premature infant: the Afghan turban sign.

The pattern of alternating dense and lucent bands, with straight outer edges, at the youngest metaphysis of long bones, the "Afghan turban" sign, occurs when incompletely treated rickets has recurred and been retreated. Recognition of this, and other, rickets patterns allows the radiologist to influence treatment, as described in a very low birth weight infant.

Scoliosis circa 2000: radiologic imaging perspective. I. Diagnosis and pretreatment evaluation.

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. Advances in CT and MR imaging have greatly improved the ability to detect or confirming non-idiopathic causes of scoliosis, including abnormalities within the spinal canal. Three-dimensional thinking has become more important in evaluating and understanding scoliosis.

[Acute roentgen diagnosis of battered child syndrome. A strategy]. / Die akute Röntgendiagnostik der Kindesmisshandlung. Eine Strategie.

A strategy is proposed for the dedicated interpretation of possible radiographic plain film signs that are suspicious for indicating child abuse. For each sign, the features "PRO" raise the question of abuse, while radiographic or clinical findings "CON" suggest an alternate explanation. Birth trauma, oesteogenesis imperfecta, rescue trauma, and metastatic neuroblastoma are among the many entities cited. A triad of situations may lead a radiologist to look systematically for changes from abuse; a triad of resolutions may result from the search. Periosteal reactions is the major factor in dating of fractures; physiologic periosteal reaction of infancy and periosteal reaction from previous fracture must be considered when so dating fractures.

Scoliosis circa 2000: radiologic imaging perspective. II. Treatment and follow-up.

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. New means of treating scoliosis have become established and should be understood by the radiologist. To the well-known postoperative complications, including pneumothorax, pneumonia, and gastrointestinal obstruction, are added new specific potential problems with the new surgical methodology.

Glen W. Hartman Lecture: Radiology Section of the National Medical Association. Centennial history of African-Americans in radiology.

It has not been an easy century for African-Americans in radiology, but many accomplishments have been achieved, often in the face of considerable adversity. Many, many important persons have been omitted from this essay. This section (Fig. 5) has supported progress through the years. May it continue the good work.

Effect of three levels of vitamin D intake in preterm infants receiving high mineral-containing milk.

Very low-birth weight (VLBW) infants fed high-calcium and high-phosphorus (10.74 and 6.93 mmol/MJ; 180 and 90 mg/100 kcal, respectively) infant formulas were randomized to one of three levels of vitamin D intake to approximate 200, 400, and 800 IU/day. Sixty-two infants completed the study (24 to 29 days), with actual mean daily vitamin D intakes of 161, 361, and 766 IU, respectively. Outcomes were not different by group: gains in body weight, length and head circumference, serum calcium, magnesium, phosphorus, alkaline phosphatase, osteocalcin, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and urine calcium:creatinine and magnesium:creatinine ratios. There were no radiographic fractures and/or rickets. A subset of 19 infants was followed between 173 and 380 days to determine descriptively if there was any delayed effect of earlier manipulation of vitamin D intake. They were fed standard infant formulas with a vitamin D content of 400 to 420 IU/L. No significant differences were present among the three groups, and data were combined. Serum 25-hydroxyvitamin D increased (p < 0.05), osteocalcin decreased (p < 0.05), and 1,25-dihydroxyvitamin D decreased (p = 0.06) at follow-up. Thus, for VLBZW infants fed high-calcium and high-phosphorus milk, an average daily vitamin D intake as low as 160 IU maintains normal and stable vitamin D status and normal physical growth, biochemical and hormonal indexes of bone mineral metabolism, and skeletal radiographs versus randomized infants receiving about 400 or 800 IU of vitamin D per day. On follow-up, vitamin D status remained normal for > or = 6 months while infants received < 400 IU of vitamin D per day.

Radiologic history exhibit. 1934: fateful year in the history of African-Americans in radiology.

The year 1934, just over a third of the way into the first century of the x ray and of the NMA, reflected both successes and difficulties for the minority radiologist. African-Americans constituted disproportionately small numbers within the radiologic community (Fig 9), and few of them were on the AMA's approved list. Membership in major radiologic societies was lacking; many were excluded from applying for the new American Board of Radiology examination. On the other hand, the major radiology journals began to publish articles by African-American authors, a select few radiologists were on the AMA specialist list, and the first steps to board certification were appearing.