We evaluated the presence of abdominal organomegaly and lymphadenopathy with ultrasound in 92 children with acute lymphoblastic leukemia (ALL) prior to chemotherapy, and compared these findings with the different immunophenotypes, age groups, and white blood cell (WBC) counts as well as the survival of the patients and the clinical findings of organomegaly. All the patients (n = 13) with a WBC higher than 50/microL showed intra-abdominal pathology compared with the patients with a low WBC, of whom 37% (n = 18) had normal scans. The children with a high WBC count also had hepatomegaly (P = 0.003) and splenomegaly (P = 0.06) significantly more often, and showed high echogenicity of the kidneys (P = 0.001). Lymphadenopathy was found significantly more often in children with T-cell leukemia (P = 0.005). The younger age groups (0 to 2 and 2 to 5 years of age) had hepatomegaly significantly more often (P = 0.02), and the youngest age group (0 to 2 years) showed increased echogenicity of the kidneys more often (P = 0.04). Ultrasound showed hepatomegaly in 14 patients and splenomegaly in 23 patients who were assessed clinically as normal. According to our results, abdominal ultrasound is a useful tool for evaluating abdominal organomegaly and the extramedullary leukemic burden and can give information that is not available in clinical examination. There was no statistical association between the primary ultrasonographic findings and the patients' later survival.
BACKGROUND: The treatment of acute leukemia in childhood has been increasingly successful. Concurrently, severe leukemia-related gastrointestinal complications have become more common. METHODS: We evaluated the findings of the abdominal ultrasound (US) examinations of 52 children with acute lymphoblastic leukemia (ALL) who had severe clinical symptoms indicating infection or abdominal complication during chemotherapy treatment or after the cessation of such treatment and assessed the impact of these findings on patients' subsequent treatment and survival. RESULTS: Our study presents ten cases of typhlitis with a prevalence of 9%, all of which were rapidly diagnosed by US and had a favourable outcome. We also found focal intra-abdominal parenchymal lesions in six children, five of them due to fungal infection and one due to leukemic infiltration. Several other intra-abdominal pathologies significant for the patients' treatment are also reported. DISCUSSION: We believe that abdominal US is a useful, rapid, safe, and accurate imaging method for children with ALL suspected to suffer from leukemia- or chemotherapy-related gastrointestinal complications. More invasive imaging methods are seldom needed. CONCLUSIONS: According to our results, abdominal US gives the necessary information in most of the cases and provides prompt diagnosis, which may prevent possible fatal complications.
PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.
The present study compares the repeatability of patellofemoral malalignment (PFM) indices obtained by 20 degree flexion axial radiography (AR) and computerized tomography (CT) with 0 degree and 20 degree flexion of the knees in children and adolescents. Thirty-one patients with a mean age of 14.2 years (range 8 to 19.2 years) suffering from PFM were examined using these two radiographic techniques. The lateral patellofemoral angle (LPA), the lateral patellar tilt (LPT), and the lateral patellar displacement (LPD) were measured by by two different investigators on different occasions, and the agreement of these indices between CT and AR was evaluated according to Bland and Altman's statistical method. LPT and LPD obtained by AR were more reliable and repeatable than those obtained by CT. The quadriceps muscle contraction exacerbates PFM indices significantly with the knees in full extension (P = 0.0001). LPT and LPD measured at 20 degrees AR show reliably the two pathological components (the patellar tilt and the lateral patellar displacement) of PFM which are necessary for diagnosis and treatment planning. CT with quadriceps contractions is better in qualitative screening of more subtle cases of PFM.
T1-weighted magnetic resonance imaging (MRI) of the lower extremities was performed 5 years after the cessation of therapy on 25 children treated for acute lymphoblastic leukaemia (ALL). Signal intensity pathologies considered to be related with the leukaemia itself or the treatment of ALL were found in nine of 25 children (36%). Two of these children had findings of osteonecrosis, five had a patchy signal pattern, one had diffuse inhomogeneity of the bone marrow signal intensity in complete remission and one had diffusely decreased signal intensity preceding the diagnosis of relapse. MRI unexpectedly revealed many bone marrow pathologies in symptomless children successfully treated for ALL. Especially, osteonecrosis might cause significant disability, and the aetiology, clinical course and prognosis of this complication are not well known. The intensive dexamethasone medication included in the treatment protocols may be responsible for the development of osteonecrosis. However, the prognosis of osteonecrosis in the long run requires further studies.
In order to assess the predictive value of neonatal brain perfusion with single photon emission computed tomography (SPET) with regard to neuromotor outcome at a corrected age of 18 months, 34 infants with birth weight
This study assessed the value of spirometry and chest X-rays in the diagnosis of airways stenosis in the tracheal or laryngeal regions at school age. A series of 14 patients was studied. Six of them had vascular ring anomalies, four subglottic stenosis, two aberrant innominate artery, one tracheal stenosis and one a laryngeal web. Four patients were suffering from chronic cough and ten from dyspnoea, noisy breathing and cough upon physical exercise. Two had had their symptoms since infancy and five since 3-6 y of age, whereas seven had had their first symptoms at school age. Nine patients had previously been suspected of having asthma, and five of them had been using inhaled corticosteroids, one inhaled sodium cromoglycate and one peroral terbutaline without any effect. The ratio of forced expiratory volume in 1 s (FEV1) to peak expiratory flow (PEF) was abnormally high in most of the patients. All six children with vascular ring anomalies also had an abnormal aortic configuration on a chest X-ray, and narrowing of the trachea was seen in two of the four with subglottic stenosis. Two children had both chest X-rays and spirometry values within the normal limits. Conclusion: The results show that children with stenosis in the laryngeal or tracheal region may not have their first symptoms until school age. Many patients are falsely suspected of having asthma. Simple spirometry and chest X-rays will help the physician to make the correct diagnosis in these patients.
We evaluated clinical characteristics and growth in 51 (24 males) long-term survivors of childhood cancer (median follow up 12.7 years). Patients were shorter, had a higher proportion of body fat and higher systolic blood pressure than their controls. The change in relative height during treatment was -0.83 standard deviation score (S.D.S.) in patients with cranial irradiation and -0.32 S.D.S. in patients without cranial irradiation; the figures after treatment were -0.56 and 0.20 S.D.S., respectively. Half (r2 = 0.50) of the variation in growth retardation during therapy could be explained by the cumulative doses of 6-mercaptopurine (6-MP) and vincristine and relative height at diagnosis. Cranial irradiation, increased relative height at diagnosis and young age at diagnosis were significant predictors of growth failure over the total observation period, explaining 43% of the variation. We conclude that long-term survivors of childhood cancer have impaired linear growth, increased body fat mass and elevated systolic blood pressure. Young children who are tall for their age at diagnosis and treated with cranial irradiation have the highest risk of impaired growth after the diagnosis. High doses of 6-MP seem to contribute significantly to growth retardation during therapy.