ROENTGENOGRAPHIC CRANIAL-BASE AND CALVARIAL MEASUREMENTS OF JAMAICAN CHILDREN BETWEEN ONE MONTH AND FIVE YEARS

Three-hundred-and-thirty lateral skull-films obtained from apparently healthy normocephalic Jamaican children between the age of one month and five years were studied, using bony reference points nasion (N), tuberculum sellae (Ts), internal occipital prominence (IOP), inion (I), bregma (B) and lambda (L). Cranial-base length was measured between N-Ts, Ts-IOP and N-I. Calvarial height was measured between Ts-B (anterior calvarium) and Ts-L (posterior calvarium). All the measurements showed an increase with age and were higher in boys. Significant correlations were seen between N-Ts and Ts-IOP, N-Ts and N-I, N-Ts and Ts-B, N-Ts and Ts-L and N-I and Ts-L at all the ages and in both sexes. Ratios between lengths of anterior and posterior cranial-base, as well as between cranial-base lengths and anterior cranial heights, were nearly constant at all the ages and in both sexes. These observations support the view that there is definite proportionality between the growth of anterior and posterior cranial-base lengths, and between anterior calvarial height and cranial-base lengths. On the other hand, a significant increase with age was seen in the ratios N-Ts/Ts-L, N-I/Ts/L and Ts/B/Ts-L, suggesting a progressive decrease in growth of posterior calvarial height. A comparison of the data with previously published figures for Indian and Norwegian populations suggests a racial difference in the various cranial-base and calvarial ratios.     

Hyperplastic Luschka ducts: a mimic of adenocarcinoma in the gallbladder fossa

Ducts of Luschka are a developmental abnormality found within the gallbladder fossa in up to 10% of cholecystectomy specimens. They are most often encountered by surgeons when injured during laparoscopic or open cholecystectomy, leading to bile leakage and subsequent peritonitis. Histologically, they are typically composed of lobular aggregates of small ductules lined by bland, cuboidal-to-columnar biliary-type epithelium, associated with centrally located, larger ductules surrounded by concentric fibrosis. We have identified 6 cases of florid Luschka duct proliferation in which the ductules demonstrated irregular growth pattern, loss of characteristic concentric fibrosis, and epithelial atypia that strongly suggested the diagnosis of invasive pancreatobiliary adenocarcinoma or metastatic adenocarcinoma involving the gallbladder serosa. Two of the cases were initially diagnosed as invasive adenocarcinoma, whereas the other 4 were sent for consultation to rule out adenocarcinoma. All cases were associated with marked acute and chronic cholecystitis with mucosal ulceration, cholelithiasis, and thickening of the gallbladder wall. The ducts of Luschka were located within the rim of adherent liver in all 6 cases and the gallbladder serosa in 5 cases. Limited follow-up information was available for all patients with no documentation of progressive disease. Awareness and proper recognition of the anatomic location and histologic features are imperative in distinguishing florid ducts of Luschka from both non-neoplastic conditions and most importantly adenocarcinoma.     

Peripancreatic paraganglioma: a potential diagnostic challenge in cytopathology and surgical pathology

Paragangliomas are rare neuroendocrine neoplasms arising in extra-adrenal chromaffin cells of the autonomic nervous system. In rare instances, paragangliomas present around and involve the pancreas, thereby mimicking one of the more common primary pancreatic lesions. These neoplasms present considerable diagnostic difficulty not only for the clinician and radiologist but also for the pathologist. We have collected a series of 9 peripancreatic paragangliomas clinically simulating a primary pancreatic lesion. The paragangliomas were diagnosed in 4 men and 5 women with an age range of 37 to 78 years (mean, 50 y). Patients presented clinically either with diffuse epigastric and abdominal pain (7 of 9, 78%) or with an incidental mass (2 of 9, 22%) discovered on routine radiographic imaging. All patients were found to have mass lesions suspicious for a primary pancreatic neoplasm on radiographic examination. The lesions were predominantly located in the body of the pancreas (5 of 9, 56%) and ranged in size from 5.5 to 17.0 cm (mean, 10.0 cm). Five of 9 (56%) neoplasms also demonstrated cystic change. Fine-needle aspiration (FNA) was performed on 6 cases; however, the diagnostic accuracy was low, with 3 of 6 (50%) neoplasms misdiagnosed as pancreatic neuroendocrine tumor (PanNET) (n=1), spindle cell neoplasm (n=1), or pseudocyst (n=1). In addition, 2 of 8 (25%) surgically resected tumors were misdiagnosed by the referring pathologist as a PanNET. Immunohistochemistry was performed on all cases, confirming the characteristic 2-cell populations: chief cells (synaptophysin positive and chromogranin A positive) and sustentacular cells (S-100 protein positive). Follow-up information was available for all patients and ranged from 2 months to 11.6 years (mean, 2.7 y). Three of 9 (33%) patients developed metastatic disease, and 2 of these 3 died of their disease at 2.8 and 4.6 years after diagnosis. In summary, in unsuspected cases, interpretation of FNA and surgical pathology resections can be diagnostically challenging. Awareness and proper recognition of this entity, including differential diagnosis, are imperative in establishing the correct diagnosis. Further, close follow-up of these cases should be considered because of the significant risk of metastatic disease.     

Aerosolized L-epinephrine <Emphasis Type="Italic">vs</Emphasis> budesonide for post-extubation stridor: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective  

To compare the efficacy and adverse effects of aerosolized L-epinephrine vs budesonide in the treatment of post-extubation stridor.     

Pseudocyst in Pulmonary Acute Respiratory Distress Syndrome (ARDS)

Childhood ARDS is mostly caused by pneumonia. Pulmonary pseudocysts are reported in adults recovering from ARDS, usually in non-dependent lung regions. We present a 1.5-year-old boy, who survived severe pulmonary ARDS with development of pulmonary giant pseudocysts and other structural abnormalities in dependent lung region. To the best of our knowledge, it is the first follow up report of pulmonary abnormality In a toddler with ARDS of extreme severity.     

Feeding Problems and Nutrient Intake in Children with and without Autism: A Comparative Study

Objective

To compare parent reported feeding difficulties and nutritional adequacy of children with Autism Spectrum Disorders (ASD) to an age and socio-economically matched group of typically developing children.

Methods

The scores on Children’s Eating Behavior Inventory (CEBI), three-day food records, anthropometric measures and adequacy of micro- and macro- nutrients were compared for 63 children diagnosed with ASD and 50 typically developing children enrolled from the department of pediatrics of a tertiary care teaching hospital from North India.

Results

The majority (79%) of the parents of ASD children reported some concern regarding their feeding behavior as compared to 64% of the parents of typically developing children. As compared to controls, ASD children had significantly higher CEBI scores (97.28 vs. 89.48, t = 3.15, P = 0.002) and more feeding problems (6.42 vs. 2.70, t = 3.74, P = 0.001). Relative to controls, ASD children consumed fewer number of food items (P = 0.022), particularly fruits (P = 0.004), vegetables (P = 0.011), and proteins (P = 0.015); had significantly lower daily intake of potassium (P = 0.001), copper (P = 0.007), and folate (P = 0.001). Although children with autism did not differ significantly from controls on intake of calories, height, weight, or body mass index, significantly greater proportion of ASD children failed to meet the estimated average requirement of thiamine (P = 0.039), vitamin C (P = 0.013), and copper (P = 0.005).

Conclusions

The findings underscore the need for comprehensive assessment and empirically-supported interventions for eating problems and dietary deficiencies found in ASD children.