Radiologic features of “adult type” polycystic kidney disease in the neonate

Two cases are reported of adult type polycystic renal disease (autosomal dominant) presenting in the newborn as a unilateral abdominal mass. The radiographic findings in the involved kidney simulated the ectatic tubules of infantile polycystic disease, yet histologic examination was consistent with the adult variety and both infants had other family members with adult type polycystic kidneys. These cases emphasize some of the ambiguities that exist in the definition and classification of polycystic renal disease.     

Lymphoma of the mediastinum and neck: evaluation with Ga-67 imaging and CT correlation

The role of gallium-67 in the differentiation between active disease and fibrotic changes in patients with childhood lymphoma involving the mediastinum and neck was evaluated prospectively. Ga-67 imaging and computed tomography (CT) were correlated with clinical findings at the time of initial presentation and follow-up in 19 patients. Both modalities enabled detection of active disease on all occasions, but CT results were false-positive for residual disease in 10 patients (53%), whereas Ga-67 imaging results were false-positive in only one patient (5%). Neither modality, however, proved accurate in patients with rebound thymic hyperplasia. Ga-67 imaging is a useful tool for assessing response to therapy in children with lymphoma of the mediastinum and neck.     

Aortic atheroma is related to number of particulates captured by intra-aortic filtration in CABG.

OBJECTIVE: Intra-aortic filtration during coronary artery bypass grafting (CABG) has the potential to harvest all particles embolized into the aorta proximal to the filter. The aim of this study was to determine risk factors for embolization of particles during CABG.METHODS: Forty consecutive patients undergoing conventional multi-vessel CABG were included in the study. Plaques of the ascending aorta were determined by epiaortic ultrasonography prior to aortic manipulation. Intra-aortic filters (Embol-X, Mountain View, CA) were inserted before removal of the aortic cross-clamp and extracted after end of cardiopulmonary bypass. Filters underwent histologic analysis at a core lab (Stanford University, Stanford, CA). RESULTS: The average number of proximal anastomoses was 2.2 (SD 0.55, range 1-3). All patients had particles in the filters. The average number of particles per filter was 10.5 (SD 5.4, range 2-23) with a mean surface area of 8.1mm(2) (SD 9.3, range 0.3-51.1). Fibrous atheroma was extracted from 85% (34/40) of the filters. Logistic regression explained 46% (r(2)=0.46, P<0.001) of the number of particles harvested by the filters. The most important independent risk factors for particles were number/grade of atheromas in the ascending aorta (P<0.01), obesity (P<0.02), hypertension (P<0.02) and number of proximal anastomoses (P<0.02). CONCLUSIONS: Atheroma in the ascending aorta is the most important risk factor for particle embolization during CABG. The number of particles correlated with the extent of atheromatous disease in the ascending aorta and logistic regression identified hypertension, obesity and the number of proximal anastomoses to have significant influence on the number of captured particulates.