Chloroquine resistant malaria in children

Malaria remains a major cause of childhood morbidity and mortality. The changing susceptibility of Malaria parasites to drugs means that it is no longer possible to make global generalization about its chemotherapy. This study was conducted in District Hospital, Mirpurkhas, Sindh. Over sixteen months period four hundred and six patients had slide documented malarial parasites. Sixty-five percent had plasmodium falciparum, 33% plasmodium vivax and 2% had both. Approximately, 81% responded to chloroquine while 19% were non-responders. Chloroquine non-responders were treated with halofantrine or sulfadoxine--pyrimethamine combination. P. falciparum being the dominant species and its emergence of resistance to Chloroquine, in life threatening and serious forms of malaria should be treated with parenteral quinine. Antimalarials other than Chloroquine should be reserved for non-responders. Therefore, rational use of drugs is essential.

Abnormally small adenoids in HIV-infected children

A number of diverse head and neck manifestations of HIV infection have been described, including adenoidal hypertrophy. We report a series of HIV-infected children in which 9 of 18 had abnormally small or radiographically absent adenoidal tissue. This finding did not, however, seem to correlate with several parameters for the severity or stage of illness.

Enhancement of thoracic masses using nonionic MR contrast agents

OBJECTIVE

This study evaluated the effect of a new nonionic MR contrast medium, gadodiamide injection (Omniscan; Sanofi-Winthrop), on enhancement of thoracic masses on T1-weighted SE images.

MATERIALS AND METHODS

Gadodiamide injection was administered intravenously at a dose of 0.2 mmol/kg to 26 patients with thoracic masses. The T1-weighted images with and without fat suppression and T2-weighted images obtained before contrast medium injection were compared with T1-weighted images obtained at 5, 30, and 45 min and a T1-weighted fat-suppressed image at 10 min after administration of the contrast medium. Enhancement of the thoracic masses and image quality were quantified by measuring signal intensity, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) using muscle and fat as reference tissues.

RESULTS

The SNR of the masses increased significantly (p < 0.001) following contrast material injection both on standard T1-weighted sequences and on T1-weighted fat-suppressed images when compared with the precontrast T1-weighted images with and without fat suppression. The CNR (reference tissue muscle) improved significantly (p < 0.001) after contrast medium injection and persisted for 45 min on T1-weighted images compared with those prior to contrast medium. However, there was no significant difference in CNR between the T2-weighted images obtained before and the T1-weighted images obtained after contrast agent administration. On the other hand, the SNR of contrast-enhanced images was significantly better than that of the T2-weighted images. When fat was used as a reference tissue, CNR of the thoracic masses decreased significantly.

CONCLUSION

This study shows that gadodiamide injection caused significant enhancement of thoracic masses on T1-weighted images, which rendered high signal intensity to the masses similar to the appearance on T2-weighted images. In comparison with the T2-weighted images, SNR was significantly improved.

Diagnostic value of chest radiography for pericardial effusion

OBJECTIVES

This study was designed to determine the diagnostic value of chest radiography for pericardial effusion.

BACKGROUND

Pericardial effusions may cause life-threatening cardiac complications, yet they are often difficult to diagnose.

METHODS

In a blinded manner, we reviewed the chest radiographs of 83 patients with echocardiographically diagnosed pericardial effusions (5 large, 18 moderate, 60 small) and those of 17 control subjects without effusions. We examined four radiographic signs: an enlarged cardiac silhouette, a pericardial fat stripe, a predominant left-sided pleural effusion and an increase in transverse cardiac diameter compared with the diameter on a previous chest radiograph.

RESULTS

An enlarged cardiac silhouette was moderately sensitive (71%) but not specific (41%) for pericardial effusion. A pericardial fat stripe, a predominant left-sided pleural effusion and an increase in transverse cardiac diameter were all specific (94%, 100% and 80%, respectively) but not sensitive (12%, 20% and 46%, respectively). A predominant left-sided pleural effusion was associated with pericardial effusions of all sizes (odds ratio = 1.3, 95% confidence interval [CI] = 1.0-1.6, p = 0.04) and with large and moderate pericardial effusions alone (odds ratio = 7.7, 95% CI = 2.5-24.0, p = 0.0004). In contrast, a pericardial fat stripe was associated only with large and moderate pericardial effusions (odds ratio = 3.3, 95% CI = 0.9-12.0, p = 0.07), and an enlarged cardiac silhouette and an increase in cardiac diameter were not associated with pericardial effusion at all.

CONCLUSIONS

A predominant left-sided pleural effusion and a pericardial fat stripe are chest radiographic signs that are suggestive, but not diagnostic, of pericardial effusion. Because these signs cannot reliably confirm or exclude the presence of pericardial effusion, we conclude that chest radiography is poorly diagnostic of this condition.

Contrast media for cardiothoracic MR imaging

Contrast media have been used for the study of disease of the thorax. Most experience has consisted of the use of MR contrast media for improving the delineation of acute myocardial infarction, for demarcating the area of acute myocardial ischemia, and for demonstrating the area of potentially jeopardized myocardium after acute coronary occlusion. Contrast agents demonstrate the ischemic or jeopardized area as a zone of decreased signal intensity to normal myocardium. On the other hand, the magnetic susceptibility agents demonstrate the ischemic or jeopardized area as a zone of increased signal intensity to normal myocardium. Little experience exists concerning the use of MR contrast media for enhancing mediastinal and lung masses. The few reports to date demonstrate that contrast media can improve the conspicuity of thoracic masses. A new nonionic contrast medium, gadodiamide injection, has been shown to considerably increase S/N and C/N of thoracic masses. Further studies are necessary to define the role of MR contrast media in the evaluation of myocardial ischemia and thoracic masses in clinical practice.

Dynamic pulmonary CT: findings in healthy adult men

The authors examined 10 healthy male subjects with dynamic computed tomography to determine normal dynamic and expiratory findings. In both the supine and prone positions, the average increase in lung attenuation during exhalation was found to be significantly greater in dependent lung regions than in nondependent lung regions. In each of the lung zones studied, there was a significant correlation between the decrease in cross-sectional lung area during exhalation and the increase in lung attenuation. At the lung bases, a greater increase in lung attenuation was noted during exhalation for a given change in cross-sectional lung area than in the upper lungs. All 10 subjects showed a distinct lobar attenuation gradient in the supine position. In general, lung attenuation increased homogeneously during exhalation, but four of the 10 subjects showed regions of inhomogeneity in lung attenuation during rapid exhalation indicative of air trapping, despite normal results on pulmonary function tests.