1067

EDITORIALS

charts

can be avoided

by use of recently

information concerning Low dose radiography

[71. portable

angiography

Downloaded from www.ajronline.org by 41.189.254.53 on 10/13/15 from IP address 41.189.254.53. Copyright ARRS. For personal use only; all rights reserved

[81. and now, of

functional

low

to apply

the

dose

and

The

adults

a striking reduction medical radiation.

technology

in its

certainly

infancy.

are yet

technique

in

for

the

of

be easy

dose

radio-

age

screen

technology

and

refinements

to come. Richard

6. Wesenberg

L. Wesenbeng

Raymond

Saskia v. W. Hilton Joel 0. Blumhagen

University

of Colorado Denver,

lation

from

resistance and

fetal

to

is characterized and

ductus

normal

functional

adaptive

hypoxemia

secondary

of the

in two

hemodynamic

over

in eight

8 year

an

experience

but

genital

heart

only

Within

the

of the

fetal

a wide

[4-71, lung

adaptation Cardiac usually

(W. past

infants

could M

year,

circulation

.

be

with

inclusive

the

entity

in the newborn catheterization

and

for

this

have

with

led to

are found

hypoxemia

helpful

1 14:

ruling

abnormalities.

In

ductal

determinations

night

radial

arteries

night-to-left

and

shunting

heart

and

simultaneous

pre-

descending

vessels,

bed

catheterization

the

size

structural

heart

[4, 51. We found in

disease

no

infants

only

of

cannot

typical the

addition

to

rare

parenchymal abnormalities disease, meconium aspiration and

a poorly

not

out

of

that

the

chest

proportion film.

normal

defined

to the This

lungs,

pattern

In most the degree

a

when excluded

of retained

the this of

,hyaline pneulung

fluid

on without pulwas generally

abnormality has

of of

number

including syndrome,

cases, with of hypoxemia

pulmonary

observation

be

pattern

In

as

Cardiac

appearance

hemodynamic

pulmonary membrane monia,

level

such pulmonary

instances

otherwise

condition.

were encountered. monany disease.

at the

vasospasm.

radiographic

with

function, pulmonary

shunting

in the

Pre-

structure

and

evidence

in identifying

is required

on

document

arteriosus.

assess

as demonstrate

post-

temporal may

ductus to

chamber

presumptive

cardiac and

from aorta

the

a fixed

electnocandio-

structural

is used

great

normal

of

out

some

through

provide

rules

obtained

echocardiography may

A

out

addition,

administration

effectively

shunt.

in

oxygen

with

infants

right-to-left

is

lungs

cardiopulmonary

We

intracardiac gram

of in many

is useful

of persistence

angiocandiography

correction oxygen

vascular

cardiac

high-speed

A Commentary

ovale [10]. A trial of a vasodilator test the responsiveness of the

I 91. diagnosis.

of

Radiology

as well

con-

have

evaluation

angiography.

hypertension

communication).

reports

K: The

in

of the foramen tolazoline to

radiographic presentations of an animal model links abnormal

Radiation exposure in Radiology 122:

newborn.

ab-

clinical

in infants

WA:

the

131

gathered

without

A, Amplatz

combinations

1 00%

and

the

cyanotic

.

of

normal

in whom

of

1977

initial

of the

series

identified

1975

with

disease. et al.

their

out

449-452.

sently

represent

I 81 These

concept

essential

This

Moore

of abnormal

of

pattern

been

pensis-

of pulmonary

personal

circulatory

has

this

of lung Silvenstein

ruled

Gensony.

range of clinical and and a recent description

disease

a more

those

not

this

fetal channels the term pensis-

infants

infants.

does

disease

catheterization

and

characteristic

newborn

period

of

of severe

documentation pattern

ovale

failure

syndrome

evidence journal,

angiocardiographic

hypertension

foremen

vasospasm

to this

adaptation

vascular

in a syndrome

to pulmonary

hearts and no radiographic In the May issue of this normal

the

infants,

results

circulation

cardiopulmonary

provided

of

some

499-504. 7. Ovitt 1W, screen-film

Circulation:

circu-

in pulmonary

shunting through patent Gersony et aI. I 21 applied fetal

Fetal

cardiopulmonary fall

closure In

response

tent night-to-left I 1 1. In 1 969, tence

postnatal

by a rapid

arteniosus.

80262

of the

AP, Hendee

examinations

8. Stables DP, Rossi AP, Caruthers SB, Anderson N: The application of newer screen-film systems to excretion urography. Am J Roentgenol 128:617-619, 1977

Center

Colorado

Persistence

Transition

M. Gilbert L. Chionis

Medical

1972

AL. Rossi

radiographic

P. Rossi

Joan Many

105:185-190,

3. Stevels ALN: New phosphors for x-ray screens. Medicamundi 20:12-22, 1975 4. Wagner RF, Weaver KE: Prospects for x-ray exposure reduction using rare-earth intensifying screens. Radiology 1 18: 183-188, 1976 5. Rossi RP, Hendee WA: An evaluation of rare-earth screenfilm combinations. Radiology 121:465-471, 1976

dose screen

significant

advances

Radiology

could

tungstate

rare-earth

1 . Rossi RP, Hendee WR, Wesenberg RL’: Reduction of patient exposure in diagnostic radiology through the use of rareearth screen-film combinations, in Operational Health Physics, Proceedings of the 9th Midyear Topical Symposium of the Health Physics Society. Denver, February 1976, pp 120-134 2. Buchanan RA, Finkelstein SI, Wickersheim KA: X-ray exposure reduction using rare-earth oxysulfide intensifying screens.

in

obvious area a presently

low

genetic

calcium

Further

use

it should

use

REFERENCES

uroradiography

next With

of reproductive

While

is at a standstill,

is only

].

Li

The

in pediatrics,

to adults.

in all children

cause from

radiography

system

system

available

various systems. has been advocated

pediatric radiography. is general radiography.

application

graphy

the

served

seen to

alert

on the

EDITORIALS

1068

radiologist

to

the

circulation

in

these

pulmonary

vasculatune

Downloaded from www.ajronline.org by 41.189.254.53 on 10/13/15 from IP address 41.189.254.53. Copyright ARRS. For personal use only; all rights reserved

unreliable cycle and ences

possibility

of

infants. has

proved

in these infants. degree of aeration

in the

prominence

persistence

of

Radiographic extremely

Variations may result

of the

parent, the Although

pulmonary vasculatune is often the pulmonary vascular bed

of

the

for

circulation stimuli.

abnormal

of the Metabolic

intrinsically

ation.While arterioles have

abnormal

hypertnophy has been

failed

of these

Correction increased remain

tolazoline

in

is in the

some

I 41

investigative

stage

and

of systemic

pressure

Utilizing cation

of

recent

work,

the

syndrome.

to

to more assure

in these

infants.

simple form myocardial

vasoconstniction fetal channels

] 1 3!

Rowe An

of pulmonary function. Within

candial simple fetal

be complex dysfunction.

and

has

acute

Finally

a chronic

variety, would be characterized type caniopulmonary circulation

form,

the

F. Merten

W.

Goetzman

of

California

California

95616

of the

in

5. Levin

DL,

6. Nielsen

radiologic

1977 P. Johnson

89:626-

630.

Aiemenschneider

W,

James

hypoxia:

Wennberg

Tolazoline

RP, respon-

vasospasm.

JA,

GA,

LS: an

Gregory

IA,

The

Phibbs

hypertension

of the

1976

Radiology

Jaffe

1 20:649-

MH, Dinwiddie hypertension Pediatrics 59:205WM. Morishima HO.

Brown

JO,

pulmonary

7. FoxWW, Gewitz GD: Pulmonary

terine

1969 WM:

presumptive

Kitterman

circulation.

8. Gersony

(persistence

considerations.

AF:

hypoxemia:

Persistent

Pediatr

HC,

1959,

40, suppl. 3:87, WJ, Steeg CN, Gersony

Bartoletti

MA,

AM:

transitional

on

Labs,

1976

Heyman J

Ross

. 788,

OF,

neonatal

Rudolph

circulation Conference

: PFC syndrome

circulation:

28:781 Sunshine

89:617-621,

newborn.

of

fetal

Merten

Ross

Circulation

1

BW, A.

Pediatr

RH,

include

RB:

Persistent

652,

1 976

A, Drummond WH, Peckham in the perinatal aspiration 211, 1977 Daniel SS. Kohl S. Cohen H,

hemodynamic

experimental

effects

model

89:631-635, 1976 9. Behrman RE: Persistence of the fetal 89:636-637, 1976

in

of

newborn

intraulambs.

J Pediatr

a

normal fall the

usually

GV, SinclairJC

J Roentgenol

siveness

a classifi-

by persistence beyond the

Duc

circulation).

transitional

in Ohio,

EF, Ellis K, Casarella

Hackel

of

of life,

Columbus,

4. Goetzman

J

observations extrauterine

Research,

fetal

syndromes.

with

to

Persistence Am

conserproper

and would

Clinical

3. Silverstein

be limited

would

vasoconstniction

AD:

adaption

of

use

proposed

type

Rowe in

pp 36- 38 2. GersonyWM,

cincul-

resulting in nightseems warranted.

vasoconstniction this group

includes

.

Pediatric

classic type originally described by Gersony et al. ] 2] as well as a secondary form associated Wit various pulmonany and metabolic abnormalities. An additional acute form would

1

pulmonary

should

and

REFERENCES

of well

In summary, an expanded clinical and radiographic concept of the syndrome to include all infants with persistent on recurrent pulmonary to-left shunting through

infant.

and

University

abnormalities,

to severely ill infants who fail to respond vative methods. Cane must be taken maintenance

fetal

Therapeutic

.

newborn

and

clinical

vasoconstniction

Boyd

other supportive measures approach. Vasodilatons,

infants

pulmonary

a useful

diverse

mech-

have proved useful in the treatment and may result in marked improvement

in oxygenation

in the

of

the

Davis,

in pulmonary investigators

in the

hematologic

provides of

David

1 2].

and

inspired oxygen, and primary therapeutic

such as tolazoline, severe vasospasm

of the

changes

I 2,

infants

of metabolic

the

the

features

hypoxemia

some cases [6]. pulmonary vessels

in persistence

structural

radiographic

a classification

consideration

yet cleanly pulmonary

respond to a variety abnonalities, as in

Such

ap-

the

of smooth muscles reported I 1 1 1. other

to identify

vasculature

pattern,

been implicated evidence that

life. format

not visualized. is cleanly the

infants is not the reactive

newborn may and hematologic

as hypoxia, have There is no definite are

these that

of

practical

When

nadiographically

hemodynamic

vasospasm in It would appear

and

vessels.

parenchymal

nidus

month

of

in the respiratory in extreme differ-

pulmonary

anism defined.

is

fetal

difficult

pulmonary

disease

the

evaluation

myo-

10.

L.

Pieroni

Echocardiographic shunts 558 11

.

Dis

newborn.

peripheral

5G. Reid structural A,

Rowe

Jean-Michel of vein

AR,

Varghese

intracardiac injections.

J Pediatr PJ:

right-to-left Circulation

54:

1976

Haworth recognized

Arch 13.

D.

detection

following 562.

1 2. Brown

of the of a first

Valdes-Cruz

circulation.

Pickering

Child

RD:

L: Persistent fetal features. J Pediatr D:

Persistent

49:883-885,

Abnormal Pediatrics

circulation:

88:61

transitional

newly

4 620,

1 976

circulation.

1974 pulmonary

59:31

8-321

vasoconstriction .

1977

in

the