Letters U Improving Using Milk

to the Acceptance for Dilution

Editor

of Barium

by Children

by

From:

Main

M. Coussement,

Department 06000 Nice,

Hopital

appears to be a normal the amniotic membrane enormous chorionic

placental development, sue culture-like chamber,

MD

of Radiology, France

oligohydramnios gestation because bryo in a relatively

de Cimiez

chorion gel (the

Editor: In examinations of the upper gastrointestinal tract, getting a toddler to drink barium may be very difficult, even when the taste is improved with sugar, chocolate, or any kind of syrup. In this situation, it may sometimes be necessary to administer the contrast material through a feeding tube. A harmless examination then becomes a traumatic experience. In more than a thousand examinations, we have diluted barium with milk instead of water when milk was the usual beverage of the child and there was no suspected milk or lactose intolerance. We noticed that the barium was much better accepted and have had almost no refusals since then. The milk is supplied by the parents for outpatients or by the pediatric department for hospitalized children. When necessary, it is possible to use dehydrated nonfat milk. This technique should not be used with children who do not like milk or who are suspected of being allergic to milk. In these cases, the utmost care should be taken to stay as close as possible to the flavor that the child likes best. We have never had any problem of contamination, but we must make sure that milk brought in by parents is safe. We have not seen any difference in coating nor have we observed any flocculation of the mixture. We use regular barium sulfate, but any kind of commercially available barium sulfate should be suitable for dilution with milk. We did not find mention of this technique in the classic textbook by Poznanski (1). We hope that it may be helpful to others.

(the extraembryonic magma reticulare)

1.

clearly

Poznanski AK. Practical cago: Year Book Medical,

approaches 1976.

to pediatric

radiology.

at least

Sac

Size

as a Predictor

of Poor

From:

Piassale

dell’Umanesimo,

00144

Gynecology, Rome,

II University

of

Italy

Editor: In the February 1991 issue of Radiology, Bromley et al (1) found that the presence of a small gestational sac in the first trimester was a predictor of poor fetal outcome, despite the presence of fetal cardiac activity. This rare sonographic finding could be important not only for ultrasound (US) diagnosis but also to understand the mechanisms and timing of early pregnancy loss. However, the term oligohydramnios, as used by the authors, could prevent the correct interpretation of this interesting finding. In fact, reduced gestational sac size can be attributed to reduction of amniotic fluid and/or magma reticulare. Actually, 578

coelom

in Figure

la

(magma

of the

to be a marked on

that

close not only Interestingly after miscarriage

Fetal

Outcome Francesco Giacomello, MD Department of Obstetrics and Rome, St Eugenio Hospital

is filled

with

a thixotropic

reticulare,

black

arrow)

is

ChiAs seen

Small

coelom) (2).

shown.

appears

a

chorionic cavity functions as a tisand the space between amnios and

Vaginal US scan obtained at 8 weeks gestation in a patient with an uneventful pregnancy. The amniotic membrane representing the limit between the amniotic cavity (amniotic fluid, white arrow) and

the extraembryonic

Reference

the

feature at 7-8 weeks is close to the emcavity (Figure). Before

image,

article

reduction the

amniotic

by

Bromley

et al (1),

of magma

reticulare

membrane

appears

there

because, to be

to the embryo but also to the chorion. enough, although pathologic findings obtained may not necessarily correspond to early ob-

servations

at vaginal

premature

fusion

US

(performed

of amnios

most frequent abnormality Thus, I believe that the

with

shortly

before

the chonon

seen after spontaneous term oligohydramnios

fetal

is reported

death),

as the

abortion (3). in first trimes-

ter vaginal US can be misleading and should be avoided, at least if its definition is based only on the measurement of the whole gestational sac. The term small gestational sac would be more appropriate.

References 1.

2. 3.

Bromley B, Harlow BL, Laboda LA, Benacerraf BR. Small sac size in the first trimester: a predictor of poor fetal outcome. Radiology 1991; 178:375-377. Hertig AT. Chorion-embryo relationship. In: Hertig AT, ed. Human trophoblast. Springfield, Ill: Thomas, 1968; 126, 168. Kalousek DK, Fitch N, Paradice BA, eds. Pathology of the human embryo and previable fetus: an atlas. New York: Springer-Verlag, 1991; 38.

Small sac size as a predictor of poor fetal outcome.

Letters U Improving Using Milk to the Acceptance for Dilution Editor of Barium by Children by From: Main M. Coussement, Department 06000 Nice...
189KB Sizes 0 Downloads 0 Views