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.