Pulmonary endarterectomy has been successfully implemented in Denmark. The perioperative mortality was reduced over time to 9% during the past 5 years. Functional outcome and long-term survival were excellent stressing the importance of surgical treatment for chronic thromboembolic pulmonary hypertension.

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Portal hypertension is a rarely encountered late complication of umbilical vein catheterization. A survey of the 38 cases previously published is presented together with an additional case report. It is concluded that catheterization for more than 2 days carries an increased risk of thrombosis, and that umbilical artery catheterization should be preferred in the majority of cases due to a reduced risk of complications. The correct position of the catheter tip must always be controlled by fluoroscopy or X-ray. Infusion of hypertonic solutions with unphysiological pH should be restricted and umbilical vessel catheterization should only be carried out in severe cases. Pretreatment of the catheters with heparin possibly reduces the hazards.

ABSTRACT. Objectives. To evaluate the reproducibility and the accuracy of pediatric radiologists' assessments of chest radiographs with respect to the presence or absence of heart defects in children with an asymptomatic heart murmur.Design. Ninety-eight children, ages 1 month to 15 years (median, 30.1 months), referred for evaluation of a heart murmur were consecutively included. They all had a standard chest radiograph and a color Doppler echocardiograph (CDE) performed. Six specialists in pediatric radiology evaluated the chest radiographs independently on two occasions 6 months apart. The radiologists were asked to classify each set of films into one of two categories: heart disease or no heart disease. The outcome of the CDE was considered the definite diagnosis. statistics were used to analyze the reproducibility of the radiologic assessments. Sensitivity, specificity, and the predictive value of a positive and a negative test were used for evaluation of the accuracy of the radiologic assessments.Results. Mean intra-and interobserver values were all <0.6, and the majority were <0.4. Mean sensitivity was 0.3 (range: 0.17-0.52), mean predictive value of a positive test was 0.4, implying that 60% of the positive assessments were falsely positive. Mean specificity was 0.86 (range: 0.75-0.93) and the mean predictive value of a negative test was 0.80 implying that 20% of the negative assessments were falsely negative.Conclusion We found a low reproducibility, as well as a low accuracy, of the radiologic assessments of the chest radiographs of children with an asymptomatic heart murmur with respect to the presence or absence of heart disease. A false-positive radiologic assessment of the chest radiograph with respect to heart defects causes unnecessary anxiety and further examinations, whereas a false-negative assessment might result in omission of relevant investigations and proper identification of the heart defect. We cannot recommend the use of chest radiographs in the initial evaluation of the asymptomatic child with a heart murmur. If a heart defect cannot be excluded by clinical examination a CDE must be performed. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e15; child, cardiac murmur, chest radiograph, reproducibility, accuracy.ABBREVIATION. CDE, color Doppler echocardiography.

Background and Purpose:Computed tomography is now routinely used in many hospitals to investigate cerebrovascular disease. The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke.Methods: Two-hundred forty-five consecutive stroke patients were included in the project during a 1-year period. Each had a detailed neurological assessment 24-72 hours after stroke onset and underwent cranial computed tomography without intravenous contrast injection within the first week after admission. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model with survival/death as the binary variable.Results: Computed tomography showed 76% of the patients had infarcts, 11% had hemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarctions. The temporal, parietal, and frontal regions and the basal ganglia were most often affected.Conclusions: We conclude that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase. (Stroke 1992;23:506-510)

The purpose of the present investigation was to evaluate the use of 99mTc-DTPA (diethylenetriaminepenta-acetate) gamma camera renography for the study of kidney function as well as morphology. Sixty-nine children with urinary tract infection or congenital hydronephrosis aged 6 days to 13.6 years were studied. A method for determination of the glomerular filtration rate (GFR) from the recorded curves without use of blood or urine samples was tested in 65 consecutive children. From each renogram an uptake index was determined. After a weight/height correction the sum of right and left kidney uptake index correlated with total GFR determined from plasma clearance of 51Cr-EDTA (ethylenediaminetetra-acetate) measured on the same day (r = 0.96). The relative standard error of estimating GFR from the renograms was 10.7% at GFR = 100 ml/min and 14.6% at GFR = 50 ml/min. In a subgroup including 20 children no difference was found in kidney morphology and length studied by renography and intravenous urography, the latter providing more details concerning the urinary tract. Relative kidney length did not correlate with relative renal function determined by renography, emphasizing the difficulty in determination of relative renal function by urography. In conclusion, not only relative but also absolute renal function (GFR) can be determined in children by 99mTc-DTPA renography; at the same time kidney and urinary tract morphology are evaluated. In our hands, 99mTc-DTPA renography has become a useful diagnostic tool, lowering the need for the more cumbersome intravenous urography and 51Cr-EDTA plasma clearance. However, intravenous urography is mandatory for the detailed study of the urinary tract, and use of the 51Cr-EDTA plasma clearance technique is necessary when a very reliable determination of GFR is wanted.

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