Browsing by Author "George R."
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- ItemCentral nervous system manifestations of HIV infection in children(2009) George R.; Andronikou S.; Du Plessis J.; Du Plessis A.-M.; Van Toorn R.; Maydell A.Vertically transmitted HIV infection is a major problem in the developing world due to the poor availability of antiretroviral agents to pregnant women. HIV is a neurotrophic virus and causes devastating neurological insults to the immature brain. The effects of the virus are further compounded by the opportunistic infections and neoplasms that occur as a result of the associated immune suppression. This review focuses on the imaging features of HIV infection and its complications in the central nervous system. © 2009 Springer-Verlag.
- ItemChylothorax as a complication of pulmonary tuberculosis in children(2008) Grobbelaar M.; Andronikou S.; Goussard P.; Theron S.; Mapukata A.; George R.Chylothorax is a rare clinical entity characterized by a milky white aspirate with increased triglyceride levels. The commonest aetiology is malignancy and trauma. Pulmonary tuberculosis is an extremely rare cause of chylothorax. Two children with chylothorax and pulmonary tuberculosis are described. One child had bilateral and the other unilateral chylous effusions. Extensive mediastinal and hilar lymphadenopathy was demonstrated. Diseased lymph nodes may infiltrate other intrathoracic structures such as the thoracic duct, and they can also obstruct the cisterna chyli and thoracic duct. A possible explanation for the development of a chylothorax in our patients is obstruction of the thoracic duct by tuberculous lymphadenopathy with subsequent increase in pressure in the surrounding lymphatic system and leaking of chyle into the pleural space. © 2007 Springer-Verlag.
- ItemComparing three-dimensional volume-rendered CT images with fibreoptic tracheobronchoscopy in the evaluation of airway compression caused by tuberculous lymphadenopathy in children(2009) Du Plessis J.; Goussard P.; Andronikou S.; Gie R.; George R.Background: Lymphobronchial tuberculosis (TB) causes airway compression in 38% of patients. The airway obstruction is conventionally assessed with fibreoptic tracheobronchoscopy (FTB). Multidetector-row spiral computed tomography (MDCT) with three-dimensional volume rendering (3-D VR) has significantly improved the imaging of the airways. No previous studies have assessed the accuracy of 3-D VR in determining the degree of airway compression in children due to TB lymphadenopathy. Objective: To compare 3-D VR CT to FTB for the assessment of airway compression due to TB lymphadenopathy in children. Materials and methods: Included in the study were 26 children presenting with symptoms of airway compression caused by pulmonary TB. MDCT of the chest and FTB were performed in all patients. Retrospective 3-D VR reconstruction of the major airways was performed from the original CT raw data and used to evaluate the tracheobronchial tree for site and degree of airway compression and then compared to the FTB findings. FTB was used as the reference standard Results: By FTB 87 sites of airway compression were identified. Using the 3-D VR technique, 138 sites of airway compression were identified, of which 78 (90%) matched with the sites identified by FTB. The sensitivity and specificity of 3-D VR when compared with that of FTB was 92% and 85%, respectively. In four patients (15%), severe narrowing of the bronchus intermedius made FTB evaluation of the right middle and right lower lobe bronchi impossible. VR demonstrated significant distal obstruction in three of these four patients Conclusion: 3-D VR demonstrates a very good correlation with FTB in determining airway compression caused by TB lymphadenopathy in children. In combination with FTB, 3-D VR adds confidence to the bronchoscopy findings and complements FTB by adding additional information on the status of the airway distal to severe obstructions unreachable by FTB. © 2009 Springer-Verlag.
- ItemCT features of tuberculous intracranial abscesses in children(2007) du Plessis J.; Andronikou S.; Wieselthaler N.; Theron S.; George R.; Mapukata A.Background: Intracranial tuberculous (TB) abscesses still cause a diagnostic dilemma on both CT and MRI as they may mimic neoplasms. Recognition of TB abscesses may prompt further imaging and appropriate trial of therapy, and may reduce the need for biopsy. Objective: To report the CT features of eight intracranial TB lesions in children initially diagnosed as neoplasms and eventually treated as TB abscesses. Materials and methods: We undertook a 3-year retrospective review of children with an initial CT diagnosis of intracranial neoplasm who were subsequently diagnosed as having TB abscesses. Results: Eight patients out of 60 with an initial diagnosis of a neoplasm on CT were misdiagnosed and were ultimately determined to have TB abscesses after biopsy or a trial of anti-TB therapy. The most consistent constellation of findings for the lesions were low density (n=5), ring enhancement (n=8), cerebral hemisphere location (n=7), mass effect (n=6), surrounding oedema (n=5) and absence of a soft-tissue-density mass (n=8). Conclusion: In endemic regions, intracranial lesions with these appearances on CT should undergo further imaging and possibly a trial of anti-TB therapy before considering biopsy. © Springer-Verlag 2006.
- ItemEndovascular Treatment of Femoral Artery Pseudoaneurysm in a HIV Positive Patient - A Case Report(2007) George R.; Przybojewski S.; Theron S.Arterial pseudoaneurysm formation has been increasingly reported in HIV positive patients and generally surgery is indicated. We paced an endovascular stent in a femoral artery pseudoaneurysm of a 30-year-old HIV-positive male. Early results of this procedure are good. We believe that implantation of an endovascular stent graft can result in a shorter hospital stay and can significantly reduce morbidity for HIV-positive patients with pseudoaneurysms. © 2007 Elsevier Ltd. All rights reserved.
- ItemNon-infective pulmonary disease in HIV-positive children(2009) Theron S.; Andronikou S.; George R.; Du Plessis J.; Goussard P.; Hayes M.; Mapukata A.; Gie R.It is estimated that over 90% of children infected with human immunodeficiency virus (HIV) live in the developing world and particularly in sub-Saharan Africa. Pulmonary disease is the most common clinical feature of acquired immunodeficiency syndrome (AIDS) in infants and children causing the most morbidity and mortality, and is the primary cause of death in 50% of cases. Children with lung disease are surviving progressively longer because of earlier diagnosis and antiretroviral treatment and, therefore, thoracic manifestations have continued to change and unexpected complications are being encountered. It has been reported that 33% of HIV-positive children have chronic changes on chest radiographs by the age of 4 years. Lymphocytic interstitial pneumonitis is common in the paediatric HIV population and is responsible for 30-40% of pulmonary disease. HIV-positive children also have a higher incidence of pulmonary malignancies, including lymphoma and pulmonary Kaposi sarcoma. Immune reconstitution inflammatory syndrome is seen after highly active antiretroviral treatment. Complications of pulmonary infections, aspiration and rarely interstitial pneumonitis are also seen. This review focuses on the imaging findings of non-infective chronic pulmonary disease. © 2009 Springer-Verlag.
- ItemPulmonary infections in HIV-positive children(2009) George R.; Andronikou S.; Theron S.; Du Plessis J.; Hayes M.; Goussard P.; Mapukata A.; Gie R.Infection of the lungs and airways by viral, bacterial, fungal and protozoal agents, often producing atypical radiographic features, is common in children with human immunodeficiency virus (HIV) infection. Conventional chest radiography and chest CT remain the most useful imaging modalities for evaluation of the immunocompromised patient presenting with a suspected pulmonary infection. In this review the radiological features of acute lung infections in this population are discussed. © 2009 Springer-Verlag.
- ItemPulmonary Kaposi sarcoma in six children(2007) Theron S.; Andronikou S.; Du Plessis J.; Goussard P.; George R.; Mapukata A.; Grobbelaar M.; Hayes M.; Wieselthaler N.; Davidson A.Background: Pulmonary involvement in Kaposi sarcoma is rare in children and can be difficult to distinguish from other pathology. Objective: To describe the radiological findings in paediatric pulmonary Kaposi sarcoma. Materials and methods: Sequential chest radiographs of six children and CT scans of four of these children were evaluated retrospectively. Their ages ranged from 18 months to 10 years; four were male and two were female. All six children were HIV-positive. The observers were two radiologists. Results: Chest radiographs revealed air-space (100%) and reticular (83%) opacification in the mid- and lower lung zones; pleural effusions were present in 83% of the children. All the children showed progressive air-space opacification on follow-up radiography. CT demonstrated bilateral air-space opacification in a perihilar distribution in all the children; reticular opacification was seen in 75%. All the children had mediastinal and axillary lymphadenopathy; 75% had bilateral hilar lymphadenopathy. Conclusion: In both adults and children, chest radiography demonstrates perihilar and lower zone involvement. Pleural effusions are more common on radiographs in children. Air-space disease and lymphadenopathy are much more common on CT in children than adults. © 2007 Springer-Verlag.
- ItemShould SPECT-CT replace SPECT for the evaluation of equivocal bone scan lesions in patients with underlying malignancies?(2010) Ndlovu X.; George R.; Ellmann A.; Warwick, James M.INTRODUCTION: Bone scintigraphy is used extensively in evaluating metastatic disease. There are currently no clear recommendations for the use of single photon emission computed tomography (SPECT)/CT in metastatic bone disease. Given its limited availability there is a need to identify the clinical indications for which SPECT/CT is clearly beneficial in influencing patient care and outcome. METHODS: Forty-two patients with equivocal lesions on planar scintigraphy were recruited and underwent SPECT/CT imaging. On reading of SPECT alone and then SPECT/CT, lesions were classified as malignant, benign or equivocal. Follow-up clinical information, radiological studies and/or bone scans were used as a gold standard. SPECT and SPECT/CT were compared in terms of the number of equivocal findings and accuracy on a patient-wise and lesion-wise basis. RESULTS: Forty-two patients with 189 skeletal lesions were examined. There was a diverse variety of primary tumours, with the majority being breast (n=22) and prostate cancer (n=8). SPECT/CT resulted in a significant reduction in the proportion of patients (48-14%, P=0.0015) and lesions (31-9%, P<0.0001) with equivocal findings. The overall accuracy of SPECT/CT was significantly higher on both a patient-wise (52-79%, P=0.0026) and lesion-wise basis (67-92%, P<0.0001). CONCLUSION: SPECT/CT significantly outperforms SPECT alone for the interpretation of skeletal lesions in patients undergoing bone scanning for metastases. When available SPECT/CT is indicated in patients in whom correct classification of equivocal lesions is expected to alter the patient's management. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.