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An integrated biorefinery (IBR) is a multi-process facility that uses agricultural waste to produce valuable bioenergy products. Several studies already have shown the potential economic, environmental, and social benefits of setting up IBRs. However, planning is crucial in the development of IBRs since several stakeholders are involved in its operation and the entire biomass-bioenergy supply chain. As an initial step, it is essential to identify the potential barriers to implementing IBRs at the local level prior to its nationwide scale-up. In this preliminary work, a Decision-Making Trial and Evaluation Laboratory (DEMATEL) framework was used in analyzing barriers to implementing IBRs on a municipality level. DEMATEL-based methods determine the relation between cause-effect factors in a given problem. Based on the results, the primary causal barrier is the "Lack of potential feedstocks due to climate change and other factors (B6)" and the "Lack of technology and infrastructure readiness (B1)" is the highly-correlated barrier. The results from this preliminary study can be used to develop a more robust assessment of establishing IBRs. Farmers, investors, local government units, and policymakers can then use such analysis to create mechanisms to address the barriers and formulate policies in developing IBRs. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this paper is to present our experience with Mycobacterium tuberculosis infections in immunocompetent children.Subjects and methods. Radiology, pathology, microbiology, and discharge records at two institutions identified the study population. Children who were immunocompromised and those with a positive skin test and no radiological or clinical evidence of active infection were excluded. Active mycobacterial infection was defined by a positive culture, biopsy, or a reactive purified protein-derivative skin test (PPD) with an appropriate clinical presentation and response to therapy and/or known exposure to an adult with active tuberculosis. Results. There were 22 children in whom Mycobacterium tuberculosis (MTb) was identified. Fourteen of the patients with MTb were 5 years of age or younger. The most common sites of radiological involvement were the lungs (15 cases) and the hila (eight cases). Four patients had evidence of extrathoracic MTb infection. Three cases of miliary tuberculosis were identified, all in children less than 9 months of age. Conclusion. Although pulmonary and/or hilar disease remains the most common radiological presentation of childhood tuberculosis, the radiologist must be aware of the many radiological presentations of childhood Mycobacterium tuberculosis infection, and should have a high index of suspicion with the increasing incidence in both normal and immunocompromised children. [ABSTRACT FROM AUTHOR]

Ultrasonography (US) has largely replaced the intravenous urogram as the first modality for the evaluation of the kidneys in children suspected of having urinary tract abnormalities. Because many renal disorders are associated with changes in the sizes of the kidneys, normative standards for assessing renal size have been developed. These standards rely upon comparison of the renal lengths or calculated volumes or both, with various assessments of overall body size, including body surface area, weight, height, and chronological age. We discuss some of the limitations of US in assessing renal size in children. Practical recommendations are offered for optimizing the measurement and interpretation of sonographic renal sizes in children. [ABSTRACT FROM AUTHOR]

Eight children forming an uncommon subgroup of renal obstructive dysplasia are presented. Each child had a nonfunctioning dysplastic kidney with a single collecting system with ectopic ureteral insertion and/or ureterocele. Five of the children had classic multicystic dysplastic kidneys, one had the hydronephrotic type of multicystic dysplastic kidney and two had hypoplastic kidneys. Other significant medical problems in 5 of the 8 children (63%) included VACTERL association, congenital heart disease and other genitourinary malformations. Unlike some children with unilateral multicystic dysplastic kidney, this subgroup of children has an increased risk of infection. They must be correctly identified on imaging so that tailored clinical management decisions can be made and associated anomalies detected. [ABSTRACT FROM AUTHOR]

57 cases of renal obstructive dysplasia (defined as the abnormal development of nephronic and ductal structures due to in utero obstruction of the urinary tract) were evaluated in terms of sonographic findings, renal and other associated anomalies, and current status of the child. More than one-third of the cases had bilateral disease and although not uniformly fatal bilateral involvement was associated with significant morbidity and mortality. In 12 of the 33 cases with unilateral dysplasia there was an association with contralateral renal problems including uretero-pelvic junction obstruction, vesicoureteral reflux and aplasia. Almost one-half of the cases had congenital anomalies, these included VACTERL association, congenital heart disease, cranial abnormalities and gastrointestinal malformations. Fifteen stillborns and 12 of the patients with bilateral involvement and four with unilateral involvement have died. Four patients are on dialysis (two with bilateral involvement and two with unilateral renal obstructive dysplasia). Only one-quarter are otherwise normal. More serious problems are reported in this mixed age population of patients with obstructive renal dysplasia than has been identified in previous studies. Management decisions of the fetus and child must be based on this new age-expanded population. [ABSTRACT FROM AUTHOR]

The Ilizarov method for limb lengthening is rapidly gaining popularity in North America. Use of this new technique has necessitated modifications in radiographic protocol. Initial imaging problems gained from our experience with twenty children are detailed including accurate centering for the plain films, correcting for magnification to accurately measure the distraction gap and the expected radiographic appearance of the regenerate bone. Ultrasonography has potential value in accurately measuring the distraction gap and in imaging the new bone prior to radiographic appearance. Since overly fast distraction inhibits bone formation and overly slow distraction leads to premature consolidation, ultrasound may serve a useful role in the qualitative evaluation of new bone formation in Ilizarov limb lengthening, enabling the orthopedic surgeon to tailor the distraction rate to the particular child. [ABSTRACT FROM AUTHOR]

This study examined 46 children 5-9 years (mean 6.7) after Nissen fundoplication surgery for gastroesophageal reflux (GER). Eleven were deceased and ten of the 35 families declined objective evaluation. The remaining 25 children (71%) had a barium swallow examination. In 16 of the 25 patients the fundoplication was intact. In 2 patients a small portion of the fundoplication was displaced above the diaphragm. In 5 patients there was residual esophageal disease. In 3 patients (one with esophageal disease), with a hiatus hernia prior to surgery, despite immediate postoperative reduction, the barium swallow examination done for this study revealed recurrent hiatus hernia but no GER. Long-term results of the Nissen fundoplication reveal success in eliminating clinically significant gastroesophageal reflux. Those patients with esophageal disease prior to the surgery need close interval follow-up to monitor continuing problems. [ABSTRACT FROM AUTHOR]

The imaging procedures utilized at presentation in the diagnostic work-up of 19 children with Burkitt lymphoma were reviewed. The distribution of disease was compared to other tumors of childhood so that the most valuable modalities could be identified. Burkitt lymphoma is a rapidly growing tumor in the child, making it essential to suggest the diagnosis as quickly as possible so that biopsy and treatment can be instigated. The primary area of involvement was abdominal (15 of 19), gastrointestinal, intraperitoneal adenopathy, hepatic and pancreatic without retroperitoneal adenopathy. Pleural effusions were common without hilar and mediastinal adenopathy. This is in contrast to other tumors of childhood where mediastinal and hilar disease in the chest and retroperitoneal node involvement in the abdomen are common. Thus sonography is an excellent imaging modality, easily identifying the extent of the disease and so suggesting the diagnosis. [ABSTRACT FROM AUTHOR]

The enterocolitis following a pull-through in Hirschsprung's disease can be life-threatening and difficult to distinguish clinically from gastroenteritis and post-operative complications. We reviewed retrospectively the abdominal radiographs in our series to identify specific radiographic characteristics of this syndrome in this population. A total of 55 episodes of enterocolitis with an abdominal series at presentation were located in the files of 43 patients following pull-through surgery for Hirschsprung's disease. There were 15 abdominal series with other complications of Hirschsprung's disease and surgery (seven cases of small bowel obstruction, one of fistula, one of abscess, six of severe constipation) and 71 surveillance follow-up studies. Radiographs were evaluated for bowel dilatation, air-fluid levels, intestinal cut-off sign, speculation, and pneumatosis. The intestinal cut-off sign with two or more air-fluid levels had sensitivity of 68% and specificity of 83%, with a positive predictive value of 0.71 and overall accuracy of 77%. Our review of enterocolitis following pull-through in children with Hirschsprung's disease concludes that the constellation of an intestinal cut-off sign and at least two air-fluid levels on the abdominal series strongly suggests the diagnosis. [ABSTRACT FROM AUTHOR]

Though surgery has been recommended in the past for the management of benign hepatic tumors, the current emphasis is on medical management. This report of 4 cases with long-term (8-28 months) follow-up emphasizes the natural history of these tumors which serves to indicate the advantages and disadvantages of CT and ultrasound. The lesions typically involute with some calcification. Calcification can technically be a problem in follow-up with sonography. [ABSTRACT FROM AUTHOR]

Dysplasia epiphysealis hemimelica can be diagnosed on plain radiographs of the affected areas. However, double contrast arthrography in three new cases provided additional information. The cartilaginous portions of the lesion at the articular surface of the bone were precisely demonstrated, aiding the orthopedic surgeon in deciding which patients should have surgery and planning the extent of operation necessary. [ABSTRACT FROM AUTHOR]

In past years the clinical and radiologic presentation of true heterotopic bone in the paralyzed patient has been confused with osteomyelitis, neoplasm, trauma, and thrombophlebitis. We reviewed 376 paralyzed patients' roentgenographic files and found 78 patients with soft tissue ossification unassociated with infection, neoplasm, or underlying fractures, which we called true heterotopic bone. From this population the usual spectrum of radiologic findings is described, so that the radiologist may separate roentgenographically a group of patients from other types of ectopic ossification. [ABSTRACT FROM AUTHOR]

A child with the suspected diagnosis of atypical acute appendicitis underwent a diagnostic barium enema. The study was complicated by perforation with leakage of a large amount of barium into the peritoneal cavity. The complex hospital course that resulted has prompted us to reevaluate the barium enema in the diagnosis of appendicitis and review the literature for contraindications. We conclude that this particular complication is extremely rare and that barium enema still has a part to play in some patients where the clinical diagnosis is uncertain. [ABSTRACT FROM AUTHOR]