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  • Digitale Medien  (173)
  • Online-Ressource
  • 1995-1999  (173)
  • 1940-1944
  • 1999  (173)
  • MRI  (93)
  • Children  (81)
Materialart
  • Digitale Medien  (173)
  • Online-Ressource
Erscheinungszeitraum
  • 1995-1999  (173)
  • 1940-1944
Jahr
  • 1
    Digitale Medien
    Digitale Medien
    Springer
    Trauma und Berufskrankheit 1 (1999), S. S92 
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter Wachstumsalter ; MRI ; Beckenfraktur ; Wirbelsäulenfraktur ; Key words Childhood ; Magnetic resonance imaging ; Pelvic fracture ; Spinal injury
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract According to the literature, from 1950 to 1995 the overall risk for children of sustaining a fracture of the spinal column or the pelvic ring doubled, the main reason being the increasing incidence of high-energy trauma caused by newly popular sporting activities such as skateboarding, inline skating and mountain biking. Nonetheless, even specialized pediatric level I trauma centers in Europe and the United States of America report an incidence of below 5% for severe spinal injuries and fractures of the pelvis. Although these specific injury patters are seen relatively infrequently, whenever present they are still highly indicative of high-velocity injury mechanisms, frequently revealing a combination of injuries – each of which would be serious in itself – involving the body cavities and the soft tissues of the trunk an extremities. In summary, spinal cord injuries and pelvic ring fractures are rare but can be serious: cervical and spinal cord injuries without radiological abnormality appear to be more frequent than in adults, and the availability of nuclear magnetic imaging technologies has helped in the diagnosis of unsuspected cord injury in children. In addition, retrospective analysis of purely nonoperative management of highly unstable C-type injuries of the spine and the pelvic ring reveal some unsatisfactory results, so that specifically for these injury morphologies the alternative of an operative strategy might be considered. The purpose of this presentation is to discuss various injury patterns in which an operative concept could be considered, particularly for a multiply injured child.
    Notizen: Zusammenfassung Verletzungen des Rückenmarks und Sprengungen des knöchernen Beckenrings liegen im Kindesalter auch im Krankengut spezialisierter Zentren unter 5%. Besonders beachtenswert erscheint hierbei, daß Rückenmark- und besonders Halswirbelsäulenverletzungen v. a. beim Kind häufig keine ossäre Mitbeteiligung der Wirbelsäule zeigen und erst durch kernspintomographische Diagnostik erfaßt werden können. Desgleichen zeigt sich bei der retrospektiven Auswertung, daß ein pauschales, rein konservatives Management aller Verletzungstypen, d. h. v.a. der sog. C-Verletzungstypen an der Wirbelsäule und am Becken, z. T. unbefriedigende Behandlungsergebnisse zeigt und daher zunehmend bei bestimmten, im weiteren näher besprochenen Verletzungskonstellationen ein eher operatives Grundkonzept diskutiert wird. Neue Erkenntnisse zur Diagnostik und Therapie der Wirbelsäulen- und Beckenverletzung beim Kind liegen insofern vor, als 1. neuere epidemiologische Erhebungen heute eine präzisere, d. h. nicht nur empirisch gesicherte Unterscheidung der selten von eher regelmäßig anzutreffenden Verletzungstypen und Frakturmorphologien erlauben, 2. durch vergleichsweise „neue“ Sportarten wie „Scate-boarding“ und „Mountain-biking“ ganz generell eine statistisch belegte Zunahme von Hochrasanztraumen und komplexen Verletzungsmustern beim Kind beobachtet werden kann sowie 3. generell v.a. beim mehrfachverletzten Kind heute eine eher aggressivere Gangart, d. h. ein in bestimmten Einzelaspekten eher operatives Versorgungskonzept angestrebt wird. Gegenstand der vorliegenden Arbeit sind 1. eine Analyse der als besonders bedeutsam erkannten Verletzungsformen sowie 2. eine Darstellung der heute in Veränderung begriffenen Behandlungskonzepte v.a. beim mehrfachverletzten Kind.
    Materialart: Digitale Medien
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  • 2
    ISSN: 1436-2023
    Schlagwort(e): Key words: hip ; acetabulum ; labrum ; MRI ; radial-sequence
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract: We investigated the usefulness of a radial-sequence magnetic resonance imaging (MRI) technique in the visualization of the acetabular labrum, which surrounds the acetabulum. In 22 hip joints of 12 volunteers, T2-weighted images were obtained on 24 radial planes of the acetabular rim, set at 15°-intervals, using the small tip angle gradient echo method. We examined 7 planes in the weight-bearing portion. The acetabular labrum in the weight-bearing portion was depicted in good contrast to the surrounding tissues. The shape of the labrum differed among individuals and also in the anterior and posterior portions of the labrum. The signal intensity of the labrum was low or partially moderate. There was a high signal intensity band on the base of the acetabular labrum in several portions, which should be carefully interpreted to avoid confusion with abnormality. We concluded that radial-sequence MRI could be a useful technique for evaluation of the condition of the acetabular labrum in the weight-bearing portion.
    Materialart: Digitale Medien
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  • 3
    ISSN: 1434-5196
    Schlagwort(e): Key words Methadone ; Dihydrocodeine ; Substitution ; Poisoning ; Children ; Schlüsselwörter Methadon ; Dihydrocodein ; Substitution ; Intoxikationen ; Kinder
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin , Rechtswissenschaft
    Beschreibung / Inhaltsverzeichnis: Zusammenfassung Es wird über 3 überlebte und 4 tödlich verlaufene akzidentelle Intoxikationen, sechs mit Methadon, eine mit Dihydrocodein, berichtet. Die Intoxikationen betrafen nicht die Substituierten selbst, sondern deren Familienangehörige, Bekannte oder Mit-Patienten. In allen Fällen wurden die Substitutionsmittel weitgehend ungesichert und teilweise vermutlich auch unbeschriftet stehengelassen. Den Substituierten selbst war dabei die Gefahr, die von ihrem Substitutionsmittel ausging, offenbar nicht ausreichend bewußt. Diese Fälle zeigen deutlich, daß qualitätssichernde Maßnahmen bei der immer großzügigeren Substitutionspraxis, insbesondere in Hinblick auf „take-home“-Dosen, notwendig sind.
    Notizen: Abstract A total of seven cases of accidental ingestion of methadone or dihydrocodeine by four children and three adults are reported of which four were fatal. In each case, someone in the environment was taking methadone or dihydrocodeine as a substitute drug for heroin addiction who obviously did not realize the dangers of methadone for non-addicts. Possible preventive measures are the usage of child-proof containers with adequate labels for take-home medications. Furthermore substituted addicts have to be thoroughly indoctrinated concerning the toxicity and hazards of methadone.
    Materialart: Digitale Medien
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  • 4
    ISSN: 1248-9204
    Schlagwort(e): Contralateral hernia ; Children ; Incidence ; Predisposing disease
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary It is impossible to determine whether or not a child will develop a contralateral hernia after inguinal hernia repair. There exists no risk score for the occurrence of a contralateral hernia. This well-known fact prompted us to perform the underlying study. In a retrospective trial, we reviewed the files of all children operated on for inguinal hernias in our department from January 1986 until December 1994. During this period, we performed 1721 hernia repairs on 1708 children aged 0–16 years. In 96 (5.6%) of these patients, the indication to operate was a contralateral hernia following previous unilateral repair. Comparison of the ages at the time of primary inguinal repair of those children who developed a contralateral hernia (n=96) and those who did not (n=1612) showed a significantly increased incidence of contralateral hernias if the primary operation was performed before the age of two months (p〈0.0001). Diseases predisposing to hernias were found in 38% of all children (prematurity, dystrophia, ventriculo-peritoneal shunt, ascites, asthma). The authors recommend a contralateral exploration for children under the age of two months if they have any predisposing disease.
    Materialart: Digitale Medien
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  • 5
    Digitale Medien
    Digitale Medien
    Springer
    Surgical and radiologic anatomy 20 (1999), S. 413-417 
    ISSN: 1279-8517
    Schlagwort(e): Penis ; Ligaments ; MRI ; Erection
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The suspensory system of the penis acquires clinical importance in reparative surgery, traumatology and through its role in erection. The aim of this study was to identify the different anatomic structures constituting the suspensory ligament by dissection and by magnetic resonance imaging (MRI). Ten unembalmed male subjects were used for dissection of the region of the base of the penis. Ten volunteer patients underwent MRI of the penis before and after the injection of prostaglandin (PGE1). The suspensory apparatus consisted of separate ligamentous structures: the fundiform ligament, which is lateral, superficial and not adherent to the tunica albuginea of the corpora cavernosa; the suspensory ligament properly so-called, further back, stretching between the pubis and the tunica albuginea of the corpora cavernosa and consisting of two lateral, circumferential, and one median bundles, which circumscribed the dorsal vein of the penis. These structures were identifiable in MRI and their supporting role was evidenced during tests of erection. The suspensory ligament seemed to maintain the base of the penis in front of the pubis and to behave as a major point of support for the mobile portion of the penis during erection.
    Materialart: Digitale Medien
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  • 6
    Digitale Medien
    Digitale Medien
    Springer
    Italian journal of neurological sciences 20 (1999), S. 119-128 
    ISSN: 1126-5442
    Schlagwort(e): Key words Learning ; Development ; Memory ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Immediate and 15-min delayed recall of semantically related or unrelated word lists was investigated in 144 normally developing children ranging from 5 to 10 years of age. Immediate recall for the related and unrelated lists increased in a parallel fashion as a function of age. The ability to cluster semantically related items during immediate recall also improved with age. However, in no age class recall scores and clustering indexes were significantly associated. Forgetting rate passing from the last immediate to the delayed recall trial increased for the unrelated list but decreased for the related list of words as a function of age. Results of regression analyses revealed that a developmental increase in forgetting on the unrelated list was actually due to the higher number of words recalled in the last immediate trial by older children. As for the related list, instead, the larger reliance on the clustering strategy of recall by older children was responsible for the progressive reduction of forgetting.
    Materialart: Digitale Medien
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  • 7
    Digitale Medien
    Digitale Medien
    Springer
    Italian journal of neurological sciences 20 (1999), S. 247-249 
    ISSN: 1126-5442
    Schlagwort(e): Key words Superficial siderosis of the central nervous system ; MRI ; Anticoagulant therapy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Superficial siderosis of the central nervous system is a rare condition characterized by deposition of haemosiderin in the leptomeninges and in the subpial layers of the brain and spinal cord. With the widespread use of magnetic resonance imaging, an increasing number of cases of superficial siderosis are being discovered, secondary forms being more frequent than idiopathic ones. We report a 78-year-old man in oral anticoagulant therapy, who presented neurosensory hearing loss, gait ataxia and spastic paraparesis. Magnetic resonance imaging suggested the diagnosis of superficial siderosis of the central nervous system, without an evident bleeding source.
    Materialart: Digitale Medien
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  • 8
    Digitale Medien
    Digitale Medien
    Springer
    Italian journal of neurological sciences 20 (1999), S. 303-307 
    ISSN: 1126-5442
    Schlagwort(e): Key words Lyme disease ; Chronic neuroborreliosis ; Children ; MRI ; Demyelinating disease
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Lyme disease is a polymorphic and multisystemic disease caused by Borrelia burgdorferi. Neurological manifestations are found in 10%–50% of cases. We present 2 cases followed for 5 and 6 years of chronic relapsing-remitting neuroborreliosis. Diagnosis of neuroborreliosis in these cases was based on serum and cerebrospinal fluid findings. We discuss clinical, neurophysiological, laboratory and instrumental aspects regarding the difficulties of reaching a correct diagnosis. Further studies, especially in the field of immunology, should help identify the mechanisms responsible for the disease becoming chronic. With this knowledge, it may be possible to design immunological therapies for relapses, and to prevent the evolution of the disease.
    Materialart: Digitale Medien
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  • 9
    Digitale Medien
    Digitale Medien
    Springer
    Der Nervenarzt 70 (1999), S. 1-10 
    ISSN: 1433-0407
    Schlagwort(e): Schlüsselwörter Tic-Störung ; Zwangsstörung ; Kinder ; Jugendliche ; Neurobiologie ; Psycho- pharmakologie ; Verhaltenstherapie ; Key words Tic-disorder ; Obsessive-compulsive disorder ; Children ; Adolescents ; Neurobiology ; Psychopharmacology ; Behavior therapy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary In children and adolescents motor/vocal tics and obsessive-compulsive behavior are known to be closely related. Thereby, a continuum of symptoms ranging from single tics to a mixed picture of tics/rituals/obsessive-compulsive traits to clinically relevant obsessions and compulsions could be described. As neurobiological substrates dysfunctions in corresponding cortico-striato-thalamo-cortical circuits (sensorimotor circuit in tic symptomatology, orbitofrontal circuit in obsessive-compulsive behavior) were postulated. For both disturbances behavioral therapy can be used to improve control mechanisms to counterregulate tics and obsessive-compulsive behavior, respectively, and psychopharmacological agents can be administerd to compensate dysbalances in neurotransmitter systems. In case of a mixed symptomatologic picture it is necessary to include interventions for both pols of the symptom-continuum in the therapeutic programme to achieve extensive improvement as a basis for a further positive development of the patient.
    Notizen: Zusammenfassung Motorische/vokale Tics und zwanghafte Verhaltensweisen kommen bei Kindern und Jugendlichen häufig gemeinsam vor; dabei kann ein Symptomkontinuum von solitär auftretenden Tics über ein Mischbild von Tics und Ritualen/zwanghaften Gedanken und/oder Handlungen bis hin zu eindeutigen Zwangsphänomenen beschrieben werden. Neurobiologisch können diesem Symptomkontinuum unterschiedlich ausgebreitete Dysfunktionen entsprechender kortiko-striato-pallido-thalamo-kortikaler Regulationssysteme zugrunde liegen. Therapeutisch lassen sich bei beiden Verhaltensauffälligkeiten mittels verhaltenstherapeutischer Techniken Steuerungs- und Kontrollmöglichkeiten zur Gegenregulation der Auffälligkeiten verbessern sowie durch Einsatz von Psychopharmaka Dysbalancen von Neurotransmittersystemen ausgleichen. Bei einem Mischbild von Tics und Zwängen sind therapeutische Interventionen für beide Zielbereiche erforderlich. Nur so können umfassende Verbesserungen erreicht und günstige Entwicklungsbedingungen für die betroffenen Kinder und Jugendlichen eröffnet werden.
    Materialart: Digitale Medien
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  • 10
    Digitale Medien
    Digitale Medien
    Springer
    Monatsschrift Kinderheilkunde 147 (1999), S. 328-332 
    ISSN: 1433-0474
    Schlagwort(e): Schlüsselwörter Asthma bronchiale ; Schulkinder ; Türkische Kinder ; Key words Asthma ; Children ; Turkish children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Objectives: In Germany 4.2% (in Munich 8.6%) of all children under 15 years of age are of Turkish origin, representing the largest ethnic minority in this age group. However, very little is known about the prevalence, severity and management of asthma and other atopic diseases in Turkish children living in Germany. Methods: In a cross-sectional survery the prevalence, severity and treatment of asthma and other atopic diseases was assessed in 7,445 schoolchildren aged 9 to 11 years, living in Munich, southern Germany. Questionnaires were distributed to the parents for self-completion and children underwent skin-prick tests and cold-air hyperventilation challenge. Results: Of those returning the questionnaires (n = 6490/87%), 5,030 (77.5%) were of German and 451 (7%) of Turkish origin. Turkish children showed a significantly lower prevalence of asthma (5.3% versus 9.4%, P 〈 0.05) than their German peers. Furthermore, Turkish children with asthma were less frequently free of symptoms (10.5% versus 34.6%, P 〈 0.05), reported more severe symptoms (41.2% versus 10.9%, P 〈 0.05) and more hospital admissions (55.6% versus 21.6%, P 〈 0.05) due to asthma than German children. Conclusions: The results of this study indicate that despite the lower prevalence of asthma and allergy in the Turkish population living in Germany, asthma is a major health problem for Turkish children. Furthermore, these findings suggest inadequate management of asthma in Turkish children.
    Notizen: Zusammenfassung Fragestellung: Türkische Kinder stellen in der Bundesrepublik Deutschland mit 4,2% und in München mit 8,6% den größten Anteil nicht-deutscher Kinder in der Altersgruppe bis 15 Jahren. Wenig ist jedoch bisher über Häufigkeit, Symptome und Behandlung von Asthma bronchiale und anderer atopischer Erkrankungen der türkischen Minderheit in Deutschland bekannt. Methodik: In einer Querschnittstudie wurde bei 7445 Schulkindern im Alter von 9 bis 11 Jahren im Großraum München die Häufigkeit, der Schweregrad und die Behandlung des Asthma bronchiale und anderer atopischer Erkrankungen untersucht. Fragebögen wurden von den Eltern ausgefüllt, Lungenfunktionsuntersuchungen und Hautpricktests wurden bei den Kindern durchgeführt. Ergebnisse: Von denen, die die zugeschickten Fragebögen ausfüllten (n = 6490/87%), waren 5030 (77,5%) deutscher und 451 (7%) türkischer Nationalität. Die türkischen Kinder zeigten eine niedrigere Prävalenz von Asthma bronchiale (5,3% versus 9,4%, p 〈 0,05) und Neurodermitis (1,6% versus 12,9%, p 〈 0,001) im Vergleich zu den deutschen Kindern. Signifikante Unterschiede bestanden zwischen türkischen und deutschen Kindern in Art der Symptome und der Krankheitswahrnehmung. Türkische Kinder mit Asthma bronchiale waren seltener beschwerdefrei (10,5% versus 34,6%, p 〈 0,05) berichteten von schwereren Symptomen (41,2% versus 10,9%, p 〈 0,05) und von einer größeren Anzahl von Krankenhausaufenthalten (55,6% versus 21,6%, p 〈 0,05) aufgrund von Asthma bronchiale. Schlußfolgerung: Die Ergebnisse der Studie legen den Schluß nahe, daß Asthma bronchiale trotz der niedrigeren Prävalenz in der türkischen Bevölkerungsgruppe ein erhebliches Gesundheitsproblem bei türkischen Schulkindern darstellt. Die höhere Anzahl von Fehltagen in der Schule und die deutlich höhere Anzahl von Klinikaufenthalten aufgrund von Asthma bronchiale sprechen für eine mangelhafte präventive Behandlung dieser Erkrankung bei türkischen Kindern.
    Materialart: Digitale Medien
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  • 11
    ISSN: 1433-0407
    Schlagwort(e): Schlüsselwörter Hallervorden-Spatz-Krankheit (HSD) ; präsenile Demenz ; MRT ; paramagnetische Substanzen ; Globus pallidus ; Key words Hallervorden-Spatz-Disease (HSD) ; Early onset dementia ; MRI ; Paramagnetic substances ; Globus pallidus
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary We report the history of a 38 year old patient who began to develop mental deterioration at the age of 26. After a time of 7 years neurological signs like writing dystonia occured. Hallervorden-Spatz-Desease (HSD) was diagnosed at the age of 36 in vivo with the clinical presentation of severe dystonia, rigidity, dementia, and typical signal loss in the globus-pallidus the reticular part of the substantia nigra, and the nucleus ruber in the T-2 weighted MRI. The „eye-of-the-tiger”-sign, a bilateral hyperintensity in the rostral globus pallidus, was not observed in follow-up examinations. HSD is a rare autosomal-recessive or sporadic disease of unknown etiology. In one third of the patients a dementing process is the first clinical sign of the disorder, and is a rare differential diagnosis of early onset dementia.
    Notizen: Zusammenfassung Wir berichten von einem 38jährigen Patienten, der im Alter von 26 Jahren eine progressive Demenz entwickelte. Erst nach einem Krankheitsverlauf von 7 Jahren kam es zur Manifestation eines rasch progredienten, dystonen Syndroms bis hin zur Immobilität im Alter von 36 Jahren. Die Diagnose der Hallervorden-Spatz-Erkrankung (HSD) wurde aufgrund des klinischen Bildes im Spätstadium der Erkrankung mit schwerster Demenz, Dystonie und Rigidität in Zusammenschau mit den typischen Signalauslöschungen in der T2-gewichteten MRT im Globus pallidus, dem Nucleus ruber und dem retikulären Anteil der Substantia nigra gestellt. Das „Eye-of-the-tiger”-Zeichen, eine bilaterale Signalhyperintensität im rostralen Anteil des Globus pallidus, wurde, auch bei Verlaufsuntersuchungen, nicht gefunden. Die Hallervorden-Spatz-Erkrankung ist ein autosomal-rezessiv oder sporadisch auftretendes Krankheitsbild ungeklärter Ätiologie. Da sich bei einem Drittel der Patienten mnestische Störungen im Kurz- und Langzeitgedächnis als Erstsymptom manifestieren, stellt die HSD eine seltene Differentialdiagnose eines präsenilen Demenzsyndroms dar. In der diagnostischen Beurteilung kommt der Magnetresonanztomographie eine wesentliche Bedeutung zu.
    Materialart: Digitale Medien
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  • 12
    Digitale Medien
    Digitale Medien
    Springer
    Der Nervenarzt 70 (1999), S. 276-280 
    ISSN: 1433-0407
    Schlagwort(e): Schlüsselwörter Metachromatische Leukodystrophie ; Totschlag ; Hebephrenie ; MRT ; Diagnose ; Key words Metachromatic leukodystrophy ; Homicide ; Hebephrenia ; MRI ; Diagnosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary We report a patient with metachromatic leukodystrophy (MLD) with a first manifestation of homicide. On admission the patient showed a hebephrenia-like syndrom with inappropriate affect, thought disorder and behavioral changes. Magnetic resonance tomography (MRT) findings suggested a diagnosis of MLD, which was confirmed by a decreased activity of leucocyte arylsulfatase A and an excessive urinary sulfatide excretion.
    Notizen: Zusammenfassung Wir berichten von einem Patienten mit metachromatischer Leukodystrophie (MLD), der im Alter von 16 Jahren ein Kind tötete. Bei der klinischen Untersuchung zeigte er ein hebephrenes Syndrom mit veränderter Affektivität, formalen Denkstörungen und Verhaltensauffälligkeiten. Bei der neuropsychologischen Testung wurde eine starke Beeinträchtigung von Planen und Problemlösen bei insgesamt überdurchschnittlicher Intelligenz nachgewiesen. Die neurologischen und internistischen Befunde waren unauffällig. Anhaltspunkte für eine MLD fanden sich im Magnetresonanztomogramm (MRT) und wurden biochemisch bestätigt.
    Materialart: Digitale Medien
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  • 13
    ISSN: 1433-0407
    Schlagwort(e): Schlüsselwörter Septum pellucidum ; Entwicklungs- störungen ; Zerebrale Fehlbildungen ; Schizophrenie ; Magnetresonanztomographie ; Key words Septum pellucidum ; Developmental disorder ; Cerebral malformations ; Schizophrenia ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Absence of the septum pellucidum is a rare developmental disorder of the human brain. Previous reports focused on the association with other cerebral anomalies. We present MRI scans showing an isolated absence of the septum pellucidum. The patient was suffering from a schizophrenic psychosis. Mental retardation or epileptic seizures, which are often found in more complex developmental brain disorders, were not observed. The septal area is part of the limbic system and aplasia of the septum pellucidum could indicate developmental anomalies of the limbic system. The concept of cerebral maldevelopment and the limbic system in schizophrenic psychosis is discussed.
    Notizen: Zusammenfassung Die isolierte Aplasie des Septum pellucidum gehört zu den seltenen dysplastischen Fehlbildungen des Gehirns. Während in älteren Arbeiten das Fehlen des Septum pellucidum meistens im Zusammenhang mit weiteren zerebralen Fehlbildungen berichtet wird, so zeigen neuere Untersuchungen doch häufiger auch isolierte Aplasien ohne weitere Fehlbildungen des Gehirns. Dabei scheint ein breites Spektrum der Fehlbildungen von komplexen Hirnfehlbildungen bis hin zur einfachen Aplasie des Septum pellucidum zu reichen. Kasuistisch wird über die Aplasie des Septum pellucidum bei einem Patienten berichtet, welche kernspintomographisch im Rahmen der routinemäßig durchgeführten bildgebenden Diagnostik gefunden wurde. Klinisch wurde bei dem Patienten eine hebephrene Psychose diagnostiziert. In der Ätiologie der schizophrenen Psychosen werden dysontongenetische Mechanismen diskutiert, v.a. Migrationsstörungen in limbischen Strukturen. Eine erhöhte Inzidenz von Anomalien des Septum pellucidum, v.a. Septum-pellucidum-Zysten ist von mehreren Autoren bei schizophrenen Patienten berichtet worden. Die Bedeutung des Septum pellucidum und des Septum verum als Bestandteile des limbischen Systems werden erörtert und eine mögliche Relevanz für das Konzept der dysontogenetischen Ätiologie schizophrener Psychosen wird diskutiert.
    Materialart: Digitale Medien
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  • 14
    Digitale Medien
    Digitale Medien
    Springer
    HNO 47 (1999), S. 535-540 
    ISSN: 1433-0458
    Schlagwort(e): Schlüsselwörter Hörschäden ; Knalltrauma ; Kinder ; Tinnitus ; Erweiterte Hochtonaudiometrie ; Key words Hearing loss ; Acoustic trauma ; Children ; Tinnitus ; High-frequency audiometry
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary The study presents an analysis of 20 cases of acute acoustic trauma caused by toy pistols. The problem generally involves boys within the age range from 6 to 11 years. Half of the incidents involved attacks with toy pistols used as weapons. Auditory damage appeared in two types, each of which had a notch in the audiogram at the frequency range between 10 and 14 kHz. In children, a shot close to one ear can damage both ears. Great differences in the severity of tinnitus were apparent. The most severe cases of tinnitus were observed in the children with no or minor premanent auditory damage. Children experiencing long periods of uninterrupted tinnitus suffer significantly. This is not only detrimental to family-life but also to the performance of the children at school. The total expenses of treatment for these 20 cases were estimated to be approximately 80,000 DM (40.000 Euro).
    Notizen: Zusammenfassung Im Rahmen einer Studie wurden 20 Fälle von Knalltraumata durch Kinderpistolen erfaßt und ausgewertet. Die Problematik betrifft fast nur männliche Personen und schwerpunktmäßig den Altersbereich von 6–11 Jahren. Die Hälfte der Vorfälle waren Angriffe, bei denen die Kinderpistole als Waffe eingesetzt wurde, 2 Typen von Hörschäden sind festzustellen, die jedoch beide durch eine Senke im Bereich von 10–14 kHz charakterisiert sind. Bei Kindern kann der Schuß in eines der Ohren auch das andere Ohr schädigen. Sehr große Unterschiede bestehen im Auftreten von Tinnitus. Die Fälle mit starkem Tinnitus haben keine oder nur geringe bleibende Hörschäden. Die von Knalltraumata betroffenen Kinder leiden oft sehr stark unter langanhaltendem Tinnitus. Dabei wird nicht nur das Leben der Familien beeinträchtigt, sondern auch die schulischen Leistungen der Kinder leiden teilweise sehr stark darunter. Für die Therapie dieser 20 Fälle entstanden Gesamtkosten von ca. 80.000,- DM
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  • 15
    ISSN: 1433-0458
    Schlagwort(e): Schlüsselwörter Laryngotracheale Stenose ; Cricotracheale Resektion ; Kinder ; Tracheotomie ; Key words Laryngotracheal stenosis ; Cricotracheal resection ; Tracheostomy ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Approximately 90% of infants and children with severe acquired laryngotracheal stenoses are tracheotomy dependent and therefore impaired in their physical and speech developments. In addition, tracheotomized infants can be endangered by the cannula due to the possible crusting of secretions or its dislocation. Thus, early repair of a stenosis is mandatory. Within the last 10 years, we successfully operated on 18 children with severe laryngotracheal stenoses. Ten children were treated with a modified Cotton technique. This paper reports our results of cricotracheal resection performed in 8 children since 1994 (age distribution: 7 months through age 15 years). Four children had Cotton grade II stenoses, three had grade III stenoses and one grade IV stenoses. In 3 patients a tracheotomy had been performed at another institution. Since their tracheostomas were too far caudal, they could not be included in the primary resection. All 8 children have been successfully decannulated. Five children without tracheotomies could be extubated uneventfully on the 5th postoperative day. All three primarily tracheotomized children needed further endotracheal stenting with T-tubes because of stomal and suprastomal collapse. Two of these latter children additionally required a tracheoplasty with rib cartilage grafts in order to stabilize the suprastomal trachea prior to decannulation. No patient experienced injuries to the recurrent laryngeal nerves or insufficiencies of the anastomosis. All children’s voices were not impaired. This is the third report in literature of cricotracheal resections in infants and children, indicating that this effective, one-stage procedure is superior to laryngotracheal reconstruction with rib cartilage.
    Notizen: Zusammenfassung Kinder mit schweren, erworbenen subglottischen laryngotrachealen Stenosen sind zu 90% tracheotomiert und daher in ihrer körperlichen und sprachlichen Entwicklung beeinträchtigt. Zusätzlich sind mit einer Trachealkanüle versorgte Kinder, insbesondere Kleinkinder, gefährdet, so daß die chirurgische Beseitigung der Stenose dringend geboten ist. Wir haben innerhalb der vergangenen 10 Jahre 18 Kinder mit einer schweren subglottischen laryngotrachealen Stenose operiert; 10 Kinder, über die kürzlich berichtet wurde, konnten mit der modifizierten Cotton-Technik erfolgreich dekanüliert werden. Über 8 Kinder (Alter 7 Monate bis 15 Jahre, 4mal Stenose II. Grades, 3mal Stenose III. Grades, einmal Stenose IV. Grades), die wir mit cricotrachealer Resektion (CTR) und thyrotrachealer Anastomose operierten, wird in der vorliegenden Arbeit berichtet. 3 Kinder waren anderenorts bereits tracheotomiert. Da die Stomata zu weit kaudal lagen, konnten sie nicht in die Resektion einbezogen werden. Alle 8 Kinder konnten inzwischen dekanüliert werden und sind beschwerdefrei: Die 5 nicht tracheotomierten Kinder konnten problemlos am 5. postoperativen Tag extubiert werden. Die zuvor tracheotomierten Kinder konnten erst nach endotrachealer Schienung (2mal nach zusätzlicher Trachealplastik mit Rippenknorpel bei suprastomaler Tracheomalazie) dekanüliert werden. Bei keinem der Kinder trat eine Recurrensparese auf. Die Stimme bei allen Kindern ist unbeeinträchtigt. Die CTR, über die bei kindlichen laryngotrachealen Stenosen mit dieser Arbeit in der Literatur zum 3. Mal berichtet wird, ist eine sehr effektive, einzeitige, komplikationsarme Operationsmethode, deren Resultate für Atmung und Stimme günstiger sind, als mit der Erweiterungsplastik nach Cotton.
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  • 16
    Digitale Medien
    Digitale Medien
    Springer
    Monatsschrift Kinderheilkunde 147 (1999), S. 122-127 
    ISSN: 1433-0474
    Schlagwort(e): Schlüsselwörter Körperliche Beschwerden ; CBCL/4 ; 18 ; Kultur-vergleichend ; Kinder ; Jugendliche ; Key words Somatic complaints ; CBCL/4 ; 18 ; Cross-cultural ; Children ; Adolescents
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Question: What is the frequency of parent-reported somatic complaints of children in Germany and the Netherlands dependent on their age, sex and the education of their parents. Methods: 4876 CBCL (Child Behaviour Checklist) of children aged 4 through 17 years from the general population were analysed. Results: Dutch children were scored higher by their parents than German children. Moreover somatic complaints increased with age and girls were scored higher. The frequencies of somatic complaints varied from 2% for ’problems with eyes’ to 15% for ’headaches’. The presence of one somatic complaint increased the likelihood of concomitant somatic complaints. Conclusion: Somatic complaints of children without any known cause are often seen. Some symptoms are often reported together. More, especially causal studies on the somatic symptoms of children are recommended.
    Notizen: Zusammenfassung Fragestellung: Wie verhält sich die Häufigkeit körperlicher Beschwerden bei Kindern in Deutschland und den Niederlanden nach Laieneinschätzung, gibt es Unterschiede abhängig vom Alter und Geschlecht der Kinder und des Ausbildungsniveaus der Eltern? Methode: 2757 deutsche und 2119 niederländische CBCL (child behavior checklist) über Kinder und Jugendliche im Alter zwischen 4 und 17 Jahren aus repräsentativen Studien wurden mit Hilfe von Varianzanalysen ausgewertet. Ergebnisse: Niederländische Eltern beschrieben mehr körperliche Beschwerden als deutsche. Die Ausprägung auf der Symptomskala stieg mit zunehmendem Alter und zeigte höhere Werte für Mädchen. Die Häufigkeit der Beschwerden variiert von 2% für „Augenbeschwerden” bis zu 15% für „Kopfschmerzen”. Bei Anwesenheit eines körperlichen Symptoms stieg die Frequenz zusätzlicher Beschwerden. Schlußfolgerung: Körperliche Beschwerden bei Kindern treten häufig ohne bekannte Ursache auf, bestimmte Beschwerden werden häufig gleichzeitig beschrieben, wobei die Koinzidenz nicht umkehrbar ist. Weitere, besonders ursächliche Studien auf dem Gebiet der körperlichen Beschwerden bei Kindern sind auch hinsichtlich steigender Kosten im Gesundheitswesen empfehlenswert.
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  • 17
    Digitale Medien
    Digitale Medien
    Springer
    Monatsschrift Kinderheilkunde 147 (1999), S. 351-355 
    ISSN: 1433-0474
    Schlagwort(e): Schlüsselwörter Latexallergie ; Neuogene Blasenentleerungsstörung ; Kinder ; Key words Latex allergy ; Neurogenic bladder dysfunction ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Objectives: The risk to suffer from natural latex allergy is increased in children with congenital neurogenic bladder dysfunction. We, therefore, evaluated whether or not a serologic screening for detection of sensitization to latex is reasonable in these children. Patients and Methods: 40 children aged from 6 months to 17 years were examined by specific questionnaire-based patient histories, and by determination of total serum immunoglobuline E (total IgE) and natural latex-specific serum immunoglobulin E (latex-IgE) by solid-phase immunoassays. Results: 5 children had a history of allergic reaction to rubber containing materials. In 10 children, latex-IgE was elevated 〉 0.35 kU/l, 6 out of these 10 children without a history of allergic reactions to rubber containing materials. There was a positive correlation of elevated latex-IgE values and the number of former surgical procedures (p 〈 0.006), while no correlation was found between elevated latex-IgE values and clean intermittent catheterization (p = 0.408). Conclusion: Compared to questionnaire-based patient histories, serologic screening examination including determination of latex-IgE values may better identify children at risk to suffer from sensitization to natural latex.
    Notizen: Zusammenfassung Fragestellung: Naturlatexallergien kommen bei Kindern mit angeborener neurogener Blasenentleerungsstörung gehäuft vor. Es wurde deshalb untersucht, ob bei dieser Patientengruppe ein serologisches Screening zur Erfassung einer Sensibilisierung gegenüber Naturlatex sinnvoll ist. Patienten und Methode: Untersucht wurden 40 Kinder im Alter von 6 Monaten bis 17 Jahren. Die Untersuchung umfaßte eine gezielte Anamneseerhebung durch Fragebogen sowie die Bestimmung des Gesamtimmunglobulin E (Gesamt-IgE) und des naturlatexspezifischen Immunglobulin E (Latex-IgE) im Serum durch Festphasenimmunoassays. Ergebnisse: 5 Kinder hatten anamnestisch Zeichen einer allergischen Reaktion nach Gummikontakt. 10 Kinder wiesen im Serum erhöhte Werte des Latex-IgE auf, wobei 6 dieser Kinder bisher noch keine Zeichen einer Latexallergie hatten. Pathologische Werte für das Latex-IgE korrelierten statistisch signifikant mit der Anzahl operativer Eingriffe (p 〈 0,0006), nicht aber mit einem durchgeführten sauber intermittierenden Einmalkatheterismus (p = 0,408). Schlußfolgerung: Im Vergleich zur alleinigen fragebogengestützen Anamneseerhebung können durch ein serologisches Screening mit Bestimmung des Latex-IgE mehr Kinder entdeckt werden, die durch eine Sensibilisierung gegenüber Naturlatex gefährdet sind.
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  • 18
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 32-35 
    ISSN: 1437-9813
    Schlagwort(e): Key words Appendicitis ; Ultrasonography ; Children ; Graded compression ultrasonography
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The diagnosis of acute appendicitis in childhood is frequently difficult. In some situations the need to operate is clear, but in others the decisions may be much “tougher” because the clinical findings are equivocal. This is a retrospective study of a consecutive series of 253 children presenting with “acute abdominal pain? appendicitis” who had graded compression ultrasonography (GCUS) because the clinical scenario did not warrant immediate laparotomy. This represents 30% of all cases seen in the study period. The aim of the study was to examine the role of GCUS and a clinical scoring system (the Alvarado score) in patients in whom the diagnosis is uncertain.
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  • 19
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 50-55 
    ISSN: 1437-9813
    Schlagwort(e): Key words Burns ; Inhalation injury ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Survival from serious burns in children has improved substantially in recent years. Mortality is predominantly determined by the total body surface area burned and the often unrecognised inhalation injury. A retrospective review of 4,451 consecutive children with thermal injuries over a 10-year period was undertaken to determine the incidence, clinical presentation, and pathology of inhalation injury and its contribution to morbidity and mortality. Inhalation burns were diagnosed clinically and confirmed endoscopically and post-mortem in 97 (2.2%) children; 77 sustained fire burns (mean age 4 years) and 20 hot-water burns (mean age 18 months). The Moylan classification stratified them into upper-airway burns in 59 children, major–airway burns in 29, and parenchymal burns in 44. Major-airway burns were always seen in conjunction with either upper-airway or parenchymal injury. Stridor and acute progressive respiratory distress were the two main symptoms, the onset of which was occasionally delayed for up to 72 h. Endoscopy was most helpful in confirming the diagnosis and determining airway management. Endotracheal intubation was needed in more than 50% of children, usually for less than 5 days, and was converted to tracheostomy in only 6. Persistent laryngeal and tracheal damage was identified in 4. Secondary pneumonia occurred in 41.5% of children with fire burns and 55% with hot-water burns. Extensive surface burns, parenchymal injury, and secondary pneumonia all contributed to the significant mortality. Post-mortem findings corroborated clinical and endoscopic evidence. This study suggests that inhalation burns were often not recognised, could present late, and usually had significant consequences. Early clinical diagnosis, supported by endoscopic findings and appropriate management, is essential if the high morbidity and mortality amongst these children is to be improved.
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  • 20
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 63-65 
    ISSN: 1437-9813
    Schlagwort(e): Key words Actinomycosis ; Antibiotic treatment ; Appendicitis ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Abdominal actinomycosis (AMC) is a rare infection in children. The appendix is the most common intra-abdominal organ involved. It presents as an undifferentiated mass, forming abscesses and fistulas in the right lower quadrant. The case of a 15-year-old girl with a AMC of the appendix detected by the pathologist after routine appendectomy is discussed. Long-term antibiotic treatment and follow-up by ultrasound and laboratory controls are necessary.
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  • 21
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 121-122 
    ISSN: 1437-9813
    Schlagwort(e): Key words Ingrowing nails ; Conservative treatment ; Children ; Adolescents
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Ingrowing nails are not uncommon in children, and even so receive little attention in the pediatric surgery literature. The purpose of the present study was to demonstrate our modification of the conservative treatment of ingrowing nails. Our technique of local treatment combined with patient education for better foot and toe care was successfully used and well tolerated by 19 out of 20 young patients with ingrown toenails.
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  • 22
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 353-357 
    ISSN: 1437-9813
    Schlagwort(e): Key words Testis torsion ; Scrotum ; Appendage ; Cremasteric reflex ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract A total of 543 boys suffering from acute scrotal pain underwent emergency surgery between 1986 and 1996. Of these, 91 had a testicular torsion (TT) (16.8%) and 250 had an appendage torsion (AT) (46%). The cause varied with patient age, with most TTs in newborns and boys of 15 years and most ATs in 10–11-year-olds; 21.5% were operated upon within 6 h of the onset of pain and 69.2% within 24 h. Most stayed in hospital for less than 24 h. Pre-surgical examination identified no criterion for excluding TT. We therefore believe that all children complaining of acute scrotal pain should undergo surgery. As release of an inflamed AT reduces pain, three-fourths of the children benefited directly from surgery.
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  • 23
    ISSN: 1437-9813
    Schlagwort(e): Key words Ovarian tumor ; Children ; Hypercalcemia ; Small-Cell carcinoma
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Tumors of the ovary in girls represent about 80% of pediatric genital tumors; approximately 30% of these tumors are malignant. The risk of malignancy increases with decreasing age. The most frequent finding is a teratoma; other tumors are rare. Small-cell carcinoma (SCCO) of the ovary is extremely rare, occurring mostly in young women. We present an 8-year-old girl with a SCCO of the hypercalcemic type. The findings and treatment are discussed with emphasis on the poor prognosis in these patients, even in stage 1 disease. The current literature is reviewed.
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  • 24
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 287-289 
    ISSN: 1437-9813
    Schlagwort(e): Key words Soft-tissue tumor ; Myositis ossificans ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Two cases on myositis ossificans circumscripta (MOC) in the arm are reported. Plain X-ray films and magnetic resonance imaging (MRI) were performed in both cases. In the first, an intramuscular tumor-like mass without calcifications was found on MRI with soft-tissue edema extension. In the second, MRI disclosed additional bone-marrow edema. The diagnosis of MOC was confirmed by biopsy in one case and by follow-up in the other. MOC is a benign soft-tissue lesion that is rare in children, with an acute course and usually spontaneously favorable evolution. The differential diagnosis from an infection or a malignant tumor remains difficult. The best imaging modalities are conventional radiography and MRI. The MRI patterns of MOC are typical but not pathognomonic; typical MRI findings in conjunction with clinical symptoms during the early phase of MOC permit the postponement of a biopsy or aggressive surgical procedures. Surgery is indicated for cases not showing typical MOC calcifications at a later stage.
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  • 25
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 579-581 
    ISSN: 1437-9813
    Schlagwort(e): Key words Hydatid disease ; Pancreas ; Children ; Echinococcosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Primary hydatid disease of the pancreas is rare. The authors report a 3-year-old girl who had a cystic mass in the head of the pancreas with no other viscera involved. At laparatomy the entire endocyst was totally extracted from the surrounding pancreatic parenchyma. The postoperative course was uneventful. She is currently disease-free with a follow-up of 5 years. Only four other pediatric cases have been reported in the English literature.
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  • 26
    Digitale Medien
    Digitale Medien
    Springer
    Pediatric surgery international 15 (1999), S. 525-526 
    ISSN: 1437-9813
    Schlagwort(e): Key words Central venous catheters ; Children ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The insertion of central venous catheters has become an established practice in the management of children with different types of malignancies for the administration of chemotherapeutic agents, antibiotics, blood and blood products, as well as drawing blood for various investigations. A commonly encountered problem is that despite the catheter being patent it may be impossible to draw blood from it. We believe this is related to the cut of the catheter tip. To overcome this problem, a technique for cutting the tip of the catheter is described.
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  • 27
    ISSN: 1432-2161
    Schlagwort(e): Key words Hip joint ; Osteonecrosis ; MRI ; Bone scintigraphy ; Femoral head ; Transtrochanteric rotational osteotomy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Objective. To assess the ability of bone scintigraphy and magnetic resonance imaging (MRI) to predict the outcome of transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH). Design. This study was a prospective evaluation of imaging techniques. Patients and methods. MRI and bone scintigraphy were performed on 20 hips in 18 patients at 3 months after TRO. The radiographic findings at 3 months after TRO, and the MRI and bone scintigraphic findings, were compared with the radiographic findings at final follow-up (mean 39 months). Results and conclusions. On MRI a low-intensity area or a low-intensity band in the new weight-bearing area extending over the acetabular edge on T1-weighted images was related to the presence of collapse on the radiographs at final follow-up. In hips with an area of absent activity in the new weight-bearing surface on bone scintigraphy, collapse was seen more frequently on radiographs at final follow-up than in hips without this feature. Bone scintigraphy was no more specific than radiography in predicting the outcome after TRO. We consider MRI to be superior to bone scintigraphy in predicting the occurrence of collapse, which is one of the major short-term problems after TRO.
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  • 28
    ISSN: 1432-2161
    Schlagwort(e): Key words Lipoma arborescens ; Synovial membrane ; MRI ; Shoulder ; Bursitis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  A 44-year-old man presented with lipoma arborescens of the right shoulder, associated with a rotator cuff tear. MRI revealed villous proliferations with signal intensity of fat on all pulse sequences. At surgery, this bursa was found to contain moderately yellow cloudy fluid without fat globules. Histological examination of the lesion showed subsynovial accumulation of mature fat cells.
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  • 29
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 298-304 
    ISSN: 1432-2161
    Schlagwort(e): Key words Osteosarcoma ; MRI ; Metastases ; skeletal muscle ; Soft tissue neoplasm
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Two cases of osteogenic sarcoma with skeletal muscle metastases are described. A 40-year-old woman presented with progressive swelling of both calves and a soft tissue back lump. She had been diagnosed with mandibular chondroblastic osteogenic sarcoma 6 years earlier. Radiographs showed calcified masses. MRI scans and bone scintigraphy revealed multiple soft tissue masses in both calves. Bone scintigraphy also showed uptake in the back lump, right thigh and left lung base. Biopsy confirmed metastatic chondroblastic osteogenic sarcoma, which initially responded well to chemotherapy. However, the metastatic disease subsequently progressed rapidly and she died 21 months after presentation. The second case concerns a 20-year-old man who presented with a pathologic fracture of the humerus, which was found to be due to osteoblastic osteogenic sarcoma. He developed cerebral metastases 17 months later, followed by metastases at other sites. Calcified masses were subsequently seen on radiographs of the abdomen and chest. CT scans confirmed the presence of densely calcified muscle metastases in the abdominal wall, erector spinae and gluteal muscles. The patient’s disease progressed rapidly and he died 30 months after presentation.
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  • 30
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 342-346 
    ISSN: 1432-2161
    Schlagwort(e): Key words Chordoma ; Notochordal rest ; MRI ; Vertebra
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Chordomas of the lumbar vertebral bodies are rare. We report an unusual case of an entirely intra-osseous chordoma of the fifth lumbar vertebra treated by vertebrectomy. Conventional radiographs and scintigraphy were normal. The lesion was well visualised by MR imaging, but showed only slight sclerosis on CT. We give our reasons for making a diagnosis of chordoma rather than giant notochordal rest and discuss the problems of management resulting from this diagnostic dilemma.
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  • 31
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 347-349 
    ISSN: 1432-2161
    Schlagwort(e): Key words Plasmacytoma ; Plasmacytoma ; amyloid ; Plasmacytoma ; calcified ; Plasmacytoma ; extraosseous ; Plasmacytoma ; thorax ; Plasmacytoma ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  We report on a rare, calcified, plasma cell tumor of the spine causing progressive myelopathy. Other unusual features were the lack of an osseous lesion at the site of the mass, considerable calcified amyloid within the mass but no identifiable amyloid elsewhere, and normal serum immunoelectrophoresis.
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  • 32
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 33-40 
    ISSN: 1432-2161
    Schlagwort(e): Key words Osteoblastoma ; Spine ; Radiography ; CT ; MRI ; Pathology
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Objectives. To illustrate the CT and MRI features of spinal osteoblastomas and correlate the imaging with histological findings. Design. In a retrospective review the CT and MRI features of spinal osteoblastomas with respect to mineralisation, signal intensity (SI), adjacent reactive changes, enhancement following gadolinium-DTPA (5 cases) and adjacent soft tissue masses were compared and correlated with the histological findings including the degree of osteoid formation and matrix mineralisation, vascularity and surrounding reactive changes in bone and soft tissue. Patients. Eleven patients (7 males and 4 females; age range 8–43 years, mean age 19.5 years) with 12 osteoblastomas (1 patient suffered a recurrence) were studied. Results. All lesions showed classical features on CT with varying degrees of matrix mineralisation, whereas MRI identified mineralisation in only eight of 12 cases. MRI showed low signal intensity of the lesion on both T1- and T2-weighted sequences in several cases in the absence of heavy mineralisation. In these cases, histological examination revealed diffuse osteoid production by the tumour. All patients given gadolinium showed enhancement within the tumour on MRI. Reactive bone marrow changes were identified on MRI in 10 cases, and in five of these the changes were at multiple levels. An adjacent soft tissue mass was demonstrated in five cases, but extraosseous tumour was present histologically in only two of these. Conclusions. The MRI appearances of spinal osteoblastomas are varied and show no characteristic features. MRI may also overestimate the extent of the lesion due to extensive reactive changes and adjacent soft tissue masses. CT should continue to be the investigation of choice for the characterisation and local staging of suspected spinal osteoblastomas.
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  • 33
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 49-51 
    ISSN: 1432-2161
    Schlagwort(e): Key words Cryptococcoma ; sacrum ; Cryptococcoma ; immunocompromised ; MRI ; sacrum ; CT ; sacrum
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Cryptococcoma of the sacrum was the initial presentation of systemic cryptococcosis in a patient on chronic steroid therapy for autoimmune hepatitis. The bone lesion was the only overt manifestation of systemic cryptococcal disease, which preceded other clinical manifestations and led to the subsequent diagnosis of systemic infection.
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  • 34
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 545-560 
    ISSN: 1432-2161
    Schlagwort(e): Key words Trauma ; Joints ; injuries ; Joints ; radiography ; Joints ; MRI ; Cartilage ; Bones ; fractures
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Fractures involving the articulating surfaces of bone are a common cause of chronic disability after joint injury. Acute fractures of the articular surface typically run parallel to the surface and are confined to the cartilage and/or the immediate subchondral cancellous bone. They should be distinguished from vertical or oblique bone fractures with intra-articular extension. This article reviews the mechanism of acute articular surface injuries, as well as their incidence, clinical presentation, radiologic appearance and treatment. A classification is presented based on direct inspection (arthroscopy) and imaging (especially MRI), emphasizing the distinction between lesions with intact (subchondral impaction and subchondral bone bruises) and disrupted (chondral, osteochondral lesions) cartilage. Hyaline cartilage, subchondral bone plate and subchondral cancellous bone are to be considered an anatomic unit. Subchondral articular surface lesions, osteochondral fractures and solely chondral fractures are different manifestations of impaction injuries that affect the articulating surface. Of the noninvasive imaging modalities, conventional radiography and MRI provide the most relevant information. The appropriate use of short tau inversion recovery, T1-weighted and T2-weighted (turbo) spin-echo as well as gradient-echo sequences, enables MRI to classify the various acute articular surface lesions with great accuracy and provides therapeutic guidance.
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  • 35
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 658-660 
    ISSN: 1432-2161
    Schlagwort(e): Key words Medial collateral ligament ; tear ; interposition ; Knee ; MRI ; Posterolateral dislocation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Displacement of the medial collateral ligament (MCL) into the medial knee joint is an extremely rare finding associated with MCL tears, and is easily diagnosed on magnetic resonance imaging. A case of intra-articular interposition of the MCL during a severe knee injury is presented. A radiolucent ”fat stripe” sign and adjacent skin dimpling on radiographs may be relatively specific indicators of this injury.
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  • 36
    ISSN: 1432-2161
    Schlagwort(e): Key words Shoulder ; arthrography ; Shoulder ; comparative studies ; Shoulder ; injury ; Shoulder ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Purpose. In a patient with internal derangement of the shoulder, the diagnostic method of choice is controversial. Conventional arthrography can diagnose most rotator cuff tears accurately; however, in many institutions MR arthrography is usually necessary to diagnose labral tears. We utilized decision tree methodology to compare the cost- effectiveness of conventional arthrography and conventional MRI with a hypothetical algorithm in which a patient underwent arthrography, performed with admixed gadolinium, which if negative, was followed by MRI. Design. The use of double-contrast arthrography alone, conventional MRI alone, and gadolinium-enhanced MRI used as an adjunct to conventional arthrography were modeled for the diagnosis of full-thickness rotator cuff tears (RCT), partial RCTs, labral tears, and the absence of cuff/labral tears using decision analysis methodology. English language medical publications were searched to determine the base probabilities for the accuracy of the diagnostic tests. The outcome utilities ranged from –1 to +1 to reflect the value of correct diagnostic evaluation. Charges for diagnostic tests and appropriate surgical treatments were based on 1997 Medicare reimbursement rates for professional fees and hospital charges in an outpatient setting. Sensitivity analyses were performed to evaluate the effects of uncertainty regarding the prevalence of each disease state and the accuracy of several diagnostic tests. Results. In the base-case analysis, the average effectiveness of double-contrast arthrography alone, MRI alone and arthrography selectively followed by MRI were 0.6610, 0.6715, and 0.7204, respectively. The average costs for each of these strategies were $1090, $2033, and $2339, respectively. Conclusion. Arthrography performed with admixed diluted gadolinium, which if negative is immediately followed by MRI, was somewhat more expensive than conventional MRI. However, because of much greater effectiveness, cost-effectiveness was significantly higher for our proposed algorithm. Conventional arthrography without gadolinium, although less expensive, had severely limited effectiveness.
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  • 37
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 61-74 
    ISSN: 1432-2161
    Schlagwort(e): Key words Ligament ; Ligament injury ; MRI ; Soft tissue injury ; Soft tissue trauma
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Magnetic resonance imaging has had a dramatic effect on the means by which we diagnose ligament injuries. Tears resulting from either acute trauma or overuse can be detected noninvasively, directing appropriate therapy be it conservative or surgical. For the elite athlete, earlier diagnosis leads to earlier intervention, or alternatively, a normal MRI examination can result in an earlier return to play. While MRI is accepted for the diagnosis of certain injuries such as complete tears of the cruciate ligaments of the knee, other injuries, such as partial cruciate ligament tears or tears of the intercarpal ligaments of the wrist, remain controversial.
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  • 38
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 717-722 
    ISSN: 1432-2161
    Schlagwort(e): Key words Sarcoid ; vertebrae ; Sarcoid ; rib ; Sarcoid ; calvarium ; Osteolytic ; CT ; MRI ; Surgical fusion
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Skeletal sarcoidosis is rare. This report describes a 31-year-old African American man who presented with a destructive osteolytic lesion of C2 and another lesion in a rib. The lesion at C2 was treated with corpectomy and bone graft. Four months later the lesion recurred and a new lesion was discovered in the cervical vertebral column. The patient declined surgery for instability for another 3 months, choosing to remain in a halo. Seven months following the initial operation, a technetium bone scan showed spread of the disease to the calvarium and thoracic and lumbar vertebrae. The patient had no symptoms referable to these sites. The patient agreed to have his neck fused at this point. For the next 10 months, the patient was on steroids and a further new lesion appeared at L5 without localizing signs or symptoms. The patient declined further evaluation over the next 12 months and is now considered lost to follow-up.
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  • 39
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 52-56 
    ISSN: 1432-2161
    Schlagwort(e): Key words Intraneural ganglion ; Peroneal nerve palsy ; Drop foot ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  A case of peroneal nerve palsy caused by an intraneural ganglion is presented. The cystic mass was located posterolateral to the lateral femoral condyle and extended along the common peroneal nerve distal to the origin of the peroneus longus muscle. The nerve was compressed in the narrow fibro-osseous tunnel against the fibula neck and the tight origin of the peroneus longus muscle. The nerve was decompressed by complete tumor excision and transection of the origin of the peroneus longus muscle. Full recovery of nerve function was obtained in 6 months.
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  • 40
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 594-598 
    ISSN: 1432-2161
    Schlagwort(e): Key words Osteochondroma ; Chondroma ; Extraskeletal tumor ; Soft tissue tumor ; Foot ; CT ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  A case of pathologically proven extraskeletal osteochondroma is presented with magnetic resonance imaging (MRI), computed tomography (CT), bone scan and radiographic findings. The diagnosis of extraskeletal osteochondroma should be considered when a discrete, ossified mass is localized in the soft tissues of the distal extremities. Nomenclature surrounding this entity is controversial and is discussed.
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  • 41
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 616-620 
    ISSN: 1432-2161
    Schlagwort(e): Key words Joint ; MRI ; Infectious arthritis ; Septic joint ; Inflammation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Objective. To differentiate the MR features of septic versus nonseptic inflamed joints. Design and patients. Thirty patients were referred for MRI with inflamed joints (19 were subsequently found to be septic and 11 nonseptic). At 1.5 T enhanced MRI five groups of signs related to joint space, synovium, cartilage, bone and peri-articular soft tissue respectively were assessed and compared between the septic and nonseptic groups. Results. The prevalence of MRI findings in septic versus nonseptic joints (respectively) was as follows: effusion (79% vs 82%), fluid outpouching (79% vs 73%), fluid heterogeneity (21% vs 27%), synovial thickening (68% vs 55%), synovial periedema (63% vs 55%), synovial enhancement (94% vs 88%), cartilage loss (53% vs 30%), bone erosions (79% vs 38%), bone erosions enhancement (77% vs 43%), bone marrow edema (74% vs 38%), bone marrow enhancement (67% vs 50%), soft tissue edema (63% vs 78%), soft tissue enhancement (67% vs 71%), periosteal edema (11% vs. 10%). The presence of bone erosions appeared to be an indicator for an infected joint (P=0.072); coexistence of bone marrow edema slightly improves the significance (0.068). A similar trend was obtained when combining bone erosions with either synovial thickening, synovial periedema, bone marrow enhancement or soft tissue edema (P=0.075). Conclusions. The combination of bone erosions with marrow edema is highly suggestive for a septic articulation; the additional coexistence of synovial thickening, synovial edema, soft tissue edema or bone marrow enhancement increases the above level of confidence. Similar to conventional radiography, the single sign that appeared to show a significant trend was the presence of bone erosions. However, no single sign or combination could either be considered pathognomonic or exclude the presence of a joint infection.
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  • 42
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 655-657 
    ISSN: 1432-2161
    Schlagwort(e): Key words Acromegaly ; Locking ; Metacarpophalangeal joint ; Osteophyte ; Volar plate hypertrophy ; Radiography ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  A 39-year-old man with acromegaly exhibited locking of metacarpophalangeal (MCP) joints of both index fingers. Large osteophytes were found at the metacarpal heads by radiography and computerized tomography (CT). Magnetic resonance (MR) images revealed hypertrophy of volar plates. We suggest that these characteristic acromegalic features caused locking of MCP joints. Surgery was required on one of the joints to release the locking.
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  • 43
    Digitale Medien
    Digitale Medien
    Springer
    Skeletal radiology 28 (1999), S. 703-709 
    ISSN: 1432-2161
    Schlagwort(e): Key words Proliferative myositis ; Childhood ; Lumbar muscles ; Ossification ; X-ray ; CT ; MRI ; PET
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  A case of proliferative myositis in the lumbar paraspinal muscles in a 14-year-old boy is presented. Imaging investigations including plain radiograph, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), bone scan and positron emission tomography (PET) were suggestive of an inflammatory process such as myositis ossificans. The diagnosis was made by incisional biopsy. More pronounced edema, more muscle fiber necrosis and a higher cellularity were found compared to adult cases. The karyotype of the lesion was normal. Clinically, the mass disappeared spontaneously. After 24 months, asymptomatic bridging ossification between the third and fourth lumbar vertebrae was noted.
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  • 44
    ISSN: 1432-2161
    Schlagwort(e): Key words Shoulder ; Biceps tendon ; Anomaly ; Arthroscopy ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  A developmental anomaly of the long head of the biceps tendon was found in a cadaveric shoulder. Findings on arthroscopy, routine MR imaging, and MR arthrography were compared and correlated with results of anatomic dissection. MR arthrography appears to be a very good diagnostic imaging method for depicting this anomaly prior to arthroscopy.
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  • 45
    ISSN: 1432-0584
    Schlagwort(e): Key words Hypergammaglobulinemia ; Polyclonal ; Acute myeloid leukemia ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Polyclonal hypergammaglobulinemia (PHG) associated with hematological malignancies is a rare occurrence. We reviewed our series of 47 children with AML in order to define the prevalence of PHG and its prognostic value in achieving complete remission (CR) after induction treatment. Patients were stratified by immunoglobulin levels into two groups: with PHG and without PHG. CR reached after induction chemotherapy was considered a positive response. Conditional exact tests were used for the statistical analysis; conditional maximum likelihood estimates of the odds ratio (OR) were obtained. Significance levels (p) were determined from two-tailed tests. Twenty-two of 38 (57.9%) evaluable children showed PHG. Children with PHG and AML were more likely to be in CR after first induction treatment (OR=6.25, p=0.021), independent of sex, age at diagnosis, white blood cell count, percentage of blasts in the bone marrow, FAB phenotype, and treatment protocol. Infections seemed to positively influence early treatment response (p=0.038). PHG and infections were not statistically associated (p=0.16). PHG may result from the uncontrolled stimulation of B lymphocytes by cytokines. Infections or transfusions may act as triggers for the immune system, leading to the antileukemic effect seen in patients with AML and PHG going into spontaneous remission. It could be that this activation caused the larger number of CRs observed in our series. Clarification of why PHG exerts a positive influence on children with AML could help us to understand the ways by which the organism is able to control a malignant disease.
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  • 46
    ISSN: 1432-0584
    Schlagwort(e): Key words Thrombopoietin ; Interleukin-11 ; Interleukin-6 ; Thrombocytopenia ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  We measured serum levels of thrombopoietin (TPO), interleukin (IL)-11, and IL-6 in 90 different samples from 67 pediatric patients with thrombocytopenia (TP). The cytokine levels were determined by enzyme-linked immunosorbent assays (ELISA), and the biological activity of TPO was measured using a cell line transfected with human c-mpl. In patients with impaired megakaryocytopoiesis, as found in diseases such as aplastic anemia, amegakaryocytic TP, or TP with absent radii, we found TPO levels which were highly elevated compared with normal values (mean=261 AU/ml, n=52, vs. 22 AU/ml in healthy controls). In contrast, patients suffering from idiopathic thrombocytopenic purpura (mean=16 AU/ml, n=31) or platelet function defects (mean=23 AU/ml, n=7) demonstrated normal TPO levels. The biological activity tested in the bioassay correlated well with the ELISA data. However, sera of some patients with amegakaryocytic TP demonstrated a remarkably higher biological activity of TPO than expected from the ELISA data. Within the different groups there was no correlation between platelet counts and TPO levels. Only 27% of all samples had elevated levels of IL-11 (mean=450 pg/ml, n=20). Elevated IL-6 serum levels were detected in only 13% of all samples analyzed (mean=42 pg/ml, n=12). We conclude that megakaryocytopoiesis is regulated mainly by TPO, that it is dependent on the platelet and the megakaryocytic mass, and that IL-11 plays an additional role in supporting the platelet production. IL-6 does not appear to be up-regulated in children with thrombocytopenia.
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  • 47
    ISSN: 1279-8517
    Schlagwort(e): Anterior cruciate ligament ; Kinematics ; Knee ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Résumé Ce travail a pour but de proposer à l'aide d'un modèle informatique 3D du genou chez un sujet vivant une étude anatomique des modifications de longueur du ligament croisé antérieur (LCA) et de ses faisceaux au cours de la flexion. La méthode d'évaluation proposée est une reconstruction informatique 3D, à partir de coupes IRM, reproduisant le mouvement de flexion du genou de 0 à 75°. Vingt-et-une coupes ont été réalisées pour chacune des 13 positions de flexion. La reconstruction de Delaunay et le recalage de chaque position permettent d'obtenir un modèle 3D. Ce modèle permet le suivi d'un point osseux lors du mouvement. En connaissant le déplacement relatif des insertions ligamentaires, il est possible de préciser la biométrie du ligament en calculant la longueur des faisceaux du LCA à chaque position, de mettre en évidence les variations de longueur au cours du mouvement. La longueur moyenne du ligament était de 34 mm. Le faisceau antéro-médial était plus long de 30 % par rapport aux deux autres faisceaux. Lors de la flexion, le faisceau antéro-médial était peu modifié (cette caractéristique semblait en faire une position de référence pour une ligamentoplastie), le faisceau postéro-latéral se tendait à partir de 30°, le faisceau intermédiaire se détendait dès le début du mouvement. En retrouvant les données de la littérature, cette méthode permet une approche anatomique du LCA faisceau par faisceau lors du mouvement de flexion.
    Notizen: Summary The aim of this study is to suggest an anatomic study of the modifications of the length of the anterior cruciate ligament (ACL) and its bundles during flexion with the aid of a 3D computerized model of the knee in a living subject. The method of evaluation suggested is a 3D computerized reconstruction based on MRI sections, reproducing the movement of flexion of the knee from 0 to 75°. Twenty-one sections were made for each of the 13 positions of flexion. The reconstruction of Delaunay and the realignment of each position provided a 3D model which allowed monitoring of a bony point during the movement. By knowing the relative displacement of the ligamentous attachments it was possible to define the biometry of the ligament by calculating the length of the bundles of the ACL in each position and to demonstrate the variations in length during the movement. The mean length of the ligament was 3.4 mm. The anteromedial bundle was longer by 30% compared with the other two bundles. During flexion the anteromedial bundle was not much modified (this feature seems to provide a reference position for a ligamentoplasty), the posterolateral bundle became taut after 30°, and the intermediate bundle relaxed from the beginning of movement. Based on the data from the literature, this method allows an anatomic approach to the ACL, bundle by bundle, during flexion movement.
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  • 48
    Digitale Medien
    Digitale Medien
    Springer
    Cancer chemotherapy and pharmacology 44 (1999), S. 203-209 
    ISSN: 1432-0843
    Schlagwort(e): Key words Vincristine ; Pharmacokinetics ; Repetitive dosing ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Purpose: We studied vincristine disposition after 169 weekly i.v. bolus injections in 32 children with acute lymphoblastic leukemia, non-Hodgkin lymphoma, or Wilms' tumor. The aim of the study was to determine intrapatient and interpatient variability in vincristine disposition and demographic, clinical, and biochemical characteristics influencing this variability. Methods: Vincristine plasma concentrations were measured by a high-performance liquid chromatography assay with electrochemical detection. A limited sampling strategy was used based on a bayesian parameter estimation algorithm that is part of the ADAPT II software package. A two-compartment, first-order model was fitted to the data, and pharmacokinetic parameters were calculated from the model using the ADAPT II software. For statistical analysis, analysis of variance (ANOVA), t test, simple and multiple regression analysis, and non-parametric or robust equivalents were used. Results: Results showed a large intrapatient and interpatient variability in distribution half-life, elimination half-life, total body clearance, apparent volume of distribution at steady state, and area under the concentration–time curve. Intrapatient variability was significantly smaller than interpatient variability for all these parameters except distribution half-life. The diagnosis or treatment protocol turned out to be the most predictive characteristic; leukemia and non-Hodgkin lymphoma patients had a significantly higher total body clearance than Wilms' tumor patients. Conclusions: We conclude that both intrapatient and interpatient variability in vincristine pharmacokinetics is large in pediatric cancer patients and that variability, although significantly influenced by diagnosis, largely remains unpredictable.
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  • 49
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 519-522 
    ISSN: 1432-1076
    Schlagwort(e): Key words Pulmonary function test ; Adjustment ; Children ; Prediction equations ; Population specific
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Fitting adequate prediction equations for pulmonary function test (PFT) parameters is crucial in the analysis of lung function tests and their interpretation. Our work aimed at studying the necessity of building population specific prediction equations, rather than using prediction equations built-in in commercial equipment. We used as an example results of studies carried out among Israeli schoolchildren. Second to sixth grade children (7–13 years old), 1064 boys and 1211 girls, were studied in Tel-Aviv. PFT (forced vital capacity, forced expiratory volume in 1st second, peak expiratory flow, forced expiratory flow in 50% volume, forced expiratory flow in 75% volume) performed by these children were adjusted for height, weight and age, for each sex separately, by a multiple regression procedure. Predicted PFT parameters of 300 boys and 301 girls aged 7–13 years, living along the southern shore of Israel, were calculated using the equations built for the same aged Tel-Aviv children as well as the prediction equations built-in in the spirometer used. The ratios between the observed PFT parameters in the southern children and their expected values, using the Israeli population specific equations, were around 1.00. Using the built-in equations resulted in ratios around 0.90. Conclusion The development of population specific prediction equations for PFT parameters is necessary. Such equations should be used both in clinical assessment to minimize misclassification (healthy/sick child) and in epidemiological studies.
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  • 50
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 550-552 
    ISSN: 1432-1076
    Schlagwort(e): Key wordsShigella ; Toxic encephalopathy ; Children ; Brain oedema ; Shiga toxin
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract A 6-year-old girl is described who died following rapid neurological deterioration, ending in lethal cerebral oedema. Despite the absence of severe intestinal and metabolic derangement, Shigella was cultured from the stool. Toxic encephalopathy is responsible for death following this rare complication of childhood shigellosis in developed countries. The pathophysiology is unknown. Conclusion Lethal toxic encephalopathy can be caused by Shigella despite the absence of severe intestinal and metabolic derangement. If shigelllosis is suspected, headache may be a first significant sign for the development of toxic encephalopathy. Early recognition and rapid measures to prevent brain oedema may improve outcome.
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  • 51
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 336-343 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Cryptorchidism ; Scrotum ; US ; CT ; MRI ; Testis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Imaging evaluation of the patient with a non-palpable testis has evolved over recent decades. The rational explanation of imaging in these patients requires a clear understanding of the various causes of a non-palpable testis, and an appreciation of the utility and limitations of the available imaging modalities. This review describes the classification of non-palpable testis and discusses the role of modern imaging in evaluation. In particular, the relative accuracies of ultrasound, CT and MRI is reviewed.
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  • 52
    Digitale Medien
    Digitale Medien
    Springer
    Experimental brain research 126 (1999), S. 200-204 
    ISSN: 1432-1106
    Schlagwort(e): Key words Motor development ; Anticipatory postural adjustments ; Bimanual coordination ; Children ; Human
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Anticipatory postural adjustments (APA) are needed to perform a movement without perturbing posture. We investigated the development of APA in 3- to 4-year-old children during a bimanual load-lifting task. The task required maintaining a stable elbow position despite imposed or voluntary unloading of the forearm. Although children can compensate the consequences of unloading by using APA, their performance did not reach an adults’ level. In addition, children showed high intra-individual variability in the voluntary situation, revealed by the coexistence of both adult-like and immature patterns in kinematic and electromyographic data. In conclusion, the present study reports that APA, associated with a bimanual load-lifting task, are still being set up in 3- to 4-year-old-children. The intra-individual variability should decrease with age and be associated with a progressive mastering of the timing parameters characterizing APA.
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  • 53
    ISSN: 1432-1076
    Schlagwort(e): Key words HIV-1 ; T-cells ; CD69 ; Activation ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We evaluated the use of a whole-blood assay that measures spontaneous and activation-induced CD69 expression on peripheral blood T-cells in vitro for assessment of T-cell function in HIV-1-infected paediatric patients. Heparinized venous blood from 28 HIV-1 positive children and adolescents and 23 healthy controls was incubated for 4 h with or without 5 μg/ml phytohaemagglutinin (PHA). Thereafter, analysis of CD69 expression on CD4+ and CD8+ T-cells was done by flow cytometry; simultaneously we determined CD4+ T-cell counts and plasma HIV-1 viral load. Neither spontaneous nor PHA-induced CD69 expression differed significantly between HIV-1 positive patients and healthy controls. However, T-cells from HIV-1 positive patients with plasma HIV-1 viral load levels above 70 × 103 copies/ml showed a higher spontaneous CD69 expression than T-cells from patients with lower plasma viral load levels in different stages of the disease. Antiretroviral treatment in four patients reduced spontaneous CD69 expression in CD4+ T-cells and PHA-induced CD69 expression in CD4+ and CD8+ T-cells significantly after 8 weeks of therapy. Conclusion Spontaneous and activation-induced expression of the early (activation) antigen CD69 on peripheral blood T-cells does not distinguish HIV-1 positive patients from HIV-1 negative healthy controls and is not correlated with peripheral blood CD4+ T-cell counts. This test may not be a reliable marker for functional T-cell deficiency during early stages of HIV disease. Increased spontaneous as well as PHA-induced CD69 expression on T-cells from HIV-1-infected children and adolescents in vitro may rather reflect HIV-induced pre-activation of T-cells in vivo.
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  • 54
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 662-667 
    ISSN: 1432-1076
    Schlagwort(e): Key words Somatosensory evoked potentials ; Far-field potentials ; Achondroplasia ; Foramen magnum stenosis ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Children with achondroplasia may have high cervical myelopathy due to stenosis of the cranio-cervical junction resulting in neurological disability and an increased rate of sudden death. To detect myelopathy we recorded somatosensory evoked potentials (SEPs) after median nerve stimulation in 30 patients with achondroplasia aged 13 months to 18 years (mean 6 years). In addition to the conventional technique of recording the cortical N20 and the central conduction time (CCT), we employed a noncephalic reference electrode recording the subcortical waveforms N13b and P13, generated near the cranio-cervical junction. The findings were related to the clinical status and MRI results. Eighteen patients had MRI evidence of spinal cord compression with indentation or narrowing of the upper cervical cord, and 13 showed signs of myelomalacia. Seven patients had neurological abnormalities. The sensitivities of the SEPs were 0.89 for cervical cord compression, 0.92 for myelomalacia and 1.0 for the clinically symptomatic patients. There were no false-positive results. The subcortical SEPs were more sensitive than the conventional recordings. However, the conventional SEPs were highly specific in the most severely affected patients; here the specificity was 1.0 for patients with myelomalacia and 0.96 for symptomatic patients. Postoperative SEPs improved after occipital decompression in two children. Conclusion The analysis of somatosensory evoked potentials, in particular of subcortical tracings, is useful in the detection of early cervical myelopathy in children with achondroplasia. Early neurosurgical decompression may prevent irreversible damage.
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  • 55
    ISSN: 1432-1076
    Schlagwort(e): Key words Antithrombin concentrate ; Children ; Septicaemia ; Acquired antithrombin deficiency
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Consumption coagulopathy is a serious problem in childhood. In addition to treatment of the underlying disease, consumption coagulopathy was previously treated with heparin. Nowadays it is treated by substitution of coagulation factors, especially antithrombin (AT) concentrate, alone or in combination with heparin. In this pilot study we administered AT concentrate (dosage 80 U/kgbw/d), without additional heparin treatment, to 29 children beyond infancy with acquired AT deficiency. Antithrombin, platelet count, fibrinogen, PT, and APTT were assayed before and during the course of AT substitution. These coagulation parameters returned to normal 48 hours after normalisation of the plasma AT level. AT levels normalised within 24 h of initial substitution in all children. Lethal outcome due to the underlying disease was observed in only two children. Conclusion Data of this pilot study suggest that, concomitantly with the treatment of the underlying disease, consumption coagulopathy in childhood can be managed successfully with early substitution of AT concentrate.
    Materialart: Digitale Medien
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  • 56
    ISSN: 1432-1076
    Schlagwort(e): Key words Coagulation ; Fibrinolysis ; Head injury ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The present study was designed to evaluate the post-trauma haemostatic changes in 27 children with severe cranio-cerebral trauma defined by a modified Glasgow Coma Score (GCS) 〈10. Blood samples for coagulation studies (fibrinogen, von Willebrand factor (vWf), factor VIII:C, antithrombin, protein C, plasminogen, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI), D-dimer) were obtained within two hours of admission, 24 h later, and on days 3–5, 7–9, 21 and 35. Data of this study indicate that alterations of coagulation in paediatric patients are similar to those in adults: On hospitalisation, activated haemostasis was found with decreased fibrinogen, antithrombin and protein C along with enhanced t-PA and PAI. Twenty-four hours later, hypercoagulability with significantly increased vWF and fibrinogen started, with a peak level within the second week. Within 24 h of admission, 17 children developed disseminated intravascular coagulation (DIC) with a clear-cut decrease of antithrombin and fibrinogen together with platelet consumption and enhanced D-dimer. The outcome of children with DIC was significantly poorer than in those without DIC. Complete recovery was seen in five patients; sequelae no handicap and moderate disability were each found in six patients. Severe disability was diagnosed in two children, and fulminant DIC with lethal outcome occurred in eight patients. The GCS (P 〈 0.01) and the occurrence of DIC (P 〈 0.005) showed the strongest association with the patients' clinical outcome. Conclusion Our data underline the significance of post-trauma disturbances of the haemostatic system for the clinical course and outcome in children with severe cranio-cerebral injuries.
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  • 57
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 485-486 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Lung disease ; Pneumoconiosis ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. We report two cases of children with malignancies and subpleural nodules found on computed tomography (CT) scan. In both cases the diagnosis was anthracosis. This pathologic condition has never been reported in children. Causes of anthracosis include a smoking environment, living in urban areas and air pollution.
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  • 58
    Digitale Medien
    Digitale Medien
    Springer
    Neuroradiology 41 (1999), S. 512-516 
    ISSN: 1432-1920
    Schlagwort(e): Key words Meninges ; Tumours ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Childhood meningeal tumours are uncommon and mostly meningiomas. We reviewed the histological and radiological findings in meningeal tumours in six children aged 12 years or less (four benign meningiomas, one malignant meningioma and one haemangiopericytoma). Compared to the adult counterpart, childhood meningiomas showed atypical features: cysts, haemorrhage, aggressiveness and unusual location. MRI features varied according to the site of the tumour, histology, haemorrhage, and presence of intra- or peritumoral cysts. Diagnosis of the extra-axial tumour was relatively easy in two patients with meningiomas, one malignant meningioma and one haemangiopericytoma. MRI findings strongly suggested an intra-axial tumour in two patients with benign meningiomas, because of severe adjacent edema. Awareness of the variable findings of childhood meningiomas and similar tumours may help in differentiation from brain tumours.
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  • 59
    Digitale Medien
    Digitale Medien
    Springer
    Neuroradiology 41 (1999), S. 929-934 
    ISSN: 1432-1920
    Schlagwort(e): Key words Magnetic resonance imaging ; diffusion weighted ; Myelination ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We studied the changes in brain water diffusion in childhood as seen on diffusion-weighted MRI in 30 children from 1 day of life to 17 years to provide a data base and to investigate the correlation of diffusion changes with known patterns of white matter maturation. The apparent diffusion coefficient (ADC) and apparent anisotropy (AA) were calculated in numerous regions of the brain to include major white matter tracts and gray matter. ADC and AA values were directly related to the structural maturity and compactness of the white matter tracts and changed with aging in a way that predated early myelination markers such as signal change on T1- or T2-weighted images. Diffusion of water is sensitive to structural changes in the brain such as white matter maturation and may be useful in investigating white matter disorders.
    Materialart: Digitale Medien
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  • 60
    Digitale Medien
    Digitale Medien
    Springer
    Der Radiologe 39 (1999), S. 876-881 
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter Kraniale arteriovenöse Duratisteln ; MRA ; DSA-Interventionelle Neuroradiologie ; Endovaskulärer Verschluß ; Key words Dural arterio-venous fistula ; MRI ; DSA ; Interventional Neuroradiology ; Venous occlusion
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary DAVF are difficult to recognize with CT- or MR-imaging. Diagnosis is often possible by arterial MRA. The type of the venous drainage as demonstrated by DSA is relevant for the clinical decision. Most often the endovascular occlusion of the affected venous segment a suitable therpeutical approach.
    Notizen: Zusammenfassung Kraniale arteriovenöse Durafisteln (DAVF) sind in der Schnittbilddiagnostik schwierig, am besten mittels der arteriellen MRA erkennbar. Klinisch ist die Einteilung nach dem in der DSA ermittelten venösen Drainagetyp relevant. Therapeutisch kommt in erster Linie der transvenöse endovasculäre Verschluss in Betracht.
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  • 61
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter Retrocochleäre Taubheit ; CISS-3D-Sequenz ; MRT ; N. cholearis ; Aplasie ; Atrophie ; Key words Retrocochlear deafness ; Retrocochlear anakusis ; Cochlear nerve aplasia ; Cochlear nerve atrophy ; MRI ; CISS-3D-sequence
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary MRI gains greater importance in the differential diagnosis of retrocochlear hearing loss. Retrocochlear anakusis is rarely caused by aplasia or atrophia of the cochlear nerv. In the following we report about a five year old boy suffering from unilateral deafness, where a strongly T2-weighted CISS-3D MRI sequence demonstrates a missing of the cochlear nerv on the deaf side.
    Notizen: Zusammenfassung Die Kernspintomographie gewinnt eine immer größere Bedeutung in der Differentialdiagnostik retrocochleärer Hörstörungen. Äußerst selten handelt es sich dabei um eine Aplasie oder Atrophie des N. cochlearis. Im folgenden wird über einen 5jährigen Jungen mit einer einseitigen Anakusis berichtet, bei dem kernspintomographisch mit einer stark T2-gewichteten CISS-3D-Sequenz (CISS: constructive interference of steady state) das Fehlen des N. cochlearis auf der tauben Seite nachgewiesen werden konnte.
    Materialart: Digitale Medien
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  • 62
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter PACS ; Filmlos ; MR ; Key words PACS ; Filmless ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary At our hospital, an average MRI examination comprises 170 images. These examinations were evaluated exclusively on digital reporting systems with two high-resolution monitors for a period of 1 year. A retrospective analysis of this reporting method in comparison with films on a conventional viewing wall was performed with subjective and objective data. Radiologists and technicians were requested to evaluate the system on a subjective scale from 1 to 5 for seven topics (image analysis, inspection, time for reporting, handling, comparison with previous reports, quality of PC laser prints, training period). Moreover, personal interviews were conducted and protocols taken. Patient and image frequency, film costs, data transfer time and amount of system failures were evaluated as objective data. The most important results were: Two thirds of the film checking radiologists prefer the conventional viewing walls over the computer monitors. However, 70% of the residents prefer using the computer monitor for reporting. Seventy percent of the interviewed radiologists considered comparison with former examinations on film very difficult. Digitizing of former MRI examinations was not a convincing method; printing on a standard PC laser printer was considered to yield insufficient quality. The different acceptance between radiologists and residents seems to be related to different experiences. The reduction in film costs (48.6%) will improve further with complete PACS installation in the whole hospital. Data transfer rates are still poor; further improvement of network performance is necessary for convenient work. One whole MRI examination and report could be stored on CD-ROM for a cost of less than 2 euros. This could be a future means of cheap archiving and documentation suitable for viewing on any PC with DICOM III viewer. Images and reports could stay with the patient as in the past.
    Notizen: Zusammenfassung Im Durchschnitt werden pro Tag 14,05 Patienten mit durchschnittlich 170 Schichtbildern pro Patient an unserer MRT-Anlage untersucht. Die Befundung dieser Bilder erfolgte über ein Jahr ausschließlich auf digitalen Befundungsstationen, bestehend aus zwei hochauflösenden Monitoren und einer Graphikworkstation. Ein Bildausdruck erfolgte zusätzlich auf einem hochauflösenden Laserpapierdrucker. Auf Grund von subjektiv und objektiv erhobenen Daten wurde ein retrospektiver Vergleich zwischen digitaler Bildschirmbefundung und Filmbefundung am Leuchtkasten durchgeführt. Material und Methode: Befragt wurde aufgrund einer subjektiven Bewertungsskala von 1 bis 5 nach 7 Kriterien. Weiters wurden in Interviews die subjektiven Erfahrungen protokolliert. Objektiv wurde überdies Anzahl und Zeit der Systemausfälle, Filmverbrauch, Untersuchungsfrequenzen, Bildmenge pro Tag sowie Zeitmessungen für Datentransfers gemessen. Ergebnisse: Zwei Drittel der Oberärzte bevorzugten die Leuchtkastenbefundung, 70% der Ärzte in Ausbildung zogen die Befundung auf Bildschirmen vor. 70% der befragten Ärzte sahen als eindeutiger Schwachpunkt des digitalen Befundungssystems den Vorbildvergleich an. Alle befragten Ärzte (n=13) bewerteten die Arbeit mit (auswärtigen) konventionellen MRT-Untersuchungen auf Film und der gleichzeitigen Bildschirmbefundung als besonders mühsam. Das Einscannen von Voruntersuchungen mit Betrachtung am Bildschirm erwies sich als nicht Praxis tauglich, die Dokumentation auf Papierbildern durch PC-Laserausdruck erwies sich als unbrauchbar. Diskussion: Der deutliche Akzeptanzunterschied zwischen Fachärzten und in Ausbildung befindlichen Ärzten ist vermutlich auf die unterschiedliche Vorerfahrung (Vorprägung) zurückzuführen. Die nur 48,6% Reduktion Filmverbrauch werden vermutlich nach einer stärkeren Verbreitung von digitalen Bilddaten verbessert werden. Die tatsächlich erzielten Bildtransferraten liegen derzeit zeitlich weit über den technisch möglichen. Die Optimierungen von Netzwerken und beteiligten Rechnern sind daher dringend erforderlich. Als alternatives Dokumentations- und Ausgabemedium könnte auch die äußerst preiswerte CD-ROM dienen. Sie sind auf jedem gängigen PC-System verwendbar. Das Prinzip, daß Befund und Bilder beim Patienten verbleiben, wäre damit leicht aufrecht zu erhalten.
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  • 63
    ISSN: 1432-2099
    Schlagwort(e): Key words Case-control study ; Children ; CNS tumour ; Environmental exposure ; Indoor radon ; Leukaemia
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Physik
    Notizen: Abstract  A population-based case-control study on risk factors for childhood malignancies was used to investigate a previously reported association between elevated indoor radon concentrations and childhood cancer, with special regard to leukaemia. The patients were all children suffering from leukaemia and common solid tumours (nephroblastoma, neuroblastoma, rhabdomyosarcoma, central nervous system (CNS) tumours) diagnosed between July 1988 and June 1993 in Lower Saxony (Germany) and aged less than 15 years. Two population-based control groups were matched by age and gender to the leukaemia patients. Long-term (1 year) radon measurements were performed in those homes where the children had been living for at least 1 year, with particular attention being paid to those rooms where they had stayed most of the time. Due to the sequential study design, radon measurements in these rooms could only be done for 36% (82 leukaemias, 82 solid tumours and 209 controls) of the 1038 families initially contacted. Overall mean indoor radon concentrations (27 Bq m–3) were low compared with the measured levels in other studies. Using a prespecified cutpoint of 70 Bq m–3, no association with indoor radon concentrations was seen for the leukaemias (odds ratio (OR): 1.30; 95% confidence interval (95% CI): 0.32–5.33); however, the risk estimates were elevated for the solid tumours (OR: 2.61; 95% CI: 0.96–7.13), mainly based on 6 CNS tumours. We did not find any evidence for an association between indoor radon and childhood leukaemia, which is in line with a recently published American case-control study. There is little support for an association with CNS tumours in the literature.
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  • 64
    Digitale Medien
    Digitale Medien
    Springer
    Der Radiologe 39 (1999), S. 16-24 
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter Sprunggelenk ; Sprunggelenksverletzung ; Bandverletzung ; Streßradiographie ; MRT ; Key words Ankle ; Ankle injuries ; Ligament injuries ; Stress X-ray ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and clinical stress tests. If the clinical stress test is positive, stress radiography could be performed. There is no consensus about the usefulness of stress radiography in acute ankle sprain, particularly about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5° to 30°. Today MRI is not used for this indication, although it allows, with controlled positioning of the foot and with defined sections, visualization of injured lateral collateral ankle ligaments. In ankle injuries, plain radiographs form the established basis of diagnostic imaging and can provide definitive answers in most cases. CT is used in complex fractures for complete visualization. MRI is the method of choice for several diagnostic problem cases, including occult fractures and post-traumatic avascular necrosis. In tendon injuries, MRI is important if ultrasound is not diagnostic. Generally, for the evaluation of acute ankle injuries, MRI is the most important second-step procedure when radiographs are nondiagnostic.
    Notizen: Zusammenfassung Die Diagnose einer lateralen Bandverletzung beim frischen Sprunggelenkstrauma fußt auf der Anamnese, der klinischen Untersuchung und klinischen Streßtests. Bei positiven klinischen Streßtests kann eine Streßradiographie durchgeführt werden. Es gibt keine Übereinstimmung für den Wert der Streßradiographie beim frischen Supinationstrauma des Sprunggelenks, insbesonders für den Winkel der Aufklappbarkeit bei einer Zweibandverletzung, der von 5°–30° reicht. Die MRT wird zur Zeit bei dieser Indikation nur in Einzelfällen benutzt, obwohl sie mit definierter Fußpositionierung und Ausrichtung der Untersuchungsebene eine ausgezeichnete Beurteilung der Sprunggelenksbänder erlaubt. Bei knöchernen Sprunggelenksverletzungen ist die Verwendung des konventionellen Röntgen die etablierte Methode und meist diagnostisch. Die CT kommt bei komplexen Frakturen zum Einsatz, um das gesamte Frakturausmaß darzustellen. Die MRT ist die Methode der Wahl bei verschiedenen Problemfällen wie okkulter Fraktur oder posttraumatischer Osteonekrose. Bei Sehnenverletzungen ist die MRT wichtig, falls eine Ultraschalluntersuchung nicht zur Diagnose führt. Allgemein entwickelt sich bei der Untersuchung der frischen Sprunggelenksverletzung die MRT zur zweitwichtigsten bildgebenden Methode, falls das konventionelle Röntgen zu keiner ausreichenden Diagnose kommt.
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  • 65
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter Fokale Leberläsionen ; Spiral-CT ; MRT ; Kontrastmittel ; SPIO ; Key words Focal liver lesions ; Spiral CT ; MRI ; Ferumoxides
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Purpose: Evaluation of the diagnostic efficacy of contrast-enhanced, dual-phase spiral CT and MRI before and after administration of SPIO particles in focal hepatic disease with previously uncertain diagnosis. Material and methods: In 46 patients in whom primary or secondary hepatic malignancy was suspected, dual-phase spiral CECT and breath-held T1-weighted gradient-echo and T2-weighted fast spin-echo MRI (1.5 T, body-phased-array coil) before and after SPIO administration were compared. The indications for the subsequent MRI studies were based on ambiguous findings on CECT. The number of hepatic lesions, the overall lesion detection and characterization was evaluated by consensus and compared to the gold standard (histological proof in 30/46 of the cases, long-term follow-up in 16/46 of the cases). Results: In 34 of 46 cases the correct diagnoses were established by CECT (sensitivity 96%, specificity 48%) revealing significantly less lesions than MRI. Unenhanced MRI had sensitivity of 93% and specificity of 71%, whereas SPIO-enhanced MRI had sensitivity of 97% and specificity of 88%. The differences between the modalities were even more pronounced in the detection of lesions smaller than 10 mm with SPIO-MRI as the most sensitive method. Conclusions: In this problem-oriented scenario, SPIO-enhanced MRI was superior to spiral CT and unenhanced MRI regarding the diagnostic efficacy in the pre-operative work-up of focal liver lesions. SPIO-enhanced MRI can be recommended as a problem-solving tool for the clinical routine.
    Notizen: Zusammenfassung Fragestellung: Analyse der diagnostischen Wertigkeit der kontrastmittelverstärkten, biphasischen Spiral-CT im Vergleich zu nativer und SPIO-verstärkter MRT bei Patienten mit V.a. fokale Leberläsionen vor eventueller Leber-OP. Material und Methode: 46 Patienten mit V.a. sekundäre oder primäre Lebertumoren wurden nach i.v.-Kontrastmittelgabe an einem Spiral-CT und an einem 1,5 Tesla-Magneten (Atemstillstand-Sequenzen, Körper-Array-Spule) vor und nach i.v.-Infusion von superparamagnetischen Eisenoxydpartikeln untersucht. Die CT- und MRT-Untersuchungen wurden hinsichtlich Läsionsanzahl, -detektion und -charakterisierung qualitativ beurteilt und mit dem Goldstandard (Histologie in 30/46, follow-up in 16/46 der Fälle) verglichen. Ergebnisse: Die Spiral-CT erbrachte in 34/46 Fällen eine korrekte Diagnose, wobei sie signifikant weniger Läsionen in der Leber zeigte als die MRT. Die native MRT war der Spiral-CT hinsichtlich Läsionsdetektion und diagnostischer Effizienz überlegen und wurde noch von der SPIO-verstärkten MRT übertroffen. Der Unterschied zwischen den Modalitäten war bei Läsionen kleiner 10 mm noch deutlicher, von denen die Spiral-CT lediglich 6/13 Läsionen detektierte. Schlußfolgerungen: Die SPIO-MRT ist der biphasischen Spiral-CT und der nativen MRT im Nachweis und bei der Charakterisierung fokaler Leberläsionen überlegen und kann in problematischen Fällen allgemein empfohlen werden.
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  • 66
    Digitale Medien
    Digitale Medien
    Springer
    Der Radiologe 39 (1999), S. 472-477 
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter Fremdkörper ; Ingestion ; Kinder ; Diagnostik ; Key words Foreign body ; Ingestion ; Children ; Diagnosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Foreign body ingestion is not infrequent in infants and children. The diagnosis of radiopaque foreign body ingestion does not pose a major problem. It is crucial to take an X-ray from the pharynx to the level of the pylorus. If a foreign body that might get stuck at the ileocoecal valve is ingested, it is necessary to perform a radiograph of the whole abdomen. Foreign bodies that do not pass the cardia must be extracted endoscopically. In the case of foreign bodies with a smooth contour that have passed the pylorus, parents are advised to check the child’s stool or collect it and bring it for X-raying. If after a week there is no definite evidence that the foreign body has been excreted a follow-up radiograph is carried out. If the foreign body is still in the stomach or duodenum, endoscopy is necessary. The detection of nonopaque foreign bodies can be facilitated by giving oral contrast medium, making the depiction of the foreign body as a filling defect possible. As a complication, perforation can occur, the diagnosis of which may entail the use of sonography, conventional radiography and, to a lesser extent, CT.
    Notizen: Zusammenfassung Fremdkörperingestion ist im späten Säuglings- und frühen Kleinkindalter kein seltenes Ereignis. Die Diagnose röntgendichter Fremdkörper bereitet keine Schwierigkeiten. Hierbei ist jedoch zu beachten, daß die Region vom Pharynx bis zum Pylorus abgebildet sein sollte. Wurden Fremdkörper verschluckt, bei denen die Gefahr der Einklemmung in der Bauhin’schen Klappe besteht, sollte das komplette Abdomen bis zum Anus dargestellt werden. Fremdkörper, welche die Kardia nicht passieren, müssen endoskopisch extrahiert werden. Haben glatt begrenzte Fremdkörper den Pylorus passiert, werden die Eltern aufgefordert, den Stuhl zu untersuchen oder zu sammeln und ihn zur röntgenologischen Untersuchung mitzubringen. Sollte der Fremdkörper innerhalb einer Woche nicht auffindbar sein, wird eine Kontrolluntersuchung durchgeführt. Ist der Fremdkörper dann noch im Magen oder im Duodenum, sollte er ebenfalls extrahiert werden. Der Nachweis nicht röntgendichter Fremdkörper kann mittels Gabe von positivem Kontrastmittel als Aussparungsfigur gelingen. Als Komplikation kann eine Perforation auftreten. Hierbei dienen Sonographie, konventionelles Röntgen und gegebenenfalls CT zur Diagnosefindung.
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  • 67
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. S154 
    ISSN: 1432-1076
    Schlagwort(e): Key words Veno-occlusive disease ; Antithrombin ; Children ; Chemotherapy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Hepatic veno-occlusive disease (VOD) is a well-known complication of chemotherapy in Wilms tumor patients, particularly young children. Although this complication resolves uneventfully in most patients, fatal cases have been reported. Severe VOD after transplantation has a high mortality rate ranging from 45% to 98%. New hemostatic therapeutic strategies have significantly improved the prognosis of VOD. Chemotherapy-related VOD in Wilms tumor usually has a good prognosis. We describe two patients with Wilms tumor and one with acute lymphoblastic leukemia, who developed severe veno-occlusive disease of the liver according to the Baltimore criteria while undergoing chemotherapy; the symptoms were hepatomegaly, ascites, hyperbilirubinemia, weight gain and, in one patient, short-term lethargy. Elevated LDH levels of 872 to 12,000 U/l were observed in our patients. All patients had thrombocytopenia between 29,000 and 40,000/μl and decreased antithrombin (AT) and protein C levels; two patients had gastrointestinal bleeding. All patients developed a coagulopathy because of severe hepatic dysfunction. Two patients received low-dose heparin at the onset of VOD. The thrombolytic therapy was rapidly changed to AT supplementation (20–80 IU/kg bw 2× per day) without heparin when thrombocytes were very low or gastrointestinal bleeding occurred. Resolution of VOD was observed in all patients receiving AT alone. The chemotherapy was discontinued in a patient with accidental actinomycin D overdosage in view of the severity of symptoms. The remaining two patients received chemotherapy according to the therapy protocol after restitution. All patients survived without sequelae with a median follow-up of 28 months (range 8–48 months). Conclusion Hepatic veno-occlusive disease is a rare but increasingly recognized complication in pediatric cancer patients receiving conventional chemotherapy. AT supplementation constitutes a good alternative treatment of severe VOD in comparison with other thrombolytic therapies, particularly in patients at high risk of bleeding.
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  • 68
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 192-200 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Sarcoma ; Metastasis ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Both the prognosis and the morbidity of a patient with a primary malignant musculoskeletal tumour have improved over the past 25 years due to the advent of adjuvant chemotherapy and limb-sparing surgery. This has important implications for the role of imaging at the time of initial diagnosis and during follow-up. This pictorial essay reviews the imaging and pitfalls in the interpretation of musculoskeletal sarcoma metastases using a variety of radiological techniques. The optimal imaging strategy will be stressed.
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  • 69
    ISSN: 1432-1084
    Schlagwort(e): Key words: Lumbar spine ; MRI ; MR myelography
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. The purpose of our study was to evaluate the accuracy of MR myelography in depicting disc herniation in the lumbar spine when compared with conventional MRI in patients presenting with clinical evidence of disc herniation. One hundred patients referred for conventional MR imaging of the lumbar spine also had coronal MR (TR 9000 ms, TE 272 ms eff, NEX 3, echo train length 32) myelography performed. Three experienced observers compared magnetic resonance myelography (MRM) with conventional lumbar spine MR using the following variables: visibility of thecal sac and nerve roots, and the presence, location and severity of disc herniation. Disc protrusions were seen at 110 disc space levels on conventional MR images as opposed to 93 on MRM. However, only 72 % of lesions seen on conventional MR were diagnosed by MRM. Similarly, only 63.8 % of nerve root compression abnormalities seen at conventional MR were visualized when compared with conventional MRM. The sensitivity, specificity and accuracy of MRM when compared with conventional MR was 72, 93 and 85 %, respectively. The MRM technique yields images that resemble conventional myelography and may be used to help confirm abnormalities seen on conventional MR in selected cases; however, the large number of false-positive and false-negative examinations indicates that caution should be used in interpreting MRM images.
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  • 70
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1098-1100 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Osteoid osteoma ; Carpal bones ; Capitate ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. A case of osteoid osteoma of the capitate in a 29-year-old male is reported. The patient suffered from unspecific clinical findings and a 3-year history of uncharacteristic wrist pain. Conventional radiographs of the wrist revealed a circumscribed sclerosis in the proximal part of the capitate bone beside a diffuse demineralisation of the carpal bones. Magnetic resonance imaging demonstrated a circumscribed, tumorous lesion with marked enhancement after IV administration of contrast agent and a highly calcified nidus, which was sharply demarcated by a small rim of granulation tissue from the surrounding spongious bone. Based on MRI findings, the diagnosis of an osteoid osteoma was established and confirmed after operation and histologic analysis.
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  • 71
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1101-1103 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Echinococcosis ; Soft tissues ; MRI ; Hydatid disease
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Hydatid disease of the soft tissues forms a rare mass lesion of the extremities. Two cases of primary hydatid disease in soft tissues are presented with MR imaging findings. A cystic mass with multiloculated or multicystic appearance was identified on MR images in both cases. The lesions were surrounded by a rim with two layers representing a collageneous and a vascularized pericyst. The contrast-enhanced images demonstrated the vascularized component of the wall clearly in the first case. In diagnosis of hydatid disease and in its differentiation from other cystic lesions of the extremities, we think that the described MR appearances can be used confidently.
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  • 72
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1113-1116 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Breast ; Rhabdomyosarcoma ; Mammography ; Ultrasound ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. The authors report a case of blood-borne bilateral metastatic breast disease of alveolar rhabdomyosarcoma (RMS) in a 21-year-old patient. The possibilities of mammography, ultrasound, and MRI in the early detection of breast metastases and their appearance on these modalities are discussed. Whereas mammography rendered no additional information due to dense breast parenchyma and ultrasound showed only a solitary tumor without definite criteria of malignancy, multifocal bilateral spread was verified with MRI and early ring-like enhancement suggested malignancy. Therefore, we conclude that MRI may provide useful information in evaluating patients with sarcomas, even when there is no clinical evidence for metastatic disease of the breast.
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  • 73
    ISSN: 1432-1084
    Schlagwort(e): Key words: Lipoid pneumonia ; Diagnosis ; Lung ; Disease ; CT ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. The objective of this study was to describe high-resolution CT (HRCT) and MR findings of exogenous lipoid pneumonia and to correlate them with pathologic findings. A retrospective review of the medical records of our institution revealed seven patients with a diagnosis of lipoid pneumonia based on clinical data, chest films, bronchoalveolar lavage, and follow-up. Both HRCT and MR imaging were reviewed by two readers. Pathologic examination of the resected specimen or surgical biopsies were also reviewed in the four available cases. The HRCT findings were pulmonary consolidations (n = 6) with fatty (n = 3) or unspecific but low attenuation values (n = 3), areas of ground-glass opacities (n = 5), septal lines, and centrilobular interstitial thickening (n = 5). In five of the seven cases, a crazy-paving pattern of various spread was also present, either isolated (n = 1) or surrounding a pulmonary consolidation. In two cases traction bronchiectasis and cystic changes consistent with fibrosis were seen. At MR imaging (n = 2) a pulmonary consolidation of high signal intensity on T1-weighted image consistent with lipid content was present in one case. Pathologic examination (n = 4) showed the coexistence of lobules with lesions of various ages, sometimes in contiguous lobules, within the same patient. Recent lesions were those with alveolar fill-in by spumous macrophages and almost normal alveolar walls and septae. In more advanced lesions, lobules were filled in with larger vacuoles often surrounded by inflammatory infiltrates of alveolar walls, bronchiolar walls, and septa. The oldest lesions were characterized by fibrosis and parenchymal distortion around large lipid-containing vacuoles. The HRCT findings reflect pathologic findings in exogenous lipoid pneumonia. Although non-specific, consolidation areas of low attenuation values and crazy-paving pattern are frequently associated in exogenous lipoid pneumonia and are indicative of the diagnosis.
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  • 74
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1596-1598 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Penile metastasis ; Corpus cavernosum ; Bladder cancer ; CT ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Metastases of the penis are uncommon, with only approximately 300 cases reported since 1870. In up to 70 % of patients, the primary tumour is located in the urogenital tract. Furthermore, isolated metastases of the penis are exceptionally rare. We report a case of solitary squamous cell metastasis of the penis presenting with painful swelling initially thought to be inflammatory in origin. The CT and MR imaging findings are presented with a short review of the literature.
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  • 75
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1859-1861 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Wegener's granulomatosis ; Cavernous sinus ; Sella turcica ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Intracerebral extension of Wegener's granulomatosis (WG) is rare. We present a patient with oculomotor and trochlear nerve palsy with histologically proved WG. An MR examination revealed granulomatous tissue in nasal cavity, paranasal sinuses with meningeal infiltration, and uncommon penetration into cavernous sinus and sella turcica. The MR images before and during pharmacological therapy are presented.
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  • 76
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1800-1803 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Bone neoplasm ; Chondromyxoid fibroma ; Sacrum ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. A 30-year-old man with a 7-month history of mild sacral pain and intermittant left sciatica was found to have an expansile lesion in the sacrum on a plain radiograph. Biopsy confirmed a chondromyxoid fibroma which was removed surgically. A 1-year follow-up showed no recurrence. The case is the fifth to be reported. Plain film and MRI appearances, histology and treatment are described. The previously reported cases are reviewed and the current literature is discussed.
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  • 77
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1804-1809 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Thalassemia ; Extramedullary hematopoiesis ; MRI ; CT
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Thalassemia is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of β-thalassemia are due in large part to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations including spine, skull, facial bones, and ribs. Extramedullary hematopoiesis (ExmH), hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia. The skeletal X-ray findings show characteristics of chronic overactivity of the marrow. In this article both skeletal and non-skeletal manifestations of thalassemia are discussed with an overview of X-ray findings, including MRI and CT findings.
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  • 78
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1810-1812 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Soft tissue neoplasm ; Parosteal lipoma ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. A case of parosteal lipoma of the femur combined with hyperostosis is presented. The parosteal lipoma is a rare benign tumor containing adipose tissue and is intimately related to the periosteum. We report the MRI features and correlative pathologic findings of a parosteal lipoma. The MRI technique is useful for evaluating the relationship between the periosteum and the lipoma.
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  • 79
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1869-1872 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Actinomycosis ; Adrenal ; Misleading diagnosis ; MIBG ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. A 34-year-old woman presented with a left-sided suprarenal space-occupying lesion on sonography. Culture of material obtained during sonographic-guided puncture of the retroperitoneal lesion yielded a mixed flora of Actinomyces and Peptostreptococcus. Initially, a misleading diagnosis of an adrenal pheochromocytoma was initiated by highly positive metaiodobenzylguanidine scintigraphy after chemical chemistry vanillylmandelic acid (VMA) test showed elevated values for adrenaline and its derivatives. Retroperitoneal actinomycosis with yet unproven spread into thoracic and cervical compartments is a particular unusual presentation of an infection with these organisms. Because it may mimic subacute infections or malignant masses in terms of clinical and laboratory findings, radiological diagnosis of this entity may be difficult. The diagnosis was based on results of culture and the response of the patient to long-term penicillin-derivate therapy after surgical drainage of the suprarenal abscess formation.
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  • 80
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 1882-1885 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Neonatal liver failure ; Neonatal hemochromatosis ; Newborn ; MRI ; Duplex Doppler sonography
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Neonatal hemochromatosis is a rare congenital disorder which affects both fetuses and newborns. It is characterized by hepatocellular failure, often appearing on the first day of life in the form of coagulopathy, hypoalbuminemia, hypoglycemia, and jaundice. Most of the affected infants die early in life, and definitive diagnosis has often been made only by post-mortem evaluation. With the help of MRI, plus increasing awareness of the disorder, diagnosis is now often made early, even in utero. Duplex Doppler sonography does not provide information on siderosis but shows abnormalities in the liver or blood-flow patterns associated with liver disease.
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  • 81
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 971-974 
    ISSN: 1432-1076
    Schlagwort(e): Keywords Liver ; Steatosis ; HIV ; AIDS ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Thirty HIV-infected children were cross-sectionally examined for morphologic hepatic abnormalities, using ultrasonography or histology. Abdominal ultrasonography was performed in 27 children. The liver structure was normal in four patients, one of whom had moderate symptoms of the HIV infection and three of them severe symptoms. Abnormal liver structure, compatible with hepatic steatosis, was found in 23 (85%) patients. Five of them were in an early stage of the HIV infection (category N or A), three patients were ranked in category B and 15 patients in category C. Histological examination of the liver was performed in 11 children and steatosis was documented in ten (91%). In seven (70%) of these ten children steatosis had been suspected by ultrasonography. In conclusion, steatosis is common in HIV-infected children. It is non-specific and has no impact on disease, diagnostic evaluation or management. Conclusion Ultrasonography is a sensitive, accurate, non-invasive screening tool. It is more reliable than liver function tests.
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  • 82
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 12-17 
    ISSN: 1432-1076
    Schlagwort(e): Key words Alternative medicine ; Complementary therapies ; Critical care ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The interest in alternative medicine (AM) is growing. In the USA and Canada, studies showed that 34% of adults and 11% of children use AM. In a prospective cohort study, we investigated the interest in AM among parents of critically ill children in the paediatric Intensive Care Unit (ICU) of a university hospital. From January 1996 to April 1997, we distributed questionnaires to the parents of critically ill children. These strictly anonymous questionnaires were completed at home and returned by mail. Exclusion criteria were short (〈1 day) or repeated hospitalizations, and insufficient proficiency of the German language. The inclusion criteria were fulfilled by 591 patients; 561 received the questionnaire (95%) and 289 (52%) were returned. Of the respondents, 70% would appreciate AM as a complementary therapy on the ICU, 23% found AM equally or more important than conventional medicine whereas only 7% regarded AM as unimportant. On the ICU, 18% used AM; surprisingly 41% of them did not discuss it with physicians or nurses. An additional 21% would have liked to use AM, but did not do so. Typically, AM-users administered AM also at home to their children and themselves. Their children were however, older. Conclusions A substantial proportion of parents used measures of alternative medicine in the intensive care unit, or would have like to do so. However, few had the confidence to discuss this wish with the medical personal. This suggests that alternative medicine is of great interest, even on an intensive care unit. Nevertheless, discussion about alternative medicine seems to be taboo in doctor-patient relations.
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  • 83
    ISSN: 1432-1076
    Schlagwort(e): Key words Mild head injury ; Fractured bone ; Late sequelae ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Two years after an accident resulting in either a mild head injury or a fractured bone, two groups of 22 children each, aged 4–14 years, were examined for the existence of any neurobehavioural symptoms by means of a standardized questionnaire filled out by their caretakers. Selection of the children was based on reports of the Accident and Emergency Department in 1 year. Significantly more symptoms were reported after mild head injury. The main symptoms reported were headache, dizziness, fatigue and memory problems. The total number of symptoms in the children with mild head injury exceeded four times this in the group of children with a fractured bone. Conclusion Even 2 years after a mild head injury there are still residual symptoms in daily life.
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  • 84
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. S117 
    ISSN: 1432-1076
    Schlagwort(e): Key words Stroke ; Coagulation ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Many studies have shown a high percentage of venous thromboses in children to be associated with haematological disorders. However, studies assessing the influence of haemostaseological disorders on paediatric stroke are rare. We compared 26 children with cerebral infarction (median age 2 months, range 0–16.2 years) and 17 with venous thrombosis (median age 4.5 years, range 0–17 years) with regard to prothrombotic risk factors. Prothrombotic disorders were found in 8 out of 26 patients with cerebral infarction (FV Leiden mutation: n = 4; protein C deficiency: n = 1; FV Leiden mutation + protein C deficiency: n = 2; prothrombin mutation G20210A: n = 1) and in 13 out of 17 with venous thrombosis (FV Leiden mutation n = 3; protein C deficiency n = 5; elevated HRGP + PAI: n = 1; combined deficiency of AT, protein C and plasminogen: n = 1; F XII deficiency: n = 1; lupus anticoagulans n = 1; FV Leiden + F XII deficiency + lupus anticoagulans + PAI: n = 1). Comparison of these prevalences with those of 150 healthy paediatric controls showed in children with FV Leiden mutation and/or protein C deficiency an increased risk of cerebral infarction (patients vs. controls: 26.9% vs. 6%; OR 5.77; 95%-CI 1.92–17.3; P = 0.0031) as well as of venous thrombosis (53% vs. 5.3% 19.9; 95%-CI 6–65.6; P 〈 0.0001). This result is in contrast with reports on thrombophilia in cerebral infarction in adult patients. Conclusion Our results indicate that FV Leiden mutation and protein C deficiency may contribute to the multifactorial aetiology of stroke in early childhood.
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  • 85
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 362-366 
    ISSN: 1432-1076
    Schlagwort(e): Key words Type 1 diabetes ; Children ; Risk factors ; Case control ; Environmental
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The aim of this study was to investigate environmental risk factors in the development of type 1 diabetes mellitus in a population-based case-control study. Parents of all patients with manifestation of type 1 diabetes between 1989 and 1994 in Vienna were asked to complete a questionnaire (n = 114). Control children (n = 495), matched for age and sex, were randomly recruited from all schools in Vienna. Fathers of diabetic children were significantly older at the time their children were born than fathers of control children (P = 0.015). Children with diabetes were more likely to be second- or third-born children (P 〈 0.05) and fewer went to kindergarten than the control group children (P = 0.007). No significant difference in duration of gestation, percentage of delivery by caesarean section, birth weight or length was found. Neonatal jaundice was more often observed in the patient group (P = 0.038). Breast feeding was reported by 82.7% of mothers of diabetic children and by 81% of mothers of control children, and the duration of breast feeding was longer in patients than in controls (n.s.). Conclusion In our study, the development of type 1 diabetes mellitus was associated with higher paternal age and neonatal jaundice. No correlation could be found with dietary intake of cow's milk products in early infancy, vaccination and other environmental factors.
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  • 86
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 24-28 
    ISSN: 1432-1076
    Schlagwort(e): Key words Hashimoto thyroiditis ; Graves disease ; Children ; TSH function-blocking antibody ; Cytotoxic antibody
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract In a cross-sectional study, 29 children aged between 1 month and 15.3 years (average age 6.8 years) born to mothers with Graves disease or Hashimoto thyroiditis were examined clinically, biochemically, and by sonography of the thyroid gland. At the time of examination all children were clinically euthyroid. Tests of thyroid peroxidase antibody, thyroglobulin antibody, TSH receptor antibody and free thyroxine (fT4) gave normal results. In 3 children subclinical hypothyroidism with elevated TSH and normal fT4 concentrations were found; one of these children had a minor decrease of total thyroxine. Three children with otherwise normal test results had marginally elevated tri-iodothyronine concentrations. Increased antibody titres were present in 8 out of 29 children. TSH function-blocking antibodies were elevated in 8 cases. In addition, cytotoxic antibodies were found in one of the children. The distribution pattern of antibodies was different in each child and unrelated to the type of maternal thyroid disease. Conclusion Children of mothers with auto-immune thyroid disease often have thyroid antibodies without signs of thyroid disease. Whether antibody-positive children have an increased risk of developing thyroid disorders later in life must be examined in a longitudinal study.
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  • 87
    ISSN: 1432-1076
    Schlagwort(e): Key words Gastro-intestinal bleeding ; Children ; Jejunal leiomyoma ; Neurofibromatosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Gastro-intestinal bleeding is an uncommon presentation in children with neurofibromatosis. Gastro-intestinal involvement caused by jejunal leiomyoma has only been described in adults. To the best of our knowledge, this is the first paediatric case of jejunal leiomyoma associated with neurofibromatosis. We present a 10-year-old girl with a 9-month history of anaemia and low gastro-intestinal bleeding. Abdominal sonography and small bowel series showed a submucosal mass in the proximal jejunum. On surgery, a submucosal tumour was excised and histological examination suggested a diagnosis of “smooth muscle tumour of undetermined malignant potential”. There were no recurrence of symptoms for 4 years after the operation. Conclusion Jejunal leiomyoma should be considered in a child with neurofibromatosis presenting with gastro-intestinal bleeding.
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  • 88
    ISSN: 1432-1076
    Schlagwort(e): Key words Respiratory chain ; Mitochondria ; Children ; Infancy ; Liver failure ; AbbreviationsMRCD mitochondrial respiratory chain disease ; OLT orthotopic ; liver transplantation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Mitochondrial respiratory chain disease may lead to neonatal or late onset liver failure, requiring liver transplantation. In rare cases, the disease is restricted to the liver and the patient is cured after surgery. More frequently, other organs are simultaneously involved and neuromuscular or other extra-hepatic symptoms may pre-exist, or appear in the post-transplant follow up. Pre-transplant evaluation should aim to rule out neurological disease, which may be difficult to differentiate from signs accompanying liver insufficiency. Cerebrospinal fluid lactic acid levels, compared to blood lactate, may be suggestive of central nervous system involvement. Of 11 cases with respiratory chain disorders who had liver transplantation in various centres, 4 are alive and well on follow up, and 6 died, three of them having developed neurological disease post orthotopic liver transplantation. All three patients with initial liver and gastro-intestinal disease died early after transplantation, indicating that these may be poor candidates for this procedure. Conclusion Liver transplantation is feasible in hepatic respiratory chain disorders, but extra-hepatic disease should be ruled out before transplantation. Extra-hepatic manifestations may, however, appear and cause patient death despite successful transplantation.
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  • 89
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. S085 
    ISSN: 1432-1076
    Schlagwort(e): Key wordsα1-Antitrypsin ; Liver disease ; Liver transplantation ; Children ; AbbreviationsAATα1-antitrypsin deficiency ; OLT orthotopic liver transplantation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Only a minority of infants born with α1-antitrypsin deficiency will develop serious liver disease during childhood, mostly but not always after neonatal cholestasis. Early prognosis is difficult and all children have to be followed up carefully. The liver disease progresses with varying speed and it lacks specific features. At the time of liver transplantation the young patients have no pulmonary disease induced by the deficiency and in those with renal involvement, the kidney problems can mostly be dealt with by conservative therapy. The peri- and postoperative care of the patients who undergo liver transplantation does not differ from the usual routines.
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  • 90
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 158 (1999), S. 298-301 
    ISSN: 1432-1076
    Schlagwort(e): Key words Isolated ; Sphenoid ; Sinusitis ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Acute isolated infectious sphenoiditis is an uncommon, potentially dangerous condition which is often misdiagnosed because of its nonspecific symptoms and paucity of clinical signs. We present eight children with isolated sphenoiditis who were managed in our medical centre during the last 2 years and review the literature. All the patients were adolescents or pre-adolescents and all experienced moderate to severe refractory oppressive headache. Four had a history of sinusitis or allergic rhinitis. None had fever or any other directing clinical sign. Diagnosis was made by cranial computer tomography. All were treated with antibiotics and recovered completely without infectious or neurological complications. Conclusion Acute isolated infectious sphenoiditis should be considered in adolescents and pre-adolescents who present with constant moderate to severe oppressive headache. Awareness of this entity will enable early diagnosis and initiation of antibiotic treatment which is essential to avoid complications and surgical intervention.
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  • 91
    ISSN: 1432-1076
    Schlagwort(e): Key words Heparin treatment ; Heparin-induced thrombocytopenia ; HIT antibodies ; Children ; Catheter patency
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The immunological form of heparin-induced thrombocytopenia (HIT) is a potentially life-threatening adverse reaction of heparin medication. It is mediated by multimolecular complexes consisting of platelet factor 4 (PF4)-heparin-IgG which bind to platelets via platelet Fcγ receptors. Cross-linking of multiple Fcγ receptors results in platelet activation, platelet aggregation and enhanced thrombin generation with a increasing risk of developing new thrombosis. In children, data on HIT are sparse. This review of the literature reports on 8 children aged 3 months to 15 years and 14 newborns suffering from HIT. Additionally, we report one new case treated with danaparoid sodium. Thrombotic complications were venous (n = 12) and arterial (n = 15). The children received heparin either for a spontaneous thrombotic event, for severe cardiac diseases or to maintain patency of intravascular catheters which are used for nutrition, blood sampling, and for application of medication. After diagnosis of HIT they were further anticoagulated with aspirin, warfarin, danaparoid sodium, lepirudin or low molecular weight heparin. Conclusion Although HIT is less frequently reported in newborns and children, paediatricians should be aware of HIT in childhood as a potential complication of heparin application. The widespread practice of flushing catheters with heparin should also be debated in view of the risk of triggering the primary immune-response of HIT. In 1999, treatment options for further parenteral anticoagulation of HIT patients are danaparoid sodium (a low-molecular weight heparinoid) and lepirudin (a direct thrombin inhibitor).
    Materialart: Digitale Medien
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  • 92
    ISSN: 1432-1076
    Schlagwort(e): Key words Factor V G1691A ; Prothrombin G20210A ; Lipoprotein (a) ; Central venous lines ; Children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract To evaluate the role of inherited thrombophilia in the development of central venous line (CVL)-related thrombosis, the following parameters were determined in 77 pediatric-oncologic patients with CVL: activated protein C (APC)-ratio, factor V (FV) G1691A and prothrombin G20210A mutation, protein C, protein S, antithrombin, coagulation factor XII, lipoprotein (a) and homocysteine. An inherited prothrombotic risk factor was found in 17 patients (23%). Four out of 14 patients with a single defect (hyperlipoproteinemia, heterozygous FV G1691A and prothrombin G20210A mutation, protein C deficiency type I) and all three patients with combined defects (heterozygous FV G1691A mutation combined with heterozygous prothrombin G20210A variant, protein S deficiency or hyperlipoproteinemia) suffered from CVL-related thrombosis. In 11 out of 77 patients (14%) a CVL-related thrombosis was detected. In 2 children thrombosis occurred a few days after asparaginase therapy and in another three thrombosis was associated with CVL-related septicemia caused by Staphylococcus epidermidis. After removal of CVL, thrombosis was detected in 5 children, in 2 without clinical symptoms but in the presence of inherited prothrombotic risk factors. Conclusion The present study demonstrates the clinical importance of CVL in combination with inherited thrombophilia in the development of thrombosis in pediatric-oncologic patients. Before or shortly after insertion of CVL, patients should be tested for the presence of factor V G1691A mutation, prothrombin G20210A variant and increased lipoprotein (a) values.
    Materialart: Digitale Medien
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  • 93
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 153-158 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Erdheim-Chester disease ; Langerhans' cell granulomatosis ; MRI ; Histiocytosis X ; Lipogranulomatosis ; Eburnated vertebra
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Erdheim-Chester (EC) disease belongs to the group of lipoid granulomatosis. Symmetric sclerosis of the meta- and diaphysis of long tubular bones are pathognomonic radiologic changes. Additionally, other skeletal segments can be affected. Extraskeletal manifestations can occur in almost all organs; lungs, pericardium, retroperitoneum, skin, and orbita play particularly important roles. The last case of 38 cases of Erdheim-Chester disease with an extraordinary mediastinal and perirenal involvement is described. For the second time following the initial description by Chester, an axial skeletal pattern of eburnated vertebra is shown.
    Materialart: Digitale Medien
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  • 94
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 16-28 
    ISSN: 1432-1084
    Schlagwort(e): Key words: CT ; MRI ; prostate ; testis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Technical advances in magnetic resonance imaging (MRI), notably in high-resolution MRI, have opened up new diagnostic applications in male pelvic pathology. A major indication is the preoperative staging of prostate cancer, where MRI is more reliable than other imaging modalities in differentiating between localized and advanced disease. In monitoring local recurrence after radical prostatectomy MRI is also valuable in differentiating scar tissue from new growth. In benign prostate disease, MRI effectively displays the congenital cysts that may be associated with infertility. Other disease, however – notably benign prostatic hyperplasia – is generally an incidental finding. Ultrasound remains the imaging modality of choice for evaluation of pathologies of the penis, testis and scrotum, e. g. in differentiating malignant from benign scrotal masses or in diagnosing acute scrotum due to testicular torsion or rupture. In isolated cases, MRI is also a valuable diagnostic aid in conditions of these organs, e. g. in the preoperative localization of ectopic testes in cryptorchidism or if US findings are equivocal.
    Materialart: Digitale Medien
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  • 95
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 525-528 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Hypereosinophilic syndrome ; Polymyositis ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. A 40-year-old white man presented with fever, muscle pain, skin nodules and persistent hypereosinophilia over a period of 1 year. In addition, he had ventricular arrhythmias with episodes of tachycardia. Besides a lack of response to antiparasitic therapy, laboratory and pathological data excluded the diagnosis of trichinosis or any other parasitic infection. The patient's course of the disease over the previous 11/2 years was compatible with hypereosinophilic syndrome. In a muscle biopsy several eosinophilic perivascular and leucocytic intravascular infiltrates were found, indicative of muscle involvement by the disease. This is a report on the MRI findings of muscle involvement in idiopathic hypereosinophilic syndrome.
    Materialart: Digitale Medien
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  • 96
    ISSN: 1432-1084
    Schlagwort(e): Key words: Ankle ; Ankle sprain ; Lateral collateral ligaments ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1.5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical repair. Eighteen patients with conservative therapy had a follow-up MR examination after 3 months. There was 1 sprain, 3 partial and 32 complete tears of the anterior talofibular ligament, and 5 sprains, 5 partial, and 7 complete tears of the calcaneofibular ligament. There were no lesions of the posterior talofibular ligament. Compared with surgery, MRI demonstrated in 18 of 18 cases the exact extent of anterior talofibular ligament injuries and underestimated the extent in 2 of 8 cases of calcaneofibular ligament injury. In patients with follow-up MRI after conservative therapy, a thickened band-like structure was found along the course of the injured ligament in 17 of 18 cases. The absence of ligament repair after conservative treatment was confirmed during operative revision in one case. The MRI technique allows for grading of the extent of injury of the lateral collateral ligamentous complex after acute ankle strain. It seems to be suitable for monitoring the healing process after conservative-functional treatment of ligament tears.
    Materialart: Digitale Medien
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  • 97
    Digitale Medien
    Digitale Medien
    Springer
    European radiology 9 (1999), S. 552-554 
    ISSN: 1432-1084
    Schlagwort(e): Key words: Adenomatoid tumor ; Adrenal gland ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. The aim of this case report is to describe the appearance on magnetic resonance imaging (MRI) of an incidentally found adenomatoid tumor of the adrenal gland, and to evaluate the utility of MRI in characterizing this type of tumor. The appearance of the tumor was nonspecific on T1-weighted in-phase, opposed-phase, and T2-weighted images, as well as its behavior after paramagnetic contrast administration, outlining the differential diagnosis among carcinoma, metastatic tumors, and pheochromocytoma. After surgery, the pathologic diagnosis was adenomatoid benign tumor of mesothelial origin. Although MRI enables the characterization of most benign lesions of the adrenal gland, the appearance of other lesions is nonspecific. In our case, MRI did not assist in preoperative diagnosis, guiding us towards a diagnosis of malignancy.
    Materialart: Digitale Medien
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  • 98
    ISSN: 1432-1084
    Schlagwort(e): Key words: Optic nerves ; Neuritis ; Children ; Central nervous system ; MR imaging
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. A 4-year-old boy developed bilateral optic neuritis. Although precise neuro-ophthalmological evaluation was difficult, the diagnosis was made with gadolinium-enhanced MR imaging using fat-suppression technique in the initial stage of the disease. Enhancement and enlargement of the intraorbital and intracanalicular optic nerve were demonstrated bilaterally as well as protrusion of the optic nerve head. The disease responded dramatically to intravenous steroid therapy. The etiologies in children usually differ from those in adolescent and adult patients.
    Materialart: Digitale Medien
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  • 99
    Digitale Medien
    Digitale Medien
    Springer
    Experimental brain research 125 (1999), S. 239-247 
    ISSN: 1432-1106
    Schlagwort(e): Key words Precision grip ; Motor development ; Motor control ; Children ; Object manipulation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Recent evidence has shown that the anticipatory control of grip and load force is not innate and develops over several years in childhood. The present study examined the development of grasping behavior by quantifying the relationship between grip force and the vertical acceleration of an object. Children and adults were requested to use a precision grip to lift an instrumented object which varied in size and weight. Grip force, grip force rate and the vertical position and acceleration profiles of the test object were measured or calculated. The results demonstrated the presence of distinct developmental milestones in the maturation of precision grip from 2 to 9 years of age. With 2-year-old children, the peak acceleration was negatively correlated (r=–0.51, n=34, P〈0.01) with peak grip force during lifting. By 3 years of age, peak acceleration and peak grip force during lifting became positively correlated (r=0.28, n=104, P〈0.01) and the correlation continued to strengthen up to 9 years of age. Variations in the temporal coupling of both peak grip force and peak acceleration also decreased with maturation. Furthermore, starting at 4-years-old, children clearly controlled the acceleration and deceleration of the object in a symmetrical pattern and used a single burst of grip force rate to grasp the object with some regularity, suggesting that the emergence of an anticipatory control strategy had already begun.
    Materialart: Digitale Medien
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  • 100
    ISSN: 1432-0932
    Schlagwort(e): Key words Spine fractures ; Trauma ; MRI ; Intervertebral disc ; Cadaver study
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract This cadaver study evaluated the value of MR images for detection of acute intervertebral disc damage associated with fractures of the thoracolumbar spine. Damage to the intervertebral disc may be a major contributor to chronic instability in non-operative treatment or failure of fixation and recurrence of deformity in posterior fixation methods. MR imaging can help us to understand the injury patterns and their prognostic significance. However, before we can justify the use of MRI in clinical cases, determination of MRI’s ability to detect acute injury to the disc is necessary. Ten fresh cadaver specimens were used for this study. After obtaining radiograms and MR images, injuries were created with a weight-dropping apparatus using a variety of weights and compression angles. Post-injury radiograms and MR images were taken and the specimens were frozen at –20 °C. Slides of these specimens obtained with cryosection techniques were compared with MR images for evaluation of the damage to different parts of the discs. A total of 20 fractures were observed on cryosections. In 12 of the discs adjacent to fractured vertebral bodies, macroscopic damage was seen on the sections. These were all detected on the corresponding MR images. The study showed that MRI is able to detect acute, macroscopic injury to the intervertebral disc. It is therefore justified to use MR for the study of acute disc damage associated with thoracolumbar fractures.
    Materialart: Digitale Medien
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