[Early detection of hepatobiliary involvement in children with mucoviscidosis using duplex sonography of the portal system]. / Frühnachweis einer hepatobiliären Beteiligung bei Kindern mit Mukoviszidose mit Hilfe der Duplexsonographie des Portalsystems.

To investigate early signs of hepatobiliary disease in CF, we measured portal, splenic, superior mesenteric vein and hepatic artery diameters, maximal flow velocity (Vmax) and time average velocity (TAV) in 25 males and 17 females with CF. Hepatic artery resistance, regional blood flow and liver perfusion were calculated. According to liver enzyme data (aminotransferases raised greater than 30 U/l) and sonographic findings (nodular changes), there were 17 CF-patients (mean age 11.4 yrs; range 0.75-31) with and 25 CF-patients (mean age 7.8 yrs; range 0.25-32) without liver involvement (L+/L-). No patient had clinical signs of portal hypertension. 61 healthy children were studied for control. Diameter of portal vein (PVD) and flow data for portal vein showed consistent abnormalities (mean +/- SD): CF-L+ CF-L- Control PVC (mm/m2) 10.7 +/- 3.9*** 10.5 +/- 3.4*** 7.2 +/- 1.3 Vmax (m/sec) 0.23 +/- 0.06*** 0.30 +/- 0.06*** 0.40 +/- 0.14 TAV (m/sec) 0.12 +/- 0.04*** 0.16 +/- 0.04* 0.18 +/- 0.05 Differences were statistically significant (* p less than 0.05, *** p less than 0.001) for CF-patients versus controls. Data for splenic and mesenteric veins and for hepatic artery were moderately alterated, with a significant reduction in TAV and Vmax of splenic vein for CF-L+ versus controls. Liver perfusion and portal vein flow showed no relevant differences in CF-patients versus controls. It is concluded that portal system abnormalities, especially a decrease in Vmax and TAV of portal vein shown by duplex sonography, may be earlier indicators of CF liver disease than biochemical and clinical signs.

[Aneurysm of the vein of Galen as a possible cause of congestive heart failure: a report of 5 new cases]. / Aneurysma der Vena Galeni als mögliche Ursache für eine kongestive Herzinsuffizienz: Bericht über 5 neue Fälle.

We report on five newborns with an arterio-venous malformation of the vein of Galen. All newborns were cyanotic and in congestive heart failure without any evidence of congenital heart disease. Congestive heart failure in these cases was mainly due to an almost two-fold increase in cardiac output of approximately 8 l/min/m2 (normal: 4.5 l/min/m2). According to previous reports, mortality is very high in patients with this malformation when becoming symptomatic during infancy, and therapy by surgery or embolization is only successful in 10-30%. While three of our patients died shortly after diagnosis because of untreatable heart failure, the other two were operated on either by subtotal ligation of the draining vein or by ligation of 4 arterial feeders. In the first case secondary thrombosis of the aneurysm occurred and cardiac failure subsided. In the second case a large shunt remained and a balloon-embolization was performed successfully. However, in both patients severe neurologic defects occurred, the severity of which remains to be assessed later since the post-operative observation period is only 2 and 5 months, respectively.

[Transcranial sonography and duplex sonography in children with cysts and tumors of the cranial base]. / Transkranielle Sonographie und Duplexsonographie bei Kindern mit Zysten und Tumoren im Bereich der Hirnbasis.

Clinical application of transcranial real-time sonography and duplex scan is demonstrated in 4 patients (2.5 to 14 years) with cysts and tumors in the basal brain area. A good correlation between ultrasound and CT-scan can be shown. With transcranial duplex scan intravascular flow velocities in the basal brain arteries can be measured. Simultaneous localization of the Doppler gate in a clearly defined part of the vessel is possible. In addition this non-invasive method can demonstrate the anatomical location of the basal brain vessels in relation to cysts and tumors. This was previously possible only with angiography.

[Sonography of the larynx in children. New perspectives due to the use of computerized sonography: 2: Sonographic findings in a case of laryngeal papillomatosis]. / Sonographie des Kehlkopfes im Kindesalter. Neue Perspektiven durch Einsatz der Computersonographie: Teil 2: Der sonographische Befund einer Larynxpapillomatose.

On our opinion one important indication for sonographic diagnosis in future are masses in the larynx area: in infancy or childhood mainly laryngeal papillomatosis. In one of our boy patients with massive laryngeal papillomatosis laser surgery was first performed at 15 months of age. After a second and third procedure interferon-therapy was begun. Sonographically it was easily possible to follow the course in control examinations. Sonographic findings correlated well with laryngoscopic findings. Laryngoscopy could therefore be limited to a minimum.

[Transcranial duplex sonography through intact bone: a new diagnostic procedure]. / Transkranielle Duplexsonographie durch den intakten Knochen: ein neues diagnostisches Verfahren.

Transcranial duplex scanning as a new diagnostic procedure is described for the first time. This method allows Doppler sonographic registration of flow profiles of basal cerebral arteries through the intact skull with simultaneous demonstration of pulsating vessels and cerebral structures in the B-mode scan. The exact localisation of the registered Doppler profile can be demonstrated under direct visual control in a clearly defined section of the cerebral artery. Therefore, an angle correction of the recorded Doppler-shift is possible allowing determination of true flow velocity. Occlusion of basal cerebral arteries can be diagnosed visually with this method. The use procedure in 51 children and adolescents aged 18 months to 19 years is described.

[Ultrasound diagnosis of the larynx with the aid of computerized sonography]. / Ultraschalldiagnostik des Larynx mit Hilfe der Computersonographie.

We report on new perspectives in diagnostic ultrasound of the larynx, a method that has become possible by the application of computed sonography. The examinations were performed by means of a computer sonography system (Acuson 128). For all investigations we used a 5 MHz linear transducer with a resolution corresponding to 10 MHz. The frame rate was between 20 Hz and 50 Hz and thus enabled good reproduction of dynamic processes. We could show that it is possible to visualize all significant structures of the larynx including the thyroid cartilage, the vocal ligament, the vocalis muscle, the arytenoid cartilage and the piriform fossa. With sufficient practice, good demonstration and hence assessment of the larynx can be already possible in infancy. We examined children and adults between 6 days and 35 years of age. - Masses in the laryngeal area are among the important indications for sonographic diagnosis: in infancy and childhood, these are mainly represented by laryngeal papillomatosis. In one of our patients suffering from massive laryngeal papillomatosis, laser surgery was first performed when he was 15 months of age. After a third removal procedure, interferon therapy was initiated. Sonographically it was easily possible to follow the course. Sonographic findings correlated well with laryngoscopic findings. Laryngoscopy could therefore be restricted to a minimum.

[Transcranial real-time sonography in children and adolescents, ultrasound anatomy of the brain]. / Transkranielle Real-Time-Sonographie bei Kindern und Jugendlichen, Ultraschallanatomie des Gehirns.

Cerebral real-time ultrasonography through the fontanelle or temporal bones is being used more and more as a primary diagnostic procedure in infants and newborn suffering from cerebral pathology. Up to now it was limited to children below 18 months. In our study we examined 125 children and adolescents aged 18 months to 18 years and 9 adults with transcranial real-time sonography. With a computed sonography system high resolution of intracerebral structures, especially in the basal parts of the brain, was possible up to the age of about 8 years. Because of thickening temporal bones with increasing age ultrasonic resolution of cerebral structures then progressively decreases. However, a general transcranial ultrasound examination is possible even in adolescents and adults. Normal transcranial ultrasound sections of the brain are compared with standard anatomic sections. Advantages and limitations of the method as well as first clinical applications are discussed.