Hereditary congenital posterior dislocation of radial heads.

We report on 4 patients with congenital posterior dislocation of radial heads in 3 generations of a family. Radiographs of the elbow joints of 3 individuals are presented. All affected subjects have mild limitation of extension and a strong restriction of rotation in the elbows. Comparison with previously described patients shows similarities in the X-ray findings. Congenital posterior dislocation of the radial head can be unilateral or bilateral. This malformation is also found in patients with antecubital pterygium or nail-patella syndrome. This family confirms the autosomal dominant inheritance of congenital posterior dislocation of radial heads.

Soft tissue infection caused by Kingella kingae in a child.

During the last years an increasing number of reports concerning Kingella kingae infections in children has been published. Most cases were osteoarticular infections. The authors report the clinical and laboratory findings from a 3-year-old child with a presternal soft tissue infection due to K kingae. After surgical excochleation and antibiotic treatment there was an uneventful recovery. J Pediatr Surg 36:946-947.

Choledochocele--a rare cause of necrotising pancreatitis in childhood.

Recurring complaints of unknown origin in the upper abdomen during childhood are not frequent. Choledochoceles, or type III choledochal cysts, are rare congenital abnormalities of unclear aetiology. They are rarely considered in the differential diagnosis of upper abdominal symptoms in childhood. Only 130 cases of choledochoceles have been reported in world literature to date. Only 20% of these patients were children or adolescents. The symptoms do not specifically suggest a choledochocele, and are usually attributed to other disorders of the upper intestinal tract, frequently resulting in a delayed diagnosis. We present the case of a 10-year old girl in whom a congenital choledochocele was diagnosed by gastro-intestinal studies and endoscopic retrograde cholangiopancreatography (ERCP) following a 2-years history of recurrent pancreatitis. Various types of choledochoceles are presented in the literature, classified according to morphology and histology. Most authors consider them to be a form of choledochal cyst. Their embryonic development is related to that of congenital duodenal diverticula. Although congenital intraluminal duodenal dilatations are of known oncogenic significance, only two cases of adenocarcinoma arising from a choledochocele have been described to date. Established treatment of large choledochoceles in childhood is transduodenal marsupialization.

[Premature craniosynostosis after ventricular shunting in hydrocephalic children (author's translation)]. / Zur vorzeitigen Synostose von Scädelnähten nach Ableitung kindlicher Hydrozephali.

The cause of premature craniosynostosis after ventricular shunting in hydrocephalic children is until now not completely understood. In 331 children we observed 41 premature synostoses (12,4%) of the satural sagittalis, coronaria, lambdoidea, either singular or in various combinations. These findings are compared with clinical data and X-ray findings of skull and ventricular system of the patients. The results suggest a congenital origin, in all probability caused by primary malformation of the basis of the skull. Most of the cranio-stenoses are attributed to a common origin of hydrocephalus and craniostenosis.

[Intervertebral disk calcification in children]. / Bandscheibenverkalkungen im Kindesalter.

Thirteen children with intervertebral disc calcifications of the cervical, thoracal and lumbar spine have been diagnosed since 1970. Most of them were observed over a period of several years. Ten children fell ill with acute pains, but only 2 of them suffered from a trauma. In 3 cases the features were discovered accidentally combined with malformations of vertebral bodies and congenital diseases. Our results suggest a primary structural inferiority of the calcified discs. The calcifications arise partially from a birth trauma, partially from an unknown etiology. They can last for a long time without symptoms. An acute event effects the pains due to shifting or herniation of calcified disc-fragments. Secondary findings such as decrease of the height of cervical vertebral bodies or destructions of the endplates of thoracal and lumbar vertebral bodies disappear retarded and often incompletely and demand a control for a long time.

[Results of cerebral sonography in children with myelomeningoceles]. / Ergebnisse der zerebralen Sonografie bei Kindern mit Myelomeningozelen.

47 infants with myelomeningocele were investigated by ultrasound after the surgical closure of the cele and followed up to 12 months. The aim was the early diagnosis of hydrocephalus and the recording of morphological features of the ventricular system in comparison with hydrocephali of other origins, especially of Chiari-Syndrome. 31 infants needed a shunt due to rapid progress of the ventricular dilatation and clinical signs of a raised intracranial pressure: in 25 of this group (81%) the ultrasound investigation demonstrated a Chiari-Syndrome. Of 16 further infants who definitely did not need a shunt, only 5 (31%) had a Chiari-Syndrome. Therefore, the first sonographic examination seems to provide a certain prognostic evidence for the development of a hydrocephalus.

[The clinical relevance of the dynamics of ventricular changes in surgically treated hydrocephalus of children with myelomeningocele]. / Zur klinischen Relevanz der Dynamik der Ventrikelveränderungen beim operierten Hydrozephalus von Kindern mit Myelomeningozele.

The normalisation of head circumference and ventricular dilatation are aims of the therapy of hydrocephalus. Sonographic follow-up after ventriculo-peritoneal shunt demonstrates a changed ventricular morphology and inform about clinical relevant questions in regard of effectivity and complications of the shunt. The different morphological development of liquor systems in spite of comparable premises is discussed on the base of 47 children with myelomeningoceles.

[A further case with Baller-Gerold syndrome (craniosynostosis--radial aplasia syndrome)--overview and new viewpoints on a rare syndrome]. / Ein weiterer Fall mit Baller-Gerold-Syndrom (Craniosynostosis--Radial Aplasia Syndrome)--Uberblick und neue Gesichtspunkte bei einem seltenen Syndrom.

The Baller-Gerold syndrome is a rare malformation syndrome with craniosynostosis. A radial defect is the main feature of this combination besides the premature craniosynostosis. The entity and the etiology of this inherited trait was often discussed in recent years. This syndrome is further characterised and presented as a distinct entity with the reported new case. Parents of such a child should be aware of the 25% recurrence risk in subsequent siblings because of an autosomal recessive mode of inheritance.

[Brachydactyly type A4 (brachymesophalangia II and V, Temtamy type). A rare type of brachydactyly]. / Brachydaktylie Typ A4 (Brachymesophalangie II und V, Temtamy-Typ). Ein seltener Typ von Brachydaktylie.

Brachydactyly is classified into 5 main types. In type A brachydactylies the shortening is mainly confined to the middle phalanges of the digits and toes. Brachydactyly type A4 is characterised by brachymesophalangy II and V. We found this rare type of brachydactyly in a child and his mother. We examined the hands and feet of these individuals radiologically. The reported malformation had affected members of 2 respectively 3 generations. There is no doubt about the autosomal dominant mode of inheritance.

[Ultrasonically-guided percutaneous puncture and drainage of a splenic abscess caused by Salmonella heidelberg in a child]. / Ultraschallgezielte perkutane Punktion und Drainage eines Milzabszesses durch Salmonella heidelberg bei einem Kind.

In a boy aged 9 years and 11 months pain developed in the left upper abdomen following Salmonella enteritis infection. Purulent splenitis was diagnosed by sonography. Ultrasonically guided percutaneous puncture and drainage, and appropriate chemotherapy led to a marked improvement in the clinical picture and finally to complication-free remission. In a review of the literature the problems associated with purulent splenitis and the possibility of treating it by percutaneous puncture are pointed out. Purulent splenitis should be considered in all patients with temperatures and unexplained abdominal pain.

[Pyogenic sacroiliitis in children]. / Beitrag zur bakteriellen Sakroiliitis im Kindesalter.

Pyogenic sacroiliitis is a rarely occurring disease. In recent years more reports have been published about this topic. We report on a case of infectious sacroiliitis in a young female patient. The multivarious clinical symptoms, the problems of diagnosis, differential diagnosis, treatment and prognosis of this disease will be described.

Spondyloenchondrodysplasia: several phenotypes--the same syndrome.

We present details of a dwarfing skeletal dysplasia in two boys. Radiographs show multiple enchondromas of tubular and flat bones together with abnormalities of the spinal column. Clinical, laboratory and radiological findings enable this entity to be grouped within the spectrum of enchondromatoses with vertebral changes. A literature review suggests heterogeneity of this group of conditions.

[BCG-vaccination in neonates as a cause of osteomyelitis--an argument against BCG-vaccination?]. / BCG-Impfung im Neugeborenenalter als Ursache einer Osteomyelitis--ein Argument gegen die BCG-Impfung?

BCG-osteomyelitis is a rare complication of BCG-vaccination. By means of a case report clinical and immunological findings are discussed. Contrary to the undramatic clinical symptoms the x-ray showed pronounced osteolytic lesions in the sternum. The bacteriological examination demonstrated mycobacteria of BCG-type. Immunological investigations presented normal humoral and cellular immunity. The therapy (curettage, antituberculous drugs) was effective. In spite of this complication the BCG-vaccination is furthermore recommended.

[Bacterial bone and joint infections in childhood--a review. 4. Subacute and primary-chronic osteomyelitis, rare forms of osteomyelitis]. / Bakterielle Knochen- und Gelenkinfektionen im Kindesalter--eine Ubersicht. 4. Subakute und primär-chronische Osteomyelitis, seltene Osteomyelitisformen.

This is an overview of the most important aspects of pathogenesis, etiology, diagnostics, therapy and differential diagnostics of the subacute and primary chronic osteomyelitis in children. This group of disease includes Brodie's abscess, plasma cellular osteomyelitis, sclerosing osteomyelitis (Garré) and the chronic recurrent multifocal osteomyelitis. The treatment of children with these not completely understood diseases requires a close cooperation between pediatricians, pediatric surgeons and radiologists.

Changing pattern of osteomyelitis in infants and children.

A retrospective analysis of 332 children with osteomyelitis (OM), managed from 1966 to 1996, was undertaken to evaluate etiology, clinical course and treatment results. In 64% of all patients positive bacterial cultures were obtained, Staphylococcus aureus, streptococci, pneumococci, and Haemophilus influenzae were the most frequently cultured pathogens. In two-thirds of the cases long bones (femur, tibia, humerus) were affected. Osteoarthritis or suppurative arthritis was evident in 27%; 32 of 170 (19%) re-evaluated patients had moderate or severe sequelae. Risk factors for an unfavorable course were the onset of disease in early infancy, suppurative arthritis, and an affected epiphysis. Suppurative arthritis, in particular, needs early evacuation to prevent sequelae. In recent years we observed an increasing number of patients presenting with atypical forms of OM. Since 1989 10 patients were considered to have chronic recurrent multifocal OM (CRMO). In 6 of them the clavicle was involved; their ages ranged from 3 to 14 years. The erythrocyte sedimentation rate was elevated (median 48, range 9-110 mm), while other inflammatory parameters like C-reactive protein (median 9, range <5-85 mg/l) or leucocyte count were slightly elevated or normal. Histopathology was stage-dependent, with a predominance of lymphoplasmacellular infiltration. A nonbacterial origin of CRMO is probable but not proven. Histopathology is not suitable for differentiation between bacterial and nonbacterial forms of bone inflammation.

[Bronchopulmonary foregut malformations with communication to the esophagus]. / Bronchopulmonale Vorderdarmfehlbildung mit Kommunikation zum Osophagus.

Congenital abnormal communications between separated pulmonary tissue and the oesophagus are rarities. Only about 50 cases have been reported in the literature. For all different forms the term of bronchopulmonary foregut malformation (BPFM) was first applied by Gerle and his coworkers in 1968. Major symptoms of this condition involved respiratory distress, cough, dyspnea, vomiting and repeated pneumonia. This paper presents reports of two own patients. In both cases was confirmed a bronchopulmonary foregut malformation in the lower right thorax with ectopic main bronchus communicating into the distal oesophagus. According to the literature we describe our own experience and discuss embryologic pathogenesis and surgical consequences for children.

[Spiral computerized tomography diagnosis of abdominal seat belt injuries in children]. / Spiralcomputertomographische Diagnostik abdominaler Sitzgurtverletzungen bei Kindern.

Seat belt injury (s.b.i.) arises from not properly applied seat belt in case of car accidents. The importance of spiral CT for the diagnosis of s.b.i., especially of hidden traumatic lesions, will be demonstrated. Our experience includes 9 children in the age of 4 to 13 years suffering from life-threatening s.b.i. After life-saving treatment we took a spiral CT (Somatom plus S): first spiral CT, 10 mm slice thickness, without contrast medium (c.m.) and second spiral CT, 5 mm slice thickness, start delay 35-45 s after a large volume of c.m. Of these, 8 of 9 children survived. Besides bruising signs head injuries, and knee joint lesions in 4 of 9 cases, a combination of ruptured duodenum, ruptured liver or spleen, and chance fractures of the spine was found which is typical for s.b.i. In the remaining 5 cases, two of the lesions were combined. Rupture of the small bowel was manifested mainly as the discrete finding of free air or inhomogeneous ascites with a high density (bowel contents mixed with blood). Not only the emergency doctor but also the radiologist should take into account the complexity of seat belt injuries. Spiral CT is the imaging method of choice in the case of polytraumatic children.

[Bacterial bone and joint infections in childhood--a review. 1. Acute hematogenous osteomyelitis]. / Bakterielle Knochen- und Gelenkinfektionen im Kindesalter--eine Ubersicht. 1. Akute hämatogene Osteomyelitis.

This is an overview of modern aspects concerning diagnostics and therapy in children with acute hematogenous osteomyelitis. A close cooperation of pediatricians, pediatric surgeons, microbiologists and radiologists in this field is essential.

Chronic recurrent multifocal osteomyelitis--report of eight patients.

The authors undertook a retrospective review of the clinical records and radiologic findings of eight children with chronic, recurrent multifocal osteomyelitis (CRMO). This disease is a recognized clinicopathologic entity with typical radiographic findings, mostly in the metaphyses of the long bones. The diagnosis is one of exclusion without pathognomonic findings. The patients were treated with non-steroidal anti-inflammatory drugs. There was no evidence of altered bone growth or abnormal joint development. It is concluded that CRMO is a distinct clinical entity that is different from acute or subacute bacterial osteomyelitis. Recognition of this condition is important to avoid treatment with antibiotics and repeated operations.