[Ultrasound diagnosis of birth trauma lesion of the cervical spine]. / Sonographische Diagnostik einer geburtstrumatischen Halsmarkläsion.

Ultrasonographic imaging in the newborn via a posterior approach allows the visualization of the craniocervical junction. We describe a case presenting with clinical signs of a spinal cord injury after delivery by forceps extraction. The sonographic examination demonstrated an increased cervical cord echogenicity during the first days of life, and a decrease of cord size at the craniocervical junction after 3 weeks. MRI confirmed these findings. Sonography is useful in showing severe spinal cord injury with minimal handling of these severely traumatized neonates.

[Ultrasonic assessment of the development of the uterus in childhood]. / Die sonographische Beurteilung der Uterusentwicklung im Kindesalter.

In 150 girls from the newborn period up to the 18. year the size of the uterus was measured by sonography. In all children the length, width, depth and volume of the uterus as well as its shape and other signs of development were determined. In the newborn period and in the following first months of life an estrogen stimulated uterus with the shape of a drop could be shown. The size of the uterus decreased till the end of the first year. The length of the uterus in the neonatal period was 4.0 +/- 0.5 cm, the volume was 3.6 +/- 1.9 cm3. In the following rest phase up to the age of 8 years the length of the uterus was 2.8 +/- 0.4 cm and the volume was 1.2 +/- 0.4 cm3. The shape of the uterus in this age group was tubular. One to two years before secondary pubertal signs could be shown, sonography already demonstrated the beginning of pubertal uterus growth. In the postpubertal period the uterus had the typical pear shape with a corpus/cervix-relation of 2:1. In the postpubertal period the length was 6.8 +/- 1 cm with a volume of 33 +/- 22 cm3. The knowledge of the normal developmental dates of the uterus in children is essential for the diagnosis of malformations and tumours of the pelvis, but also for the diagnosis of distorted puberty such as pubertas praecox, pubertas tarda, amenorrhea and growth retardation.

[Sonographic diagnosis of solid space-occupying abdominal lesions in childhood]. / Sonografische Diagnostik abdomineller solider Raumforderungen im Kindesalter.

Between 1981 and May 1986 31 children with solid abdominal tumor masses were observed in our clinic. The first diagnostic procedure was a sonographic examination, followed by further radiological investigations if necessary. 30 cases were examined histologically; in one case the sonographic findings were confirmed by an angiography. The most frequent abdominal masses were neuroblastomas and Wilms tumors (7 cases each). A mesoblastic nephroma was diagnosed in 3 cases, a lymphoma, a hepatoblastoma and a rhabdomyosarcoma 2 times each. One time we found a pancreas carcinoma, a teratoma, a hemangiomatosis of the liver, a malignant Schwannoma, a Ewing sarcoma, an adenoma of the adrenal gland, a pheochromocytoma and an osteosarcoma. According to our own experience and recent reports in the literature it seems possible in most cases, to predict the correct diagnosis of solid abdominal masses using the informations of sonographic imaging. Sonography is a highly specific non-invasive diagnostic tool for planning treatment (e.g. early surgery, cytostatic therapy and/or radiation) of solid abdominal masses. Nevertheless the histological examination should be performed in every case to confirm the definitive diagnosis.

[Doppler sonographic detection of reduced flow velocity in the celiac trunk of the newborn infant with patent ductus arteriosus Botalli compared to a healthy control group]. / Dopplersonographischer Nachweis erniedrigter Flussgeschwindigkeiten im Truncus Coeliacus beim offenen Ductus Arteriosus Botalli des Frühgeborenen im Vergleich zu einer gesunden Kontrollgruppe.

Pulsed doppler recordings were obtained in the truncus coeliacus in 12 premature born infants (gestational age 30.3 +/- 2.5 weeks) with the clinical signs of patent ductus arteriosus Botalli (PDA) and compared to a control group of 24 healthy infants (gestational age 40.5 +/- 5.3 weeks). In all children the maximal systolic velocity, the endsystolic and the enddiastolic velocity and the pulsatility-index were measured. The 24 healthy newborns showed the following velocities: Maximal systolic velocity: 77 +/- 16 cm X s-1; endsystolic velocity: 31 +/- 10 cm X s-1; enddiastolic velocity; 18 +/- 9 cm X s-1. The pulsatility-index was 0.75 +/- 0.11. In children with PDA the maximal systolic velocity was 72 +/- 21 cm X s-1, the endsystolic velocity 15 +/- 14 cm X s-1 and the enddiastolic velocity -5 +/- 8 cm X s-1. The pulsatility-index was 1.08 +/- 0.12. All infants with large PDA showed a significant decrease of the endsystolic velocity and enddiastolic velocity, whereas the pulsatility-index was significantly increased. The decrease of the endsystolic and enddiastolic velocity in infants with large PDA in comparison to the healthy control group may lead to hypoxemic-ischemic lesions of the intestinal organs. The increased incidence of necrotizing enterocolitis in premature infants with large PDA may be the result of hypoperfusion of the small bowel.

[Doppler sonographic flow parameter of the anterior cerebral artery in patent ductus arteriosus of the newborn infant compared to a healthy control sample]. / Dopplersonographische Flussparameter in der Arteria cerebri anterior beim offenen Ductus arteriosus des Frühgeborenen im Vergleich zu einem gesunden Kontrollkollektiv.

33 premature infants (age: 32 +/- 3 weeks; birth weight 1,268 +/- 535 gs) with the clinical signs of patent ductus arteriosus Botalli (PDA) and a control group of 96 healthy infants (age: 37 +/- 4 weeks; birth weight 2 348 +/- 944 gs) were investigated. Pulsed doppler recordings were obtained in the anterior cerebral arteries (ACA) and compared with the flow pattern in the truncus coeliacus (TC). In all children the maximal systolic velocity (Vs), the endsystolic (Ves) and the enddiastolic velocity (Ved) and the pulsatility-index (PI) were measured. The 96 healthy premature born infants showed the following velocities: Vs: 41 +/- 12 cm X sec-1; Ves: 19 +/- 7 cm X sec-1; Ved: 10 +/- 4 cm X sec-1. The pulsatility-index was 0.74 +/- 0.08. In children with PDA all velocities were significantly lower than in the healthy control group: Vs: 31 +/- 10 cm X sec-1; Ves: 7 +/- 6 cm X sec-1; Ved: -1 +/- 5 cm X sec-1. Ved was more decreased than Vs resulting in a significant increase in PI (1.04 +/- 0.14). 22 infants with surgically proven large PDA (age: 31 +/- 3 weeks; birth weight: 1,160 +/- 467 gs) showed significant lower velocities (Vs: 34 +/- 8 cm X sec-1; Ves: 4 +/- 4 cm X sec-1; Ved: -4 +/- 4 cm X sec-1) in comparison with the healthy control group and the 11 children with small PDA (age: 33 +/- 4 weeks; birth weight: 1,494 +/- 621 gs).(ABSTRACT TRUNCATED AT 250 WORDS)

[Cerebral ultrasound diagnosis in brain abnormalities]. / Zerebrale Ultraschalldiagnostik bei Hirnmissbildungen.

Gray scale ultrasonography of the brain was performed in 93 infants with cerebral malformations. The most common malformation was the Chiari-malformation (56 children), characterized by the caudal displacement of the cerebellar vermis into the foramen magnum. The rest of the cerebellum, pons and medulla oblongata were displaced caudally and dysplastic. All children with Chiari-syndrome showed more or less severe hydrocephalus. The Dandy-Walker-malformation (3 children) was characterized by a huge retrocerebellar cyst communicating with the fourth ventricle. The cerebellar vermis was dysplastic. In alobar holoprosencephaly (2 children) a large singular midline ventricle could be shown. Both thalami and plexus chorioidei were fused in the midline. Absence of the falx cerebri, interhemispheric fissure, corpus callosum and septum pellucidum was characteristic for alobar holoprosencephaly. Stenosis of the Sylvian aqueduct (4 children) was characterized by enlarged lateral ventricles and third ventricle, whereas the fourth ventricle was normal in size. Porencephalic cysts (7 children) were spheric echofree lesions of various size, usually located symmetrically in both cerebral hemispheres. In hydranencephaly (4 children) both hemispheres were replaced by echofree space occupying bubbles. In 5 children with agenesis of the corpus callosum no corpus callosum could be demonstrated by sonography. Coronal sections displaced the typical bull's head shape, formed by the enlarged third ventricle and the side ventricles as well as randomly arrayed sulci around the lateral ventricles, which are pathognomonic for agenesis of the corpus callosum. Agenesis of the septum pellucidum (5 children) was characterized by fusion of the frontal horns of the lateral ventricles. One child with aneurysmatic malformation of the vein of Galen showed dilated sinus rectus and pulsations of a cyst, located behind the third ventricle. Pulsed doppler recording showed pulsatile arterial flow patterns within the cyst.

[Surgical treatment of patent ductus arteriosus Botalli in the premature infant. Indications and results of treatment]. / Operative Behandlung des offenen Ductus arteriosus Botalli beim Frühgeborenen. Indikation und Behandlungsergebnisse.

125 preterm infants with persistent ductus arteriosus (PDA) had surgical ligation between November 1978 and December 1984. In an additional case the situation was complicated by severe coarctation, which had not been diagnosed prior to surgery. The mean birth weight was 1340 +/- 448 g (85 infants weighed less than 1500 g). Gestational age was 30.6 +/- 2.5 weeks. Age at surgical ligation was 13 +/- 7 days for all patients. Preterm infants from our hospital were operated on with a mean age of 9.5 days. Indications for surgical ligation were clinical and radiographic signs of large PDA, during the last two years supported by the results of pulsed doppler ultrasonography. Only one preterm infant with PDA and coarctation died intraoperatively. The overall results showed a mortality rate of 21.6%. This rate has decreased from 30.4 to 11.7% in the last year. Important improvement could be obtained by early ligation, with carefully maintained body temperature during surgery. Preoperative ventilation parameters were kept constant and changes in arterial blood pressure during operation were avoided. The percentage of permanent handicaps was lowered from 15.2 to 5.9% in the last year of our study. According to failure of indomethacin therapy in the very beginning of PDA treatment, it is our policy now to ligate PDA in preterm infants early and without delay by a trial with indomethacin therapy.

[Differential diagnostic and therapeutic problems in a neuroblastoma patient with hypertension]. / Differentialdiagnostische und therapeutische Probleme bei einem Neuroblastompatienten mit Hypertonie.

A 2 1/2 year old dystrophic girl with polyuria and polydipsia was found to have an arterial hypertension, increased catecholamines in serum and urine, and a suprarenal tumour was diagnosed by ultrasonic scan. By means of histology and staging a neuroblastoma grade 3 was revealed. The sonography and Iodine-benzyl-guadinin-scintigraphy gave the clearest information about the tumour. Before operating it is necessary to stabilize the blood pressure at a normal level with alpha and beta blocking substances, in order to reduce the risk of an intraoperative hypertonic crisis and a vasodilative shock after tumour extirpation.