MRI examination and monitoring of pediatric patients under sedation.

From April 1992 to May 1994, 780 patients aged from 1 day to 8 years were examined. Sedation of these patients was conducted by giving chlorprothixene orally and, in some cases, chloral hydrate had to be added. The patients were monitored with a pulse oxymeter. Investigations could begin after 50 -120 min. In 710 patients (91%) the first attempt to perform the examination was successful; 70 patients required one or two further attempts. Only two of the 780 patients (0.5%) showed evidence of respiratory depression. The total number of pediatric MRI examinations performed in 1 year is almost 1000. In the hands of an experienced pediatric radiologist these examinations can be performed entirely without anesthesia.

Cranial ultrasound findings in aspartoacylase deficiency (Canavan disease).

Canavan disease (CD) is a rare leukodystrophy which is lethal in infancy or early childhood. The underlying biochemical abnormality in CD is a hereditary deficiency of N-aspartoacylase transmitted in an autosomal recessive fashion. We report on the ultrasound (US), CT, and MRI findings of three unrelated boys with biochemically confirmed CD. At 6 and 9 months of age, two CD patients with rapid neurological deterioration showed markedly enhanced acoustic attenuation of the white matter with the exception of the corpus callosum, giving the appearance of a reversed pattern of echogenicity of cortical gray and subcortical white matter. While gyri and sulci had an almost normal US appearance, the periventricular gray matter featured prominently with increased echogenicity. In contrast another CD patient with a more protracted course had ventricular enlargement when examined by US at 5 and 9 months but no alteration in white matter echogenicity. MRI showed impaired myelinization in all three patients with Canavan disease.

Pulmonary arteriovenous fistula: ultrasonographic approach.

Report of a pediatric case with pulmonary arteriovenous fistula (PAVF) in hereditary hemorrhagic teleangiectasia (HHT), primary suspected by ultrasound. There is a characteristic sonographic feature of the complex type of PAVF revealing septations in contrast of the simple type. The diagnosis was established by angiography.

Lesions of skull base observed on high resolution computed tomography. A comparison with magnetic resonance imaging.

Forty patients with tumors involving the skull base were selected on the basis of findings at high resolution computed tomography (CT). The reliability of demonstrating bony lesions with magnetic resonance imaging (MRI) and CT were compared. CT showed osseous lesions of the skull base better than MRI but was less sensitive in evaluating an associated inflammatory reaction or in defining intracerebral infiltration. Small cortical lesions were only demonstrable with CT. MRI was superior in defining the full extent of soft tissue infiltration. Arterial encasement was observed at MRI. The special advantage of Gd-DTPA lies in the additional possibility to differentiate vessels from tumor-like lesions and in en plaque tumors.

[Ewing's sarcoma of the rib]. / Ewing-Sarkom der Rippe.

In addition to eosinophilic granuloma, chondroma, osteochondroma, aneurysmatic bone cyst, and osteomyelitis, the differential diagnosis of primary costal tumors in children must also include Ewing's sarcoma. Radiologic diagnostic problems in localizing the tumor, in differential diagnosis, and the importance of imaging procedures are discussed with reference to a 16-year-old female patient.

Therapeutic approach to ingested button-type batteries. Magnetic removal of ingested button-type batteries.

Button-type batteries ingested by 13 children were removed from the esophagus and the upper gastro-intestinal tract by means of the FE-EX "OGTM-technique". An initial radiogram from the nasopharynx to the anus was performed. We used the FE-EX tube magnet with a cylindric Vacomax/Vacodym magnet. In all cases the button type battery was easily detected and retracted under fluoroscopic control with the magnet. All patients tolerated the procedure without subjective complaints and were discharged soon without a need of anesthesia, surgery/endoscopy or more radiography. The FE-EX "OGTM" procedure is a relatively non-invasive approach to a potentially catastrophic pediatric problem.

Nonionic contrast media in gastrointestinal studies in newborns and small infants.

Since January 1983, 431 patients were examined by oral or rectal application of nonionic contrast medium for gastrointestinal studies. The contrast medium was uniformly well tolerated, even by severely ill preterm babies and infants. We present a review of our experience and a list of indications for the use of nonionic contrast media in gastrointestinal studies. In addition, the urinary iodine concentration of eight patients was examined after oral application of nonionic contrast medium in order to evaluate the resorption of the substance.

[Removal of swallowed metallic foreign bodies by orogastric magnetic intubation]. / Entfernung von verschluckten metallhaltigen Fremdkörpern durch eine oro-gastrische Magnetsonde.

Foreign bodies with metal content ingested by 16 patients were removed from the upper gastrointestinal tract by means of a magnet inserted into the end of orogastric tube. In only one case did the foreign body uncouple from the orogastric tube-magnet arrangement during retrieval. The procedure is an alternative to endoscopic or surgical removal in some cases of metal foreign body ingestion.

Nonsteroidal anti-inflammatory drugs activate quiescent inflammatory bowel disease.

Four patients with quiescent inflammatory bowel disease had prompt exacerbations when given nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs can have noxious effects on the distal intestine as well as on the proximal gut. Eight previous cases of exacerbation of ulcerative colitis have been reported, as have instances of de-novo colitis and ileitis in persons treated with nonsteroidal anti-inflammatory drugs who did not have preexisting inflammatory bowel disease. Nonsteroidal anti-inflammatory drug ingestion should be considered in the differential diagnosis of inflammatory bowel disease. These drugs should be administered to patients with inflammatory bowel disease only after consideration of their possible harmful effects.

[Sonography of the hip joint in skeletal dysplasias and chromosome disorders]. / Sonographie des Hüftgelenkes bei Skelettdysplasien und Chromosomopathien.

The preliminary results of ultrasound of the hip in patients with skeletal dysplasias and chromosomal aberrations are described. Pathology of the hip joint can be demonstrated by ultrasound; especially the entities with abundant cartilage can be visualized by sonography. Ultrasound of the hip is a valuable method in the diagnosis of skeletal dysplasias complementary to plain x-ray surveys.

[Sonography of the hip in underweight premature infants]. / Hüftsonographie bei untergewichtigen Frühgeborenen.

In a prospective study 120 hips of preterm babies below 2,000 g were investigated by ultrasound studies in order to determine the distribution of the types according to Graf's classification. Compared with unselected newborns, preterm babies show a significantly higher incidence of ultrasound types Ib and IIa. The distribution of the ultrasound types of the hips of both groups is compared.

Osteomalacia of the mother--rickets of the newborn.

During the last 4 years we observed four cases of neonatal rickets. The mothers of the infants suffered from osteomalacia for 1-3 years prior to its diagnosis shortly after the birth of their children. All four infants were born with craniotabes, and one infant had, in addition, a radial fracture. The diagnoses were confirmed by radiological and laboratory tests which revealed a rarefied bone structure, decreased serum 25-hydroxy-vitamin D and increased alkaline phosphatase levels in all patients. The disorder regressed under low-dose vitamin D3 therapy. As osteomalacia seems to be predominant in oriental women living in Berlin, it is necessary to consider vitamin D deficiency when clinical symptoms of this disease arise and to treat these women at least during pregnancy.

Arteriovenous malformation of the great cerebral vein (of Galen) in a newborn. Diagnosis by ultrasound and digital subtraction angiography.

This is a report of a case with an arteriovenous (a.v.) malformation of the great cerebral vein. Applicable diagnostic procedures are reviewed. The initial diagnostic procedure in the approach to an a.v. malformation of the great vein of Galen is cerebral ultrasound. The findings in our patient are compared with those reported in the literature.