H M Strassburg — Page 3

PubMedDate not supplied

[Improved diagnosis of subdural effusions in infants--importance of sonography and the noninvasive measurement of intracranial pressure].

The detection of small frontal and high-parietal subdural effusions by ultrasound examination has some problems of methods. The diagnostic accuracy of the noninvasive investigation may be improved by using the following proceeding. The application of a short-focus transducer (focus-zone 1 to 4 cm) instead of the usual medium-focus transducer; The noninvasive measurement of intracranial pressure by aplanation-tonometry of the fontanelle. We report our results with this proceeding in 35 infants with liquid accumulation between cortex and cranium (27 infants with subdural effusions, 8 infants with enlarged subarachnoid spaces because of brain atrophy). The ultrasound features of a flattened superficial relief of brain-cortex and a wedge-shaped enlarged interhemispheric fissure are morphologic references to subdural effusions. Strong reflexions of the convexly arched superficial relief of brain-cortex, an enlarged interhemisphaeric fissure with parallel vertical bounds and enlarged lateral ventricles in the frontal parts with irregular outlines are signs for brain atrophy with enlarged subarachnoid spaces. If sonographic signs do not allow an accurate diagnosis, the noninvasive measurement of intracranial pressure bei aplanation-tonometry enables us to discriminate between subdural effusion and enlarged subarachnoid spaces by measuring a rised basic pressure and pathologic pressure waves (results from 26 long-term measurements in the above-mentioned 35 infants).

Humans↗

PubMedDate not supplied

Primary systemic carnitine deficiency under successful therapy: clinical, biochemical, ultrahistochemical and renal clearance studies.

Systemic carnitine deficiency is an often fatal, but treatable metabolic disorder which should be considered in any child with repeated episodes of a Reye-like syndrome or a cardiomyopathy. A 4-year-old girl with a typical history and clinical findings was successfully treated with oral carnitine. Despite low liver carnitine, ketogenesis upon fasting was normal. Normal muscle function under therapy was associated with unchanged low muscle carnitine levels. Improvement of mitochondrial structure and function was demonstrated by controlled ultrahistochemical studies. A renal carnitine leak, evident from renal clearance studies, may contribute to the pathogenesis of systemic carnitine deficiency.

Biopsy↗