Intussusception reduction techniques.
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Fluoroscopy↗
Biomedical subjects
J Tröger
Publications and source records attributed to J Tröger.
[Identification of wood splinters in soft tissues with ultrasound].
Two cases of wooden foreign bodies in soft tissue found by ultrasound are described. Furthermore we proved the existence of a typical sonographic pattern of wood in muscle tissue.
Animals↗
[Child abuse. Important findings in diagnostic imaging].
The radiologist must be familiar with all signs of the battered child syndrome to prevent misinterpretation. Important clinical signs are hematoma at different ages and in uncommon locations. The principle imaging signs are subdural hematoma, brain contusion and multiple skeletal injuries sometimes at different ages. The parents or the persons responsible for care often neglect mentioning an injury. The principle signs are shown and a diagnostic flow chart is presented.
Battered Child Syndrome↗
The post-reduction donut sign.
A donut-shaped intestinal structure in the lower right abdomen, observed during abdominal ultrasound investigation following nonoperative intussusception reduction, may create a diagnostic problem concerning differentiation from a residual or recurrent intussusception or underlying small bowel disease. In 30 cases of ileocolic intussusception an abdominal ultrasound examination was performed after reduction, the success of which was proven by radiological and clinical criteria. More than half of the examinations showed an aperistaltic "donut" in the ileocecal region which was similar to the target sign commonly seen in intussusception. Differentiation was possible according to the following two criteria: first, the diameter of the donut was smaller than that of the original target sign seen in these patients. Second, the donut consisted of a broad hypoechoic rim and an echogenic center, whereas the target was normally composed of multiple concentric rings. One third of the patients showed localized thickening of the walls of the distal ileal loops which did not cause diagnostic problems. All of the suspicious intestinal structures disappeared within the first 5 days following reduction. It is our opinion that the post-reduction donut correlates with significant edema of the ileocecal valve and does not represent a mechanical lead point or persisting residual intussusception.
Female↗
[The initial experiences with a new method for treating invagination: sonography-guided hydrostatic reduction].
During the last four months we have been treating all 15 sonographically diagnosed intussusceptions by a new method; this is based on the introduction of a saline enema under sonographic control. In 13 cases the method was successful according to imaging and clinical criteria. In two patients conservative reduction was impossible: in one patient partial resection of the ileum was necessary and in the other there was a recurrence which was reduced at operation. There were no complications. The advantages of the method are reduced radiation exposure, complete evaluation of the course of the procedure with definite criteria for success, the ability to recognise an ileo-ileal invagination and to determine the head of the intussusceptum. We can see no disadvantages compared with conventional methods. We regard this method as optimal in future for the treatment of infantile intussusceptions.
Child, Preschool↗
Metacarpal index in Marfan's syndrome and in constitutional tall stature.
The metacarpal index (MCI) in 54 children with constitutional tall stature was mean (SD) 8.65 (0.8) and in 55 with Marfan's syndrome 9.15 (0.9). Indices in both groups showed arachnodactyly and differed from those found in normal individuals (< 7.9). Because the MCI is a poor discriminator patients with tall stature or clinical signs of arachnodactyly should be examined for additional signs of Marfan's syndrome or other hereditary disorders of connective tissue.
Adolescent↗
Therapeutic use of surfactant in neonatal respiratory distress syndrome. Correlation between pulmonary X-ray changes and clinical data.
As part of a multicenter surfactant rescue study, the chest X-rays of 239 preterm and term infants were analyzed. To study the influence of surfactant administration on radiographic appearance, 130 patients with a clinical and radiological diagnosis of typical respiratory distress syndrome were selected, in whom adequate chest x-rays before and within 48 h after treatment were available. Median gestational age was 30 weeks (range 25-38 weeks), median birth weight was 1335 g (range 625-3450). The time of surfactant application ranged between 90 min and 24 h after birth (median 6 h). The most common finding after surfactant administration was uniform (n = 47) or disproportionate (n = 46) improvement of pulmonary aeration, which showed a significant correlation to posttreatment reduction of oxygen requirement (p less than 0.0001). Asymmetric clearance was more often localized on the right side and usually disappeared within two to five days. Only in 13 patients no change of ventilation was found. Development of interstitial emphysema (n = 24, including three patients with pneumothorax) after surfactant treatment was an unfavourable prognostic sign. 54% of these patients (13 of 24) died within the first month of life, compared to 8% (7 of 93) in the group of patients with initial improvement of ventilation.
Female↗
Ovarian cysts in the fetus and neonate--changes in sonographic pattern in the follow-up and their management.
In a multicenter trial we retrospectively evaluated the clinical and sonographic data of 49 neonatal ovarian cysts, 44 of which were detected prenatally and 5 on the first day after delivery. Of the 44 prenatally detected cysts 39 were purely cystic, 5 echogenic or had a mixed pattern. In 20 patients the cystic appearance changed during delivery from purely cystic to a mixed pattern being independent on the size of the cyst. 26 of the 44 cysts were treated surgically. Salpingotorsion was found in 8 and was independent on the size of the cyst. In 15 a salpingo-oophorectomy or oophorectomy was performed, in 11 the ovary was saved. 23 patients were followed sonographically: 15 cysts showed complete resolution within 14 months without correlation to the sonographic pattern. The volume of these cysts varied between 5 and 71 ml. Neonatal ovarian cysts disappear spontaneously frequently and rarely cause severe symptoms. The authors recommend follow-up by ultrasound as the primary modality. Surgical intervention is recommended only if the cyst is space-occupying and percutaneous puncture can not be performed or in the case of emergency.
Female↗
The conus medullaris: time of ascendence to normal level.
This study was intended to determine the level of the conus medullaris in normal babies. We examined 114 healthy infants using high resolution ultrasound which identified the spinal cord and the tip of the conus medullaris. This method provided a good analysis of the level of the conus medullaris so that we could assess the rate of ascent to L1/2. The range of the conus level for all children was at TH12/L1 interspace to L4.78% of babies aged between the 30th and 39th postmenstrual week had the tip of the conus medullaris between L2 and L4.84% of babies aged between the 40th and 63rd postmenstrual week had their conus level between TH12/L1 and L1/2 interspace. In one girl aged 53 weeks the tip was found at L4. Ultrasound is a reliable method to observe the development of the conus level in young infants and to identify a tethered cord.
Female↗
Acquired cystic kidney disease before and after renal transplantation.
To determine the prevalence of acquired cystic kidney disease (ACKD), as reported in adults receiving long-term hemodialysis treatment, we studied 48 pediatric patients (aged 17 +/- 5.1 years) with end-stage renal disease by high-resolution ultrasonography or magnetic resonance imaging or both. Forty patients (83%) had a functioning renal transplant, with a mean transplant survival time of 3.4 years (range, 0.3 to 14.8 years); four patients were treated by hemodialysis and four by peritoneal dialysis. The mean duration of end-stage renal disease was 5.7 +/- 3.8 years. Ultrasonography detected ACKD in 12 (29%) of 42 patients, solitary cysts in 14 patients (33%), and no cysts in 16 patients (38%). In contrast, ACKD was diagnosed in only 3 of 37 patients studied by magnetic resonance imaging. In 31 patients studied by both imaging techniques. ACKD was diagnosed in three patients by magnetic resonance imaging but in 11 by ultrasonography. In patients with ACKD, the duration of end-stage renal disease was significantly longer, but renal (transplant) function was not different from that in patients with solitary cysts or no cysts. One patient with a history of 12 1/2 years of hemodialysis had multiple renal tumors that were diagnosed as renal cell carcinomas after bilateral nephrectomy. These results indicate that young patients with end-stage renal disease should be monitored regularly for the presence of ACKD, preferably by ultrasonography, even after successful renal transplantation.
Adolescent↗
[Ureteropelvic stenosis in infancy. The value of diuresis sonography compared with diuresis excretory urography].
Examinations under conditions of diuresis produced by drugs can be useful to differentiate pyelo-ureteric obstruction from a dilated collecting system with normal flow. 22 infants with 42 kidneys showing moderate dilatation of one of both renal collecting systems were examined by sonography and excretory urography under conditions of diuresis and the results were compared. Depending on the radiological appearances and contrast clearance rates, four diagnostic groups could be identified; these also differed significantly on the sonographic examinations. In general, there was good agreement between the two methods. Carefully performed, diuresis sonography will clearly distinguish between urodynamically significant obstruction from a wide but non-obstructive collecting system. The number of radiographic examinations can therefore be reduced in these patients.
Diagnosis, Differential↗
US measurement of the subarachnoid space in infants: normal values.
The subarachnoid space was examined with real-time ultrasonography (US) in 89 healthy infants. US of the brain in all infants revealed no abnormalities. Three variables were measured in the coronal plane at the level of the foramen of Monro: the sinocortical width (SCW) ranged from 0.4 to 3.3 mm, the craniocortical width (CCW) from 0.3 to 6.3 mm, and the interhemispheric width (IHW) from 0.5 to 8.2 mm. All variables can be used routinely, as the SCW could be demonstrated in all infants, and the CCW and IHW were demonstrated in 96% (85 of 89). Correlation of sonographic measurements with the independent variables age, head circumference, body weight, and body length was poor. To differentiate normal from pathologically dilated subarachnoid spaces, the following upper limits are proposed on the basis of the 95th percentile: 3 mm for SCW, 4 mm for CCW, and 6 mm for IHW.
Female↗
[Sonography in therapy-oriented diagnosis and after-care of primary bone and soft tissue tumors].
Based on the results of 150 patients with primary tumors or the suspicion of malignant lesions of the locomotor system the perspectives and limits of the sonographic diagnosis under the therapeutic aspects of interdisciplinary oncologic cooperation is demonstrated. As the ideal adjunct to conventional roentgenograms, ultrasound is the first-line imaging procedure in the fields of primary diagnosis, follow-up, post-therapeutic care as well as tumor exclusion for methodic, patient-related and economic/logistic reasons. Its consequent application will markedly reduce the number of more invasive and expensive methods.
Adult↗
Ultrasonography of the hip in preterm neonates.
Over the period of one year, the hips of 92 preterm neonates were examined by ultrasound. Using the Graf classification only 7% showed an angle alpha between 50 and 60 degrees, which is characteristic of type IIa hips. In all other cases the angle alpha was above 60 degrees (type I). Sonographically there were no pathological cases (type IIg or worse). A reason for the relatively low number of type IIa hips could be that the short osseous acetabular rim and the broad cartilagenous Y-joint in this age group result in a "false" increase of the angle alpha.
Hip Dislocation, Congenital↗
Ultrasonographical investigations of onchocerciasis in Liberia.
The efficiency of ultrasonography (US) for the diagnosis and clinical characterization of onchocerciasis was evaluated. US was performed on 120 probands in Liberia. Ninety-two patients had generalized onchocerciasis, 21 patients suffered from the chronic hyperreactive form of onchocerciasis (sowda), and 7 probands served as controls. Patients were examined by US with linear (7.5 MHz and 5 MHz) and sector (3.5 MHz) scanners. US results were evaluated by examination of extirpated nodules. The US structure of nodules revealed a typical pattern consisting of a homogeneous echogenicity with small echodense particles and a lateral acoustic shadow, and differentiation from lymph nodes, lipoma, or fibroma was achieved. Within the onchocercomata, calcifications or fluid were identified. Regarding the estimation of the worm burden, it is important to note that in 24 patients, additional nodules not previously palpated were found by US. Also, the number of worm centers in palpable conglomerate nodules were determined more exactly by US than by palpation. In 4 of 16 sowda patients, impalpable nodules were found by US. In 13 patients with positive microfilaria counts, no nodules could be detected. The highly characteristic ultrasonographical pattern of onchocercomata may serve as a basis for further US investigations in onchocerciasis.
Adolescent↗
Three years' experience with large ovarian cysts diagnosed in utero.
Thirteen fetuses with abdominal cystic tumors were diagnosed by routine prenatal ultrasonography between the 28th and 36th week of gestation. Postnatal ultrasonography of the full-term newborns confirmed the findings. Laparotomies were performed in all cases except one. Patients who were operated on had large ovarian pseudocysts with volumes between 24 and 120 cc. In seven patients (54%), the cysts arose from the left ovary; this included four cases in which the postnatal ultrasound was interpreted as showing the cysts in the right abdomen. Very thin cystic walls threatening perforation were found in 91%. In 33%, we found salpingotorsion on the affected side. Small contralateral ovarian cysts were found in 66% of the patients. One infant required resection of 30 cm of necrotic jejunum because adhesions to the cyst had caused bowel volvulus. Histology of the cysts showed hemorrhage and calcifications, but ovarian stroma was absent in all but one patient. Serum estradiol-17 beta, progesterone follicle-stimulating hormone, and luteinizing hormone were normal in all cases, and similar levels were found in the cyst fluid. These results show that large abdominal cystic masses in full-term infant girls with normal gonadotrophin levels and normal serum estradiol-17 beta and progesterone levels are very likely to require surgery; this is in contrast to preterm neonates with elevated gonadotrophins who can be treated with medroxyprogesterone acetate in the absence of clinical signs necessitating surgery.
Female↗
Long-term follow-up of children with surgically treated vesicorenal reflux: postoperative incidence of urinary tract infections, renal scars and arterial hypertension.
With a mean follow-up of 10.8 years, 160 female and 29 male patients were investigated after successful correction of vesicoureterorenal reflux. All patients suffered from urinary tract infection (UTI) preoperatively, while postoperatively 42% of the patients developed further UTIs but with a significantly diminished rate of febrile infections. In comparison to a group of patients without postoperative UTI (n = 16), the uroepithelial cells of those patients with a high infection rate after reflux correction showed a significantly lower bacterial growth suppression (n = 37). Renal scars were found in 22% of the investigated renal units with operated ureters (n = 211). Of the preoperatively unscarred kidneys, 3.4% developed new scars during the observation period, mainly within the first 2 years after operation. In 7 (11.5%) of the 61 patients with renal scars, moderate arterial hypertension was found.
Child↗
Gastrointestinal diagnosis with iotrolan: experience in pediatric radiology.
The use of low-osmolar, nonionic, monomeric contrast media has made gastrointestinal diagnosis with water-soluble contrast media less hazardous with a greater diagnostic yield. Since, however, even this group of compounds is hypertonic in comparison with blood, water is still drawn from the body into the bowel, resulting in water and electrolyte shifts and distal dilution of the contrast material with deterioration of the image quality. The use of iotrolan, which is isotonic in comparison with blood, therefore, appears to offer advantages for selected groups of patients. The superiority of the contrast medium iotrolan over iohexol was demonstrated in a double-blind study. A further 72 examinations in an open-ended study confirmed this result.
Child, Preschool↗