Biomedical subjects

T Rupprecht

Publications and source records attributed to T Rupprecht.

47 records · Page 3Linked to original sources

PubMed1988

[Acute recurrent pancreatitis as the main symptom of lupus erythematosus disseminatus in childhood].

A 17 year old girl with chronic relapsing pancreatitis since the age of 11 developed focal seizures, leukopenia, anemia and thrombozytopenia, signs suggesting lupus erythematodes. All immunologic investigations, including tests for Anti-DNS-Antibodies were negative, however. Therapy with prednisone and azathioprine resulted in clinical remission. Reduction of the immunosuppression lead to a severe crisis, which was controlled by plasmaseparation and cyclophosphamide. Subsequent analysis of circulating immune complexes revealed bound anti-DNS-antibodies.

Acute Disease↗

PubMed1988

[Pulsed Doppler sonographic determination of absolute flow velocities in the anterior cerebral artery in infants with hydrocephalus in comparison with a healthy patient sample].

In 52 infants (weight: 3174 +/- 1165 g; gestational age: 41.3 +/- 6.5 weeks) with hydrocephalus pulsed doppler recordings were obtained in the anterior cerebral arteries. For comparison 52 healthy infants (weight: 3148 +/- 1118 g; gestational age: 40.6 +/- 5.7 weeks) were investigated. In all children the maximal systolic velocity, the end-systolic velocity, the end-diastolic velocity and the pulsatility-index were measured. In the healthy control group the maximal systolic velocity was 43 +/- 14 cm x s-1, the end-systolic velocity 20 +/- 8 cm x s-1, the end-diastolic velocity 11 +/- 5 cm x s-1 and the pulsatility index was 0.75 +/- 0.10. All 9 children with minimal ventricular dilation without progression showed normal flow profiles with normal flow velocities and pulsatility-index in the anterior cerebral arteries. 17 infants with moderate, slowly progressive ventricular enlargement showed significant increase of the maximal systolic velocity (60 +/- 27 cm x s-1) and the pulsatility-index PI (0.82 +/- 0.14). There was no difference in the end-systolic and end-diastolic velocities to the healthy control group. 26 children with marked and rapid progressive hydrocephalus showed significant decrease of the end-systolic and end-diastolic velocities and an increase in the pulsatility-index. The end-systolic velocity was 15 +/- 7 cm x s-1, the end-diastolic velocity was 4 +/- 7 cm x s-1 and the pulsatility-index measured 0.91 +/- 0.18. There was no difference in the maximal systolic velocity which measured 41 +/- 17 cm x s-1. All children with increased intracranial pressure showed a pathological flow profile with a decrease of diastolic forward flow. Absent or retrograde diastolic flow in rapid progressive hydrocephalus may lead to a decrease of brain perfusion resulting in hypoxemic ischemic brain lesions. After implantation of a ventriculo-atrial shunt an increase in the end-systolic and end-diastolic velocities and a decrease of the pulsatility-index could be shown. Shunt insufficiency can be shown early by a decrease in diastolic forward flow.

Blood Flow Velocity↗

PubMed1987

[Detection of reduced flow velocities in the anterior cerebral artery in premature and newborn infants and in older infants with cerebral hemorrhages using pulsed Doppler sonography].

34 infants with intracerebral haemorrhage (intraventricular haemorrhage 26; subdural haemorrhage 2; epidural haemorrhage 2; subarachnoidal haemorrhage 4) were investigated by pulsed Doppler-sonography. Absolute flow velocities were measured in the anterior cerebral arteries in infants with intracranial haemorrhage and compared with the flow velocities of a healthy control group of identical gestational age, actual age and weight. All flow velocities were significantly reduced in premature and full-term infants with intracranial haemorrhage, whereas the pulsatility-index was significantly increased. 10 infants with severe intracranial haemorrhage developed a shunt-depending posthaemorrhagic hydrocephalus. These children showed a significant reduction of all flow velocities in the anterior cerebral arteries in comparison to the healthy control group. The diastolic forward flow was more reduced than the maximal systolic velocity resulting in a significant increase of the pulsatility index. In rapidly progressive hydrocephalus, often no diastolic flow or even a retrograde diastolic flow could be found. After shunt-implantation normalisation of the flow velocities could be observed. Reduced flow velocities could be observed. Reduced flow velocities in the anterior cerebral arteries in infants with subdural, epidural and subarachnoidal haemorrhage were associated with a bad outcome: 1 infant died, 1 infant developed severe leucomalacia, and 1 infant showed atrophy of one cerebral hemisphere. Normal flow velocities in the intracranial arteries in subdural, epidural and subarachnoidal were associated with a favourable prognosis. Absent or even retrograde diastolic flow indicates a dramatic decrease of cerebral perfusion. The longer the pathologic flow patterns were demonstrable the worse was prognosis.

Blood Flow Velocity↗

PubMedDate not supplied

[Sedation versus general anesthesia in pediatric endoscopy].

Upper endoscopy was performed in 567 patients: 237 under general anesthesia, 261 in intravenous sedation with midazolam and etomidat (mean dosage 0.26 mg/kg bodyweight), 69 without any premedication. In these many patients defended strongly and some investigations have to been interrupted. On the other hand general anaesthesia needed much more time and personnel and produced more costs. In our experience sedation with midazolam and etomidat is most comfortable for patient and endoscopist and the time needed is shorter than in general anaesthesia. Therefore we recommend this method even in therapeutic endoscopy, except only in sclerotherapy of esophageal varices.

Adolescent↗

PubMedDate not supplied

[Experiences with capnometry in pediatric intensive care].

We investigated the correlation between arterial and end-tidal pCO2 in 17 children during intensive care. The indications for using capnometry were noninvasive monitoring of ventilation after cardiac surgery or during complicated course of illness or for control of intended hyperventilation. We found a good correlation between arterial and end-tidal pCO2 in the overall patient population (r = 0.82), but the relationship varied widely from patient to patient. There was only a weak correlation (r = 0.44) in pCO2 over 45 mm Hg. Hyperventilation could be identified in 64.2%, whereas hypoventilation was correctly indicated in only 23%.

Carbon Dioxide↗

PubMedDate not supplied

[Penis agenesis].

Congenital absence of the penis is a very rare malformation. The incidence is about 1:30 million persons or 1:16,000 necropsies. The cause of the malformation is unknown. Frequent associated malformations of the lungs, the colon and the urinary tract are determinating the prognosis. The therapy of choice in case of isolated penile agenesis is primary orchidectomy, later vaginoplasty and hormonal feminisation. We report our experience with two cases.

Combined Modality Therapy↗

PubMedDate not supplied

[Doppler sonographic flow measurement in the anterior cerebral artery and celiac trunk in infants with coarctation syndrome in comparison with healthy infants].

15 infants (gestational age 47 +/- 11 weeks; weight 3180 +/- 1082 g) with angiocardiographically proven coarctation of the aorta and 53 healthy infants (gestational age 39 +/- 8 weeks; weight 2830 +/- 1418 g) were investigated by echocardiography and pulsed doppler sonography. In all children pulsed doppler recordings were obtained in the anterior cerebral artery (prestenotic reference vessel) and the truncus coeliacus (poststenotic reference vessel). Nine variables were measured from each doppler signal: The maximal systolic velocity, the endsystolic and enddiastolic velocity, the pulsatility-index, the acceleration slope (peak rate of acceleration), the deceleration slope (peak rate of deceleration), the antegrade flow time and the acceleration and deceleration time. The healthy infants showed a pulsatile flow profile in the anterior cerebral artery and the truncus coeliacus. In normal subjects the maximal systolic velocity and the acceleration slope in the truncus coeliacus were always higher than in the anterior cerebral artery. There was no difference in the endsystolic and enddiastolic velocity, the pulsatility-index, the flow times and the deceleration slope. In children with coarctation of the aorta a decreased and nonpulsatile flow in the truncus coeliacus could be shown. The following variables were significantly lower than in the healthy control group: The maximal systolic velocity, the pulsatility-index, the acceleration and deceleration slope and the antegrade flow time and acceleration time. In the anterior cerebral arteries of children with coarctation the maximal systolic and enddiastolic velocity were significantly higher than in the healthy control group. Pulsed doppler recordings were obtained in 9 patients after surgical correction: The maximal systolic and endsystolic velocity, the pulsatility-index, the acceleration and deceleration slope in the truncus coeliacus increased significantly although these values were lower than in the healthy control group. The flow parameters in the anterior cerebral arteries postoperatively showed no significant difference from the preoperative values. Pulsed dopplersonography of the flow in the anterior cerebral artery and the truncus coeliacus is a good method for diagnosis of coarctation of the aorta and postoperative controls.

Aortic Coarctation↗

PubMedDate not supplied

[Pulsed Doppler sonographic determination of normal values of blood flow velocities in the anterior cerebral artery in premature and newborn infants].

In 384 healthy prematurely born infants, full-term newborns and older infants (conceptional age: 26 to 60 weeks; weight at investigation: 720 g to 5800 g) the flow in the anterior cerebral arteries was measured by pulsed doppler-sonography. All infants were investigated with a 5 MHz probe (ATL Mark 600 and Acuson 128). The following parameters were measured from the flow profile: The maximal systolic velocity, the end-systolic and end-diastolic velocity as well as the mean flow velocity, the pulsatility-index and the resistance-index. For all parameters the relationship to the conceptional age and weight were analysed. All flow velocities increased with increasing conceptional age: There was an exponential increase of the flow velocities with the conceptional age, whereas the relationship between the weight and the flow velocities was linear. In contrast to this neither the pulsatility-index nor the resistance-index changed with increasing conceptional age and weight. As flow velocities in the anterior cerebral arteries increase with increasing conceptional age and weight both parameters must be taken into consideration when pathologic flow velocities are measured.

Birth Weight↗

PubMedDate not supplied

[Extra-cerebral intracranial fluid collections in childhood: differentiation between benign subarachnoid space enlargement and subdural effusion using color-coded duplex ultrasound].

BACKGROUND: Extracerebral fluid collections in infancy are a common diagnostic problem, because by noninvasive imaging studies (including cranial ultrasonography, CT and NMR), no definite differentiation between two distinct pathological conditions can be found until today: An enlargement of the subarachnoid spaces in children with macrocephaly is a frequent observation of mostly unknown etiology but is known to be associated with a good prognosis. If surgery is necessary in these patients, ventricular shunting is required. On the other hand subdural effusions are often of traumatic origin and require frequently neurosurgical intervention (subdural shunting). Most reports on extracerebral fluid collections in infancy have not differentiated between both pathological conditions and therefore reveal confusing results. Recent studies using magnetic resonance imaging have shown that vascular flow phenomena in the arachnoid space can be used to a reliable diagnosis, whereas previous noninvasive neuroimaging attempts including high resolution computerized tomography (CT) have been useless. PATIENTS AND METHODS: We investigated a cohort of 20 patients aged 4 mths to 30 mths (mean 10.5 +/- 6.6 months) 16 with the history of macrocephaly and normal neurological development and 4 patients after head trauma and symptoms of an elevated intracranial pressure. RESULTS: In all 16 patients with the clinical diagnosis of benign subarachnoid space enlargement colour coded Doppler sonography detected archnoid vessels within the fluid collection, furthermore high resolution ultrasound demonstrated the dural border of of the arachnoidea as an echogenic membrane, an observation useful as a further sign of the subarachnoid location of the fluid collection. In the 4 patients with subdural hematoma the fluid collection showed an increased echogenity, no vascular structures and no surrounding border. CONCLUSION: Out of these observations we conclude that high resolution ultrasound and colour-Doppler sonography are able to reliably differentiate between a subdural and a subarachnoid fluid collection. An NMR investigation with its higher risks (sedation, anesthesia) focused on this target only seems therefore to be not necessary in these patients.

Blood Flow Velocity↗

PubMedDate not supplied

Successful systemic low-dose lysis of a caval thrombus by rt-PA in a neonate with congenital nephrotic syndrome.

PURPOSE: Thrombotic complications in nephrotic syndrome due to renal loss of antithrombin III (AT III) are well known. With this case report, we want to demonstrate the possibility of achieving the lysis of such a thrombosis in the neonatal period with low-dose rt-PA. PATIENTS AND METHODS: We treated a 10-day-old newborn who had congenital nephrotic syndrome, who developed a caval thrombosis during the first days of his life. After a trial of heparin (up to 20 IU/kg/hour) over a period of 24 hours and treatment with AT III (2 x 250 IU/day) proved to be ineffective, we started systemic thrombolytic therapy with rt-PA. An initial bolus of 0.4 mg/kg during 1 hour was followed by an infusion of 0.5 mg/kg/d rt-PA over a period of 36 hours. Low-dose heparin (5 IU/kg/hour) was given simultaneously. Complete clot dissolution could be achieved this way. No adverse effects were observed, including no clinical signs of bleeding. CONCLUSION: It seems that low-dose rt-PA treatment is safe and effective in dissoluting large caval thromboses in neonates.

Dose-Response Relationship, Drug↗

PubMedDate not supplied

[Cerebral Doppler ultrasound in fetal hydrocephalus].

Within a six-year period (1988-1993), we diagnosed and treated 143 cases of fetal hydrocephalus. We investigated the relationship between the degree of dilatation of the cerebral ventricles, the thickness of the pallium, and blood flow velocities in cerebral arteries. The assumption that progressive dilatation of the fetal ventricles leads to increasing resistance of the cerebral blood flow and disrupted cerebral perfusion was confirmed. Applying the postnatal pediatric principle of indication for shunt implantation based on Doppler sonographic diagnosis, delivery was instituted immediately in cases with pathologically increased pulsatility indices (PI). In all cases, this indication and the need for immediate shunt implantation were confirmed by postnatal pediatric ultrasonography. Cerebral Doppler velocimetry enables timely identification of fetuses at risk for pressure- or ischemia-induced cerebral tissue damage. The timing of delivery and subsequent neurosurgical therapy can thus be optimized.

Blood Flow Velocity↗