Biomedical subjects
Publications and source records attributed to D Färber.
The etiology of the painful hip in children is widespread. In this paper, predominants cases without previous trauma are discussed in detail. Depending on age, history, clinical picture and laboratory results, an imaging diagnostic algorithm is presented, which should avoid unnecessary tests and lead to the necessary therapeutic measure. Several common as well as uncommon clinical entities are illustrated by representative examples.
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PURPOSE: The aim of this study was to determine the presentation of the appendix in patients with cystic fibrosis (CF) compared to a healthy control group and patients with acute appendicitis using high resolution graded compression sonography. METHOD: 59 CF patients (mean age 11 years), 54 healthy children (mean age 9 years) and 322 patients with histologically proven acute appendicitis were evaluated by sonography. A blind ending tubular structure in longitudinal sections and a target-like figure in cross sections without peristalsis was considered as appendix. The maximum distance between the outer echolucent layers was calculated as diameter. RESULTS: In 20%, 67% and 90% of the cases, the appendix was identified in the CF-group, healthy children, and patients with acute appendicitis. The mean diameters were 9.8, 3.9, and 10.9 mm respectively. These differences were statistically significant (p < 0.001 and p < 0.012). CONCLUSION: The appendiceal mucocele in cystic fibrosis is an uncommon but important differential diagnosis of the acute appendicitis.
From 1989 to 1995 high-resolution ultrasonography (US) was performed in 3,546 children (age: 1-17 years) with clinically suspected appendicitis. A total of 518 patients underwent laparotomy; 420 had histologically proven acute or perforated appendicitis (prevalence 11.8%). In these children, the sensitivity, specificity and overall accuracy of US examination were 90%, 97% and 96% respectively. The use of US in clinically doubtful acute abdomen may allow earlier diagnosis of acute appendicitis; in 1995 the rate of unnecessary appendectomy was reduced to 13%.
Only few systematic studies are available on the status of sleep deprivation therapy in the overall treatment regimen of depressive patients. 51 patients suffering from a major depressive episode (ICD-10) were randomly allocated to 4 weeks' treatment with amitriptyline (150 mg/day) or to a combination of amitriptyline with six partial-sleep-deprivation treatments late in the night (at 4-5 day intervals). According to observer rating (Hamilton Rating Scale for Depression, 21- and 10-item version), a highly significant amelioration was recorded in both groups until the 14th day of treatment. A further improvement occurred, however, only in those patients treated with both antidepressants and sleep deprivation. Hence the response rate ( > or = 50% HAMD reduction) after 4 weeks' treatment was distinctly more favourable in this group than in those patients under pharmacotherapy alone. The superiority of the combined therapy cannot be confirmed statistically by self-rating (Befindlichkeitsskala: von Zerssen; Visual Analogue Mood Scale). The immediate antidepressive effect of sleep deprivation diminished in the course of the sleep deprivation series. The response to the first sleep deprivation was a predictor neither for the response to further sleep deprivation treatments nor for the overall treatment outcome.
In childhood blunt trauma to the chest wall is more frequent than penetrating injuries. Most of these are the result of traffic accidents. Solitary or serial rib fractures are seen more often than fractures of the sternum. Complications of thoracic injuries are pulmonary contusion, hemothorax and, less frequently, pneumothorax. Pulmonary contusion can result in post-traumatic pneumatocele or chronic pulmonary hematoma. Injuries of the heart, the great vessels and bronchotracheal rupture, presenting initially with pneumothorax, followed by atelectasis, rarely occur. Blunt thoracic trauma is frequently associated with further injuries (head and/or blunt abdominal trauma). The prognosis also depends on the concurrent injuries. The initial evaluation of an injured child is based on the chest X-ray and abdominal ultrasound examination. Additional information can be obtained by a CT scan in mediastinal injuries.
In blunt abdominal trauma in children, the basic diagnostic work-up should include, in addition to history, physical examination, routine laboratory and X-ray studies, ultrasound and color Doppler ultrasonography. With these methods, most lesions can be identified both in the acute phase and in follow-up. They are also helpful to decide if surgery is indicated or if conservative management is justified. The diagnostic hallmarks of the most common organ lesions are summarized. Additional imaging studies, e.g. CT, angiography, or MRI, should be reserved for specific questions.
In ultrasonographic diagnosis of the hip severe bony deformities due to osteogenesis imperfecta are potential pitfalls. In this condition, even x-ray of the pelvis is unreliable, whereas MRT is a helpful diagnostic method.
The autosomal recessive form of osteopetrosis becomes manifest in early infancy and often is lethal during the first decade of life. In an infant diagnosed at the age of eight weeks, a therapy with Calcitriol (Rocaltrol) was initiated with the intention to stimulate the osteoclast activity and to improve the bone marrow insufficiency. During therapy, a massive diarrhoea has been observed as potential and previously undescribed side effect of Calcitriol. Therefore the therapy had to be discontinued. A simultaneous trial with Ca-depleted diet did not show any effect. In the absence of a suitable donor, a bone-marrow transplantation could not be performed. The patient died at the age of five month.
In patients with chronic renal failure, aluminium, which is included in the dialysate or released from phosphate binders, cannot be eliminated adequately. It forms a deposit in the tissues and leads to intoxication. After a 6-month therapy with aluminium-containing phosphate binders in a non-dialysed baby with chronic renal insufficiency, an osteomalacia arose with distinct subepiphyseal and metaphyseal changes attributable to disorders of mineralization. The consequence of this was a "bone-within-bone" appearance and pathological fractures. After a change of therapy, the bone alterations receded within a few months. Simultaneously, the distinctly elevated serum level of aluminium fell. Therefore, aluminium should be avoided in non-dialysed children with chronic renal insufficiency.
In children with asthma, routine chest X-ray typically shows bilaterally increased air volume, low diaphragms, wide diaphragmatic angles, and often a slender cardiac silhouette with a prominent pulmonic arch. Such an X-ray is not diagnostic of asthma itself, however, but rather of its complications: pneumonitis (particularly in toddlers with infectious asthma), atelectasis due to mucus obstruction, and, rarely, extra-alveolar air trapping (pneumomediastinum with or without cutaneous emphysema more often than pneumothorax). The differential diagnosis has to rule out "pseudo asthma" due to cystic fibrosis, alveolitis, achalasia, and foreign body aspiration.
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We are reporting a case of hypothyroidism in an infant which developed at the end of the second quarter of the first year of life on the basis of a dysgenetic thyroid gland. By the time of its diagnosis in the ninth month of life it had led to bone age retardation and dysgenesis of the second lumbar vertebra. Clinical picture, longitudinal growth and psychomotor development were minimally or not affected. Pathogenetically this case of relatively mild postnatally acquired hypothyroidism has to be classified under the spectrum of congenital hypothyroidism. Clinically it is important that it would not have been picked up by a neonatal screening program and still might have led to impairment of the cerebral development.
In 1978 43 patients have been operated in the Department of Pediatric Surgery, Krankenhaus München-Schwabing, because of recurrent urinary-tract infections with ureterovesical reflux or obstructive urinary-tract diseases. In all patients a split whole body clearance-study with a method modified after the method of Mühle with 131J-Hippuran was carried out pre- or postoperatively, respectively. In 78,5% of these cases the clearance-results were corresponding to the results of x-ray examination; 6 of the remaining patients had a worse clearance result and 3 had a better result than the x-ray findings would have suggested.
There are very few reports of bacteriologically proven Candida arthritis. With the increasing number of cases of immune deficient infants being treated now, one must expect an increase in frequency of fungus infections, including Candida arthritis. We have observed three cases of fungus arthritis in infants with reduced resistance. The radiological changes were indistinguishable from bacterial arthritides. During the acute phase the accumulation of pus and exudate showed widening of the joint space on the radiograph, with increase of the peri-articular soft tissues. In two patients a central bone abscess was seen in the metaphysis which later showed a sclerotic margin. In one patient with a gonarthritis there was complete healing, but in two fungus infections of the hip there was persistent late demage. One patient developed a deformed hip joint with subluxation, which had to be treated surgically after ineffective medical treatment. In the other case there was considerable flattening of the femoral head.
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