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Biomedical subjects

J Tröger

Publications and source records attributed to J Tröger.

15 recordsLinked to original sources
PubMed1992

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↗
PubMed1992

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↗
PubMed1992

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↗
PubMed1992

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↗
PubMed1992

[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↗
PubMed1992

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↗
PubMed1992

[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↗
PubMed1979

[Course of metastatic osteogenic sarcoma treated with chemotherapy only (author's transl)].

The case of a six year old girl with metastatic (or primarily multifocal) osteogenic sarcoma is reported, which was treated with chemotherapy only. Within 15 months--the primary tumor regressed and at least a transient inactivation has resulted until now;--the pulmonary metastases showed no progression;--an osteoplastic destruction of the sacrum has completely regressed. At the time of report (15 months after initiation of treatment) neither on X-ray controls nor on bone scan signs of tumor regrowth are evident. The child is without any complaints and the leg has no loss of function.

Antineoplastic Agents↗
PubMed1979

[Diagnosis and differential diagnosis of acute hematogenous osteomyelitis in infants (author's transl)].

Clinical and laboratory data are frequently unspecific in acute hematogenous osteomyelitis of infants. As prognosis is dependent on early treatment, a timely radiologic diagnosis is mandatory. Because of specialties in the vascular supply, the roentgenmorphologic alterations of acute hematogenous osteomyelitis in infants differ from the appearance of the disease in other age groups. The acute osteomyelitis in infants frequently leads to destruction of the epiphysis and purulent joint effusion. A subtle analysis of soft tissue lesions will already rise suspicion for acute hematogenous osteomyelitis before destructive or reactive osseous alterations prove the diagnosis by roentgenology. Nuclear medicine examinations of the bone have contributed significantly to radiologic diagnosis of acute hematogenous osteomyelitis in infants despite of few negative results. Osseous trauma and other diseases should be included in differential diagnosis. Especially in neonatals and premature infants, variations in the typical course and appearance of the disease may occur.

Acute Disease↗
PubMed1979

[Complications and survival rate in preterm infants and neonates treated with mechanical ventilation (author's transl)].

Between January 1972 and December 1976 201 preterm infants and neonates were treated with mechanical ventilation. These children were classified into 6 groups according to the indications for mechanical ventilation: P = respiratory failure caused by pulmonary disease; Z-P = respiratory failure caused by cerebral disturbance with simultaneous respiratory disease; Z = respiratory failure caused by cerebral disturbance; C = respiratory failure caused by cardiac disease; SCH = respiratory failure through shock; M = respiratory failure caused by mechanical disturbance; Bronchopulmonary complications developed in 70% of the survivors and in 60% of the fatalities. The most serious bronchopulmonary complications were infections which occured with similar frequency in all indication groups as late-onset complications, and air-leaks which occured as early complications. The latter complication was significantly higher (38%) in the first than in the other groups. The most serious extrapulmonary complications were seizures, intracerebral hemorrhages and septicemia. 71 of the 201 patients survived. There was a significant increase in the survival rate from 21.2% in 1972-1973 to 43% in 1974-1976. The survival rates differed significantly within the indication groups. The best result was found in the p-group followed by the Z-group. The highest mortality rate was found in the SCH and C-group.

Bronchial Diseases↗
PubMed1978

[The battered child (author's transl)].

The diagnosis of the battered child syndrome is the first and most important step for adequate therapy and prevention. The recognition of this entity by the radiologist is possible because of the high frequency of skeletal lesions. Osteoepiphyseolysis with fragmentation of the edges and periosteal calicifications are characteristic for the roentgenographic pattern of the battered child syndrome. In addition to the Roentgen diagnosis total body bone scans should be performed because the diagnostic accuracy will improve, the lesions will be detected earlier, and the radiation dose can be decreases in numerous children.

Battered Child Syndrome↗
PubMed1977

Renal sonography in pediatric patients. A comparative study between sonography and urography.

Renal sonograms of 260 children were compared with the corresponding excretory urograms. Since each kidney was evaluated separately 520 sonographic and urographic findings could be compared. The study is based on single investigations only, serial investigations were not included. 326 kidneys could be classified as being normal, primarily on the basis of the urogram. By sonography only 10 out of these 326 were misinterpretated as being pathological, 2 by urography. 194 kidneys could be classified as being pathological either by urography or- if necess -by other methods. In 16 out of these 194 no evidence for a pathological process could be found in the sonogram (7 cases of destructive pyelonephritis, 3 cases of double kidneys, 2 cases of slight obstruction of urine flow, 2 cases of small kidneys, 2 cases of ureteral buds), in 10 cases no evidence was seen in the urogram (6 cases of glomerulonephritis, 2 cases of polycystic kidneys, 1 case of preversial ureteral buds), in 10 cases no evidence was seen in the urogram (6 cases of glomerulonephritis, 2 cases of polycystic kidneys, 1 case of prevesical ureterolith, 1 case of ureteral bud). In 2 cases pathological alterations of the kidney was found by both methods, however, the diagnosis differed. Nonfunctioning kidneys were found in 15 cases. In all of these the sonogram provided important complementary information. Our results show 1) that by a systematic application of sonography the early diagnosis of urinary tract malformations can be improved 2) that renal sonography provides the basis for a stricter application of excretory urography and 3) that by the combination of both methods the diagnosis of renal diseases can be improved.

Adolescent↗
PubMedDate not supplied

[Diagnostic value of imaging procedures in nephroblastoma before preoperative chemotherapy: initial results].

According to the international SIOP 9 study preoperative chemotherapy for patients between 6 months and 16 years old is a major component of the therapeutic management of Wilms' tumour. Prior to treatment, the diagnosis is established by diagnostic imaging alone, without biopsy. This study was therefore undertaken to verify the accuracy of diagnostic imaging in the German GPO study group. Between July 1988 and November 1990, 156 patients with known histology were registered in the study centre. Of these patients, 67% (105/156) received preoperative chemotherapy. The diagnosis was initially established by US, TVP and CT, and in some cases MRT without prior biopsy. Of these preoperatively treated patients, 92.4% (97/105) had Wilms' tumour or one of its variants. Five patients had a different malignant tumour. Three cases, i.e. 2.8% of the preoperatively treated patients or 1.9% of all registered patients with known histology, had benign tumours of the kidney. Morphologically, the Wilms' tumour was revealed by a characteristic inhomogeneity in sonography and the CT scan. The inhomogeneity in the CT scan increased following injection of contrast medium. Intratumoral bleeding and cystic areas were observed frequently in the native scan. Calcifications were seen in 5% of the cases. The predictive value of pretherapeutic diagnostic imaging was good enough to justify instituting chemotherapy without diagnostic biopsy. It is still difficult in diagnostic imaging to differentiate the very rare benign cystic nephroma from malignant nephroblastoma. Intravenous pyelography proved to be the best method for distinguishing extrarenal from renal tumours.

Child↗