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Biomedical subjects

K H Deeg

Publications and source records attributed to K H Deeg.

At least 19 recordsLinked to original sources
PubMed2006

[Carotid artery dissection with cerebral infarction after soft tissue trauma in the pharyngeal region].

We report the case of an 8-year-old boy who suffered an internal carotid artery dissection as a result of an enoral soft tissue trauma. After an initial interval with minor symptoms he developed a cerebral infarction in the vascular region of the left middle cerebral artery. The patient was treated with decompression hemicraniectomy while therapy was monitored with intracranial pressure (ICP) measurements.

Carotid Artery, Internal, Dissection↗
PubMed2005

[Trans-fontanellar Doppler sonography of the intracranial veins in infants--part I--Normal values].

Doppler sonographic flow measurements in the intracranial veins of infants are not often applied. For the understanding of intracranial pathology such as vascular malformations, intracranial hemorrhagic infarction and venous thrombosis, a thorough understanding of the anatomical position and of the normal flow profiles and flow velocities in intracranial veins is essential. We describe the normal anatomic course of the cerebral veins and their flow profiles and flow velocities in infants. In sagittal sections, the following veins can be shown by colour coded Doppler sonography and measured by pulsed Doppler sonography: The superior and inferior sagittal sinus, and the straight sinus as well as the internal cerebral vein, the vein of Galen and the thalamostriatic veins. In coronal sections, the medullary and subependymal veins, the terminal veins, the internal cerebral veins, the great vein of Galen, the superior sagittal, straight and transverse sinus can be demonstrated and measured.

Blood Flow Velocity↗
PubMed2003

Sonographic diagnosis of a carcinoid tumour of the appendix in a 14-year-old boy.

Carcinoid tumours of the appendix are rare tumours of the bowel which occasionally are found histologically in resected appendices. There are no publications on the sonographic diagnosis of carcinoid tumours of the appendix in children. We report on the sonographic examination of a carcinoid tumour in a 14-year-old boy. Sonography showed a hypoechoic tumour located at the apex of the appendix with eccentric growth. Histology revealed a carcinoid tumour with invasion of the regional lymphatic vessels.

Adolescent↗
PubMed2003

[Doppler sonographic estimation of normal values for flow velocity and resistance indices in renal arteries of healthy infants].

UNLABELLED: Summary. Colour coded Duplex sonography (CDI) is an important method for the judgement of renal perfusion in infancy. By means of CDI the renal artery (RA), the segmental renal arteries (SA) and the interlobar arteries (ILA) can be differentiated. By means of pulsed Doppler sonography flow parameters in renal vessels can be measured. AIM: As flow parameters in different renal arteries are age dependent, normal values of the flow velocities and resistance indices were estimated. METHOD: We investigated 147 healthy children by CDI. Children were subdivided into 4 groups: 38 infants (< 1 year), 38 toddlers (> or = 1 year and < 6 years), 37 school children (> or = 6 and < 12 years) and 34 adolescents (> or = 12 and < 18 years). All children were investigated by computersonography with a 5 or 7,5 MHz transducer. In all children blood flow was measured in the RA, SA and ILA. From the flow profile peak systolic flow velocity (Vmax), endsystolic (Ves), enddiastolic (Ved) and time average (TAV) flow velocity as well as the resistance index (RI) were measured. RESULTS: Flow velocity and resistance indices were age dependent and related to the location within the renal vascular tree. The highest flow velocity was found in the renal artery, lowest in the ILA. In infants, Vmax in the RA was 51,5 +/- 13,4, in the SA 33 +/- 8 and in the ILA 19,5 +/- 5 cm/s. In toddlers, Vmax in the RA was 71,3 +/- 13,5, in the SA 43,6 +/- 8,5 and in the ILA 28,3 +/- 6,8 cm/s. In school age children, Vmax in the RA measured 80 +/- 18, in the SA 45,5 +/- 9,1 and in the ILA 27,9 +/- 5,3 cm/s. In adolescents, Vmax in the RA was 80,7 +/- 13,7, in the SA 46,8 +/- 11,8 and in the ILA 28 +/- 6,1 cm/s. From RA to SA the other flow velocity Ves, Ved, TAV decreased about 30 % and from SA to ILA about 30 %. Flow velocity in the different renal arteries was age dependent. The lowest flow velocity was found in newborns and infants, highest in elder school children and adolescents. The flow velocity markedly increased from infancy to early childhood whereas in elder children and adolescents a slower increase of the flow velocity could be found. Every flow velocity within the RA and AIL showed a statistically significant increase with increasing age (p < 0,0001). Resistance indices decreased from the renal artery to the interlobar arteries. The RI of infants within the RA was 0,82 +/- 0,11, within the SA 0,81 +/- 0,12 and within the AIL 0,73 +/- 0,17. In toddlers the RI within the RA was 0,71 +/- 0,08, within the SA 0,67 +/- 0,07 and within the ILA 0,65 +/- 0,08. In school age children the RI within the RA was 0,71 +/- 0,09, within the SA 0,66 +/- 0,08 and the ILA 0,58 +/- 0,10. In adolescents the RI within the RA was 0,69 +/- 0,06, within the SA 0,63 +/- 0,07 and within the ILA 0,60 +/- 0,06. Additionally, resistance indices decreased with increasing age. Statistical analysis showed a significant decrease with increasing age (p < 0,0001). Highest resistance indices could be found in early infancy and in the renal arteries, lowest resistance indices were measured in school age and adolescence and in the interlobar arteries. CONCLUSION: As flow velocity and resistance indices are age dependent and dependent on the location of the sample volume in different renal arteries, both parameters have to be considered if pathological flow parameters are measured. The determination of normal values of flow velocity and resistance indices in different renal arteries facilitate the judgement of pathologic flow parameters. For comparative controls flow measurements within the renal artery and interlobar arteries should be used.

Aging↗
PubMed2001

[Aortic root abscess without involvement of the aortic valve: diagnosis and therapy in a 2.5-year-old child].

Although formation of an aortic root abscess is a frequent complication of aortic valve endocarditis in adults, this complication has been rarely observed in children. In the majority of cases it has been described in children without underlying congenital heart disease. Due to the rarity of this complication, diagnosis and treatment is frequently delayed in childhood. We report a 2 1/2 year old girl who developed pericardial effusion in the course of pneumonia. Echocardiographic examinations, which were performed because of the pericardial effusion, revealed after 6 days the development of a cystic structure posterior to the aortic root. There was a perforation of this aortic root abscess to the left ventricular outflow tract; the aortic and mitral valves however were normal without endocarditic vegetations. Surgery was performed on the 10th day following a rapid increase in the size of the abscess. During surgery the abscess was drained and the perforation to the left ventricle was closed with direct sutures. Intraoperative transesophageal echocardiography confirmed a good surgical result. Blood cultures remained negative; in the material from the abscess however we found staphylococcus aureus. The postoperative course was uneventful. Our case demonstrates the necessity of detailed and repeated echocardiographic examinations in children with possible symptoms of bacterial endocarditis (in our case pericardial effusion) as well as the requirement of cultures of the abscess for identification of the infective organism. Intraoperative transesophageal echocardiography allows exact description of an aortic root abscess, its relation to other cardiac structures and immediate evaluation of the surgical result.

Abscess↗
PubMed2001

[Doppler ultrasound diagnosis of increased intracranial pressure by comparison of 2 blood flow velocities in the extra- and intracranial segment of the internal carotid artery. 2: Findings in children with increased intracranial pressure].

AIM: We investigated the correlation between intracranial pressure and flow parameters by simultaneous Doppler sonographic flow measurements in the internal carotid arteries and estimation of the intracranial pressure over the anterior fontanelle. METHOD: 12 infants (7 boys and 5 girls) with increased intracranial pressure were investigated. The corrected gestational age at investigation was 42 +/- 14 weeks, the weight was 3080 +/- 2540 g. Intracranial pressure was measured by applanation tonometry over the anterior fontanelle. The infants were subdivided into two groups: Group 1 (9 infants) with slightly increased intracranial pressure (16.9 +/- 3.3 cm H2O) and group 2 (3 infants) with moderately increased intracranial pressure (21.6 +/- 3.3 cm H2O). In all infants Doppler sonographic flow measurements within the intra- and extracranial segments of the internal carotid arteries were performed. From the flow profile, the peak systolic flow velocity Vs, the enddiastolic flow velocity Ved as well as the time average flow velocity TAV and the resistance index RI were measured. From the flow velocities, the I/E-ratio was calculated. The measured variables were compared with the values of matched pairs of a healthy control group of similar age and weight. RESULTS: Group 1 with slightly increased intracranial pressure displayed no significant difference of the RI within intracranial and extracranial sections of the internal carotid artery and the control group. The flow velocities, however, showed a significant increase within the intracranial segment of the internal carotid artery in comparison with the extracranial part of the internal carotid artery as well as the healthy control group. I/E-ratio for Vs increased significantly to 1.29 +/- 0.19, for Ved to 1.24 +/- 0.27 and for TAV to 1.08 +/- 0.27. Group 2 with moderately increased intracranial pressure displayed a significant increase of RI within the intracranial section of the internal carotid artery to 0.89 +/- 0.08 in comparison to the extracranial section with 0.79 +/- 0.07 and to the healthy control group with 0.75 +/- 0.07. All flow velocities decreased significantly within the intracranial section of the internal carotid artery in comparison to the extracranial part of the internal carotid artery and the healthy control group. The I/E-ratio was significantly reduced in group 2 with 0.76 +/- 0.11 for Vs, 0.38 +/- 0.21 for Ved, and 0.58 +/- 0.16 for TAV. CONCLUSION: Flow measurements in extra- and intracranial sections of the internal carotid arteries are an accurate method for semiquantitative estimation of increased intracranial pressure. This method is superior to the measurement of the RI. Slightly increased intracranial pressures below 20 cm H2O cause an increase of the I/E-ratio above 1, whereas the RI does not change. Moderately increase of the intracranial pressure above 20 cm H2O lowers the I/E-ratio significantly below normal values of 0.8, whereas the RI increases.

Blood Flow Velocity↗
PubMed2000

[Doppler ultrasonographic diagnosis of increased intracranial pressure by comparison of flow velocities in the extra- and intracranial secitons of the internal carotid artery].

AIM: By comparison of the flow velocities in the intracranial and extracranial parts of the internal carotid artery the influence of an increased intracranial pressure on cerebral perfusion can be determined. Aim of the study was to establish normal values in healthy infants not displaying clinical signs of increased intracranial pressure. METHOD: 108 healthy infants (35 girls, 73 boys) with a gestational age of 42 +/- 14 weeks and a weight of 2440 +/- 2310 g were investigated. In all infants Doppler sonographic flow measurements were performed within the petrosal part (extracranial) and the cerebral part (intracranial) of the internal carotid artery. From the flow profile the peak systolic (Vs), enddiastolic (Ved) and time average (TAV) flow velocities were estimated. In all infants the I/E-ratio of the intracranial and extracranial flow velocities was calculated. RESULTS: Flow velocities within the intracranial section of the vessel were lower than in the extracranial part, due to the greater angle of incidence (33 +/- 8 degrees) between the pars cerebralis and the Doppler beam. In the pars petrosa of the internal carotid artery Vs was 59.7 +/- 21.4, Ved 14.6 +/- 9.5 and TAV 17.2 +/- 11.8 cm/sec. Within the pars cerebralis Vs was 48.8 +/- 22.1, Ved 12.3 +/- 8.4 and TAV 12.9 +/- 7.5 cm/sec. I/E-ratio of intracranial and extracranial flow velocities was 0.83 +/- 0.14 for Vs, 0.88 +/- 0.29 for Ved and 0.82 +/- 0.24 for TAV. CONCLUSION: The relation between intracranial and extracranial flow velocities within the internal carotid artery as described by the I/E-ratio is constant. Alterations of the flow velocities intracranially such as in cases of increased intracranial pressure, may cause changes of the I/E-ratio. Determining the I/E-ratio may be a valuable method for the assessment of increased intracranial pressure.

Blood Flow Velocity↗
PubMed1999

[Classification of intracranial hemorrhage in premature infants].

The most common classification of intracranial haemorrhage in premature infants into four degrees of severity is based on the results of CT-scans. However, this classification does not adequately account for some pathophysiological and morphological changes. For this reason, the paediatric section of DEGUM developed a new method of classification. This classification distinguishes more precisely between the bleeding itself and secondary changes, such as posthaemorrhagic ventricular dilation, which were excluded from the revised classification. The new system contains three levels: Grade I: subependymal haemorrhage, grade II: intraventricular haemorrhages taking up < 50% of the ventricular volume, grade III: intraventricular haemorrhages of > 50% of ventricular volume. Areas of increased echo levels within the brain tissue (formerly grade IV) which are caused by haemorrhagic infarction are now taken as a separate entity. The morphological description lists the side and the location of the haemorrhagic infarction as well as its size, which is classified into 'small' (< or = 1 cm in diameter), 'medium' (1 < or = 2 cm) and large (> 2 cm). Bleeding into the basal ganglia, cerebellum and brainstem are separate entities. In post-haemorrhagic ventricular dilation the distinction is made between self-limiting transient dilation and hydrocephalus requiring treatment.

Cerebral Infarction↗
PubMed1998

Differential diagnosis of neonatal adrenal haemorrhage and congenital neuroblastoma by colour coded Doppler sonography and power Doppler sonography.

UNLABELLED: The differentiation between neonatal neuroblastoma and adrenal haemorrhage may be very difficult in the individual case. We investigated eight neonates with adrenal haemorrhage and one patient with congenital neuroblastoma by colour coded Doppler sonography and power Doppler sonography. Six haemorrhages were cystic, whereas the neuroblastoma and four adrenal haemorrhages had a solid appearance. Colour coded Doppler sonography and power Doppler demonstrated vessels within the neuroblastoma. In none of the ten adrenal haemorrhages could flow be shown either with conventional colour coded Doppler sonography or power Doppler sonography. CONCLUSION: Conventional colour coded Doppler sonography and power Doppler sonography are useful to differentiate between neuroblastoma and adrenal haemorrhage.

Adrenal Gland Diseases↗
PubMed1998

[Basilar artery insufficiency--a possible cause of sudden infant death? Results of a Doppler ultrasound study of 39 children with apparent life-threatening events].

AIM: Hypoperfusion of the brain stem in dependence on head and body position followed by central bradycardia and apnea may be an important cause of sudden infant death syndrome (SIDS). METHODS: 39 infants with a mean age of 10.6 +/- 10.2 weeks (6 days to 11 months) with apparent life threatening events (ALTE) were investigated by cranial Doppler sonography. Additionally 68 healthy infants aged 6 days to 5 months (m 3.7 +/- 4.1 weeks) were investigated. In all patients flow measurements were performed in one anterior cerebral artery (ACA), both internal carotid arteries (ICA), the basilar artery (BA), and both vertebral arteries (VA) in dependence on head (right/left/neutral) and body position (prone/supine). RESULTS: In healthy infants flow velocities within all intracranial arteries were independent of head and body position. In none of our infants with ALTE significant flow alterations in the ACA and both ICA in dependence on head and body position could be found. In 23 patients with ALTE no dependence of flow in the BA and both VA of head and body position could be shown. In 16 infants however pathologic flow profiles with low flow velocities could be found in the contralateral VA if the head was rotated to the other side. In 9 infants additionally pathologic flow profiles with a dramatic decrease of the flow velocities in the BA could be found. The reduction of the blood flow is caused by compression of the contralateral vertebral artery at the craniocervical junction. CONCLUSION: The reduction of blood flow in the VA and especially the BA may cause hypoperfusion of the brainstem followed by central bradycardia and apnea. Hypoperfusion of the brainstem in dependence on head and body position may be a significant cause of SIDS. By means of cerebral Dopplersonography infants at risk for SIDS may be detected. Body and head positions which should be avoided can be evaluated noninvasively.

Blood Flow Velocity↗
PubMed1997

[Sonography of the kidneys and urinary tract in infancy].

Sonography is the imaging method of choice in all diseases of the kidneys and urinary tract in infancy. The most important indications are all malformation syndromes, especially malformations of the urinary tract, urinary tract infections, space occupying lesions of the kidney, renal insufficiency, hematuria, arterial hypertension, abdominal pain and inherited kidney diseases.

Humans↗
PubMed1994

[Cerebral color-coded duplex ultrasound in infancy].

With the help of colour-coded duplex sonography intracranial vessels can be displayed within the gray scale image. The sample volume of the pulsed Doppler device can be placed optimally within intracranial vessels. Angle correction is possible and allows the quantification of flow velocities. Indications for colour coded Doppler sonography are diseases such as intracranial haemorrhage, hydrocephalus, meningoencephalitis, hypoxaemic-ischaemic insults, brain oedema, brain death, vasculitis and cerebrovascular malformations. Additionally all cardiovascular malformations such as a leakage of the aortic "windkessel" or obstructions of the left heart are associated with pathologic flow profiles in the intracranial arteries.

Brain Death↗
PubMed1994

Sonographic demonstration of multiple intrahepatic meconium masses in a newborn with meconium peritonitis.

We report on a patient with atresia of the colon transversum and a large meconium pseudocyst adherent to the liver. Sonography additionally revealed multiple cystic structures due to intrahepatic meconium masses. Surgical evacuation of the meconium pseudocyst resulted in massive diffuse hemorrhage from the liver which could not be stopped. The child died intraoperatively due to hemorrhagic shock. Histologically the intrahepatic meconium masses were surrounded by various degrees of necrosis and hemorrhage without a well-defined capsule of fibrous granulation tissue.

Colonic Diseases↗
PubMed1993

Brain abscesses in neonates--report of three cases.

We report three newborns with brain abscesses. Two infants suffered from Serratia marcescens meningitis and one infant had enterococcal sepsis and meningitis. Brain abscesses were detected by cerebral sonography. Outcome in one infant with S. marcescens infection was poor. This patient developed multicystic encephalo-malacia and severe developmental retardation. In the other patient with S. marcescens infection surgical drainage of the abscess was performed. The outcome was good both in this infant and in the patient with enterococcal brain abscess.

Brain Abscess↗
PubMed1993

Polyposis of the gallbladder associated with metachromatic leukodystrophy.

We report on two children with metachromatic leukodystrophy and polyposis of the gallbladder. In both patients ultrasound examination revealed a small gallbladder with a thickened echogenic wall and multiple polypoid masses. In one patient diagnosis of gallbladder polyposis was made 6 months before the first neurological symptoms occurred. As gallbladder polyposis is a rare phenomenon in childhood, metachromatic leukodystrophy should be excluded.

Child, Preschool↗
PubMed1993

Sonographic diagnosis of a huge necrotizing thymic cyst.

We report on a 10-year-old boy with a huge right-sided thoracic mass. The chest radiograph, ultrasonography CT and laboratory data were suspicious of an abscess-forming pneumonia. Following unsuccessful antibiotic treatment the mass was surgically removed. Histological examination revealed a huge necrotizing thymic cyst.

Child↗
PubMed1993

Diagnosis of veno-occlusive disease of the liver by color-coded Doppler sonography.

In a girl with bilateral Wilms' tumor veno-occlusive disease occurred during chemotherapy. The diagnosis was established by reversed flow in the portal vein displayed by color and pulsed Doppler sonography. After successful conservative treatment normalization of flow in the portal vein could be shown by both Doppler techniques.

Antineoplastic Combined Chemotherapy Protocols↗