Biomedical subjects
Publications and source records attributed to M Reither.
Although limited by osseous structures and gas the sonographic evaluation of the chest may be useful for certain conditions. Illustrated by three cases--supradiaphragmatic and parasternal tumor, subpulmonic effusion, and pleural effusion combined with a mediastinal tumor--the indications for ultrasound studies in children are discussed. In many cases the ultrasound may be helpful considering the diagnostic procedure and therapeutic consequences.
Shortly after birth a preterm infant suffering from aspiration syndrome and subsequent Pseudomonas aeruginosa sepsis showed signs of renal insufficiency and mycotic infection: Yeast cells were identified in several urinalyses; there was also an increasing anti-Candida IgM antibody titer. At the same time sonographic examinations revealed an increasing echogenicity of the renal cortex and echogenic masses of variable size which did not cause acoustic shadows in both enlarged kidneys. A few days later, we found a right-sided hydronephrosis caused by an intraureteric prevesical mass of equal echogenicity. As we could observe sonographically, the aggressive antimycotic therapy was successful. Eleven weeks later there were signs of cardiac insufficiency. An angiographically demonstrated filling defect within the pulmonary artery showed the same sonographic findings as the previously found intrarenal masses. The baby underwent embolectomy and recovered. The thrombotic material contained yeast cells giving evidence of systemic Candidiasis. Provided appropriate equipment is available, ultrasound today is an excellent non-invasive screening and follow-up method not only for echoencephalography, but also for more complicated neonatal problems as seen here. The detailed observation of a changing echogenicity of the renal cortex and pelvis is important and often allows a decisive diagnostic clue before other radiological methods become conclusive.
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The history of a 6-year-old girl with a tumor originating from thoracic spine and finally becoming resistant to surgery, radio-, and chemotherapy is reported. Tumor-biopsy material was studied by light and electron microscopy, in cell culture, by acetylcholinesterase ultracytochemistry, and by quantitative catecholamine analysis and this led to the rejection of the initial diagnosis of a neuroblastoma. Light microscopy revealed a uniform population of undifferentiated cells incompletely lobulated by broad fibrovascular septa. Using the electron microscope, cells were characterized by large intracellular pools of glycogen, little cytoplasm with an abundance of free ribosomes and a paucity of organelles. A few cells displayed desmosome-like attachment sites. Staining for specific and unspecific acetylcholinesterase was negative with light and electron microscopy, as were the results of catecholamine histofluorescence using the glyoxylic acid method. The latter result was confirmed by the negative outcome of quantitative analyses of dopamine, noradrenaline, and adrenaline with high pressure liquid chromatography nd electrochemical detection in tissue samples. Tumor cells could easily be maintained in culture for up to 4 weeks. None of a variety of treatments that are known to favor expression of neuronal characteristics in neuroblastoma cells (serum withdrawal, nerve growth factor, dbcAMP, dexamethasone) induced morphological differentiation in cultured tumor cells. On the basis of the clinical history, morphology, and of our experiments with tumor cells, the diagnosis of a so-called extraskeletal Ewing's sarcoma is most likely. Our results strengthen the view that a cell biology approach may be valuable in neuroblastoma differential diagnosis.
Spleen exposure to ultrasound has been reported to influence antibody response to sheep red blood cell injection in mice (decreased hemagglutination and hemolytic titers and IgM, IgG2a and IgG2b levels and elevated IgG1 levels). In a controlled clinical trial, we investigated the possible immunosuppressive side-effect of splenic exposure (2.0 mW/m2, 3.5 MHz, 5 minutes) to ultrasound on the immune response to Rubella vaccination in 41 anti-Rubella antibody-negative volunteers. The measured parameters (blood cell count, IgA, IgM, IgG including subclasses IgG1-IgG4, isoagglutinins, anti-Rubella hemagglutinin and hemolysin titers, complement C3, skin tests to mumps and tuberculin, T, B and O lymphocytes, esterase-positive and negative T-cell subsets) suggest changes dependent on the time of vaccination, but provide no evidence of an immunosuppressive effect of ultrasound in man.
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Three contrast media--Hexabrix Conray EV and Tele-brix 300--used for urography in children were compared in a randomized controlled study; Hexabrix showed a significantly better contrasted collecting system of the kidneys. Therefore feeding of the babies and small children after injection of the contrast medium and conventional tomography were almost superfluous. There was no significant difference in side effects. Hexabrix is expensive, but in general it is possible to reduce the dose of contrast per examination without lack of information. Compared to Amipaque Hexabrix has the great advantage that it is available ready for injection.
The development of paediatric radiology which began in the late 1950's has been characterised by the need to limit the dose of ionising radiation to which the child is subjected. The aim has been to keep radiation exposure as low as possible by the introduction of suitable techniques and by the development of new methods. It is therefore surprising that studies in dosimetry in the paediatric age range have only been carried out in recent years. One reason for this may have been the fact that a suitable technique of measurement was not available at the time. The introduction of solid state dosimetry based on thermo-luminescence, first into radiotherapy (1968) and subsequently into radiodiagnosis, has made it possible to abandon the previously widely used ionisation chamber (1, 2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 14 and 14). The purpose of the present paper is to indicate the suitability of this form of dose measurement for paediatric radiological purposes and to stimulated its application in this field.
The past decade has seen the emergence of different ultrasound techniques for a wide variety of disorders. We directed our interest to the study of superficially located structures. We succeeded in percepting and distinguishing pathological liquid and parenchymal structures (effusion, abscess, hematoma, lymph-node, tumor ...), in discribing their exact location and in calculating their volume. Annotations about the ultrasonographic patterns of these pathological structures are given beside the illustration of cases.
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The congenital cystic adenomatoid malformation (CCAM) of the newborn is a particular form among the cystic disorders of the lung. The clinical findings, illustrated by four cases, and especially the roentgenographic symptoms are typical. Different radiologic examinations, including the computer tomography, are discussed. The differential diagnosis of the disease is various, and therefore a correct and on time diagnosis is necessary, because the prognosis of the patient depends on an adequate therapy.
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30 children prepared from barium enema using Cascara-Salax are reported on. The results are: 1. A satisfactory preparation is possible in out-patient children older than ten years. 2. For children aged 6 to 10 years only the half dose early in the afternoon before the X-ray examination is necessary. 3. In most cases the colon is completely clear, if not, the X-ray study is generally not influenced by rests of stool. 4. It should be considered that other--and often unreliable--cleaning manoevers aren't necessary, the Cascara-Salax--method is time--saving and side-effects are not of value.
Voiding disturbances and available radiologic examinations are reported. The importance of a correct analysis of the findings for the orthopedic, nephrologic and neurologic treatment is emphasized. Intravenous urograms and voiding cystogram are standard methods; recently ultrasound is also included in the management of children with neurogenic bladder.
A simple dose-saving procedure for the diagnosis of congenital hip dysplasia employing a diaphragm in near-focus position is presented. Doses to the skin and the gonads are measured with a phantom, comparing the new and other techniques. With optimal techniques the skin dose is smaller than 2 mR and the gonadal doses lie around 0.1 mR for both male and female patients.
A simple dose-saving procedure for the diagnosis of congenital hip dysplasia employing a diaphragm in nearfocus position is presented. Doses to the skin and the gonads were measured with a phantom for the new and other techniques. With optimal techniques the skin dose is smaller than 2 mR and the gonadal doses lie around 0.1 mR for both male and female patients. An estimate of the dose burden from undesired radiation is appended.