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T Rupprecht

Publications and source records attributed to T Rupprecht.

At least 37 records · Page 2Linked to original sources
PubMed1997

Congenital intracerebral teratoma: a rare differential diagnosis in newborn hydrocephalus.

Congenital hydrocephalus is caused by a broad spectrum of underlying disorders. In the majority of cases it is due to aqueductal stenosis and other distinct congenital anomalies, like Arnold-Chiari malformation. Nevertheless, in the differential diagnosis rare conditions such as cerebral malignancies must also be considered. We present two cases of congenital intracerebral teratoma as a differential diagnosis in congenital obstructive hydrocephalus. A teratoma is suggested when a rapidly growing hydrocephalus with a central calcified and vascularized mass is found sonographically. Regular cerebral structures usually cannot be detected. Early diagnosis in such cases is of clinical importance as the prognosis of congenital intracerebral teratoma is generally very poor.

Brain Neoplasms↗
PubMed1994

[Doppler echocardiography assessment of hemodynamic values and additional heart defects in atrial septal defects].

Due to the rapid progress in (Doppler-) echocardiography "one must question whether cardiac catheterisation remains a necessary prelude to cardiac surgery in atrial septal defects" (8). Although the estimation of the magnitude of the intracardiac shunt and the anatomical size of the defect ist possible by (Doppler-) echocardiography there remains the problem of associated disorders (e.g. anomalies of the pulmonary venous connection) which may not be detected by transthoracic echocardiography. In 25 children submitted to cardiac catheterisation studies in the period between 1990 and 1992, the anatomical size of an atrial septal defect was measured echocardiographically. The haemodynamic parameters Qp/Qs and Rp/Rs were employed to calculate the so-called effective resistance of the defect (Rd/Rs), which was derived from an electrical analogue and represents the ratio of the resistance of the defect (Rd) to the systemic vascular resistance (Rs). The echocardiographically measured anatomical size (expressed as the ratio of the area of the defect to the cross-sectional area of the ascending aorta) was related to the effective resistance of the defect. A significant (non-linear) correlation was found between Rd/Rs and the anatomical size of defect. Based on these data we developed a nomogram describing the relationship of the size of the defect to the haemodynamic parameters (Qp/Qs and Rp/Rs). If the data of a patient do not comply with this nomogram there is strong evidence of an additional cardiovascular malformation, necessitating further evaluation. A second cohort of four patients with associated defects (partial and total anomalous pulmonary venous connection and a corresponding sinus venosus defect) was clearly identified by the nomogram method.

Adolescent↗
PubMed1994

Frequency of stress lesions of the upper gastrointestinal tract in paediatric patients after cardiac surgery: effects of prophylaxis.

BACKGROUND: Stress lesions of the upper gastrointestinal tract are well recognised in adult patients in intensive care. There are no controlled studies of the incidence of these lesions and the effects or side effects of prophylactic treatment in high risk paediatric patients. METHODS: 79 paediatric patients in intensive care were studied prospectively after operation for congenital heart disease. All patients had at least one endoscopic examination. The first 36 patients were not given prophylactic medication: later 43 children were treated randomly either with pirenzepine (n = 21) or with famotidine (n = 22). Gastric and tracheal secretions were taken daily for culture in those patients given prophylactic medication. RESULTS: Severe inflammation or ulceration of the upper gastrointestinal tract was less common in those patients who were given prophylactic medication (18% v 44%). Prophylactic treatment did not, however, reduce the total incidence of postoperative stress lesions: it shifted the severity of these changes towards mild lesions and reduced the incidence of ulcerations from 25% to 2%. None of the patients developed a pneumonia caused by an organism previously isolated from the stomach. CONCLUSIONS: The incidence of stress lesions in children after cardiac surgery resembles that in high risk adult patients. Children in intensive care after cardiac surgery should be treated prophylactically with famotidine or pirenzepine until they can be fed by mouth.

Adolescent↗
PubMed1994

[Total cavopulmonary anastomosis: risk factors and results in patients under 4 years of age].

In recent years, an increasing number of modified Fontan-operations has been performed in children younger than 4 years of age. The purpose of this study was to identify preoperative risk factors in this age group. From February 1990 until February 1993, we performed in our center a modified Fontan-operation using the technique of total cavopulmonary anastomosis (TCPA) in 37 consecutive patients (17 pts. < 4 years = group I, 20 pts. > 4 years = group II). Early postoperative mortality occurred in patients of group I only (n = 3 pts.). All of these patients had additional preoperative risk factors. Pulmonary vascular resistance (PVRI) > 2 U x m2 was a significant risk factor for the younger patients while pulmonary artery size alone (expressed as the McGoon-ratio or Nakata-index) could not be identified as a separate risk factor. Using two additional indices (McGoon-ratio/PVRI and Nakata-index/PVRI), we were able to identify patients with unfavorable postoperative hemodynamics as high-risk patients. In our experience, TCPA can be performed in patients younger than 4 years of age with a low mortality, if there are no additional preoperative risk factors. For high-risk patients we recommend either a bidirectional Glenn-anastomosis as a first step procedure or a TCPA with fenestration of the intraatrial tunnel-patch.

Adolescent↗
PubMed1993

Doppler sonographic detection of increased flow velocities in the celiac trunk and superior mesenteric artery in infants with necrotizing enterocolitis.

Fourteen infants (gestational age 28.4 +/- 4.4 weeks; birth weight 1170 +/- 910 g) with clinical and radiological signs of necrotizing enterocolitis (NEC) were investigated by pulsed Doppler sonography. Pulsed Doppler recordings were performed in the celiac trunk and the superior mesenteric artery at an age of 15 +/- 10 days. The peak systolic, end-systolic, end-diastolic and time average velocities were measured and compared with the flow velocities of a healthy control group. Infants with NEC showed a significant increase in peak systolic and time average velocity within the celiac trunk and the superior mesenteric artery in comparison with healthy infants.

Blood Flow Velocity↗
PubMed1992

Diagnosis of neonatal aortic thrombosis by colour coded Doppler sonography.

We report on a neonate with complete aortic thrombosis following umbilical artery catheterization. Diagnosis was established by colour coded Doppler sonography which showed absent flow in the region distal to the thrombosis. After thrombolytic therapy with recombinant tissue plasminogen recanalization of the descending aorta could be shown by Colour Doppler imaging (CDI).

Aorta, Thoracic↗
PubMed1992

Diagnosis of moyamoya disease with additional renal artery stenosis by colour coded Doppler sonography.

Moyamoya disease is a rare vascular anomaly of the cerebral arteries. The etiology of the disease has not yet been clearly identified. We report the noninvasive diagnosis of Moyamoya disease in a patients with a very early onset of symptoms in infancy. The diagnosis was made by colour coded Doppler sonography and confirmed by angiography at the age of 6 months, following two episodes of cerebral infarction. A bilateral encephalodurosynangiosis was performed at the age of 7 months with subsequent slight improvement of the neurological deficits. Colour Doppler sonography revealed early vascularisation from the fascia temporalis graft into the arachnoid space. At the age of 10 months the patient developed arterial hypertension caused by left renal artery stenosis. Our case suggests, that in infancy Moyamoya disease can be suspected noninvasively by colour Doppler sonography of the cerebral arteries. Patients should be carefully screened for possible extracranial arterial stenoses which may develop in the course of time. Encephalodurosynangiosis seems to be a good therapeutic option for patients with severe neurological symptoms.

Cerebral Arteries↗
PubMed1991

Determination of the anatomical size of ventricular septal defects on the basis of hemodynamic data and noninvasive assessment of pulmonary to systemic vascular resistance ratio Rp/Rs by Doppler-echocardiography.

The pulmonary and systemic flow (Qp/Qs) and resistance ratios (RP/Rs) were determined in children with isolated ventricular septal defects (VSD) to derive an "effective defect resistance" (Rd/Rs) representing the ratios of the resistance of the defect to the systemic vascular resistance. The defect size (expressed as the ratio of the area of the defect to the cross-sectional area of the ascending aorta) was related to the calculated "effective defect resistance," where a significant (non-linear) correlation was found. The effective resistance of the defect is a useful aid for estimation of the anatomical size of a ventricular septal defect. The close correlation between anatomical size and the hemodynamic parameter Rd/Rs allows one to calculate the ratio Rp/Rs with this concept using noninvasive Doppler-ultrasound and echocardiography. This was performed in 21 children with VSD who underwent cardiac catheterisation. The noninvasive calculated flow ratio Qp/Qs and the resistance ratio Rp/Rs showed a close correlation to the values measured at cardiac catheterisation.

Cardiac Catheterization↗
PubMed1991

[Presystolic increasing maximal flow velocity in the intracranial vessels in 3 children with heart failure].

The doppler-sonographic examination of flow velocities in intracerebral arteries is of central importance in the diagnostic evaluation of potential neurologic complications in intensive care patients. Furthermore pulsed Doppler-sonography can assess the hemodynamic consequences of several congenital heart defects (e.g. the ductus arteriosus Botalli). Characteristics of the normal flow profile in the intracranial arteries are the systolic and diastolic forward flow caused by the "Windkessel" function of the aorta. Well known pathologic flow profiles (systolically and diastolically increased flow velocities, diastolically decreased flow velocities and diastolic retrograde flow) occur in neurologic and cardiovascular diseases. We have investigated three children after cardiac surgery, who showed a presystolic increase in the flow velocities, which is clearly different from the flow profiles mentioned above. In our opinion, this abnormal flow pattern is due to a decreased ventricular output in combination with an elevated central venous pressure in these patients.

Aortic Valve Stenosis↗
PubMed1991

[Faulty origin of the right subclavian artery from the pulmonary artery: a rare cause of subclavian steal syndrome in childhood].

A congenital subclavian steal syndrome may be caused by coarctation or interruption of the aortic isthmus or by isolation of a subclavian artery. We describe a patient with D-transposition of the great arteries, a left aortic arch, and isolation of the right subclavian artery which originated from the right pulmonary artery via a right ductus arteriosus. A subclavian steal syndrome was demonstrated noninvasively by echocardiography and doppler sonography of the cerebral arteries. We recommend routine cerebral doppler sonography for all infants with congenital heart disease and unilaterally weak brachial pulses. Since the long term outcome of the congenital subclavian steal syndrome is uncertain the aberrant subclavian artery should be reimplanted at the time of corrective cardiac surgery.

Angiocardiography↗
PubMed1990

Dopplersonographic classification of brain edema in infants.

25 infants, 23 newborns and 2 older infants with B-mode sonographic evidence of cerebral edema (gestational age of the newborns 39.1 +/- 2.1 weeks, weight 3270 +/- 672 g) were examined by means of pulsed Doppler sonography. Pulsed Doppler recordings were obtained in the anterior cerebral, internal carotid, basilar, and middle cerebral arteries. In all measured arteries the peak systolic peak endsystolic, peak enddiastolic and the time averaged mean velocities, as well as the resistance index and the pulsatility index were determined. In addition to the flow parameters the pH, pCO2, pO2, oxygen saturation and the blood pressure were measured. The flow velocities were compared with the normal values established by our group. Three different types of flow profiles and velocities could be found: Group 1: 12 infants had normal flow velocities. Group 2: 7 infants showed increased diastolic flow velocities. Group 3: 6 infants demonstrated decreased diastolic flow velocities. There were no significant differences according to gestational age, weight, pH, pCO2, pO2, oxygen saturation and blood pressure in the three groups. The outcome of the 12 children in group 1 was favourable: normal development 10; minor retardation 2. In group 2 only 1 child showed normal development; 2 infants had minor, 1 major handicaps; 2 infants died. Patients in group 3 had the worst outcome: no patient developed normally; 4 infants died; 2 severely handicapped infants showed polycystic leucomalacia and brain atrophy; 1 infant had minor psychomotoric problems.

Blood Flow Velocity↗
PubMed1990

[Life-threatening perinatal hemorrhage of a sacral teratoma].

Great sacral teratomas are rare congenital tumors. The frequency in liveborns is about 1:40,000. Well known complications of sacral teratomas are malignant degeneration, infection and, in case of intraabdominal expansion, compression of the urogenital tract. We report a case of unusual fulminant perinatal bleeding out of a great sacral teratoma ruptured during birth.

Cesarean Section↗
PubMed1989

Pulsed Doppler sonographic measurement of normal values for the flow velocities in the intracranial arteries of healthy newborns.

121 healthy premature born infants and full term newborns (corrected gestational age 29 to 45 weeks, weight at investigation 1070 to 3750 g) were investigated by pulsed Doppler sonography with a 5 MHz transducer. In all infants pulsed Doppler recordings were obtained from the internal carotid arteries (ICA), the basilar artery (BA) and both anterior cerebral arteries (ACA). From the flow profile the maximal systolic velocity (Vs), the endsystolic velocity (Ves) and the enddiastolic velocity (Ved), the time average velocity (TAV) and the time average maximal velocity (TAMX) as well as the resistance-index (RI) and the pulsatility-index (PI) were measured. For all parameters the relationship to the gestational age was analysed and normal values were established. There was a linear increase of all flow velocities with increasing gestational age. Vs in the ICA was about 20% higher than in the ACA and BA whereas Ves and Ved were not significantly different in the three arteries. The TAV in the ICA was 9% higher than in the ACA and 15% higher than in the BA. The TAMX in the ICA was 10% higher than in the ACA and 14% higher than in the BA. In contrast to the increase of the flow velocities neither the RI nor the PI showed a significant age dependency. For the RI in the ICA 0.77 +/- 0.08, in the ACA 0.73 +/- 0.08 and in the BA 0.72 +/- 0.09 were measured. The PI in the ICA was 3.0 +/- 0.08, in the ACA 2.7 +/- 0.09 and in the BA 2.7 +/- 0.7.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1989

[Doppler sonography determination of flow ratios Qp/Qs and resistance ratios Rp/Rs in isolated ventricular septal defect].

We present a model based on an electric analogon that describes the haemodynamic situation of an isolated ventricular septal defect. The model shows a way to estimate the ratio of pulmonary to systemic vascular resistance by Doppler sonographic measurements of pulmonary to systemic flow ratio (Qp/Qs) and the ratio between the size of the defect and the cross-sectional area of the aorta (Av/Aa). The ratio of pulmonary to systemic vascular resistance is theoretically given by: Rp/Rs = Qs/Qp + log (Av/Aa) * (1-Qs/Qp). Systemic to pulmonary flow ratio can be measured by Doppler echocardiography as well as Av/Aa; therefore, Rp/Rs can be estimated noninvasively by the equation given above. The values estimated noninvasively by Doppler echocardiography showed a good correlation with the haemodynamic data obtained at cardiac catheterisation.

Aorta, Thoracic↗
PubMed1989

[Colonoscopy: indications, procedure, results].

Colonoscopy in childhood is indicated as a valuable procedure mainly in rectal bleeding and suspected inflammatory bowel disease. Because of high efficiency and low complication rates this procedure should be used more often.

Adolescent↗
PubMed1988

[Age-dependent blood flow velocity in the cerebral arteries of newborn infants and infants measured by Doppler sonography].

In 121 prematurely born infants, newborn and older infants (age 1-30 days, weight at investigation 1070-3750 g) flow velocities in the anterior cerebral artery, the internal carotid artery and the basilar artery were measured. All investigations were performed by computerised pulsed Doppler sonography (Acuson 128), with a 5 MHz transducer. Maximal systolic, endsystolic, and end diastolic flow velocities were measured as well as the pulsatility index and the resistance index. The flow velocities showed a strong positive linear correlation with age. The pulsatility indices were independent of age. For all flow parameters normal values were estimated.

Basilar Artery↗