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Biomedical subjects

V Klingmüller

Publications and source records attributed to V Klingmüller.

At least 19 recordsLinked to original sources
PubMed1992

[Risk of cerebral hemorrhage in premature and mature newborn infants].

We launched a prospective cranial ultrasound screening study at the Maternity Hospital of the University of Giessen to examine the incidence and severity of brain damage in newborns. More than 90% of all neonates born during 1984-86 were included in the study (n = 2781) and were screened for cerebral abnormalities on 5.9 +/- 3.3 (SD) day post partum. There were in 7.8% sonographic abnormalities, the most frequent being peri/intraventricular haemorrhages (5.2% PIVH of various degrees (grade I-III). Periventricular leucomalacia, porencephalia, subarachnoidal haemorrhages, and hydrocephali were rare (less than or equal to 0.2%). The incidence of PIVH increased progressively with decreasing gestational age, e.g. from 1.5% at 41 weeks up to 61% at 24-30 weeks of gestation. A large percentage of babies with cerebral haemorrhages were clinically normal. There was a close inverse relationship between the Apgar score at 1,5 and 10 min and both incidence and severity of PIVH. However, the relation between PIVH and both cardiotocography (matched-pairs analysis) and arterial cord blood-pH was poor. The incidence of PIVH was increased in growth retarded newborns (pH less than or equal to 7.29), preterm multiples and amnionitis, but not after preeclampsia and premature rupture of membranes. It is interesting to note that, in mature newborns (greater than or equal to 38 weeks), there was no difference in the incidence of PIVH between spontaneous deliveries, vacuum extractions, and Caesarean sections, and that there was no difference between vaginally delivered (1.5%) and sectioned breech presentations (3.5%) in this group. In preterms at 35-37 weeks with protracted labour and secondary Caesarean section, the incidence of PIVH was high (19%). We conclude, that neonatal cranial ultrasound screening is an important tool for risk assessment and quality control in obstetrics. It clearly improves both the quality of the advice given to the patients and the clinical management of high-risk pregnancies.

Acid-Base Equilibrium↗
PubMed1992

[Characteristics of thyroid sonography in infants and children].

In a prospective study the thyroid glands of 598 healthy boys and girls (newborn to 17 years old) were examined by ultrasound. The volume of the normal gland was 1.1 cm3 in neonates, 2 cm3 in 4 year-old-children, and 8.7 cm3 in schoolchildren. The gland of a normal newborn, a girl with congenital hypothyroidism, a girl with inflammation of a median cervical cyst, a girl with insulin-dependent diabetes mellitus and autoimmune thyroiditis, and a girl with an adenoma all showed typical differences in ultrasonic structure from the normal adult gland. Sonography of the thyroid gland discloses valuable information, especially in childhood.

Adolescent↗
PubMed1991

[Ultrasonographically determined thyroid gland volume in children].

The size of the thyroid was evaluated by sonography in 199 boys and 237 girls age one month to 17 years. The volume is 1.2/1.06 ml in boys/girls during the first month, 1.2/1.6 ml at the end of the first year of life, 1.7/2.4 ml at age four, 3.2/3.4 ml with eight years and up to the age of 12 years 5.7/5.7 ml. In juveniles older than 12 years the average volume is 8 ml, sex independently. However, the range appears to be rather wide (1.5-14.5 ml). The right lobe is usually larger than the left one. The rates of the length of the right lobe and the body length, of the total volume and the body weight, and of the total volume and the body surface area are almost independent of age for schoolchildren. There is no significant difference of the thyroid volume between the sexes.

Adolescent↗
PubMed1990

[The vascularized pedicled flap of superior gluteal artery to hip bone chip--a new concept in the revascularization of hip necrosis in adults].

The development and introduction of microsurgical technique has made possible completely new concept of revascularisation surgery in femoral head necrosis. The bone graft described in this presentation is a pedicled one from the lateral ilium. In five femoral head necrosis a pedicled corticocancellous pelvic graft, supplied by the deep branch of the superior gluteal artery, was transplanted in the femoral head. In all cases it was possible to lift out the pelvic graft from the same side as the affected hip joint. Contrary to the medial iliac bone graft (deep circumflex iliac artery) the lateral iliac bone graft (deep branch of the superior gluteal artery) is inserted into the femoral head dorsally. Preoperatively and postoperatively performed selective angiographies are necessary and presented. In all cases an unimpeded perfusion could be shown three months postoperatively. Advantages and indications of the pedicled bone graft are discussed.

Adult↗
PubMed1990

[Efficacy and side effects of differential calcium and phosphate administration in prevention of osteopenia in premature infants].

The prevention of osteopenia and frequency of renal and intestinal side effects of mineral supplementation was studied in 24 preterm infants with birth weight under 1,500 g, prospectively (gestational age 26-34 weeks). Calcium intake varied from 2.5 vs. 3.75 vs. 5 mmol/kg/day, phosphate was offered in dose of 2.5 mmol/kg/day. At the expected birth date 40% of infants with low calcium dose showed an activity of serum alkaline phosphatase greater than five times the maximum adult normal value which is defined as a reliable marker; for osteopenia no infant with medium or high calcium intake reached this critical value (p = 0.03). Medium and high calcium doses resulted in an increased risk for hypercalcuria (25 vs. 50%) (p = 0.03). Half of these infants developed typical signs of nephrocalcinosis on ultrasound examination. No significant difference of fecal fat content was observed with increased calcium intake; but more episodes of abdominal distension occurred during the first days of high calcium supplementation (p = 0.03). We conclude, that a calcium intake of 3.75 mmol/kg/day in combination with phosphate 2.5 mmol/kg/day is sufficient for adequate bone mineralization on a low level of side effects. Calcium excretion in urine has to be observed for early diagnosis of nephrocalcinosis.

Alkaline Phosphatase↗
PubMed1989

[Sonography of the thyroid gland in children].

The total volume of the thyroid gland is 1.2/1.0 ccm in male/female newborns; it increases with age up to 7.4 ccm in boys and 7.5 ccm in girls (13-16 years). The relation of total thyroid volume and body surface area is without a significant sex difference 4.5/4.8 ccm/sqm in newborn and about 4.8 ccm/sqm in children aged more than 9 years. Thyroid disorders to be discussed are a cyst, a nodule with an echo-free centre, connatal athyreosis and goitre.

Adolescent↗
PubMed1989

[Ultrasonic evaluation of multicystic ovaries in childhood].

High resolution real-time ultrasound showed multicystic pattern of the ovaries in 30 prepubertal infants. In three neonates the cystic abdominal tumour was known since the 33/34 gestational week; the sonographic diagnosis of ovarian cyst was confirmed by the pathologist. The ultrasound study was carried out in 10 patients with suspected idiopathic precocious puberty, whereas in 17 patients, almost 2/3 of the remaining 27 girls, the multicystic ovaries were a fortuitous finding. The maximal diameter of the cysts was 8 mm in multicystic ovaries, one solitary cyst was 13 mm. The follow-up study of 13 patients demonstrated a change in the sonographic pattern. The multicystic structure of the prepubertal ovary is a common finding and must be interpreted as normal.

Adolescent↗
PubMed1989

[The femoral neck pseudarthrosis following medial femoral neck fracture. An indication for the vascularized pedicled iliac crest transplant].

Revascularisation surgery was performed in six cases following medial femoral neck fracture with femoral head necrosis and non-union of the femoral neck. A corticospongiosis pelvic graft supplied by the deep circumflex iliac artery was implanted as an autologous heterotopic pedicled transplant. The operative procedure was the same in all cases, since it was possible to lift out the pelvic graft from the same side as the affected hip joint, thus making a microvascular anastomosis unnecessary. Follow-up examination after 15-27 months revealed that, in all cases, osseous consolidation of the pseudarthrosis had been achieved and that further segmental collapse of the contour of the femoral head had been prevented. The angiographic studies performed during the examination demonstrated unimpeded circulation in the pedicle of the transplants in five of the six cases, as long as 3 months after the operation. For the first time it was possible in these five cases, by means of a transplant angiograph, to demonstrate integration of the graft into the biologically weak post-traumatic transplant region.

Bone Transplantation↗
PubMed1989

[Functional pictures in superselective angiography of the femur head vessels].

The arterial supply of the femoral head was studied by Hipp. Superselective angiographies in different positions of the hip joint contribute informations especially about the smaller vessels e.g. rami nutritii capitis. Angiographies in different positions of the hip joint were performed in twenty cases. Furthermore the results of functional stress angiographies of five patients, who underwent the transplantation of pedicle bone graft, are reported. These patients had femoral head necrosis. Especially these postoperative examination demonstrates in one case impressive deterioration of the perfusion of the pedicle bone graft in some positions of the joint.

Angiography↗
PubMed1988

[What significance does superselective angiography of the hip joint have in femur head necrosis of the adult before and after management with a vascular pedicled ileal crest graft?].

The use of microsurgical techniques in orthopaedics makes it possible to revascularize the necrotic femoral head in adults. Superselective angiography improves preoperative planning. Furthermore, using this method postoperative perfusion control of the pedicle bone graft can be carried out. This paper reports on a special way of positioning the pelvis, as well as on the results of angiography in various functional positions of the hip joint.

Adult↗
PubMed1988

[Superselective electronic subtraction angiography. Experience in 6 surgically treated hips using the double cup prosthesis].

Six hips in five patients with Wagner double cup surface replacement prostheses were examined by superselective angiography of the medial femoral circumflex artery to determine a possible relationship between a lesion of the artery and loosening of one or other components of the prosthesis. Electronic subtraction of the angiographic images allowed a precise appreciation to be made of the condition of the vessels. No relationship was found. Lesions of the medial femoral circumflex artery were found, even when the prosthesis was firmly in place. This finding is contrary to that of authors who consider that an extra-osseous vascular lesion always leads to bone necrosis and loosening in double cup surface replacement prostheses.

Adult↗
PubMed1987

[Angiographic control of treatment of femur head necrosis with a pedicled pelvic bone graft].

A new operative method is introduced in the therapy of the idiopathic necrosis of the femoral head. This operation is based on the idea, that ischaemic processes play an important role in the origin of the idiopathic necrosis of the femoral head. The transplantation of a pedicle bone graft should provide a good arterial supply. 28 Preoperative superselective angiographies of the A. circumflexa femoris medialis showed pathological findings in 17 cases. A good supply of the bone graft was found in 4 from a total of 7 postoperative angiographies of the reset A. circumflexa ilium profunda.

Angiography↗
PubMed1985

[Enteral resorption of ioxitalamate].

Ioxitalamate is a water-soluble, iodine-substituted contrast medium, now available in an oral presentation. Its enteral absorption was studied in an open trial (n = 10). In the 24 hours after the maximum clinical dose (100 ml of the solution--equivalent to 66 g meglumine ioxitalamate, 30 g iodine), the mean excretion of iodine in urine was 126 mg. This is equivalent to an absorption rate of 0.4% of the administered dose.

Administration, Oral↗
PubMed1984

[Status of sonography versus roentgen and computed tomography in the diagnosis of nephrocalcinosis].

Sonography proves a highly sensitive instrument in recognition of nephrocalcinosis (nc). We demonstrate four cases of cortical and medullary nc of different etiology. While abdominal x-rays were unsuspective sonography demonstrated typical findings of nc. In the medullary type of nc the sonographic findings are typical. On the other hand cortical hyperechogenity does not prove nc but in extreme cases. Computerized tomography is able to measure Hounsfield Units and to demonstrate by this deposits of calcium without necessity of histology. We discuss the differential diagnosis of highly echogenic cortical and medullary renal tissue.

Child↗
PubMed1984

[Urinary alanine aminopeptidase excretion in children: reference values and effect of nephrotropic contrast media].

The catalytic activity of alanine aminopeptidase (EC 3.4.11.2) in urine shows a clear cut difference between boys (1530 mU/d X m2) and girls (1143 mU/d X m2). Nineteen children (preterms to 14 years) received contrast media (loxaglate (Hexabrix) (N = 15) or lotalamate (Conray 70) (N = 4] according to the diagnostic indication. The alanine aminopeptidase activity increases to 10-fold of the initial value in the loxaglate and 19-fold of the initial value in the lotalamate group. These results demonstrate a much higher response of the kidney to contrast medium in children than in adults.

Adolescent↗
PubMed1983

[Sonographic studies of gallbladder kinetics in childhood--a comparison between healthy and mucoviscidosis patients].

In mucoviscidosis, the gallbladder can show signs of disease even in childhood. In 10 of 35 mucoviscidosis patients the authors found thickening of the walls, gallstones and micro-gallbladders on sonographic examination. Compared with healthy children (N = 70), the mucoviscidosis patients showed impairment of the kinetics of the gallbladder to an increasing extent in step with progressing age. X-ray films of the gallbladder were preferably taken while using a preparation containing bile acids for better absorption of the contrast medium. When using this preparation, the gallbladder was found to yield good contrast more frequently than with double-dose cholecystography recommended in literature. However, oral cholecystography yielded additional information in one case only where sonography had failed to produce a clear sonographic image of the gallbladder.

Adolescent↗
PubMed1983

[Sonographic diagnosis of abdominal tumors in childhood].

The analysis of the case histories of 27 patients suffering from abdominal tumors - mainly localized within the retroperitoneal space - and observed during the last 4 years shows that sonography is the method of choice if an abdominal tumor is suspected. In only a few cases however a definite diagnosis was possible. In most cases additional roentgenologic methods such as intravenous pyelography, computerized tomography, rarely angiography and barium study were needed to get more information for diagnosis and treatment. On the other hand sonography should also be performed when there are uncharacteristic and ambiguous symptoms in order to detect tumors or systemic lymphatic diseases. Indication, results and sono-histologic patterns are discussed as is the importance of other imaging methods. Personal experience influencing the diagnostic procedure of dealing with abdominal tumors in children is reported in the second part of the paper including technical requirements of sonography equipment for use in children.

Abdominal Neoplasms↗