Subdural hygroma in infants with congenital toxoplasmosis (author's transl)

Cytological examination of the fluid from subdural hygromas revealed congenital Toxoplasmosis in 14 of 43 infants (32,5%). Conversely, subdural hygroma was a significant clinical symptom in 42 cases of congenital Toxoplasmosis. In 9 cases trophozoites or cystes of Toxoplasma Gondii were found in the subdural fluid, and in 4 of these in the cerebrospinal fluid as well. Since serological investigations in young infants and particularly severe infections often remain inconclusive the cytological examination of cerebrospinal fluid is emphasized importance of.     

Intracellular localisation of urea-cycle enzymes in liver (author's transl)

Enzymes of the Krebs-Henseleit urea-cycle were localized by means of differential centrifugation and fractional tissue extraction in rat liver and in human liver. Argininosuccinatlyase (ASAL) and Argininosuccinatsynthetase (ASAS) represent enzymes of the soluble cytoplasmic fraction. Ornithine-ketoacid-transaminase(OKT), carbamyl-phosphate-synthetase (CPS) and ornithine-carbamyl-transferase (OCT) are localized in the mitochondrial and nuclei fractions of the liver cell. Most of the arginase activity is bound to subcellular structures (probably to nuclei). A small portion of arginase-activity was found in the soluble cytoplasmatic fraction. The enzymes of the Krebs-Henseleit urea-cycle are equally distributed in rat liver and in human liver. Differences in the subcellular localisation of (mitochondrial) enzymes in human liver could be attributed to mitochondrial breakage during tissue preparation and do not represent in-vivo conditions.     

Pseudoatresia of the oesophagus in the newborn infant (author's transl)

Pseudoatresia of the oesophagus seems to occur more frequently than assumed from the cases actually diagnosed. With reference to an appropriate case its traumatic origin is discussed and is considered to be closely connected with anatomical facts and special circumstances arising in newborn infants. Clinical symptoms, therapy and prophylaxis are pointed out. Common oesophageal atresia is the most important condition to be ruled out in the differential diagnosis.     

CT and MR in infants with pericerebral collections and macrocephaly: benign enlargement of the subarachnoid spaces versus subdural collections

PURPOSE: To compare CT and MR in the differentiation of benign enlargement of the subarachnoid spaces and subdural collections in infants with macrocephaly. METHODS: MR was performed in 19 infants with macrocephaly, showing bifrontal enlargement of the subarachnoid spaces on CT. RESULTS: In 11 patients, a single fluid layer could be distinguished on MR of the pericerebral collections, suggesting benign enlargement of the subarachnoid spaces. In eight patients, two separate layers were clearly differentiated, an outer layer that was hyperintense on all sequences and an inner layer with the same intensity as the cerebrospinal fluid. This indicated the presence of subdural collections. These collections were mainly frontal in six and extended over the entire hemisphere in two patients. On CT, these separate lesions were seen only in three patients and missed in three others. In two final patients, CT findings were equivocal with evidence of membrane formation within the hypodense collections. In seven patients with a subdural collection, subdural-external drainage was performed. In three patients, the collection was hemorrhagic. The protein content of the fluid showed a mean of 1381.7 +/- 785.6 mg/dL. The MR and surgical findings of a subdural collection correlated with the absence of a family history of macrocrania, an age under 5 months, and acute clinical signs of vomiting, somnolence, and hypotonia. CONCLUSION: MR appears essential in the differential diagnosis between benign enlargement of the subarachnoid spaces and subdural collections in infants.     

Hemangioma simplex of the larynx in an infant (author's transl)

Symptoms of inspiratory stridor, dyspnoa and cyanosis appeared in a four month old boy. After the direct laryngoscopy and biopsy a hemangioma simples of the larynx was diagnosed. The tumor itself was successfully treated by cryosurgery. The advantages of this therapy were pointed out and the cryosurgery can be recommended in cases of larynxangioma.     

Vater or Vacterl syndrome (author's transl)

Analysis of malformations in 65 newborns with limb anomalies, 39 with esophageal atresia with tracheoesophageal fistula, and 41 with anal atresia confirmed the nonrandom tendency for the defects of the VATER or VACTERL syndrome to associate together. 11 new patients with 4 or more of these anomalies were compared with 41 previously reported cases. There was good agreement with reference to the frequency of the major malformations noted in the VACTERL association. While anal atresia was not so common in our patients, cardiac anomalies and radial limb dysplasia occurred somewhat more frequently. In accordance with previous findings we also emphasize a single umbilical artery as one of the malformations in the spectrum of the VACTERL association (V = vertebral defects and vascular anomalies). Because of the high incidence of rib anomalies in our patients and in earlier cases with complete medical records it is suggested that the scope of the VACTERL association should be enlarged by this malformation. Thus the R in VACTERL would stand not only for renal defects but als for rib anomalies. Furthermore, the spectrum of anomalies could be extended by auricular defects (A = anal atresia and auricular defects). When one of these VACTERL components is found attention should be drawn to the possibility of the presence of the other associated anomalies. The developmentally correlated malformations seen in the VACTERL syndrome are generally sporadically observed. At the present time the etiology is unknown but heterogeneity is suggested. Although a causal relationship between maternal intake of progesteron/estrogen during the vulnerable period of embryogenesis and the VACTERL syndrome has been suggested, none of the mothers of our patients were exposed to these hormones during early pregnancy. Cytogenetic investigation in one patient and his mother showed a so-called marker chromosome 9 (C9qh+ variant) which is difficult to interpret at the present time.     

Connexions between instrumental delivery and cerebral damage in the infant (author's transl)

An interdepartmental investigation was carried out on the incidence of brain injury, especially so-called minimal brain injury, after instrumental delivery of infants by means of forceps or vacuum extractor. There is no statistically-significant difference in the incidence of brain injury in infants delivered by means of forceps as compared with the vacuum extractor; there is, however, a significant increase in incidence of brain injury in infants following instrument-aided delivery as opposed to spontaneous delivery. A thorough explanation of the methods is given and the results are discussed.     

Prolonged endotracheal intubation or tracheostomy in children (author's transl)

Five patients with subglottic tracheal stenosis following prolonged endotracheal intubation are reported. To minimize tracheal stenosis the indications for prolonged intubation should be well defined and tracheostomy considered as an alternative. The incidence of tracheal stenosis following prolonged intubation is stimilar to that following tracheostomy. The risk of stenosis increases with the duration of intubation, the degree of physical trauma to the laryngotracheal mucosa (suction, tube changing, restlessness), infection of the trachea or larynx, and with the age of the child. Prolonged intubation necessitates sedation and intensive care. Tracheostomy has a higher mortality but this and the risk of stenosis depend greatly on the operative technique. Particularly in cases where prolonged intubation increase the risk of tracheal stenosis, the advantages of tracheotomy become evident. Tracheostomised children rarely need sedation, the tracheobronchial tree can be easily and carefully toileted and the changing of the tube is without risk. Neither method is absolutely preferable, but the correct application of both will minimise the complication rate. The indications for each may be summarised as follows: for primary treatment of acute respiratory distress in children prolonged intubation is the treatment of choice. If after 3 days there is no chance of extubation, tracheostomy should be considered but this depends also on the child's age and behaviour, and on the laryngotracheal mucosal reaction. The younger the child the more cautiously should tracheostomy be considered. Children under 2 years of age should only be tracheostomised if there is no alternative.     

Dumping-prophylaxis (author's transl)

The dumping syndrome is due to a vigorous reflex distension of the jejunum, caused by the stomach violently evacuating its contents. The aim of treatment is to overcome the drastic evacuation by restoring the rhythmic peristalsis of the stomach (eukinetics). This can be achieved by a special diet. Every meal should begin with well chewed solids (pulp) and avoid all fluids. With a well organised medical staff a complete success can be achieved. Surgical measures in Dumping can be avoided.