Introduction: Posttraumatic cerebral oedema may be resistant to therapy despite maximal intensive care treatment. In such cases an on time decompressive craniectomy may be helpful. The indication and outcome are presented.

Fragestellung: NSE (glykolytisches Enzym in Neuronen und neuroendokrinen Zellen) und Protein S-100B (Ca2+-bindendes Protein in astroglialen und Schwannschen Zellen) sind bekannte neurobiochemische Marker, die zur Beurteilung des Schweregrades einer hirnorganischen Schädigung herangezogen werden können. Die Untersuchung dieser Parameter im Serum von hirntraumatisierten Kindern sollte die praktische Relevanz in Zuordnung zu weiteren Beurteilungskriterien (Glasgow-Coma-Scale, kranialer Bildgebung, stationäre Behandlungszeit und Outcome herausarbeiten.

BACKGROUND:Chlamydophila pneumoniae was frequently found in bronchial secretions of children with therapy-refractory bronchitis or pneumonia. It was studied, how the agent modifies the course of disease and what findings are associated with the infection.PATIENTS AND METHODS:Bronchial secretions obtained at bronchoscopy of 428 children were studied for C. pneumoniae infection using polymerase chain reaction with enzyme immunoassay detection. Children tested negative and positive were compared for their clinical findings.RESULTS:C. pneumoniae was found in 143 children (33 %). A C. pneumoniae infection has been found to be associated with a purulent bronchial inflammation (90/143 vs. 144/285, p = 0.02), a Streptococcus pneumoniae co-infection (13/143 vs. 6/285, p = 0.002) and a restrictive disturbance (11/51 vs. 8/93, p = 0.04). Purulent inflammation (Odds ratio 7.9; 95 % confidence interval [CI] 1.6-39.3), 2 co-infections (Odds ratio 14.3; 95 % CI 1.4-144.4) and co-infection with M. pneumoniae (4/4 versus 9/26, p = 0.03; Mantel Haentzel 3.0; 95 % CI 1.1-8.0) were identified as factors more often associated with a restrictive disturbance in children with bronchial C. pneumoniae infection. An adequate antibiotic therapy improved pulmonary function. No association was found for wheezing, eosinophil inflammation of the nasal mucosa, alpha-1 antitrypsin or immunoglobulin deficiency in serum, level of secretory IgA in bronchial mucus, pathological lung scintigram, gastro-esophageal reflux disease, sweat test and other co-infections.CONCLUSIONS:In children with therapy-refractory bronchitis or pneumonia bronchial C. pneumoniae infection was associated with a more severe disease in case of several, mostly bacterial co-infections. Adequate antibiotic therapy for C. pneumoniae infection has been demonstrated to improve pulmonary function.

Problemstellung: Rasch proliferierende Raumforderungen im Halsbereich erfordern eine Notfalldiagnostik dieser vital sensiblen Region. Zur Primärdiagnostik für die Halsweichteile scheint die nichtinvasive Sonographie besonders im Kindes-und Jugendalter geeignet zu sein. Bei einem Fall mit zervikothorakalem Non-Hodgkin-Lymphom wurde der Stellenwert der Ultraschallbefunde mit weiteren bildgebenden Verfahren verglichen.

An 8-year old girl from Kazakhstan after unremarkable pregnancy and perinatal period, presented at our hospital with progressive loss of mental functions and gait ataxia since the age of six. Neurologic examination revealed spastic tetraplegia with preference of the lower limbs, mild ataxia, dysarthria and bilateral large and unresponsive pupils.

Problemstellung: Pelvine Tumoren sind im Kindesalter selten und werden oft erst nach klinisch sichtbarer Raumforderung erkannt. Häufig gibt die sonographische Primärdiagnostik Hinweise zu Lage, Größe und Textur. Solide Tumoren müssen bis zum Ausschluss als maligne angesehen werden.

The Chiari-syndrome Type I being a malformation of the posterior cranial fossa often leads to syringomyelia. The disease becomes apparent in adolescence with kyphoscoliosis, headache, vertigo, ataxy, hearing loss, partial paralysis and other neurological disorders. The onset is typically characterized by dissociated anesthesia, due to the frequent localization of the syrinx in the neighborhood of the posterior column of the spinal cord. It is reported a case of an 15-years-old-girl suffering from intensive headache, recurrent left-sided paresthesias and progredient scoliosis. Somatosensory evoked potentials of left ulnar and tibial nerves revealed a complete loss of cortical response. Diagnostic imaging showed an Chiari-malformation I with herniation of cerebellar tonsils and secondary syringomyelia of the cervical spinal cord. After surgical treatment with posterior fossa decompression, C1 laminectomy and partial excision of cerebellar tonsils the patient had a clear improvement in symptoms. Postsurgical the width of cervical syrinx decreases. Now somatosensory evoked potentials of the left ulnar and tibial nerves show amplitude-reduced cortical responses with a normal latency.

Die stationäre Aufnahme erfolgte in deutlich reduziertem Allgemeinzustand mit seit 2 Tagen bestehenden Schmerzen rechts collar, Ruhedyspnoe, Husten und blutigem Expektorat. Es bestand ein obstruktives Atemgeräusch über allen Lungenabschnitten bei Minderbelüftung der rechten Thoraxhälfte und Klopfschalldämpfung im rechten Oberfeld.

. Background: The importance of Chlamydia pneumoniae respiratory tract infection in childhood is under discussion. Patients and Methods: 798 hospitalized children with respiratory tract diseases were prospectively studied during a 2-year period by polymerase chain reaction and enzyme immunoassay (PCR-EIA) detection from throat swabs. Paired serum samples were used to screen for Chlamydia antibodies. Results: C. pneumoniae was detected by PCR-EIA in 74 children. Prevalence was 11% in lower and 4% in upper respiratory tract disease (p = 0.049) without age dependency. From November to February prevalence was elevated (42/277 vs. 32/521; p < 0.001). Using serology, prevalence of acute Chlamydia infection increased with age (p < 0.001) and the number of coinfections (p < 0.001), without seasonal variation. Conclusion: Characteristics of C. pneumoniae carriage in the respiratory tract in childhood differ from those in systemic infection.

The Chiari-syndrome Type I being a malformation of the posterior cranial fossa often leads to syringomyelia. The disease becomes apparent in adolescence with kyphoscoliosis, headache, vertigo, ataxy, hearing loss, partial paralysis and other neurological disorders. The onset is typically characterized by dissociated anesthesia, due to the frequent localization of the syrinx in the neighborhood of the posterior column of the spinal cord. It is reported a case of an 15-years-old-girl suffering from intensive headache, recurrent left-sided paresthesias and progredient scoliosis. Somatosensory evoked potentials of left ulnar and tibial nerves revealed a complete loss of cortical response. Diagnostic imaging showed an Chiari-malformation I with herniation of cerebellar tonsils and secondary syringomyelia of the cervical spinal cord. After surgical treatment with posterior fossa decompression, C1 laminectomy and partial excision of cerebellar tonsils the patient had a clear improvement in symptoms. Postsurgical the width of cervical syrinx decreases. Now somatosensory evoked potentials of the left ulnar and tibial nerves show amplitude-reduced cortical responses with a normal latency.

More than 90% of all bacterial meningitis cases result from hematogenous dissemination of the bacteria during bacteriemia. It is seldom to witness an ascending infection over cerebrospinal fluid fistula in malformations (e.g. myelomenigocele ) or after head trauma, or even continuous infection during sinusitis or mastoiditis. Antrotomy (on both sides) was preformed in an 18-month-old girl with celiac disease suffering from a subacute mastoiditis at that time. Three months later the girl suffered from a pneumococcal meningitis that was treated accordingly with antibiotics. Surgical therapy was performed later on the left lateral skull-base after diagnosis of cerebrospinal fluid otorrhea (dura laceration). Seven months later, the child was admitted again with pneumococcal meningitis. The CT and MRT scans revealed a skull defect on the left petrosal bone with protrusion of brain tissue, however without a fistula; surgical therapy was performed once again. After several surgical revisions on the skull-basis, it is advisable to take into account the possibility of an ascending infection through a cerebrospinal fistula especially in patients with a history of meningitis. Surgical closure of the fistula is an obligation.

Untersuchungen an Kindern mit Mukoviszidose zeigen, dass akute infiltrative Veränderungen mit hoher Sensitivität erkannt werden können.Andere Aspekte, wie beispielsweise Ventilationsraumveränderungen durch Emphyseme oder chronische Fibrosen mit Diffusionsstörungen werden mit der MRT nicht adäquat reflektiert. Deshalb wurden (zunächst am Tiermodell) Möglichkeiten einer komplexen, bildgebend und funktionell orientierten Lungendiagnostik erprobt. Wichtige Resultate der tierexperimentellen Studie werden demonstriert, insbesondere solche Aspekt, die sich schon jetzt aus dem tierexperimentellen Stadium in die klinische Forschung überführen lassen. Hierzu gehört die Visualisierung von inhaliertem molekularem Sauerstoff, sowie die Erkennung von obstruktiv überblähten Lungenarealen durch eine Exspirationstechnik nach der Inhalation eines Bronchialkonstriktors. Die Lungenperfusionsbeurteilung ist diejenige Lungenfunktion, die in Form der pulmonalen MRA eine Beurteilung bis in die Subsegmentebene erlaubt und Eingang in die klinische Praxis gefunden hat. Mit einer optimierten Bolustechnik und Akquisitionszeiten von 3–5 Sekunden lassen sich auch periphere Perfusionsdefekte nachweisen. Die Diffusionsstörungen der Lunge ließen sich bisher bildgebend nicht erkennen. Mit Hilfe der Gadolinium-Inhalation scheint auch für diese Lungenfunktion eine Quantifizierung möglich. Patientenuntersuchungen liegen hier aus zulassungsrechtlichern aus Gründen noch nicht vor. Die tierexperimentellen Untersuchungen belegen, dass eine MR-tomographische Beurteilung der wichtigen Lungenfunktionen möglich ist. Erste Untersuchungen an Patienten zeigen, dass sich schon zum jetzigen Zeitpunkt einige der erzielten tierexperimentellen Ergebnisse auf Patienten übertragen lassen.

Introduction: Skeletal Tuberculosis is a result of haematogenous spreading of Mycobacterium tuberculosis and manifests itself mainly in the vertebral column. It is a late complication of tuberculosis and has become a veryrare entity since the introduction of antituberculous therapy. Case Report: A 2-year-old boy was presented to us after he fell off on the right leg. He avoided walking for a while after which he continuously limped but without restriction of movement of the particular leg. Clinical recovery was observed after a month. During the course of time, recurrent periods of low-grade intermittent fever without clinical inflammatory signs were documented. Diagnosis: The skeletal scintigraphy revealed high activity and perfusion of the distal right tibia. The Tuberculin skin test (10TU) was negative. Chest radiographs showed no signs of pulmonary tuberculosis whereas a long periosteal reaction on the right tibia was revealed on the leg radiograph. The resultant biopsy showed a fibrous, myxoid bone lesion. Mycobacterium tuberculosis were detected through PCR and were microscopically documented after enrichment in Bouillon. An antituberculosis chemotherapy with INH, RMP and PZA over a period of 6 months was initiated. Conclusion: In skeletal processes, it is mandatory to always think about the possibility of skeletal tuberculosis even though the Mantoux test has turned out to be negative; malignant diseases must of course have to have been ruled out!

GER can be treated either by physical means (positioning) or by medical therapy with antacidic or prokinetic drugs. The different prokinetic drugs have to be throroughly tested in order to find out the best drug for the individual patient. Twenty four (24)-hour pH-monitoring of the distal esophagus was carried out in 63 children (age range 3 months-16 years) with recurrent or chronic respiratory diseases. Thirty three (33) of the patients (52%) had a GER. In 24 patients with GER therapy tests with metoclopramide (Cerucal®), cisapride (Propulsin®) and a placebo were carried out under pH-monitoring. The most effective drug was then administered to the patient for 6 weeks and 12-17 weeks thereafter another pH-monitoring was initiated (control). The 2 prokinetic drugs showed a marked reduction of the reflux episodes although cisapride had upper hand by affecting more reflux parameters as compared to metoclopramide. The effectiveness of cisapride was witnessed mostly when the stomach was empty and during the end of sleep. Only 2/19 patients had GER at the end of therapy. We are going to discuss the various mechanisms of cisapride and metoclopramide in regard to their influences on GER especially in children with chronic bronchopulmonary diseases.

An 11-year-old girl presented with recurrent vomiting, reduced food and fluid intake, weight loss and dizziness. In an external hospital she was diagnosed as having habitual vomiting and a beginning eating disorder. The physical examination revealed a very thin, malnourished child with abdominal pain on palpation but without neurologic deficits. Laboratory findings, X-rays, endoscopy and ultrasound revealed no pathological results either. Since the EEG and the cranial computed tomography (CT) were normal, we also suspected the beginning of an eating disorder especially due to some psychical peculiarities. The MRI which was done for ultimate exclusion of an infratentorial tumor showed a well defined displacing structure in the dorsal medulla oblongata and in the upper cervical spinal cord. A corresponding prolongation of the central conduction time was found in the median nerve SSEP whereas the BAEPs were normal. The tumor was excised in toto and the histological examination confirmed the suspected diagnosis of cavernous hemangioma (cavernoma). The post operative phase was without any complications and the intiated nutrition was well tolerated. Neurological deficits were not observed.

Nystagm is found as a symptom in different conditions that can affect various organs of the body. It always requires sophisticated diagnostic procedures, including radiologic imaging, consultation of ENT and ophthalmologic specialists and electrophysiological measurements. Case report: The child presented with ocular flutter that parents noted from about the 9th week after birth, otherwise he had developed normally so far. MRI of the brain showed enlargement of internal and external cerebrospinal space, so that a neurodegenerative disorder was suspected. On examination cerebrospinal fluid had normal cell count and differenciation, protein and lactat content. The diagnosis was made by the experienced ophthalmologist, who discovered altered pigmentation in iris and retina, disclosing ocular albinism. Visual evoked potentials showed an asymmetry in cortical potentials that confirmed the diagnosis. Conclusion: Underlying disorder causing the nystagm in our patient is an ocular albinism. Albinism is caused by a disorder in biosynthesis and distribution of melanin, it affects about ½0,000 people. In the case of our patient the enlargement of cerebrospinal space and albinism seem to appear coincidentally, further ophthalmologic and neuropediatric follow-ups are definitely necessary.

Decompressive craniectomy can be the ultimate therapeutic possibility of severe traumatic brain edema. Indications, surgical techniques and results are presented.