Publications by authors named "Jörg Jüngert"

27 Publications

  • Page 1 of 1

Pediatric Buried Bumper Syndrome: Diagnostic Validity of Transabdominal Ultrasound and Artificial Intelligence.

Ultraschall Med 2021 May 25. Epub 2021 May 25.

Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany.

Purpose:  Buried bumper syndrome (BBS) is a severe complication of percutaneous endoscopic gastrostomy (PEG) resulting from overgrowth of gastric mucosa and penetration of the inner holding plate into the gastric wall. The aim of this study was to evaluate the diagnostic value of transabdominal ultrasound (US) in comparison to an artificial intelligence (AI) model for the diagnosis of BBS in children.

Materials And Methods:  In this monocentric retrospective study, pediatric US data concerning BBS from a ten-year period (2009-2019) were analyzed. US findings were compared to a clinical multiparameter-based AI model and reference standard endoscopy. Clinical risk factors for the occurrence of pediatric BBS were determined.

Results:  In n = 121 independent examinations of n = 82 patients, the placement of the inner holding plate of the PEG was assessed by US. In n = 18 cases BBS was confirmed. Recall and precision rates were 100 % for US and 88 % for the AI-based assessment. Risk factors for the occurrence of BBS were mobilization problems of the PEG (r = 0.66, p < 0.001), secretion/exudation (r = 0.29, p = 0.002), time between 1 PEG placement and US (r = 0.38, p < 0.001), and elevated leukocyte count (r = 0.24, p = 0.016).

Conclusion:  Transabdominal US enables correct, rapid, and noninvasive diagnosis of BBS in pediatric patients. Preceding AI models could aid during diagnostic workup. To avoid unnecessary invasive procedures, US could be considered as a primary diagnostic procedure in suspected BBS. .
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http://dx.doi.org/10.1055/a-1471-3039DOI Listing
May 2021

Contrast-enhanced ultrasound of benign and malignant liver lesions in children.

Pediatr Radiol 2021 May 12. Epub 2021 May 12.

Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.

Contrast-enhanced ultrasound (CEUS) is increasingly being used in children. One of the most common referrals for CEUS performance is characterization of indeterminate focal liver lesions and follow-up of known liver lesions. In this setting, CEUS is performed with intravenous administration of ultrasound contrast agents (UCAs). When injected into a vein, UCA microbubbles remain confined within the vascular network until they dissipate. Therefore, visualization of UCA within the tissues and lesions corresponds to true blood flow. CEUS enables continuous, real-time observation of the enhancement pattern of a focal liver lesion, allowing in most cases for a definite diagnosis and obviating the need for further cross-sectional imaging or other interventional procedures. The recent approval of Lumason (Bracco Diagnostics, Monroe Township, NJ) for pediatric liver CEUS applications has spurred the widespread use of CEUS. In this review article we describe the role of CEUS in pediatric liver applications, focusing on the examination technique and interpretation of main imaging findings of the most commonly encountered benign and malignant focal liver lesions. We also compare the diagnostic performance of CEUS with other imaging modalities for accurate characterization of focal liver lesions.
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http://dx.doi.org/10.1007/s00247-021-04976-2DOI Listing
May 2021

Contrast-enhanced ultrasound of the small organs in children.

Pediatr Radiol 2021 Apr 8. Epub 2021 Apr 8.

Department of Radiology, King's College Hospital, Denmark Hill, London, UK.

In pediatric and adult populations, intravenous contrast-enhanced ultrasound (CEUS) remains off-label for imaging of organs other than the liver and heart. This limited scope inhibits potential benefits of the new modality from a more widespread utilization. Yet, CEUS is potentially useful for imaging small organs such as the thyroid gland, lymph nodes, testes, ovaries and uterus, with all having locations and vasculature favorable for this type of examination. In the adult population, the utility of CEUS has been demonstrated in a growing number of studies for the evaluation of these small organs. The aim of this article is to present a review of pediatric CEUS of the thyroid gland, lymph nodes, testes, ovaries and uterus as well as to draw from the adult literature indications for possible applications in children.
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http://dx.doi.org/10.1007/s00247-021-05006-xDOI Listing
April 2021

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB): An Update on the Pediatric CEUS Registry on Behalf of the "EFSUMB Pediatric CEUS Registry Working Group".

Ultraschall Med 2021 Jun 9;42(3):270-277. Epub 2021 Mar 9.

Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland.

The European Federation of Ultrasound in Medicine and Biology (EFSUMB) created the "EFSUMB Pediatric Registry" (EFSUMB EPR) with the purpose of collecting data regarding the intravenous application of pediatric contrast-enhanced ultrasound (CEUS). The primary aim was to document the current clinical practice and usefulness of the technique and secondarily to assess CEUS safety in children. We issue the preliminary results of this database and examine the overall practice of CEUS in children in Europe.
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http://dx.doi.org/10.1055/a-1345-3626DOI Listing
June 2021

Lung ultrasound in children, WFUMB review paper (part 2).

Med Ultrason 2021 Mar 3. Epub 2021 Mar 3.

Institute of Mother and Child, Cystic Fibrosis Department, Warszawa, Poland.

Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. In the current World Federation of Societies for Ultra-sound in Medicine and Biology (WFUMB) paper series so far (part I) the topic has been introduced and the technical require-ments explained. In the present paper the use of US in the lung in paediatric patients is analysed. Lung diseases including the interstitial syndrome, bacterial pneumonia and viral infections, CoViD findings, atelectasis, lung consolidation, bronchiolitis and congenital diseases of the respiratory system including congenital pulmonary airway malformation (CPAM) and sequester but also pneumothorax are discussed.
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http://dx.doi.org/10.11152/mu-3059DOI Listing
March 2021

Ultrasound of the pleura in children, WFUMB review paper.

Med Ultrason 2021 Feb 1. Epub 2021 Feb 1.

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland, Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favorable acoustic windows in children makes US the first line of investigation for the evaluation of pleural and chest wall abnormali-ties. Lung parenchyma was previously thought to be inaccessible to ultrasound due to the presence of the air and bony thorax. The change in attitude and growing awareness of the diagnostic possibilities has led to lung ultrasound (LUS) being accepted as a valuable point of care method. In addition, the application of LUS has widened with improvements in technology such as higher resolution transducers, harmonic imaging and contrast-enhanced ultrasound. In the current World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) paper series the topic will be introduced, the technical requirements explained and the use of ultrasound in the lung and pleura in pediatric patients are discussed.
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http://dx.doi.org/10.11152/mu-3058DOI Listing
February 2021

Contrast-enhanced ultrasound of the pediatric brain.

Pediatr Radiol 2021 Feb 18. Epub 2021 Feb 18.

Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.

Brain contrast-enhanced ultrasound (CEUS) is an emerging application that can complement gray-scale US and yield additional insights into cerebral flow dynamics. CEUS uses intravenous injection of ultrasound contrast agents (UCAs) to highlight tissue perfusion and thus more clearly delineate cerebral pathologies including stroke, hypoxic-ischemic injury and focal lesions such as tumors and vascular malformations. It can be applied not only in infants with open fontanelles but also in older children and adults via a transtemporal window or surgically created acoustic window. Advancements in CEUS technology and post-processing methods for quantitative analysis of UCA kinetics further elucidate cerebral microcirculation. In this review article we discuss the CEUS examination protocol for brain imaging in children, current clinical applications and future directions for research and clinical uses of brain CEUS.
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http://dx.doi.org/10.1007/s00247-021-04974-4DOI Listing
February 2021

Precision of handheld multispectral optoacoustic tomography for muscle imaging.

Photoacoustics 2021 Mar 11;21:100220. Epub 2020 Nov 11.

Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.

Photo-or optoacoustic imaging (OAI) allows quantitative imaging of target tissues. Using multi-wavelength illumination with subsequent ultrasound detection, it may visualize a variety of different chromophores at centimeter depth. Despite its non-invasive, label-free advantages, the precision of repeated measurements for clinical applications is still elusive. We present a multilayer analysis of n = 1920 imaging datasets obtained from a prospective clinical trial (NCT03979157) in n = 10 healthy adult volunteers. All datasets were analyzed for 13 single wavelengths (SWL) between 660 nm-1210 nm and five MSOT-parameters (deoxygenated/oxygenated/total hemoglobin, collagen and lipid) by a semi-automated batch mode software. Intraclass correlation coefficients (ICC) were good to excellent for intrarater (SWL: 0.82-0.92; MSOT-parameter: 0.72-0.92) and interrater reproducibility (SWL: 0.79-0.87; MSOT-parameter: 0.78-0.86), with the exception for MSOT-parameter lipid (interrater ICC: 0.56). Results were stable over time, but exercise-related effects as well as inter-and intramuscular variability were observed. The findings of this study provide a framework for further clinical OAI implementation.
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http://dx.doi.org/10.1016/j.pacs.2020.100220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723806PMC
March 2021

Transfontanellar Contrast-Enhanced Ultrasound for Monitoring Brain Perfusion During Neonatal Heart Surgery.

Circ Cardiovasc Imaging 2020 03 2;13(3):e010073. Epub 2020 Mar 2.

Department of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.N., W.R., J.W., J.J.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany.

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http://dx.doi.org/10.1161/CIRCIMAGING.119.010073DOI Listing
March 2020

Ultra-high-frequency ultrasound in patients with spinal muscular atrophy: A retrospective feasibility study.

Muscle Nerve 2020 03 9;61(3):E18-E21. Epub 2020 Jan 9.

Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.

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http://dx.doi.org/10.1002/mus.26796DOI Listing
March 2020

Detection of collagens by multispectral optoacoustic tomography as an imaging biomarker for Duchenne muscular dystrophy.

Nat Med 2019 12 2;25(12):1905-1915. Epub 2019 Dec 2.

Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

Biomarkers for monitoring of disease progression and response to therapy are lacking for muscle diseases such as Duchenne muscular dystrophy. Noninvasive in vivo molecular imaging with multispectral optoacoustic tomography (MSOT) uses pulsed laser light to induce acoustic pressure waves, enabling the visualization of endogenous chromophores. Here we describe an application of MSOT, in which illumination in the near- and extended near-infrared ranges from 680-1,100 nm enables the visualization and quantification of collagen content. We first demonstrated the feasibility of this approach to noninvasive quantification of tissue fibrosis in longitudinal studies in a large-animal Duchenne muscular dystrophy model in pigs, and then applied this approach to pediatric patients. MSOT-derived collagen content measurements in skeletal muscle were highly correlated to the functional status of the patients and provided additional information on molecular features as compared to magnetic resonance imaging. This study highlights the potential of MSOT imaging as a noninvasive, age-independent biomarker for the implementation and monitoring of newly developed therapies in muscular diseases.
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http://dx.doi.org/10.1038/s41591-019-0669-yDOI Listing
December 2019

Time Tracking of Standard Ultrasound Examinations in Pediatric Hospitals and Pediatric Medical Practices - A Multicenter Study by the Pediatric Section of the German Society of Ultrasound in Medicine (DEGUM).

Ultraschall Med 2019 Oct 24. Epub 2019 Oct 24.

Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany.

Purpose:  Ultrasonography is the primary imaging modality in pediatrics but still lacks sufficient reimbursement in Germany. In this multicenter study, national data for the duration of standard ultrasound in pediatrics were systematically documented in order to specify the actual time required.

Materials And Methods:  N = 10 hospitals (N = 5 university hospitals, N = 5 non-university hospitals) and N = 3 medical practices in Germany recorded the entire process of an ultrasound examination in a special protocol developed by the Pediatric Section of the DEGUM. The duration of each of seven single steps during ultrasonography (from data input to final discussion of the results) of different organ systems was logged.

Results:  In total, N = 2118 examinations from different organ systems were recorded. N = 10 organ systems were examined frequently (> 30 times). The total duration of an ultrasound examination was statistically significantly longer in hospitals compared to medical practices (median (IQR) 27 min. (18-38) vs. 12 min. (9-17), p < 0.001). The "hands-on" patient time was approximately one half of the total required time in both settings (49.9 % vs. 48.9 %). Ultrasonography of the abdomen and brain lasted longer in university hospitals than in non-university hospitals (p < 0.001, and p = 0.04, respectively). Cooperation and age did not uniformly correlate with the total duration.

Conclusion:  This study provides novel comprehensive national data for the duration of standardized ultrasound examinations of children and adolescents in Germany. These data are essential for a further evaluation of the economic costs and should support better remuneration in the future.
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http://dx.doi.org/10.1055/a-1023-4024DOI Listing
October 2019

Reply.

Ann Thorac Surg 2019 05 23;107(5):1583. Epub 2018 Nov 23.

Department of Pediatric Cardiac Surgery and Pediatrics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany.

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http://dx.doi.org/10.1016/j.athoracsur.2018.10.039DOI Listing
May 2019

Intrauterine Growth Restriction (IUGR) Induces Signs of Subclinical Atherosclerosis in 6-Year-Old Infants Despite Absence Of Excessive Growth.

Klin Padiatr 2017 Jul 17;229(4):209-215. Epub 2017 Jul 17.

Department of Paediatrics and Adolescent Medicine University of Cologne, Köln, Germany.

Postnatal catch-up growth and rapid weight gain after intrauterine growth restriction (IUGR) seem to increase the risk for later disease. This study aimed to compare features of the metabolic syndrome early in life between IUGR and appropriate for gestational age (AGA) infants. Data for 9 infants with IUGR defined by a birth weight<10 percentile and ultrasound-proven placental insufficiency and 11 AGA children were available. Postnatal growth, auxological, cardiovascular, and metabolic parameters up to a chronological age of 6 years were assessed: Fasting serum concentrations of LDL-cholesterol, insulin, leptin, IGF-I, DHEAS, skinfold thicknesses, blood pressure, and mean carotid intima-media thickness (cIMT). All IUGR infants showed catch-up growth, although mean BMI SDS and total subcutaneous fat mass at the age of 6 years were still slightly lower compared to the AGA cohort. Reduced serum leptin concentrations were observed in IUGR infants (p=0.02), whereas no significant difference was found for IGF-I, insulin, LDL-cholesterol and DHEAS concentrations. Mean cIMT was significantly higher in IUGR infants (p<0.05). Mean arterial pressure did no differ. In 6-year-old IUGR infants with catch-up growth, who still had a slightly reduced BMI SDS compared to the AGA group, signs of subclinical atherosclerosis were detectable suggesting that cardiovascular risk in IUGR may be present even in the absence of excessive growth.
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http://dx.doi.org/10.1055/s-0043-104528DOI Listing
July 2017

Microbubbles in macrocysts - Contrast-enhanced ultrasound assisted sclerosant therapy of a congenital macrocystic lymphangioma: a case report.

BMC Med Imaging 2017 07 6;17(1):39. Epub 2017 Jul 6.

Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Loschgestrasse 15, D-91054, Erlangen, Germany.

Background: Congenital cystic lymphangiomas are benign malformations due to a developmental disorder of lymphatic vessels. Besides surgical excision, sclerosant therapy of these lesions by intracavitary injection of OK-432 (Picibanil®), a lyophilized mixture of group A Streptococcus pyogenes, is a common therapeutical option. For an appropriate application of OK-432, a detailed knowledge about the structure and composition of the congenital cystic lymphangioma is essential. SonoVue® is a commercially available contrast agent commonly used in sonography by intravenous and intracavitary application.

Case Presentation: Here we report the case of 2 month old male patient with a large thoracic congenital cystic lymphangioma. Preinterventional imaging of the malformation was performed by contrast-enhanced ultrasound after intracavitary application of SonoVue® immediately followed by a successful sclerotherapy with OK-432.

Conclusions: Contrast agent-enhanced ultrasound imaging offers a valuable option to preinterventionally clarify the anatomic specifications of a congenital cystic lymphangioma in more detail than by single conventional sonography. By the exact knowledge about the composition and especially about the intercystic communications of the lymphangioma sclerosant therapy becomes safer and more efficient.
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http://dx.doi.org/10.1186/s12880-017-0213-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501511PMC
July 2017

Diagnosis of Complex Pulley Ruptures Using Ultrasound in Cadaver Models.

Ultrasound Med Biol 2017 03 23;43(3):662-669. Epub 2016 Dec 23.

Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuremberg, Erlangen, Germany.

Pulley ruptures are common in climbing athletes. The purposes of this study were to determine the specific positioning of each pulley with regards to the joint, and to evaluate the ultrasound diagnostics of various pulley rupture combinations. For this, 34 cadaver fingers were analyzed via ultrasound, the results of which were compared to anatomic measurements. Different pulley ruptures were then simulated and evaluated using ultrasound in standardized dynamic forced flexion. Visualization of the A2 and A4 pulleys was achieved 100% of the time, while the A3 pulley was visible in 74% of cases. Similarly, injuries to the A2 and A4 pulleys were readily observable, while A3 pulley injuries were more challenging to identify (sensitivity of 0.2 for singular A3 pulley, 0.5 for A2/A4 pulley and 0.33 for A3/A4 pulley ruptures). Receiver operating characteristic analysis was used to evaluate the optimal tendon-bone distance for pulley rupture diagnosis, a threshold which was determined to be 1.9 mm for A2 pulley ruptures and 1.85 for A4 pulley ruptures. This study was the first to carry out a cadaver ultrasound examination of a wide variety of pulley ruptures. Ultrasound is a highly accurate tool for visualizing the A2 and A4 pulleys in a cadaver model. This method of pathology diagnosis was determined to be suitable for injuries to the A2 and A4 pulleys, but inadequate for A3 pulley injuries.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2016.10.005DOI Listing
March 2017

Comparable Cerebral Blood Flow in Both Hemispheres During Regional Cerebral Perfusion in Infant Aortic Arch Surgery.

Ann Thorac Surg 2017 Jan 23;103(1):178-185. Epub 2016 Aug 23.

Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.

Background: Cerebral protection during aortic arch repair can be provided by regional cerebral perfusion (RCP) through the innominate artery. This study addresses the question of an adequate bilateral blood flow in both hemispheres during RCP.

Methods: Fourteen infants (median age 11 days [range, 3 to 108]; median weight, 3.6 kg [range, 2.8 to 6.0 kg]) undergoing RCP (flow rate 54 to 60 mL · kg · min) were prospectively included. Using combined transfontanellar/transtemporal two- and three-dimensional power/color Doppler sonography, cerebral blood flow intensity in the main cerebral vessels was displayed. Mean time average velocities were measured with combined pulse-wave Doppler in the basilar artery, and both sides of the internal carotid, anterior, and medial cerebral arteries. In addition, bifrontal regional cerebral oximetry (rSO) was assessed. Comparing both hemispheres, measurements were performed at target temperature (28°C) during full-flow total body perfusion (TBP) and RCP.

Results: A regular circle of Willis with near-symmetric blood flow intensity to both hemispheres was visualized in all infants during both RCP and TBP. In the left internal carotid artery, blood flow direction was mixed (retrograde, n = 5; antegrade, n = 8) during TBP and retrograde during RCP. Comparison between sides showed comparable cerebral time average velocities and rSO, except for higher time average velocities in the right internal carotid artery (TBP p = 0.019, RCP p = 0.09). Unilateral comparison between perfusion methods revealed significantly higher rSO in the right hemisphere during TBP (82% ± 9%) compared with RCP (74% ± 11%, p = 0.036).

Conclusions: Bilateral assessment of cerebral rSO and time average velocity in the main great cerebral vessels suggests that RCP is associated with near-symmetric blood flow intensity to both hemispheres. Further neurodevelopmental studies are necessary to verify RCP for neuroprotection during aortic arch repair.
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http://dx.doi.org/10.1016/j.athoracsur.2016.05.088DOI Listing
January 2017

Particularities of Crohn's disease in pediatric patients: current status and perspectives regarding imaging modalities.

Expert Rev Gastroenterol Hepatol 2015 1;9(10):1313-25. Epub 2015 Sep 1.

a 1 Medical Department, Caritas-Krankenhaus, Uhlandstr. 7, D-97980 Bad Mergentheim, Germany.

A consensus on the best imaging modality evaluating inflammatory bowel disease in the pediatric population is lacking and it is often unclear which modality to choose in specific clinical circumstances. Children with inflammatory bowel disease are exposed to ionizing radiation from multiple imaging studies performed at initial diagnosis, throughout treatment and during the follow-up period. This paper discusses the value of different imaging techniques in pediatric patients with inflammatory bowel disease and gives a review of the literature. In addition, particular features of inflammatory bowel disease in children including the predilection of affected segments in the gastrointestinal tract are highlighted. Based on current literature knowledge, we encourage an integrative approach to the interpretation of clinical and imaging data for diagnosis and follow-up in daily clinical settings.
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http://dx.doi.org/10.1586/17474124.2015.1083420DOI Listing
June 2016

Benign liver tumors in pediatric patients - Review with emphasis on imaging features.

World J Gastroenterol 2015 Jul;21(28):8541-61

Liliana Chiorean, Xin-Wu Cui, Dagmar Schreiber-Dietrich, Jian-Min Chang, Christoph F Dietrich, Sino-German Research Center of Ultrasound in Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, Henan Province, China.

Benign hepatic tumors are commonly observed in adults, but rarely reported in children. The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking. Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors. In pediatric patients, most benign focal liver lesions are inborn and may grow like the rest of the body. Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis. Selection of the appropriate imaging test is challenging, since it depends on a number of age-related factors. This paper will discuss the most frequently encountered benign liver tumors in children (infantile hepatic hemangioendothelioma, mesenchymal hamartoma, focal nodular hyperplasia, nodular regenerative hyperplasia, and hepatocellular adenoma), as well as a comparison to the current knowledge regarding such tumors in adult patients. The current emphasis is on imaging features, which are helpful not only for the initial diagnosis, but also for pre- and post-treatment evaluation and follow-up. In addition, future perspectives of contrast-enhanced ultrasound (CEUS) in pediatric patients are highlighted, with descriptions of enhancement patterns for each lesion being discussed. The role of advanced imaging tests such as CEUS and magnetic resonance imaging, which allow for non-invasive assessment of liver tumors, is of utmost importance in pediatric patients, especially when repeated imaging tests are needed and radiation exposure should be avoided.
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http://dx.doi.org/10.3748/wjg.v21.i28.8541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515836PMC
July 2015

Ultrasound-guided neuronavigation improves safety of ventricular catheter insertion in preterm infants.

Brain Dev 2013 Nov 21;35(10):905-11. Epub 2012 Dec 21.

Department of Pediatrics, University of Erlangen-Nuremberg, Germany. Electronic address:

Background: Intra-ventricular hemorrhage (IVH) is a frequent cause of shunt-dependent hydrocephalus. The management of IVH in preterm babies remains a challenge both for neonatologists and pediatric neurosurgeons, compounded by the lack of low-risk, validated therapy techniques.

Objective: The aim of this study was to evaluate the feasibility and safety of a novel technique involving the ultrasound-guided placement of a central catheter connected with a Rickham-Capsule in a cohort of preterm, low-birth-weight babies with post-hemorrhagic hydrocephalus (PHH).

Methods: Eight preterm infants with PHH in which a Rickham-Capsule was placed from 2008-2012 were included. Conventional surgical techniques were used in four preterm infants; whereas in the other four preterm babies ultrasound guided catheter placement was performed with an 8 MegaHertz (MHz) micro convex transducer from LOGIQ 9, GE Healthcare; whereby the anterior fontanel was used as an acoustic window.

Results: Overall gestational age was 24-31 weeks, mean age at operation was 20.1 (7-36) days, mean birth weight 972.5±370 g, mean weight at first surgical intervention 1023.75±400.4 g. Six patients had bilateral IVH II-III°, two patients had parenchymal involvement. Using the conventional approach, incorrect catheter placement occurred in one of four patients below 1000 g, whereas none of the ultrasound guided cases needed correction.

Conclusions: Ultrasound-guided neuronavigation represents a relevant tool in the treatment of hydrocephalus in preterm infants through increased accuracy in placement of a central catheter connected to a Rickham-Capsule. The benefit of utilizing this form of neuronavigation needs to be assessed through corresponding standardized studies.
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http://dx.doi.org/10.1016/j.braindev.2012.11.008DOI Listing
November 2013

An unusual thyroid mass in a 5-year-old girl.

J Pediatr 2012 Sep 18;161(3):565. Epub 2012 May 18.

Clinic for Children and Adolescents, University Erlangen-Nuremberg, Erlangen, Germany.

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http://dx.doi.org/10.1016/j.jpeds.2012.04.017DOI Listing
September 2012

Malignant epithelioid peripheral nerve sheath tumor with prominent reticular/microcystic pattern in a child: a low-grade neoplasm with 18-years follow-up.

Appl Immunohistochem Mol Morphol 2014 Sep;22(8):627-33

*Institute of Pathology, Universitätsklinikum Erlangen †University Children's Hospital ‡Department of Radiology §Department of Surgery, Erlangen, Germany.

Malignant peripheral nerve sheath tumors (MPNSTs) constitute <2% of soft tissue neoplasms in children and display a wide histologic spectrum including low-grade and epithelioid variants, although most are high-grade spindle cell sarcomas. Here, we describe an unusual case of a large retroperitoneal epithelioid MPNST diagnosed in a 7-year-old girl without family history or clinical features of neurofibromatosis type 1. The patient was treated by repeated surgical interventions, polychemotherapy, autologous stem cell transplantation, and irradiation therapy. Over the years, she developed multiple disseminated abdominal recurrences but is currently alive with very slowly progressing disseminated intra-abdominal disease 18 years from initial diagnosis. Histologically, the tumor was composed of medium-sized polygonal and ovoid-to-spindled cells set within a copious myxoid matrix with a prominent reticular and microcystic pattern reminiscent of the recently described reticular/microcystic schwannoma. Immunohistochemistry revealed strong and diffuse expression of S100, CD56, CD57, collagen IV, and neuron-specific enolase, with negativity for perineurial cell markers (claudin-1, epithelial membrane antigen, and glucose transporter-1) and other lineage-specific mesenchymal and epithelial antigens. This unusual variant of low-grade MPNST must be differentiated from a variety of other entities, in particular benign perineurioma, myxoid neurofibroma, and benign reticular/microcystic schwannoma. Confinement of the recurrent disease to the abdominal cavity emphasizes the necessity of primary curative wide excision of this highly recurring but nonmetastasizing low-grade neoplasm.
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http://dx.doi.org/10.1097/PAI.0b013e318224751fDOI Listing
September 2014

Childhood polyarteritis nodosa in autoimmune lymphoproliferative syndrome.

Pediatrics 2010 Jan 21;125(1):e169-73. Epub 2009 Dec 21.

Clinic for Children and Adolescents, Radiology Institute, University Erlangen-Nuremberg, Erlangen, Germany.

Autoimmune lymphoproliferative syndrome (ALPS) is an uncommon disorder of Fas-mediated apoptosis that results in impaired lymphocyte death and, therefore, disturbed immune homeostasis. Besides presentation with lymphadenopathy and splenomegaly, patients with ALPS have a high incidence of autoimmune phenomena. To our knowledge, this is the first description of polyarteritis nodosa that includes numerous arterial aneurysms in a child with ALPS. Active vasculitis resolved after allogeneic hematopoietic stem cell transplantation. This report of polyarteritis nodosa associated with human ALPS supports previous findings in Fas-deficient mouse models that frequently develop vasculitic manifestations and suggests that apoptotic defects of lymphocytes may play a role in the pathophysiology of systemic vasculitis. Thus, patients with ALPS might be more susceptible to autoimmune vessel inflammation. This case furthermore emphasizes that even rare autoimmune manifestations should be considered and investigated in patients with immunodeficiencies, because that might help in planning treatment strategies for these patients.
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http://dx.doi.org/10.1542/peds.2009-1999DOI Listing
January 2010

Successful interventional treatment of arteriovenous fistula after kidney biopsy in pediatric patients--a report of three cases.

Nephrol Dial Transplant 2008 Oct 21;23(10):3215-8. Epub 2008 May 21.

Department of Pediatric Nephrology, University Hospital, Loschgestr. 15, 91054 Erlangen, Germany.

Background: With an incidence of up to 16%, arteriovenous fistula (AVF) is a frequent complication after renal biopsy.

Methods: We report on three cases, where renal biopsy in pediatric and adolescent patients led to various but clinically significant complications. In each patient two cores of renal parenchyma from the upper pole of the renal transplant or the lower pole of the right native kidney, respectively, were obtained with two attempts.

Results: Immediate post-bioptic ultrasound did not show any abnormalities. Setting of an AVF was suspected when complications occurred and ultrasound and Doppler studies showed AVF. The diagnosis was confirmed by angiography and occlusion of the fistulae was performed in the same session.

Conclusion: We conclude that persistent AVF is an uncommon but serious complication after renal biopsy. Well-timed angiography when AVF is suspected can prevent loss of function, especially in transplant recipients.
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http://dx.doi.org/10.1093/ndt/gfn253DOI Listing
October 2008

Closed flexor pulley injuries in nonclimbing activities.

J Hand Surg Am 2006 May-Jun;31(5):806-10

Department of Trauma and Orthopaedic Surgery, Klinikum Bamberg, Bamberg, Germany.

Closed flexor pulley injuries have been reported in rock climbers. We report 6 digital flexor pulley injuries in 6 patients aged 5 to 73 years that were not associated with a climbing injury. Excellent outcomes were achieved through conservative therapy in 5 patients and surgical therapy in 1 patient.
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http://dx.doi.org/10.1016/j.jhsa.2006.02.006DOI Listing
October 2006

Femoral vein occlusion and spontaneous collateral ectasia presenting as recurrent hernia of the groin: a case report.

J Pediatr Surg 2005 Jul;40(7):e17-9

Division of Pediatric Surgery, University Hospital, 12D-91054 Erlangen, Germany.

Femoral vein occlusion is not a common complication even after repeated hernia repair. We describe a case of a 14-year-old boy with a visible and soft, yet irreducible, mass below the inguinal ligament after 3 previous inguinal hernia repairs and heart catheterization in infancy. Further examination showed dilated venous collaterals, bypassing an occluded common femoral vein via the testicular sheaths and across the pelvic floor. We discuss etiology, diagnostic pitfalls, therapeutic options, and possible future complications, with a literature review.
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http://dx.doi.org/10.1016/j.jpedsurg.2005.03.071DOI Listing
July 2005