Comparison of the immunogenicity and reactogenicity of two commercially available hexavalent vaccines administered as a primary vaccination course at 2, 4 and 6 months of age.

Infants (N = 459) were randomly assigned to receive either Infanrix hexa or Hexavac vaccines at 2, 4 and 6 months of age as a primary vaccination schedule. The immunogenicity of the hepatitis B component was statistically significantly higher for Infanrix hexa compared to Hexavac in terms of both seroprotection (98.6% versus 94.7%, p = 0.0302) and GMCs (905.6 versus 226.4, p < 0.0001). Significantly (p < or =0.0001) higher antibody levels against diphtheria and the 3 polio components were also induced by Infanrix hexa. The responses to tetanus, Hib and pertussis components were similar. The incidences of clinically relevant solicited symptoms, unsolicited symptoms or serious adverse events were low in both groups.

Duplex sonography of renal arteries as a diagnostic tool in hypertensive children.

Computed duplex sonography was used to examine the renal arteries in 36 hypertensive children and adolescents (ages 4-17 years) with arterial hypertension of either renal or non-renal origin. Time-averaged flow velocities, maximum blood flow velocities as well as absolute renal blood flow and renal blood flow per gram kidney weight were measured. Normal flow velocities and normal to elevated renal blood flow volume was found in patients with acute glomerulonephritis and those with signs of chronic glomerulonephritis onset. Patients having advanced stages of chronic glomerulonephritis, on the other hand, were characterized by lower levels of all parameters. Unilateral renal artery stenosis was diagnosed correctly in four patients, although one intra-renal artery stenosis escaped imaging. Scarred kidneys exhibited low-normal or reduced flow velocities and renal blood flow volumes corresponded roughly to kidney size and preservation of normal kidney structure. Hypertension in some patients with normal kidneys showed a tendency to cause higher renal blood flow without consistent acceleration of blood flow velocities. We conclude that duplex sonography is a suitable primary diagnostic tool in measuring blood flow velocities and absolute renal blood flow volume in hypertensive children, thus facilitating the choice of the next diagnostic step.

Demonstration of giant MCA aneurysm by transcranial duplex sonography and color Doppler imaging.

Transcranial color Doppler sonography is a new diagnostic technique which allows real-time, color-coded imaging of basal cerebral arteries, with simultaneous demonstration of parenchymal structures in the B-mode scan. With this technique we were able noninvasively to show a giant fusiform aneurysm of the middle cerebral artery (MCA) in an 11-year-old boy. Transcranial color Doppler sonography through the intact temporal bone demonstrated the size and location of the aneurysm and provided real-time imaging of the pulsating intra-aneurysmal flow. Additionally, duplex sonographic measurements of intravascular flow velocities within the aneurysm and the feeding and draining artery were possible. Postoperatively, patency of the MCA with reduced flow velocities after excision of the aneurysm could be shown. This is the first transcranial color Doppler report in a patient with an intracerebral aneurysm. In our opinion, transcranial color Doppler sonography offers new diagnostic possibilities in patients with cerebrovascular disorders.

[Early detection of hepatobiliary involvement in children with mucoviscidosis using duplex sonography of the portal system]. / Frühnachweis einer hepatobiliären Beteiligung bei Kindern mit Mukoviszidose mit Hilfe der Duplexsonographie des Portalsystems.

To investigate early signs of hepatobiliary disease in CF, we measured portal, splenic, superior mesenteric vein and hepatic artery diameters, maximal flow velocity (Vmax) and time average velocity (TAV) in 25 males and 17 females with CF. Hepatic artery resistance, regional blood flow and liver perfusion were calculated. According to liver enzyme data (aminotransferases raised greater than 30 U/l) and sonographic findings (nodular changes), there were 17 CF-patients (mean age 11.4 yrs; range 0.75-31) with and 25 CF-patients (mean age 7.8 yrs; range 0.25-32) without liver involvement (L+/L-). No patient had clinical signs of portal hypertension. 61 healthy children were studied for control. Diameter of portal vein (PVD) and flow data for portal vein showed consistent abnormalities (mean +/- SD): CF-L+ CF-L- Control PVC (mm/m2) 10.7 +/- 3.9*** 10.5 +/- 3.4*** 7.2 +/- 1.3 Vmax (m/sec) 0.23 +/- 0.06*** 0.30 +/- 0.06*** 0.40 +/- 0.14 TAV (m/sec) 0.12 +/- 0.04*** 0.16 +/- 0.04* 0.18 +/- 0.05 Differences were statistically significant (* p less than 0.05, *** p less than 0.001) for CF-patients versus controls. Data for splenic and mesenteric veins and for hepatic artery were moderately alterated, with a significant reduction in TAV and Vmax of splenic vein for CF-L+ versus controls. Liver perfusion and portal vein flow showed no relevant differences in CF-patients versus controls. It is concluded that portal system abnormalities, especially a decrease in Vmax and TAV of portal vein shown by duplex sonography, may be earlier indicators of CF liver disease than biochemical and clinical signs.

[The problems of the success of afterbirth removal in cattle. Expert veterinary opinion]. / Zur Problematik des Erfolgs der Nachgeburtsabnahme beim Rind. Tierärztliches Gutachten.

If a severe uterine inflammation is diagnosed 15 days post partum in a cow with retained placenta by clinical examination, it has to be assumed that this inflammation was already manifest two days before (in the discussed case at the time of purchase). By an external examination of the animal this genital inflammation cannot be seen, if there is no vaginal discharge or dried uterine fluids at the tail and around the vulva. The inflammation is the consequence of the placental retention, even if there has been veterinary assistance (manual removal of the retained placenta, antibiotic treatment of the uterus) in time. After manual removal of the placenta, part of it is normally left in the tips of the uterine horns; they cannot be reached by the veterinarian's hand. Even by additional means - like application of oxytocin, lifting the abdomen of the cow with the aid of a plank or trying to invert the tip of the uterine horn - the fetal membranes cannot always be totally removed. The statement that the placenta has been totally removed, is correct only if the end of the chorionic membranes could be clearly identified. Each placental retention in cattle carries the risk of reduced fertility. If a cow is sold a few days post partum, this defect, which can reduce the animal's breeding value, may be unnoticed.

[The portal system and the hepatic artery in children with extrahepatic bile duct atresia. 2: Further duplex sonography parameters and flowmetry]. / Das Portalsystem und die Arteria hepatica bei Kindern mit extrahepatischer Gallengangsatresie. Teil 2: Weitere Duplexsonographische Parameter und Flowmetrie.

Since 1 1/2 year we performed duplex-sonographic examinations including flowmetry of the portal system and hepatic artery in children with biliary atresia. In children with hepatofugal collaterals we found a significant decreased Time Average Velocity (TAV) with 0.09 m/s against the control group with TAV of 0.18 m/s. The TAV in the splenic vein was also decreased. In the hepatic artery we found no change of the TAV. In most of the children a portal hypertension with hepatofugal collaterals was to be found in the first year of life. In 14 children the collaterals were visible. In these 14 children and 7 other children calculated parameters indicated the very high probability of collateral vessels. In children with hepatofugal collaterals we found a decreased portal vein flow. In 16 of 21 cases the flow in the hepatic artery was increased.

[The portal system and hepatic artery in children with biliary atresia. 1: Ultrasound and simple duplex ultrasound parameters]. / Das Portalsystem und die Arteria hepatica bei Kindern mit Gallengangsatresie. Teil 1: Sonographische und einfache duplexsonographische Parameter.

In 37 children with extrahepatic biliary atresia between 12 days in 9 years of age we performed 72 duplexsonographic examinations of the portal system and the hepatic artery. In the control group we investigated 61 healthy children. All investigations were performed with computer sonography (Acuson 128) with a 3.5 MHz and 5 MHz-Transducer. We described changes of sonographic parameters such as hepatic structure, liver and splenic size. In 14 children with extrahepatic biliary atresia hepatofugal collaterals were visible. Specially in patients with collaterals we found changes of vessel diameters. The maximal flow velocity of the portal vein was significantly decreased in patients with extrahepatic biliary atresia.

Renal blood flow and flow velocity in children and adolescents: duplex Doppler evaluation.

The renal arteries of 62 children and adolescents aged 1-16 years without renal or renovascular disease were examined by computer Doppler duplex sonography (DDS) to measure absolute renal blood flow velocities. Maximum systolic velocity (Vmax) and time average velocity (TAV) were not age-dependent. In addition, absolute values of renal artery and renal blood flow were measured. Renal blood flow was 4.1 +/- 1.2 ml/min per gram kidney (two standard deviations), independent of age and comparable to commonly accepted physiological values. The coefficient of variation of blood flow calculations was 6%-15% depending on vessel diameter.

[Control of surgical portosystemic shunt in children using computerized duplex sonography]. / Kontrolle operative angelegter portosystemischer Shunts im Kindesalter mit Hilfe der Computer-Duplexsonographie.

The major postoperative question is whether or not the shunt is patent. We demonstrate the possibilities of the postoperative controls of shunt patency with computer Duplex scan. Direct visualization of the shunt only is not a good parameter for shunt patency and function. An early postoperative control of shunt patency is possible by a Duplex sonographic investigation including flowmetry of the shunt, the portal vein, the hepatic artery and the hepatofugal collaterals. In this article we demonstrate the change of the portal system after a portosystemic shunt is made. If the shunt is patent, we found a decrease of the diameter, the time average velocity and the flow of the portal vein and the hepatofugal collaterals. These parameters can be used as indirect signs of patency.

[Aneurysm of the vein of Galen as a possible cause of congestive heart failure: a report of 5 new cases]. / Aneurysma der Vena Galeni als mögliche Ursache für eine kongestive Herzinsuffizienz: Bericht über 5 neue Fälle.

We report on five newborns with an arterio-venous malformation of the vein of Galen. All newborns were cyanotic and in congestive heart failure without any evidence of congenital heart disease. Congestive heart failure in these cases was mainly due to an almost two-fold increase in cardiac output of approximately 8 l/min/m2 (normal: 4.5 l/min/m2). According to previous reports, mortality is very high in patients with this malformation when becoming symptomatic during infancy, and therapy by surgery or embolization is only successful in 10-30%. While three of our patients died shortly after diagnosis because of untreatable heart failure, the other two were operated on either by subtotal ligation of the draining vein or by ligation of 4 arterial feeders. In the first case secondary thrombosis of the aneurysm occurred and cardiac failure subsided. In the second case a large shunt remained and a balloon-embolization was performed successfully. However, in both patients severe neurologic defects occurred, the severity of which remains to be assessed later since the post-operative observation period is only 2 and 5 months, respectively.

[Transcranial sonography and duplex sonography in children with cysts and tumors of the cranial base]. / Transkranielle Sonographie und Duplexsonographie bei Kindern mit Zysten und Tumoren im Bereich der Hirnbasis.

Clinical application of transcranial real-time sonography and duplex scan is demonstrated in 4 patients (2.5 to 14 years) with cysts and tumors in the basal brain area. A good correlation between ultrasound and CT-scan can be shown. With transcranial duplex scan intravascular flow velocities in the basal brain arteries can be measured. Simultaneous localization of the Doppler gate in a clearly defined part of the vessel is possible. In addition this non-invasive method can demonstrate the anatomical location of the basal brain vessels in relation to cysts and tumors. This was previously possible only with angiography.

[Sonography of the larynx in children. New perspectives due to the use of computerized sonography: 2: Sonographic findings in a case of laryngeal papillomatosis]. / Sonographie des Kehlkopfes im Kindesalter. Neue Perspektiven durch Einsatz der Computersonographie: Teil 2: Der sonographische Befund einer Larynxpapillomatose.

On our opinion one important indication for sonographic diagnosis in future are masses in the larynx area: in infancy or childhood mainly laryngeal papillomatosis. In one of our boy patients with massive laryngeal papillomatosis laser surgery was first performed at 15 months of age. After a second and third procedure interferon-therapy was begun. Sonographically it was easily possible to follow the course in control examinations. Sonographic findings correlated well with laryngoscopic findings. Laryngoscopy could therefore be limited to a minimum.

[Sonography of the larynx in childhood: new perspectives due to the use of computerized sonography. 1: Anatomy and method]. / Sonographie des Kehlkopfes im Kindesalter: neue Perspektiven durch Einsatz der Computersonographie. Teil 1: Anatomie und Methode.

We report on new perspectives in diagnostic ultrasound of the larynx, which has become possible by applications of computer sonography. To our knowledge no such comprehensive ultrasonic diagnostics in children are reported as yet in the area of larynx. All examinations were performed with a computed sonography system (Acuson 128). We used a linear transducer with a penetration corresponding to 5 MHz an a resolution corresponding to 10 MHz. The frame rate was around 25 Hz and thus enabled a good reproduction of dynamic processes. As we could show, it is possible to visualize all significant structures of the larynx including the thyroid cartilage, the vocal ligament, the vocalis muscle, the arytenoid cartilage and the piriform fossa. Of course the vestibular fold and the cervical musculature are also demonstrable. The high frame rate of the instrument anaibled a good reproduction of dynamic processes. The sonographic demonstration of anatomical structures is possible as well as a functional diagnosis.

[Ultrasound diagnosis of the larynx with the aid of computerized sonography]. / Ultraschalldiagnostik des Larynx mit Hilfe der Computersonographie.

We report on new perspectives in diagnostic ultrasound of the larynx, a method that has become possible by the application of computed sonography. The examinations were performed by means of a computer sonography system (Acuson 128). For all investigations we used a 5 MHz linear transducer with a resolution corresponding to 10 MHz. The frame rate was between 20 Hz and 50 Hz and thus enabled good reproduction of dynamic processes. We could show that it is possible to visualize all significant structures of the larynx including the thyroid cartilage, the vocal ligament, the vocalis muscle, the arytenoid cartilage and the piriform fossa. With sufficient practice, good demonstration and hence assessment of the larynx can be already possible in infancy. We examined children and adults between 6 days and 35 years of age. - Masses in the laryngeal area are among the important indications for sonographic diagnosis: in infancy and childhood, these are mainly represented by laryngeal papillomatosis. In one of our patients suffering from massive laryngeal papillomatosis, laser surgery was first performed when he was 15 months of age. After a third removal procedure, interferon therapy was initiated. Sonographically it was easily possible to follow the course. Sonographic findings correlated well with laryngoscopic findings. Laryngoscopy could therefore be restricted to a minimum.

[Transcranial duplex sonography through intact bone: a new diagnostic procedure]. / Transkranielle Duplexsonographie durch den intakten Knochen: ein neues diagnostisches Verfahren.

Transcranial duplex scanning as a new diagnostic procedure is described for the first time. This method allows Doppler sonographic registration of flow profiles of basal cerebral arteries through the intact skull with simultaneous demonstration of pulsating vessels and cerebral structures in the B-mode scan. The exact localisation of the registered Doppler profile can be demonstrated under direct visual control in a clearly defined section of the cerebral artery. Therefore, an angle correction of the recorded Doppler-shift is possible allowing determination of true flow velocity. Occlusion of basal cerebral arteries can be diagnosed visually with this method. The use procedure in 51 children and adolescents aged 18 months to 19 years is described.

[Transcranial real-time sonography in children and adolescents, ultrasound anatomy of the brain]. / Transkranielle Real-Time-Sonographie bei Kindern und Jugendlichen, Ultraschallanatomie des Gehirns.

Cerebral real-time ultrasonography through the fontanelle or temporal bones is being used more and more as a primary diagnostic procedure in infants and newborn suffering from cerebral pathology. Up to now it was limited to children below 18 months. In our study we examined 125 children and adolescents aged 18 months to 18 years and 9 adults with transcranial real-time sonography. With a computed sonography system high resolution of intracerebral structures, especially in the basal parts of the brain, was possible up to the age of about 8 years. Because of thickening temporal bones with increasing age ultrasonic resolution of cerebral structures then progressively decreases. However, a general transcranial ultrasound examination is possible even in adolescents and adults. Normal transcranial ultrasound sections of the brain are compared with standard anatomic sections. Advantages and limitations of the method as well as first clinical applications are discussed.

[Prospective one-year epidemiologic longitudinal study of air pollutants and the incidence of croup]. / Prospektive epidemiologische Einjahreslängsschnittstudie über Luftschadstoffe und Krupp-Häufigkeit.

Among a population of 18,175 children below 7 years of age in medium sized towns and rural areas in south-western Germany 552 (3.03%) cases of croup were registered during a 12 months period in 1984-85 by their physicians. Distributions according to months, sex and age at the onset of the disease were the same as in other recent investigations: The level of the air-pollution measured (SO2, NOx, CO, CO2, ozone and dust) was low (highest monthly means in microgram/m3: SO2 88, NO2 73, NO 119, dust 41). There was no relevant influence of the degree of air pollution on croup-frequency. The rise of croup-frequency shortly after a period of several days of higher pollution was accompanied by an influenza epidemic as proved by virus isolations.

5-Azacytidine-induced undercondensations in human chromosomes.

The cytosine analogue 5-azacytidine induces very distinct undercondensations in human chromosomes if applied to lymphocyte cultures. The number of induced undercondensations and their chromosomal localization can be varied by the 5-azacytidine dose and the treatment time. "Pulverized" chromosomes or undercondensations in the G-band-positive chromosome regions are produced with high doses and long treatment times. If applied in low doses during the last hours of culture, 5-azacytidine induces specific undercondensations in the heterochromatin of chromosomes 1, 9, 15, 16, and Y. Optimum conditions required for inducing the various types of undercondensation in the chromosomes were determined. Various examples of the use of 5-azacytidine in the analysis of chromosome rearrangements involving heterochromatic regions are presented.

A direct demonstration of somatically paired heterochromatin of human chromosomes.

Human lymphocyte cultures were treated with different concentrations of 5-azacytidine for various lengths of time. This cytosine analog induces very distinct undercondensation in the heterochromatin of chromosomes 1, 9, 15, 16, and Y if applied in low doses during the last hours of culture. These regions are further distinguished by their intense distamycin A/DAPI-staining and highly methylated DNA. In interphase nuclei, these heterochromatic regions are frequently somatically paired. These somatic pairings are preserved up to the metaphase stage in the 5-azacytidine-treated cultures and are thus susceptible to direct analysis. The specific effect of 5-azacytidine on the heterochromatin of these chromosomes, its conserving effect on somatic pairing, and some of the consequences of the somatic pairing on the development of human chromosome aberrations are discussed.