1
|
Burkert N, Roy S, Häusler M, Wuttke D, Müller S, Wiemer J, Hollmann H, Oldrati M, Ramirez-Franco J, Benkert J, Fauler M, Duda J, Goaillard JM, Pötschke C, Münchmeyer M, Parlato R, Liss B. Deep learning-based image analysis identifies a DAT-negative subpopulation of dopaminergic neurons in the lateral Substantia nigra. Commun Biol 2023; 6:1146. [PMID: 37950046 PMCID: PMC10638391 DOI: 10.1038/s42003-023-05441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
Here we present a deep learning-based image analysis platform (DLAP), tailored to autonomously quantify cell numbers, and fluorescence signals within cellular compartments, derived from RNAscope or immunohistochemistry. We utilised DLAP to analyse subtypes of tyrosine hydroxylase (TH)-positive dopaminergic midbrain neurons in mouse and human brain-sections. These neurons modulate complex behaviour, and are differentially affected in Parkinson's and other diseases. DLAP allows the analysis of large cell numbers, and facilitates the identification of small cellular subpopulations. Using DLAP, we identified a small subpopulation of TH-positive neurons (~5%), mainly located in the very lateral Substantia nigra (SN), that was immunofluorescence-negative for the plasmalemmal dopamine transporter (DAT), with ~40% smaller cell bodies. These neurons were negative for aldehyde dehydrogenase 1A1, with a lower co-expression rate for dopamine-D2-autoreceptors, but a ~7-fold higher likelihood of calbindin-d28k co-expression (~70%). These results have important implications, as DAT is crucial for dopamine signalling, and is commonly used as a marker for dopaminergic SN neurons.
Collapse
Affiliation(s)
- Nicole Burkert
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Shoumik Roy
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany.
| | - Max Häusler
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | | | - Sonja Müller
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Johanna Wiemer
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Helene Hollmann
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Marvin Oldrati
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Jorge Ramirez-Franco
- UMR_S 1072, Aix Marseille Université, INSERM, Faculté de Médecine Secteur Nord, Marseille, France
- INT, Aix Marseille Université, CNRS, Campus Santé Timone, Marseille, France
| | - Julia Benkert
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Michael Fauler
- Institute of General Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Johanna Duda
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Jean-Marc Goaillard
- UMR_S 1072, Aix Marseille Université, INSERM, Faculté de Médecine Secteur Nord, Marseille, France
- INT, Aix Marseille Université, CNRS, Campus Santé Timone, Marseille, France
| | - Christina Pötschke
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
| | - Moritz Münchmeyer
- Wolution GmbH & Co. KG, 82152, Munich, Germany
- Department of Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Rosanna Parlato
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany
- Division of Neurodegenerative Disorders, Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences, Heidelberg University, 68167, Mannheim, Germany
| | - Birgit Liss
- Institute of Applied Physiology, Medical Faculty, Ulm University, 89081, Ulm, Germany.
- Linacre College & New College, Oxford University, OX1 2JD, Oxford, UK.
| |
Collapse
|
2
|
Knopp C, Häusler M, Müller B, Damen R, Stoppe A, Mull M, Elbracht M, Kurth I, Begemann M. PDE10A mutation in two sisters with a hyperkinetic movement disorder - Response to levodopa. Parkinsonism Relat Disord 2019; 63:240-242. [PMID: 30777652 DOI: 10.1016/j.parkreldis.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/12/2022]
Affiliation(s)
- C Knopp
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - M Häusler
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - B Müller
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - R Damen
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - A Stoppe
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - M Mull
- Department of Diagnostic and Interventional Neuroradiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - M Elbracht
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - I Kurth
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - M Begemann
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| |
Collapse
|
3
|
Pfniß I, Csapo B, Häusler M, Greimel P, Lang U, Klaritsch P. Outcome von Drillingsschwangerschaften in Abhängigkeit ihrer Chorionizität – Datenanalyse eines Tertiärzentrums. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- I Pfniß
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - B Csapo
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - M Häusler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Greimel
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| |
Collapse
|
4
|
Rempen A, Chaoui R, Häusler M, Kagan KO, Kozlowski P, von Kaisenberg C, Wisser J. Quality Requirements for Ultrasound Examination in Early Pregnancy (DEGUM Level I) between 4+0 and 13+6 Weeks of Gestation. Ultraschall Med 2016; 37:579-583. [PMID: 27626239 DOI: 10.1055/s-0042-115581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- A Rempen
- Clinic of Gynecology and Obstetrics, Diakonie-Klinikum, Schwaebisch Hall, Germany
| | - R Chaoui
- Practice of Prenatal Medicine, Berlin, Germany
| | - M Häusler
- Department of Obstetrics, University Clinic, Graz, Austria
| | - K-O Kagan
- University Clinic of Obstetrics and Gynecology, Tübingen, Germany
| | - P Kozlowski
- Prenatal Medicine and Genetics, Duesseldorf, Germany
| | - C von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - J Wisser
- Clinic of Obstetrics, University Hospital, Zurich, Switzerland
| |
Collapse
|
5
|
von Kaisenberg C, Chaoui R, Häusler M, Kagan KO, Kozlowski P, Merz E, Rempen A, Steiner H, Tercanli S, Wisser J, Heling KS. Quality Requirements for the early Fetal Ultrasound Assessment at 11-13+6 Weeks of Gestation (DEGUM Levels II and III). Ultraschall Med 2016; 37:297-302. [PMID: 27093520 DOI: 10.1055/s-0042-105514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The early fetal ultrasound assessment at 11 - 13(+6) weeks of gestation remains the cornerstone of care despite the progress in diagnosing fetal chromosomal defects using cell-free fetal DNA (cffDNA) from the maternal circulation. The measurement of nuchal translucency (NT) allows the risk calculation for the fetal trisomies 21, 18 and 13 but also gives information on those fetal chromosomal defects which are at present unable to be detected using cffDNA. Nuchal translucency is the only auditable parameter at 11 - 13(+6) weeks and gives thus information on the quality of the first trimester anomaly scan. In addition it gives indirect information on the risks for fetal defects and for cardiac anomalies. Also the chances for a healthy live baby can be estimated. As experience with first trimester anomaly scanning increases, and the resolution of the ultrasound equipment has increased substantially, more and more details of the fetal anatomy become accessible at the first trimester scan. Therefore fetal anatomical defects and complex anomalies have become amenable to examination in the first trimester. This guideline describes compulsory and optional parameters for investigation at the first trimester scan and outlines a structured method of examining a first trimester fetus at 11 - 13(+6) weeks of gestation.
Collapse
Affiliation(s)
- C von Kaisenberg
- Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - R Chaoui
- Praxis für Pränatalmedizin, Berlin, Germany
| | - M Häusler
- Obstetrics and Gynecology, University of Graz, Graz, Austria
| | - K O Kagan
- Obstetrics and Gynecology, University of Tübingen, Germany
| | - P Kozlowski
- Praenatal-Medizin und Genetik, Düsseldorf, Germany
| | - E Merz
- Obstetrics and Gynecology, Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - A Rempen
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Schwäbisch-Hall, Germany
| | - H Steiner
- Ordination Salzburg, Salzburg, Austria
| | - S Tercanli
- Pränatalmedizin, Ultraschallpraxis Freie Straße, Basel, Switzerland
| | - J Wisser
- Obstetrics and Gynecology, University of Zurich, Zurich, Switzerland
| | - K-S Heling
- Praxis für Pränatalmedizin, Berlin, Germany
| |
Collapse
|
6
|
Schmid M, Klaritsch P, Arzt W, Burkhardt T, Duba HC, Häusler M, Hafner E, Lang U, Pertl B, Speicher M, Steiner H, Tercanli S, Merz E, Heling KS, Eiben B. Cell-Free DNA Testing for Fetal Chromosomal Anomalies in clinical practice: Austrian-German-Swiss Recommendations for non-invasive prenatal tests (NIPT). Ultraschall Med 2015; 36:507-510. [PMID: 26468773 DOI: 10.1055/s-0035-1553804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Schmid
- Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde Wien (Österreich)
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz (Österreich)
| | - W Arzt
- Abteilung für Pränatalmedizin, Landesfrauen- und Kinderklinik Linz (Österreich)
| | - T Burkhardt
- Klinik für Geburtshilfe, Universitäts-Spital Zürich (Schweiz)
| | - H C Duba
- Zentrum Medizinische Genetik, Landes-Frauen- und Kinderklinik Linz (Österreich)
| | - M Häusler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz (Österreich)
| | - E Hafner
- Geburtshilflich-Gynäkologische Abteilung, Sozialmedizinisches Zentrum Ost - Donauspital, Wien (Österreich)
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz (Österreich)
| | - B Pertl
- Pränatalzentrum, Privatklinik Graz-Ragnitz (Österreich)
| | - M Speicher
- Institut für Humangenetik, Universität Graz (Österreich)
| | - H Steiner
- Praxis für Pränatalmedizin, Praxis für Pränatalmedizin, Salzburg (Österreich)
| | - S Tercanli
- Ultraschall Freie-Strasse, Basel (Schweiz)
| | - E Merz
- Zentrum für Ultraschall und Pränatalmedizin; Frankfurt (Deutschland)
| | - K S Heling
- Praxis Friedrichstrasse für Pränataldiagnostik, Berlin (Deutschland)
| | - B Eiben
- Institut für Labormedizin und Klinische Genetik Rhein/ Ruhr, amedes Gruppe, Essen (Deutschland)
| |
Collapse
|
7
|
Baumann M, Sahin K, Lechner C, Hennes EM, Schanda K, Mader S, Karenfort M, Selch C, Häusler M, Eisenkölbl A, Salandin M, Gruber-Sedlmayr U, Blaschek A, Kraus V, Leiz S, Finsterwalder J, Gotwald T, Kuchukhidze G, Berger T, Reindl M, Rostásy K. Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein. J Neurol Neurosurg Psychiatry 2015; 86:265-72. [PMID: 25121570 DOI: 10.1136/jnnp-2014-308346] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibodies have been recently described in children with acute disseminating encephalomyelitis (ADEM), but the clinical and neuroradiological characterisation of this subgroup is lacking. OBJECTIVE To compare the clinical and neuroradiological features of paediatric ADEM with and without MOG antibodies. METHODS Clinical course, cerebrospinal fluid (CSF)-, MRI studies, outcome and MOG status of 33 paediatric ADEM prospectively studied were reviewed. RESULTS MOG antibodies (median 1:2560; range 1:160-1:20 480) were detected in 19 children with ADEM. The majority of children showed a decline of serum MOG-IgG titres over time. Children with MOG antibodies did not differ in their age at presentation, sex ratio, the presence of oligoclonal bands, clinical symptoms or initial severity, apart from a higher CSF cell count (p=0.038), compared with children without MOG antibodies. In addition, further relapsing demyelinating episodes associated with MOG antibodies were observed only in children with MOG antibodies. All 19 children with MOG antibodies had a uniform MRI pattern, characterised by large, hazy and bilateral lesions and the absence of atypical MRI features (eg, mainly small lesions, well-defined lesions), which was significantly different compared to that of children without MOG antibodies (p=0.003; and p=0.032, respectively). In addition, children with MOG antibodies had involvement of more anatomical areas (p=0.035) including the myelon characterised by a longitudinally extensive transverse myelitis (p=0.003), more often a complete resolution of lesions (p=0.036) and a better outcome (p=0.038). CONCLUSIONS Patients with ADEM with MOG antibodies in our cohort had a uniform MRI characterised by large, bilateral and widespread lesions with an increased frequency of longitudinal extensive transverse myelitis and a favourable clinical outcome in contrast to children lacking MOG antibodies.
Collapse
Affiliation(s)
- M Baumann
- Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - K Sahin
- Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - C Lechner
- Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - E M Hennes
- Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria Clinical Department of Neurology, Klinikum Bogenhausen, Munich, Germany
| | - K Schanda
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - S Mader
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria The Feinstein Institute for Medical Research, Center for Autoimmune and Musculoskeletal Diseases, Manhasset, New York, USA
| | - M Karenfort
- Department of General Pediatrics, Pediatric Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - C Selch
- Behandlungszentrum Vogtareuth, Vogtareuth, Germany
| | - M Häusler
- Department of Pediatrics, Division of Neuropediatrics and Social Pediatrics, University Hospital, Aachen, Germany
| | - A Eisenkölbl
- Department of Pediatrics, Landes- Frauen- und Kinderklinik Linz, Linz, Austria
| | - M Salandin
- Department of Pediatrics, Bozen Hospital, Bozen, Italy
| | | | - A Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - V Kraus
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - S Leiz
- Pediatric Neurology, Department of Pediatrics, Klinikum Dritter Orden, Munich, Germany
| | - J Finsterwalder
- Division of Pediatric Neurology, Department of Pediatrics, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - T Gotwald
- Radiological Institute, Kettenbrücke, Innsbruck, Austria
| | - G Kuchukhidze
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria Department of Neurology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - T Berger
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - M Reindl
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - K Rostásy
- Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| |
Collapse
|
8
|
Reif P, Elsayed H, Tappauf C, Greimel E, Bjelic-Radisic V, Häusler M, Tamussino K. Einführung des Word-Katheters zur ambulanten Behandlung von Bartholin'schen Zysten und Abszessen – eine Pilotstudie zu Quality of Life & Sexual Activity im Behandlungsverlauf. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
9
|
Häusler M, Ferreira M, Conceição N. ASSESSMENT OF VEGETATION PARAMETERS IN OLIVE TREES IN THE REGION OF ALENTEJO: A COMPARISON OF DIRECT AND INDIRECT METHODS. ACTA ACUST UNITED AC 2014. [DOI: 10.17660/actahortic.2014.1038.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
Hennes E, Zotter S, Dorninger L, Hartmann H, Häusler M, Huppke P, Jacobs J, Kraus V, Makowski C, Schlachter K, Ulmer H, van Baalen A, Koch J, Gotwald T, Rostasy K. Long-term outcome of children with acute cerebellitis. Neuropediatrics 2012; 43:240-8. [PMID: 22936351 DOI: 10.1055/s-0032-1324732] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Acute cerebellitis (AC) is characterized by cerebellar symptoms and magnetic resonance imaging (MRI) changes primarily confined to the cerebellum. OBJECTIVE To analyze the neurological and cognitive long-term outcome of children with AC. METHODS Children with AC diagnosed by typical clinical features and MRI findings were included in this retrospective study. Medical charts were reviewed and neurological deficits were assessed by neurological examination or by the expanded disability status scale telephone interview. Cognitive outcome was evaluated with a parental questionnaire (Kognitive Probleme bei Kindern und Jugendlichen). RESULTS A total of 11 children (6 boys, 5 girls; age range: 3 years to 14 years and 10 months) were included. Of them, six children had a severe disease manifestation including mental status changes and neurological symptoms. Of the rest, two children had a moderate and three children had a mild form of AC. MRI of the cerebellum was obtained in the acute phase revealing signal alterations with different patterns. The average follow-up period was 4 years and 4 months. A complete recovery was observed in five children. Neurological sequelae were reported in five children ranging from ataxia to mild tremor. Cognitive deficits were found in six patients. The affected areas of cognition did include spatial visualization ability, language skills, and concentration. CONCLUSION Neurological and cognitive sequelae are common in children with AC and underline the role of the cerebellum in cognition.
Collapse
Affiliation(s)
- E Hennes
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Kollmann M, Glawitsch M, Csapo B, Häusler M, Lang U, Klaritsch P. Outcome und Management monochorialer Zwillingsschwangerschaften – eine retrospektive Analyse. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1313678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
12
|
Schest EC, Tappauf C, Reif P, Csapo B, Häusler M, Klaritsch P. Mirror Syndrom als Komplikation eines feto-fetalen Transfusionssyndroms (FFTS). Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1313693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
13
|
Kollmann M, Walch J, Rotky-Fast C, Häusler M, Lang U, Klaritsch P. Neurologisches Langzeit-Outcome frühgeborener Zwillinge. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1313679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
14
|
Idris T, Stern C, Kolovetsiou V, Häusler M, Lang U, Cervar-Zivkovic M. Prognostischer Wert für die Entwicklung einer Präeklampsie bei seriellen Doppleruntersuchungen der Arteriae uterinae in Hochrisikoschwangerschaften. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1313674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
15
|
Schest EC, Schellnegger J, Koidl C, Häusler M, Lang U, Klaritsch P. Ätiologie und perinatales Outcome des Polyhydramnion. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1313694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
16
|
Grapp M, Just IA, Linnankivi T, Wolf P, Lücke T, Häusler M, Gärtner J, Steinfeld R. Molecular characterization of folate receptor 1 mutations delineates cerebral folate transport deficiency. ACTA ACUST UNITED AC 2012; 135:2022-31. [PMID: 22586289 DOI: 10.1093/brain/aws122] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cerebral folate transport deficiency is an inherited brain-specific folate transport defect that is caused by mutations in the folate receptor 1 gene coding for folate receptor alpha (FRα). This genetic defect gives rise to a progressive neurological disorder with late infantile onset. We screened 72 children with low 5-methyltetrahydrofolate concentrations in the cerebrospinal fluid and neurological symptoms that developed after infancy. We identified nucleotide alterations in the folate receptor 1 gene in 10 individuals who shared developmental regression, ataxia, profound cerebral hypomyelination and cerebellar atrophy. We found four novel pathogenic alleles, one splice mutation and three missense mutations. Heterologous expression of the missense mutations, including previously described mutants, revealed minor decrease in protein expression but loss of cell surface localization, mistargeting to intracellular compartments and thus absence of cellular binding of folic acid. These results explain the functional loss of folate receptor alpha for all detected folate receptor 1 mutations. Three individuals presenting a milder clinical phenotype revealed very similar biochemical and brain imaging data but partially shared pathogenic alleles with more severely affected patients. Thus, our studies suggest that different clinical severities do not necessarily correlate with residual function of folate receptor alpha mutants and indicate that additional factors contribute to the clinical phenotype in cerebral folate transport deficiency.
Collapse
Affiliation(s)
- M Grapp
- Department of Paediatrics and Paediatric Neurology, University Medical Centre Göttingen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Kollmann M, Häusler M, Haas J, Csapo B, Lang U, Klaritsch P. Komplikationen nach genetischer Amniozentese und Chorionzottenbiopsie. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
18
|
Schest E, Moser F, Häusler M, Lang U, Schöll W. Zervikalschwangerschaft mit Plazenta accreta – ein Fallbericht. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
19
|
Schest E, Csapo B, Karpf E, Pichler G, Häusler M. Großer Plazentatumor mit vitaler Bedrohung des Kindes – ein Fallbericht. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
20
|
Abstract
BACKGROUND Epilepsy with myoclonic absences (EMA) is a rare epileptic syndrome with frequently poor response to antiepileptic treatment. Rufinamide (RUF) is a relatively new EMEA- and FDA-approved anticonvulsant licensed as an orphan drug for the adjunctive treatment of patients with Lennox-Gastaut syndrome. METHODS A retrospective data analysis in 3 patients was performed. RESULTS Add-on RUF treatment was initiated in 3 boys with EMA refractory to conventional antiepileptic therapy (primidone + valproic acid, n=1; levetiracetame + ethosuximide, n=2). It resulted in complete cessation of all seizures in 2, and a 50% reduction of the seizure frequency in one child, respectively. CONCLUSIONS RUF add-on therapy should be considered in children with EMA not responding to conventional antiepileptic therapy.
Collapse
Affiliation(s)
- M Häusler
- Department of Pediatrics, University Hospital, RWTH Aachen, Aachen, Germany.
| | | | | |
Collapse
|
21
|
Krüttgen A, Scheithauer S, Häusler M, Kleines M. First report of an autochthonous hepatitis E virus genotype 3 infection in a 5 month old female child in Germany. J Clin Virol 2010; 50:175-6. [PMID: 21084220 DOI: 10.1016/j.jcv.2010.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/19/2010] [Indexed: 11/19/2022]
Abstract
Hepatitis E virus (HEV) is well-known to cause endemic outbreaks of hepatitis in tropical countries, mostly caused by HEV genotypes 1 or 2 and transmitted from humans to humans via the fecal-oral route. In contrast, HEV genotypes 3 or 4 are commonly encountered as sporadic cases in a non-endemic setting; these autochthonous cases are transmitted from animals to humans and commonly affect elderly male subjects. We report a five-month-old caucasian girl presenting with diarrhea, emesis, and elevated ALT. Surprisingly, acute infection with Hepatitis E virus (HEV) genotype 3 was laboratory-confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) and sequencing. Thirteen months later, RT-PCR for HEV from stool tested negative whereas anti-HEV IgG in serum tested positive. Neither HEV RNA nor anti-HEV antibodies could be detected in stool or serum of the parents. To our knowledge, this is the first pediatric case of a HEV infection in Germany. Thus, HEV should be included into the differential diagnosis of pediatric infectious liver and bowel disease.
Collapse
Affiliation(s)
- A Krüttgen
- Division of Virology, Department of Medical Microbiology, University Hospital Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | | | | | | |
Collapse
|
22
|
Scheithauer S, Manemann AK, Krüger S, Häusler M, Krüttgen A, Lemmen SW, Ritter K, Kleines M. Impact of herpes simplex virus detection in respiratory specimens of patients with suspected viral pneumonia. Infection 2010; 38:401-5. [PMID: 20589523 PMCID: PMC7101829 DOI: 10.1007/s15010-010-0036-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 06/09/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory infection and failure is a commonly encountered problem in intensive care unit (ICU) patients. However, despite the accumulating body of evidence to suggest that herpes simplex virus type 1 (HSV-1) is associated with pneumonia, the exact role played by this virus in this process is still not fully understood. Therefore, to identify patients at risk, we have conducted a case-control study to characterize patients with HSV-1-positive pneumonia. PATIENTS AND METHODS Between 2007 and 2009, all patients with suspected viral pneumonia were tested for the presence of herpes viruses using a PCR assay approach with respiratory specimens. To identify possible associations, risk factors, and impact of HSV, HSV-1-positive ICU patients (n = 51) were compared to age-, gender-, and department- and season-matched HSV-negative patients (n = 52). RESULTS HSV-positive patients differed significantly from the HSV-negative ones only in terms of time of mechanical ventilation (13 vs. 6 days, respectively; p = 0.002). Subgroup analysis in the patients aged >60 years and in those without bacterial detection revealed a similar trend (p = 0.01 and p = 0.004, respectively). Mortality did not differ between the groups or between the HSV-1-positive patients treated with aciclovir and those who were not. A viral load >10E+05 geq/ml was associated with mechanical ventilation (20/21 vs. 17/29; p = 0.004), acute respiratory distress syndrome (ARDS; 19/21 vs. 18/29; p = 0.005), sepsis (18/21 vs. 14/29; p = 0.008), detection of a bacterial pathogen in the same specimen (10/21 vs. 4/29; p = 0.01) and longer ICU stay (25 vs. 30 days; p = 0.04). CONCLUSION Despite several associations with high viral load, the clinical outcome of HSV-1-positive ICU patients did not differ significantly from the clinical outcome of HSV-negative patients. This finding indicates that HSV-1 viral loads in respiratory specimens are a symptom of a clinically poor condition rather than a cause of it. Longitudinal and therapy studies are therefore needed to distinguish between HSV-1 as a causative pathogen and HSV-1 as a bystander of pneumonia/ARDS.
Collapse
Affiliation(s)
- S Scheithauer
- Department of Infection Control and Infectious Diseases, University Hospital Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
van Baalen A, Boor R, Stephani U, Stephani U, Häusler M, Kluger G. Febrile infection responsive epileptic syndrome (FIRES): A novel non-encephalitic encephalopathy in children admitted to ICU? Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
24
|
Abstract
BACKGROUND Whether cerebral venous sinus obstruction is a cause or consequence of idiopathic intracranial hypertension (IIH) is uncertain. METHODS AND RESULTS Among the nine children with IIH, five showed stenosis (n = 5) and occlusion (n = 1) of cerebral venous sinus on cranial magnetic resonance imaging (n = 4) or conventional angiography (n = 1), respectively. Follow-up magnetic resonance imaging performed in four children showed complete regression of the venous pathology in one and partial regression in two of them. CONCLUSIONS Our data demonstrate that cerebral venous sinus obstruction is frequent and frequently transient in pediatric IIH and suggest that stenoses may result from elevated intracranial pressure.
Collapse
Affiliation(s)
- A Stienen
- Department of Pediatrics, University Hospital RWTH, Aachen, Germany
| | | | | | | | | |
Collapse
|
25
|
Hengst M, Häusler M, Honnef D, Scheithauer S, Ritter K, Kleines M. [Human Bocavirus-infection (HBoV): an important cause of severe viral obstructive bronchitis in children]. Klin Padiatr 2008; 220:296-301. [PMID: 18716982 DOI: 10.1055/s-0028-1083806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Apart from established pathogens of lower respiratory tract infections, such as respiratory syncytial virus (RSV), an increasing number of additional agents has been identified in recent years. In 2005 the human bocavirus (hBoV) has been isolated from respiratory tract samples and has been reported worldwide with frequencies ranging from 1.5 to 18.3% in respiratory samples from children with airway infections. PATIENTS We investigated 173 specimens of a total number of 162 children who were inpatients with severe respiratory tract infections most of whom required oxygen therapy. METHOD We analyzed respiratory tract samples (83% nasopharyngeal washes, 15% tracheal secretions, 2% bronchoalveolar lavages) for adenoviruses, influenza A und B viruses, parainfluenzaviruses types 1 to 3 and RSV using antigen-specific immunofluorescence assays. Additionally we tested human metapneumovirus (hMPV) and hBoV using a PCR assay. MAIN RESULTS 35.8% specimens were negative in all assays, 54.3% were positive for RSV and 9.8% were positive for adeno-, influenza-, parainfluenzaviruses or hMPV. HBoV could be detected in 17 specimens (9.8%), defining HBoV to be the second most frequent pathogen. Nine of these patients showed a coinfection with RSV, one with parainfluenza virus. Viral loads did range from 2x10 (2) to 5.6x10 (10) genome equivalents/ml with higher viral loads being observed in the first days after disease onset. Most children were infected in the months between December and April. Half of the patients with isolated HBoV infection showed rhinopharyngitis, a third suffered from pulmonary obstruction and nearly every second required oxygen therapy. However, no HBoV-specific symptoms were found. CONCLUSION HBoV is a common pathogen causing viral respiratory tract infection in infants and young children. Among the here reported patients HBoV was the second most frequent identified pathogen. X-ray studies frequently revealed peribronchial and pneumonic infiltrates with only moderately elevated laboratory inflammatory markers. So far, no HBoV-specific clinical symptoms are known. Additional questions for example related to the way of transmission and optimal treatment remain to be investigated in prospective studies.
Collapse
Affiliation(s)
- M Hengst
- 1Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Aachen
| | | | | | | | | | | |
Collapse
|
26
|
Rudnik-Schöneborn S, Weis J, Kress W, Häusler M, Zerres K. Becker’s muscular dystrophy aggravating facioscapulohumeral muscular dystrophy – double trouble as an explanation for an atypical phenotype. Neuromuscul Disord 2008; 18:881-5. [DOI: 10.1016/j.nmd.2008.06.387] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 06/13/2008] [Accepted: 06/19/2008] [Indexed: 02/07/2023]
|
27
|
Häusler M, Koroschetz F, Tamussino K, Walcher W. Ist eine Curettage nach Abortus completus noch zeitgemäß? Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2007-1023106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
28
|
Lercher-Hartlieb A, Pertl B, Häusler M, Pieber D, Hüttner U, Vadon M, Winter R. Erste klinische Erfahrungen mit der pränatalen Analyse des fetalen RH-Faktors unter Verwendung der Polymerase-Chain-Reaction an Fruchtwasserzellen. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2007-1022764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
29
|
Hüttner U, Weiss P, Maurer U, Engele H, Zehetleitner G, Häusler M, Haas J, Winter R. Früh- und Spätprognose von extrem Frühgeborenen (EFG): Grazer Analyse. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2007-1022746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
30
|
Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Häusler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C, Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology 2008; 70:853-60. [PMID: 18332343 DOI: 10.1212/01.wnl.0000304747.38502.e8] [Citation(s) in RCA: 333] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) vasculopathy produces stroke secondary to viral infection of cerebral arteries. Not all patients have rash before cerebral ischemia or stroke. Furthermore, other vasculitides produce similar clinical features and comparable imaging, angiographic, and CSF abnormalities. METHODS We review our 23 published cases and 7 unpublished cases of VZV vasculopathy. All CSFs were tested for VZV DNA by PCR and anti-VZV IgG antibody and were positive for either or both. RESULTS Among 30 patients, rash occurred in 19 (63%), CSF pleocytosis in 20 (67%), and imaging abnormalities in 29 (97%). Angiography in 23 patients revealed abnormalities in 16 (70%). Large and small arteries were involved in 15 (50%), small arteries in 11 (37%), and large arteries in only 4 (13%) of 30 patients. Average time from rash to neurologic symptoms and signs was 4.1 months, and from neurologic symptoms and signs to CSF virologic analysis was 4.2 months. CSF of 9 (30%) patients contained VZV DNA while 28 (93%) had anti-VZV IgG antibody in CSF; in each of these patients, reduced serum/CSF ratio of VZV IgG confirmed intrathecal synthesis. CONCLUSIONS Rash or CSF pleocytosis is not required to diagnose varicella zoster virus (VZV) vasculopathy, whereas MRI/CT abnormalities are seen in almost all patients. Most patients had mixed large and small artery involvement. Detection of anti-VZV IgG antibody in CSF was a more sensitive indicator of VZV vasculopathy than detection of VZV DNA (p < 0.001). Determination of optimal antiviral treatment and benefit of concurrent steroid therapy awaits studies with larger case numbers.
Collapse
Affiliation(s)
- M A Nagel
- Department of Neurology, Mail Stop B182, University of Colorado Health Sciences Center, 4200 E. 9th Ave., Denver, CO 80262, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Häusler M, Berghold A, Krenn L. Steirisches Fehlbildungsregister (SFR) seit 1985. Erhebung und Auswertung der Daten im internationalen Vergleich. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1078362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
32
|
Magnet E, Klaritsch P, Karpf E, Prayer D, Brugger P, Pertl B, Häusler M. Rechtsseitige Diaphragmahernie und pränatale Prognosestellung. Ein Methodenvergleich. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1078372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
33
|
Abstract
Guanidinoacetate methyltransferase deficiency typically presents with muscular hypotonia, global developmental delay, extrapyramidal signs, and seizures during infancy and childhood. The authors report a 5-year-old child with guanidinoacetate methyltransferase deficiency who presented with severe speech delay, emphasizing the importance of an early screening for disorders of creatine synthesis and transport in every infant or child with isolated speech delay of unknown cause.
Collapse
Affiliation(s)
- J Vodopiutz
- Division of Biochemical and Paediatric Genetics, Department of General Paediatrics, University Children's Hospital Vienna, Austria
| | | | | | | | | |
Collapse
|
34
|
Schlembach D, Häusler M, Klaritsch P. Detektion von Neuralrohrdefekten jenseits der fetalen Lebensfähigkeit – Die Probleme des Fetozids. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
35
|
Affiliation(s)
- H Ott
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 502074, Aachen.
| | | | | | | | | |
Collapse
|
36
|
Ott H, Häusler M, Götz-Kohl D, Dreuw M, Megahed M, Baron JM, Blazek C, Talhari C, von Felbert V, Abuzahra F, Beckmann C, Neis M, Rösener I, Helmer A, Merk HF, Renn CN, Wirpts G. [Meeting of the Department of Dermatology, University of Aachen]. Hautarzt 2006; 57:1111-26. [PMID: 17096135 DOI: 10.1007/s00105-006-1245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- H Ott
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Blaicher W, Häusler M, Gembruch U, Bollmann R, Terinde R, Rempen A, Deutinger J, Bernaschek G. Feto-amniotic shunting -- experience of six centres. Ultraschall Med 2005; 26:134-141. [PMID: 15852177 DOI: 10.1055/s-2005-858121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
AIM Foeto-amniotic shunting is an ultrasound-guided, therapeutic intervention for drainage of persistent intracavital fluid retention in severely affected foetuses with a high risk of mortality. In order to weigh up the comparatively high risk of intervention against the possible benefit, we evaluated the value of different indications, the complication rate and the time span of drains in situ. PATIENTS AND METHODS We made a survey of all level III ultrasound centres of German-speaking countries from 1993 to 2001. Six level III centres returned the questionnaire: forty-seven foeto-amniotic shunting procedures were performed in 30 foetuses [megacystis in 18 foetuses (three of these with urinary ascites), hydrothorax in eight foetuses, hydronephrosis in two foetuses, cystic adenomatoid malformation of the lung in one foetus, ovarian cyst in one foetus]. RESULTS The median gestational age at time of shunting was 23.5 (range 16 - 33) weeks, at time of delivery 35 (range 23 - 41) weeks. The median time span of drains in situ was 19 (range 0 - 170) days. Altogether 18 of 30 foetuses (60 %) had a benefit of foeto-amniotic shunting. CONCLUSION The best possible selection of pregnancies which might profit from foeto-amniotic shunting is required. The decisive criteria are the underlying defect as well as the severity and progression of the disorder.
Collapse
Affiliation(s)
- W Blaicher
- Department of Gynaecology and Obstetrics, Ludwig Boltzmann Institute for fetal development and behavior, University Hospital Vienna.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Häusler M, Anhuf D, Schüler H, Ramaekers VT, Thron A, Zerres K, Möller-Hartmann W. White-matter disease in 18q deletion (18q?) syndrome: magnetic resonance spectroscopy indicates demyelination or increased myelin turnover rather than dysmyelination. Neuroradiology 2005; 47:83-6. [PMID: 15645149 DOI: 10.1007/s00234-004-1309-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Accepted: 08/24/2004] [Indexed: 10/25/2022]
Abstract
Proton magnetic resonance spectroscopic data ((1)H-MR spectroscopy) of patients with 18q deletion syndrome have not yet been reported. (1)H-MR spectroscopy, performed in an affected 2-year-old girl with markedly delayed neuromotor development and typical supratentorial white-matter disease (WMD), showed an increase of choline and alpha-glutamate concentrations. Eight months later, simultaneously with clinical improvement, alpha-glutamate had normalised whereas choline remained slightly increased. Active demyelination or increased myelin turnover might contribute to the hitherto unexplained WMD of this rare disorder.
Collapse
Affiliation(s)
- M Häusler
- Department of Pediatrics, University Hospital of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
39
|
Hutterer G, Bauer M, Häusler M, Orescovic I, Winter R, Bianchi DW, Eder M, Pertl B. Fetale DNA im mütterlichen Plasma: Ein neuer Marker für Schwangerschaftskomplikationen. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
40
|
Abstract
BACKGROUND Although considered of high prognostic impact, knowledge on the long-term outcome after neonatal parenchymatous brain lesions (PBL) is limited. PATIENTS 29 children with either unilateral (n = 19) or bilateral (n = 10) hemorrhagic/ischemic PBL. METHODS The patients were reinvestigated at 9 9/12 +/- 3 4/12 years of age, using a standardized clinical investigation, the Beery-Buktenica Scales of Visuomotor Integration (VMI) and the Bruininks-Oseretzky Test of Motor Proficiency (BOT). The parents were questioned by means of a standardized questionnaire and the Child Behavior Checklist (CBCL). RESULTS 90 % of the children showed cerebral palsy (including 12 with hemi- and 8 with tetraplegia). Only 11 % showed normal results on BOT and 39 % on VMI testing. 50 % were bed wetters. Six had required ventriculoperitoneal shunting and 11 were on long-term antiepileptic therapy. Herewith bilateral versus unilateral lesions and low 5-minute APGAR scores were associated with poorer outcome (Cox model and Kaplan-Meier analysis). During follow-up the impact of different disabilities changed. Despite the high rate of cerebral palsy, 71 % learned to walk unaided and 86 % to communicate with words. The last patient learned to walk at 7 years of age. Only one showed poor seizure control. No severe shunt-related complications occurred after 5 years of age. Social, cognitive and behavioral problems increased with age. Only 34 % could attend mainstream schools or kindergartens, and only 50 % displayed normal behavior according to CBCL data, with attention deficiency and social problems being the most important domains. In consequence, nearly all children required 24-hour supervision. CONCLUSIONS After birth, organic problems such as delayed motor development, epilepsy and ventriculoperitoneal shunting are of major importance for children with PBL. Although delayed, basic skills such as verbal communication are achieved by the majority of patients. In later childhood and adolescence, social, behavioral and cognitive problems increase. In the future, vast resources will be required to provide adequate education and carers as substitutes for elderly parents.
Collapse
MESH Headings
- Adolescent
- Birth Weight
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/rehabilitation
- Cerebral Hemorrhage/diagnosis
- Cerebral Hemorrhage/rehabilitation
- Child
- Child Behavior Disorders/diagnosis
- Child Behavior Disorders/rehabilitation
- Child, Preschool
- Epilepsy/diagnosis
- Epilepsy/rehabilitation
- Female
- Follow-Up Studies
- Gestational Age
- Humans
- Infant
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/rehabilitation
- Intellectual Disability/diagnosis
- Intellectual Disability/rehabilitation
- Leukomalacia, Periventricular/diagnosis
- Leukomalacia, Periventricular/rehabilitation
- Male
- Neuromuscular Diseases/diagnosis
- Neuromuscular Diseases/rehabilitation
- Psychomotor Disorders/diagnosis
- Psychomotor Disorders/rehabilitation
- Risk Factors
- Social Adjustment
- Treatment Outcome
Collapse
Affiliation(s)
- M Häusler
- Department of Pediatrics, University Hospital RWTH, Aachen, Germany.
| | | | | | | |
Collapse
|
41
|
Blau N, Bonafé L, Krägeloh-Mann I, Thöny B, Kierat L, Häusler M, Ramaekers V. Cerebrospinal fluid pterins and folates in Aicardi-Goutières syndrome: a new phenotype. Neurology 2003; 61:642-7. [PMID: 12963755 DOI: 10.1212/01.wnl.0000082726.08631.e7] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe three unrelated children with a distinctive variant of Aicardi-Goutières syndrome (AGS) characterized by microcephaly, severe mental and motor retardation, dyskinesia or spasticity, and occasional seizures. RESULTS Neuroimaging showed bilateral calcification of basal ganglia and white matter. CSF glucose, protein, cell count, and interferon alpha were normal. Abnormal CSF findings included extremely high neopterin (293 to 814 nmol/L; normal 12 to 30 nmol/L) and biopterin (226 to 416 nmol/L; normal 15 to 40 nmol/L) combined with lowered 5-methyltetrahydrofolate (23 to 48 nmol/L; normal 64 to 182 nmol/L) concentrations in two patients. The absence of pleocytosis and normal CSF interferon alpha was a characteristic finding compared to the classic AGS syndrome. Genetic and enzymatic tests excluded disorders of tetrahydrobiopterin metabolism, including mutation analysis of GTP cyclohydrolase feed-back regulatory protein. CSF investigations in three patients with classic AGS also showed increased pterins and partially lowered folate levels. CONCLUSIONS Intrathecal overproduction of pterins is the first biochemical abnormality identified in patients with AGS variants. Long-term substitution with folinic acid (2-4 mg/kg/day) resulted in substantial clinical recovery with normalization of CSF folates and pterins in one patient and clinical improvement in another. The underlying defect remains unknown.
Collapse
Affiliation(s)
- N Blau
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital, Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
42
|
Ramaekers VT, Hansen SI, Holm J, Opladen T, Senderek J, Häusler M, Heimann G, Fowler B, Maiwald R, Blau N. Reduced folate transport to the CNS in female Rett patients. Neurology 2003; 61:506-15. [PMID: 12939425 DOI: 10.1212/01.wnl.0000078939.64774.1b] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous CSF studies in Rett syndrome suggest reduced turnover of the biogenic monoamines serotonin and dopamine. Because diminished turnover may result from CNS folate depletion, the authors studied transport of folate across the blood-brain barrier. METHODS In four patients with Rett syndrome, the authors measured CSF values of 5-methyltetrahydrofolate (5MTHF), biogenic monoamine end-metabolites, and pterins together with serum and red blood cell folate. In CSF, the overall folate binding capacity by the two soluble folate-binding proteins FBP1 and FBP2 (sFBP) was measured using a radioligand binding method for H3-labeled folate. A specific immunoreactive test (ELISA) detected sFBP1, which normally contributes to 30 to 35% of the total folate binding capacity. Genetic analysis included DNA sequencing of the MECP2, FBP1, and FBP2 genes. Empirical treatment with oral folinic acid was evaluated. RESULTS Two patients without and two with mutations of the MECP2 gene had normal values for red blood cell folate, serum folate, homocysteine, and methionine. In CSF, all patients had low values for 5MTHF, neopterin, and the serotonin end-metabolite 5-hydroxyindoleacetic acid (5-HIAA). Genetic analysis of FBP1 and FBP2 genes had normal results. Compared to controls, patients with Rett syndrome had normal immunoreactive sFBP1 in CSF, whereas the total folate binding capacity was disproportionately lowered. Empirical treatment with oral folinic acid normalized 5-MHTF and 5-HIAA levels in CSF, and led to partial clinical improvement. CONCLUSION Irrespective of the MECP2 genotype, 5MTHF transfer to the CNS is reduced in Rett syndrome. Folinic acid supplementation restores 5MTHF levels and serotoninergic turnover. The lowered folate binding capacity of FBP is not explained by a defect of the FBP1 or FBP2 gene, but most likely occurs as a secondary phenomenon in Rett syndrome.
Collapse
Affiliation(s)
- V T Ramaekers
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Aachen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Ramaekers VT, Häusler M, Opladen T, Heimann G, Blau N. Psychomotor retardation, spastic paraplegia, cerebellar ataxia and dyskinesia associated with low 5-methyltetrahydrofolate in cerebrospinal fluid: a novel neurometabolic condition responding to folinic acid substitution. Neuropediatrics 2002; 33:301-8. [PMID: 12571785 DOI: 10.1055/s-2002-37082] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Normal brain development and function depend on the active transport of folates across the blood-brain barrier. The folate receptor-1 (FR 1) protein is localized at the basolateral surface of the choroid plexus, which is characterized by a high binding affinity for circulating 5-methyltetrahydrofolate (5-MTHF). PATIENTS AND METHODS We report on the clinical and metabolic findings among five children with normal neurodevelopmental progress during the first four to six months followed by the acquisition of a neurological condition which includes marked irritability, decelerating head growth, psychomotor retardation, cerebellar ataxia, dyskinesias (choreoathetosis, ballism), pyramidal signs in the lower limbs and occasional seizures. After the age of six years the two oldest patients also manifested a central visual disorder. Known disorders have been ruled out by extensive investigations. Cerebrospinal fluid (CSF) analysis included determination of biogenic monoamines, pterins and 5-MTHF. RESULTS Despite normal folate levels in serum and red blood cells with normal homocysteine, analysis of CSF revealed a decline towards very low values for 5-methyltetrahydrofolate (5-MTHF), which suggested disturbed transport of folates across the blood-brain barrier. Genetic analysis of the FR 1 gene revealed normal coding sequences. Oral treatment with doses of the stable compound folinic acid (0.5-1 mg/kg/day Leucovorin(R)) resulted in clinical amelioration and normalization of 5-MTHF values in CSF. CONCLUSION Our findings identified a new condition manifesting after the age of 6 months which was accompanied by low 5-MTHF in cerebrospinal fluid and responded to oral supplements with folinic acid. However, the cause of disturbed folate transfer across the blood-brain barrier remains unknown.
Collapse
Affiliation(s)
- V T Ramaekers
- Division of Paediatric Neurology, Department of Paediatrics, University Hospital Aachen, Aachen, Germany.
| | | | | | | | | |
Collapse
|
44
|
Kutschera J, Tomaselli J, Urlesberger B, Maurer U, Häusler M, Gradnitzer E, Burmucic K, Müller W. Absent or reversed end-diastolic blood flow in the umbilical artery and abnormal Doppler cerebroplacental ratio--cognitive, neurological and somatic development at 3 to 6 years. Early Hum Dev 2002; 69:47-56. [PMID: 12324182 DOI: 10.1016/s0378-3782(02)00039-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED The objective of this study was to examine the cognitive, neurological and somatic developments of children who had in utero an absent or reversed end-diastolic blood flow (ARED) in the umbilical artery or an abnormal cerebroplacental ratio (ABF). METHODS 16 children with ARED blood flow and 15 children with ABF were each matched to children with the same gestational age, appropriate for gestational age, the same sex and born within 4 months. Data were assessed at the age of 3-6 years. Children with asphyxia, neonatal infection, malformation or major surgical interventions in the neonatal period were excluded. Each child underwent a neuropediatrical examination; furthermore, a Kaufman Assessment Battery for Children, a Snijders-Oomen Intelligence Scale for Children and a Man-Drawing Test were used to evaluate cognitive development. The socioeconomic status was also assessed. RESULTS Children in the ARED group remained lighter and had a higher frequency of microcephaly. In the Kaufman Assessment Battery for Children and the Snijders-Oomen Intelligence Scale for Young Children, cognitive development was impaired in the ARED and the ABF groups compared to the control group. The ARED and the ABF groups, however, showed no differences. The Man-Drawing Test and the Denver Development Test did not show any differences. DISCUSSION ARED blood flow and ABF showed impaired cognitive development. The degree of impairment was the same in the ARED and the ABF groups. Long-term follow-up studies until adulthood are necessary to see if impaired cognitive development remains significant in these groups of patients.
Collapse
Affiliation(s)
- J Kutschera
- Division of Neonatology, Department of Pediatrics, University Hospital Graz, Auenbruggerplatz 30, A-8036 Graz, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Häusler M, Schaade L, Kemény S, Schweizer K, Schoenmackers C, Ramaekers VT. Encephalitis related to primary varicella-zoster virus infection in immunocompetent children. J Neurol Sci 2002; 195:111-6. [PMID: 11897240 DOI: 10.1016/s0022-510x(02)00017-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Encephalitis is a rare complication of primary varicella-zoster virus (VZV) infection in immunocompetent children. METHODS The clinical and laboratory findings of two girls with VZV-related encephalitis are reported. RESULTS Both children presented with focal epileptic seizures, corresponding to cortical/subcortical as well as white matter lesions. The first showed a typical vesicular skin rash. She was easily diagnosed and made a rapid recovery during acyclovir and steroid treatment. In the second girl, a preceding measles-mumps-rubella virus vaccination and the absence of skin vesicles were misleading with respect to the diagnosis, which was finally proven by IgG seroconversion and intrathecal synthesis of IgG antibodies to VZV. She developed left parieto-occipital tissue necrosis and recovered only transiently during initial acyclovir/steroid treatment. Eight weeks after onset, progressive white matter demyelination and the occurrence of erythema nodosum in the lower limbs necessitated a second 4-month course of oral steroids. The VZV PCR from cerebrospinal fluid was negative in both children. CONCLUSIONS Primary VZV infection may cause severe encephalitis that may occur without skin vesicles and lead to a chronic course with systemic vasculitis. The coincidence of vaccination and neurologic diseases offers no proof per se of a causal relationship.
Collapse
Affiliation(s)
- M Häusler
- Department of Pediatrics, Pediatric Neurology Division, University Hospital, RWTH Aachen, Pauwelsstr. 30, D-52074, Aachen, Germany.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Interstitial lung disease, although of prognostic impact for patients with cystic fibrosis (CF), remains difficult to assess without histopathologic investigations. As changes of peripheral blood lymphocyte subsets (LS) may accompany severe systemic lymphocyte immune responses, we compared peripheral LS of 44 patients with CF, 23 non-CF patients with recurrent pulmonary infections and 83 healthy controls (flow cytometry; CD3, CD19, CD16, CD56, CD4, CD8, CD11b, CD45RA, CD45RO, HLA-DR and CD25 antigens). Additional immunohistochemistry was performed on lung tissue of four CF patients aged 0.5, 12, 17 and 20 years, respectively. Patients with CF showed low absolute counts of CD4+CD45RO+ memory helperT cells, CD16+CD56+ NK cells, CD8+ and interleukin-2 receptor-positive T cells in peripheral blood (P < 0.001). Similar changes were registered in the non-CF patients with pulmonary infections, indicating that those were not specific for CF. Immunohistochemistry showed activation of bronchus-associated lymphoid tissue with interstitial accumulation of CD4+CD45 RO+ T cells in the three older patients. Patients with CF show marked changes of peripheral blood LS which are presumably not CF-specific and may mirror homing to lung tissue in the course of interstitial lung disease. Further research should evaluate its usefulness in monitoring progression of lung disease in CF.
Collapse
Affiliation(s)
- M Häusler
- Department of Pediatrics, University Hospital, RWTH Aachen, Germany.
| | | | | | | | | |
Collapse
|
47
|
Häusler M, Heimann G, Biesterfeld S. Fibrosis: a general feature in cystic fibrosis? J Pediatr Gastroenterol Nutr 2002; 34:236-9. [PMID: 11840048 DOI: 10.1097/00005176-200202000-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Häusler
- Department of Paediatrics, University Hospital RWTH Aachen, Germany.
| | | | | |
Collapse
|
48
|
Schaade L, Kleines M, Häusler M. Application of virus-specific immunoglobulin M (IgM), IgG, and IgA antibody detection with a polyantigenic enzyme-linked immunosorbent assay for diagnosis of Epstein-Barr virus infections in childhood. J Clin Microbiol 2001; 39:3902-5. [PMID: 11682505 PMCID: PMC88462 DOI: 10.1128/jcm.39.11.3902-3905.2001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Enzygnost anti-Epstein-Barr virus enzyme-linked immunosorbent assay (ELISA) system, which is based on a defined antigen mixture and on detection of antibodies of the immunoglobulin G (IgG), IgM, and IgA classes, was evaluated for its reliability in diagnosing Epstein-Barr virus infections in childhood. With samples from 66 children, the Epstein-Barr virus status and the infection phase were defined by indirect immunofluorescence and anticomplement fluorescence assays: 11 children were seronegative, 8 had a primary infection, 20 had a recent primary or past infection, and in 27 a reactivated Epstein-Barr virus infection was diagnosed. When applying the Enzygnost ELISAs, 15 serum samples (22.7%) were not interpretable due to indeterminate results in at least one of the assays used and were therefore excluded from further evaluation. The respective sensitivities and specificities for the diagnosis of seronegativity were 100 and 100%, those for the diagnosis of primary infection were 100 and 97%, those for the diagnosis of recent primary or past infection were 100 and 52%, and those for the diagnosis of reactivated infection were 10 and 100%. This poor performance of the Enzygnost system with reactivated infections is due to the prerequisite of an IgG antibody value of >650 IU/ml for the diagnosis of viral activity, which was fulfilled in only two of the children. Despite the high rate of indeterminate results, the Enzygnost system is useful in diagnosing acute and past Epstein-Barr virus infection in childhood. For serological diagnosis of viral activity in childhood, a supplementary assay is necessary.
Collapse
Affiliation(s)
- L Schaade
- Division of Virology, Department of Medical Microbiology, University Hospital RWTH Aachen, D-52057 Aachen, Germany
| | | | | |
Collapse
|
49
|
Barisic I, Clementi M, Häusler M, Gjergja R, Kern J, Stoll C. Evaluation of prenatal ultrasound diagnosis of fetal abdominal wall defects by 19 European registries. Ultrasound Obstet Gynecol 2001; 18:309-316. [PMID: 11778988 DOI: 10.1046/j.0960-7692.2001.00534.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To evaluate the current effectiveness of routine prenatal ultrasound screening in detecting gastroschisis and omphalocele in Europe. DESIGN Data were collected by 19 congenital malformation registries from 11 European countries. The registries used the same epidemiological methodology and registration system. The study period was 30 months (July 1st 1996-December 31st 1998) and the total number of monitored pregnancies was 690,123. RESULTS The sensitivity of antenatal ultrasound examination in detecting omphalocele was 75% (103/137). The mean gestational age at the first detection of an anomaly was 18 +/- 6.0 gestational weeks. The overall prenatal detection rate for gastroschisis was 83% (88/106) and the mean gestational age at diagnosis was 20 +/- 7.0 gestational weeks. Detection rates varied between registries from 25 to 100% for omphalocele and from 18 to 100% for gastroschisis. Of the 137 cases of omphalocele less than half of the cases were live births (n = 56; 41%). A high number of cases resulted in fetal deaths (n = 30; 22%) and termination of pregnancy (n = 51; 37%). Of the 106 cases of gastroschisis there were 62 (59%) live births, 13 (12%) ended with intrauterine fetal death and 31 (29%) had the pregnancies terminated. CONCLUSIONS There is significant regional variation in detection rates in Europe reflecting different policies, equipment and the operators' experience. A high proportion of abdominal wall defects is associated with concurrent malformations, syndromes or chromosomal abnormalities, stressing the need for the introduction of repeated detailed ultrasound examination as a standard procedure. There is still a relatively high rate of elective termination of pregnancies for both defects, even in isolated cases which generally have a good prognosis after surgical repair.
Collapse
Affiliation(s)
- I Barisic
- Department of Pediatrics, Children's University Hospital Zagreb, Croatia.
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
AIM To evaluate the long term outcome after paediatric inferior vena cava (IVC) thrombosis. METHODS A combined retrospective and prospective study on infants and children with IVC thrombosis treated at Aachen and Maastricht University Hospitals between 1980 and 1999. RESULTS Forty patients were enrolled, including four with preceding cardiac catheterisation, 18 with central venous saphenous lines, and an additional eight with umbilical venous catheters. Six patients died within three months of diagnosis; one patient was lost to follow up. Twelve of the remaining 33 patients had suffered from limited IVC thrombosis; during follow up (for up to nine years) none showed persisting caval obstruction (successful thrombolysis, n = 2; spontaneous recanalisation, n = 10). The remaining 21 patients presented with extensive IVC thrombosis. During follow up (for up to 18 years) complete restitution was found in only four cases (one thrombolysis, two surgery, one spontaneous recanalisation). Persisting iliac and/or caval venous obstruction occurred in 17 patients, including six with thrombolysis. Varicose veins were found in 12, and post-thrombotic syndrome in seven of these cases. According to Kaplan-Meier analysis, 30% of patients with persisting venous disease will develop post-thrombotic syndrome within 10 years of the thrombotic event. CONCLUSIONS Infants and children with extensive IVC thrombosis are at high risk for persisting venous disease and serious long term complications. Prospective trials are urgently needed to establish effective treatment strategies and to improve long term prognosis. Central venous catheters, contributing to IVC thrombosis in the majority of cases reported here, should be inserted only if essential.
Collapse
Affiliation(s)
- M Häusler
- Department of Paediatrics, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
| | | | | | | |
Collapse
|