Ernst Dinkel

Kidney size in childhood. Sonographical growth charts for kidney length and volume.

Kidney size was determined in a sonographic study of 325 children without kidney pathology. Real-time ultrasound equipment adjusted for the pediatric age group, provided standardized renal biometry. Outer kidney diameters showed a linear correlation to somatic developmental parameters. Renal volume was established by the formula for an ellipsoid and showed good correlation to body weight. Growth charts for kidney length and volume in childhood are constructed and provide the basis for objective intra- and interindividual determination of renal size.

Pancreatic lesions in the von Hippel-Lindau syndrome

Common manifestations of the von Hippel-Lindau syndrome, an autosomally dominant inherited cancer-prone disorder, include retinal angiomatosis, hemangioblastoma of the central nervous system, renal cysts, renal cancer, pheochromocytoma, and epididymal cystadenoma. Multiple cysts and microcystic (serous) cystadenomas of the pancreas have also been reported occasionally in patients afflicted with this syndrome. In the large Freiburg study of the von Hippel-Lindau syndrome composed of 66 affected individuals, pancreatic lesions were systematically studied. Fifty-five living individuals were examined by abdominal ultrasound imaging. Abnormal findings were confirmed by computed tomographic scan and/or magnetic resonance imaging. For an additional 11 decreased patients autopsy data were available. Cystic lesions of the pancreas were found in 10 patients (15%). One of these patients presented with multiple pancreatic cysts as the only manifestation of the syndrome. In one patient, a malignant islet-cell tumor was found at autopsy. Because multiple pancreatic cysts did not cause major clinical symptoms and because follow-up examinations over an average period of 5 years did not show significant progression of the lesions, it is concluded that these patients usually do not require surgical treatment. Abdominal ultrasound screening is recommended for patients at risk as a tool to identify potential von Hippel-Lindau syndrome gene carriers with pancreatic manifestations. In all patients with multiple pancreatic cysts, the von Hippel-Lindau syndrome should be included in the differential diagnosis.

Sonographic biometry of liver and spleen size in childhood.

In 194 healthy children of all ages, sonographic measurements of the liver and spleen were performed on standardized section planes and normal values established. These measurement values showed an approximately linear increase in the course of development and correlated best with the body length. For a rapid orientative evaluation of the liver size, sonographic nomograms of the individual measurements were developed. The spleen size was determined by volume calculation. On the basis of an index of liver size, which was calculated from the individual measurements, a diagram for simultaneous determination of liver and spleen size could be developed. These nomograms permit objective morphometry of size changes in the two organs.

Real-time ultrasound in Crohn's disease: characteristic features and clinical implications

Thirty-two children with Crohns disease were evaluated by real-time ultrasonography. The typical pattern of Crohns disease caused by bowel wall thickening is the “bulls eye phenomenon”, the elongated tubular stiff bowel loop with narrowing of the lumen and the small bowel conglomerate tumor. In indefinable abdominal complaints sonography may lead to the correct diagnosis. The differential diagnosis of similar sonographic features and the limitations of ultrasound in gastrointestinal disease must be considered. In proven Crohns disease the findings in follow-up match the clinical course and may delineate complications, such as ileus, abscess, hydronephrosis, gallstones or involvement of parenchymal organs, as seen in 15 patients. Thus ultrasound will restrict repeated x-ray studies and support patient management.

Renal growth in patients nephrectomized for Wilms tumour as compared to renal agenesis

Compensatory growth in 27 undiseased congenital solitary kidneys and in 31 solitary kidneys in patients with Wilms tumour was monitored in long-term follow-up studies by ultrasound volume biometry. In congenital solitary kidneys hypertrophy was not detectable at the time of birth. Parenchymal mass increase achieved 188% of the volume of a healthy kidney within at least 4 years of life and afterwards paralleled the physiological growth documented in healthy kidney pairs. Disease-free kidneys in Wilms tumour patients all developed a similar 180% volume augmentation within 2–4 years after nephrectomy, irrespective of the chosen mode of radiation and single or tripte chemotherapy. The age of the patient at onset of surgical and concomitant conservative therapy determined slight differences in kinetics but not in degree of compensatory growth.

Sonographic evidence of intraperitoneal fluid an experimental study and its clinical implications

In order to evaluate the sensitivity of ultrasound to intraperitoneal fluid, such as ascites or blood, an experimental study was performed in the pig. Various amounts of fluid were injected into the peritoneal cavity to investigate distribution and diagnostic criteria in different positions. As little as 10 ml of fluid was visualized around the urinary bladder in an upright position. In the supine position, 20 ml could be detected around the bladder and 30 ml around the liver. The injection of at least 60 ml resulted in a pattern of free-floating bowel loops. The sonographic findings of fluid distribution were correlated to radiological studies. As different amounts of fluid produce characteristic sonographic patterns, an approximate estimation of the intraperitoneal fluid volume can be made.

Sonographic biometry in obstructive uropathy of children: Preoperative diagnosis and postoperative monitoring

Renal sonography was performed in 92 children with obstructive uropathy or vesicoureteral reflux preoperatively and at follow-up. Renal volume and the anteroposterior diameter of the renal pelvis proved to be the most reliable morphometric criteria for objective sonographic staging and follow-up of urinary tract obstruction. If transient obstruction occurred after uncomplicated antireflux ureterovesico-plasties (n=41), it lasted at most 4 weeks. Kidneys with transient postoperative ureterovesical junction obstruction (n=21) reverted to normal sonographic pattern within 4 weeks following ureteral reimplantation. In cases of ureteropelvic junction obstruction (n=30), it took up to 6 months for the majority of kidneys to present almost normal sonographic findings. Sonographic biometry and the knowledge about the uncomplicated postoperative course render postsurgical monitoring easier and more reliable.

Intraarterial digital subtraction angiography of renal transplants

Nineteen renal allograft recipients with suspected vascular pathology of the graft were examined by digital subtraction angiography combined with intraarterial catheter technique. Image quality was excellent and diagnosis was definite in all cases. Dosages of contrast medium are reduced to a minimum (1.5 g iodine/patient) and the risk of nephrotoxic side effects is virtually negligible with this technique.

Diagnostische Flußschemata bei abdominellen Leitsymptomen

Anlaslich eines Seminars uber den Stellenwert der bildgebenden Untersuchungstechniken in der padiatrischen Abdominaldiagnostik im Kindesalter (Herbst 1980, Mainz) wurden Flusschemata erarbeitet, die den Untersuchungsablauf bei ausgewahlten klinischen Leitsymptomen skizzieren. Diese z. T. in modifizierter Form vorliegenden Flusschemata sind als Orientierungshilfe fur die Planung des diagnostischen Vorgehens gedacht.