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Funnel chest (Pectus excavatum) is the most common deformity of the anterior chest in children. Present paper describes a method to process and classify CT slices representing funnel chest deformities. A manually chosen CT slice was processed to detect the inner curvature of the chest for characterization. Normalized data from the detected inner curvature was gained and saved next to a manually-given deformity type for further classification rule determinations. Based on the multiple correlations of the values gained from the inner curvature, a hierarchical classification was performed on 199 patient data. Results have shown that the calculated values gained from the inner curvature can accurately characterize the deformity type of the chest. Since minimal user interaction was necessary to detect and characterize the inner curvature, our method is considered to be an effective automated procedure for funnel chest deformity classifications.

This paper presents a comparison study between 10 automatic and six interactive methods for liver segmentation from contrast-enhanced CT images. It is based on results from the "MICCAI 2007 Grand Challenge" workshop, where 16 teams evaluated their algorithms on a common database. A collection of 20 clinical images with reference segmentations was provided to train and tune algorithms in advance. Participants were also allowed to use additional proprietary training data for that purpose. All teams then had to apply their methods to 10 test datasets and submit the obtained results. Employed algorithms include statistical shape models, atlas registration, level-sets, graph-cuts and rule-based systems. All results were compared to reference segmentations five error measures that highlight different aspects of segmentation accuracy. All measures were combined according to a specific scoring system relating the obtained values to human expert variability. In general, interactive methods reached higher average scores than automatic approaches and featured a better consistency of segmentation quality. However, the best automatic methods (mainly based on statistical shape models with some additional free deformation) could compete well on the majority of test images. The study provides an insight in performance of different segmentation approaches under real-world conditions and highlights achievements and limitations of current image analysis techniques.

The basic scheme of modern medical imaging consists of the following steps: (1) data acquisition, (2) data (image) processing, (3) further data processing by the computer graphic system, (4) image display, and finally (5) visual perception and interpretation. Medical monitors represent a forgotten part of the whole chain. The purpose of this review is to present the key facts about the display technologies used today, as well as their characterization and quality assurance.

Today several modalities for imaging the spine, the spinal canal and the spinal cord are available. Since children represent one of the most vulnerable patient groups, care has to be taken and imaging assessment should start always with less invasive procedures. Thus, in neonates and infants ultrasound should be used as first line imaging procedure due to their unique features of more cartilaginous parts of the yet non-ossified bones. Beyond this age group Magnetic Resonance Imaging (MRI) represents the modality of choice for radiological assessment of the spine, the spinal canal and the spinal cord. The purpose of this review is to present MRI and common MRI findings of typical diseases in children-ranging from congenital to acquired conditions. In addition, general imaging details will be given as well as a brief embryological description of the spine and spinal canal.

We present the clinical application of a new method for objective assessment of both grade and length of laryngo-tracheal stenoses (LTS) on a CT-based skeletonization algorithm, called laryngo-tracheal profile (LTP). Extraction of the laryngo-tracheal tract (LTT)-medial axis was performed after S-CT scanning. Orthogonal to the medial axis, the LTT cross-profile was computed, and the length and degree of LTS were presented as line charts. Clinical application of this newly developed method is demonstrated on three patients who had to undergo preoperative assessment before surgical treatment of tracheal stenoses. LTP provides an objective method of assessment of both the length and degree of tracheal stenoses in precise correlation to defined anatomical landmarks. This method provides important additive information for preoperative evaluation as well as for monitoring of therapeutical success. Current methods used so far are able to evaluate the severity of LTS, but do not provide exact quantitative assessment of complex LTS. Especially in CT-scans of strong curved passages, where an overestimation of the cross-sectional area results by an oblique cut of the tubular structure, LTP may overcome this problem by a simple post processing skeletonization algorithm.

A variety of traumatic lesions can occur during the neonatal period. Some of those lesions are clearly birth injuries due to delivery and others are caused by necessary procedures during intensive care in critically ill neonates. As usual patient history must be known and knowledge about the typical complications is necessary in order to select the appropriate imaging modality and thus enabling correct interpretation of those investigations by the radiologist. The purpose of this article is to present typical neonatal injuries, describe the underlying pathomechanisms and aetiology as well as the imaging findings.

The challenge of managing pediatric foot injuries is the identification of the rare injuries that require operative treatment and the management of complications such as compartment syndrome, post-traumatic foot deformities, and avascular necrosis. With these complications in mind, the authors discuss fractures of the talus, calcaneus, lesser tarsal bones, Lisfranc's joint, metarsals, and phalanges. Dislocation of metatarsophalangeal or interphalangeal joints is also discussed.

Abdominal aortic aneurysm (AAA) is a serious vascular disease which may have a fatal outcome. AAA shape and size is important for diagnostics and intervention planning. In this paper, we present a new method for segmentation of AAA from computed tomography (CT) angiography images. The method works by segmenting the inner and the outer aortic border. Segmentation of AAA is a challenging problem because of low contrast of the outer aortic border. In our method, the inner aortic border is segmented using a geometric deformable model (GDM) and morphological postprocessing. The GDM is implemented using the level-set algorithm. The outer aortic border is segmented by a preprocessing method utilizing a priori knowledge about the aorta shape, followed by the GDM-based method, and morphological postprocessing. The preprocessing algorithm operates on a slice-by-slice basis with some information flow among neighboring slices. The GDM performs three-dimensional (3D) segmentation, reducing possible errors in the previous step. The proposed method is automatic and requires minimal user assistance. The method was statistically validated on 12 patient scans having a total number of 497 image slices. Statistical analysis has confirmed high correlation between the results obtained by the proposed method and the gold standard obtained by manual segmentation by an expert radiologist.

Purpose: To evaluate the frequency and influence of perfused side branches (lumbar arteries [LA] and inferior mesenteric artery trunks) on development of type II endoleaks (EL-II) and on volume changes of abdominal aortic aneurysms (AAA) after endovascular repair., Methods: Of 114 patients undergoing EVR of AAA, 89 patients (83 men; mean age 72+/-7.5 years, range 51-88) with >6 months' follow-up and no type I endoleaks were retrospectively analyzed to determine any relationships between retrograde perfusion, endoleaks, and sac volume. Data were derived from computed tomographic angiographic (CTA) scans taken before and after intervention, at discharge, and at 1, 3, 6, and semi-annually thereafter in follow-up. Two groups were identified and compared based on their status at 6 months post EVR: without perfused side branches (group 1) and with perfused collaterals (group 2); group 2 was further divided according to the absence (2a) or presence (2b) of endoleak., Results: Median follow-up was 24 months (range 6-36). Based on a total of 582 CTAs analyzed, 17 (19%) patients developed type II endoleaks (EL-II) during follow-up. There was a significant difference in the number of perfused LAs prior to EVR between groups 1 (n=44) and the 45 patients with postprocedural patent collateral arteries in group 2 (p<0.05); there was no significant difference between groups 2a and 2b (p=0.88) relative to the number of pre-existing patent collaterals. The number of pLAs preoperatively and the rate of type II endoleak were significantly correlated (p<0.05). No type II endoleak was seen in patients without perfused side branches (p=0.01). No significant differences in mean volumes were found between groups 1 and 2a (no EL-II), but significant differences between groups 1 and 2b were seen in later follow-up., Conclusions: A larger number of patent LAs before EVR was associated with a significantly higher rate of type II endoleak. Patent collateral vessels were common after aneurysm repair, but the frequency decreased during follow-up. Persistent side branch perfusion was associated with increased type II endoleak after endovascular AAA repair. Significant differences in volume changes in later follow-up were seen between patients with or without type II endoleak.

Intussusception represents the most common abdominal emergency in infancy. The classical clinical triad, consisting of abdominal colics, red jelly stools and a palpable mass, is only present in approximately 50% of cases, 20% of patients are symptom free at clinical presentation. Primary imaging modality of choice is ultrasound scanning, which enables the diagnosis or exclusion of an intussusception at a sensitivity of 98-100%, specificity of 88% and a negative predictive value of 100%. In emergency cases, additional plain films are necessary to detect potential intestinal perforation, to identify intestinal obstruction or other diseases mimicking the clinical presentation. Once the diagnosis of an intussusception is established, non-surgical reduction (NSR) is used. A surgical approach is chosen in patients with signs of perforation, shock or peritonitis. Depending on the choice of guiding imaging technique, different contrast media are used for NSR. Barium suspension or air with fluoroscopic guidance, or saline only or mixed with water-soluble contrast under sonographic guidance, has to be used. Regardless of the used contrast medium, NSR is an effective technique, being successfully employed in more than 90% of cases.

In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, "flaps") now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with (99m)Tc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that (99m)Tc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to provide better prognosis.

The recognition of a battered child represents a challenge for all groups of adults dealing with children. Radiology plays a special role in this setting. By detection typical injuries, imaging is able to confirm the suspicion of a battered child. Recognition of those injuries on films, taken for other reasons, gives the caretaker an important hint, thus maybe preventing a fatal outcome for the child. One of the most important injury types is represented by the so called "shaken baby syndrome". The infant is held by the thorax and shaken. Thus causing a repetitive acceleration-deceleration trauma, which leads to the typical paravertebral rib fractures, intracranial bleeding and eye injuries. After shaking the child is thrown away, with subsequent injuries. The aim of this article is the presentation of an overview regarding the radiology of the battered child. Typical examples will be shown.

Background: 3D post-processing of spiral-CT (S-CT) data using perspective projection allows the generation of virtual views similar to endoscopy., Objective: To evaluate whether simultaneous reading of axial S-CT, multiplanar reconstruction (MPR) and virtual tracheobronchoscopy (VTB) is more precise and accurate than reading of axial S-CT and MPR alone in paediatric patients., Materials and Methods: S-CT studies of 15 symptomatic and 4 normal patients were investigated. Two radiologists independently read two sets of images for airway abnormalities: first axial CT and MPR, followed by axial CT, MPR and VTB. A final decision was later made by consensus. All results were compared to fibre-optic bronchoscopy (FTB). Interobserver agreement was used as an indicator of precision for the display technique used., Results: At reading of axial S-CT and MPR an interobserver agreement of 89.5% (kappa=0.776, P<0.00103) was found. Based on the consensus decision, a diagnostic accuracy of 89.5% at a sensitivity 86.6% and specificity of 100% (kappa=0.776, 95% CI 0.491-1.062, P<0.00103) was achieved. At reporting on axial S-CT, MPR and VTB, all cases were classified correctly by both readers, indicating 100% accuracy, interobserver agreement, sensitivity and specificity (kappa=1.00, 95% CI 1.0-1.0, P<0.000258)., Conclusions: The simultaneous display of axial S-CT, MPR and VTB raises the precision, accuracy and sensitivity of radiological reports.

Objective: The value of CT angiography and three-dimensional (3D) reconstructions was investigated in the postoperative care after surgical repair of aortic coarctation and compared with conventional angiography., Subjects and Methods: Twenty-five patients referred because of suspicion of stenosis in the area of former coarctation were prospectively studied with CT angiography and catheter angiography. We determined the morphometric and morphologic findings such as aortic diameter, stenosis, aneurysm, intimal flaps, circumscribed pouch, or arteriosclerotic plaques with 3D reconstructions, using maximum-intensity-projection (MIP) technique and catheter angiography. The results of both techniques were compared. The ratio of the narrowest diameters of the former coarctation and the descending aorta was correlated with the systolic pullback blood pressure gradient in all patients., Results: The former coarctation was normal in 11 patients, (44%), group A; narrowed in 12 children (48%), group B; and dilated in two children (8%), group C. An intimal flap and a circumscribed pouch were delineated in four subjects. MIP reconstructions and catheter angiography revealed identical results regarding the classification into groups A, B, C; intimal flaps; and circumscribed pouches. Statistical analysis revealed good correlation between the narrowest aortic diameters measured on MIP reconstructions and catheter angiography, whereas no correlation between the systolic pullback blood pressure gradient and the diameter ratio of the former coarctation and the descending aorta was found., Conclusion: CT angiography and 3D reconstructions using MIP represent a reliable noninvasive technique to replace diagnostic catheter angiography in the postoperative care of patients with coarctation and provide the clinician with valuable information concerning further invasive procedures.

In this paper we propose a technique for 3-D segmentation of abdominal aortic aneurysm (AAA) from computed tomography (CT) angiography images. Output data form the proposed method can be used for measurement of aortic shape and dimensions. Knowledge of aortic shape and size is very important for selection of appropriate stent graft device for treatment of AAA. The technique is based on a 3-D deformable model and utilizes the level-set algorithm for implementation of the method. The method performs 3-D segmentation of CT images and extracts a 3-D model of aortic wall. Once the 3-D model of aortic wall is available it is easy to perform all required measurements for appropriate stent graft selection. The method proposed in this paper uses the level-set algorithm instead of the classical active contour algorithm developed by Kass et al. The main advantage of the level set algorithm is that it enables easy segmentation surpassing most of the drawbacks of the classical approach. In the level-set approach for shape modeling, a 3-D surface is represented by a real 3-D function or equivalent 4-D surface. The 4-D surface is then evolved through an iterative process of solving the differential equation of surface motion. Surface motion is defined by velocity at each point. The velocity is a sum of constant velocity and curvature-dependent velocity. The stopping criterion is calculated based on image gradient. The algorithm has been implemented in MATLAB and C languages. Experiments have been performed using real patient CT angiography images and have shown good results.

We investigated a method for a fully automatic identification and interpretation process for clustered microcalcifications in mammograms. Mammographic films of 100 patients containing microcalcifications with known histology were digitized and preprocessed using standard techniques. Microcalcifications detected by an artificial neural network (ANN) were clustered and some cluster features served as the input of another ANN trained to differentiate between typical and atypical clusters, while others were fed into an ANN trained on typical clusters to evaluate these lesions. The measured sensitivity for the detection of grouped microcalcifications was 0.98. For the task of differentiation between typical and atypical clusters an Az value of 0.87 was computed, while for the diagnosis an Az value of 0.87 with a sensitivity of 0.97 and a specificity of 0.47 was obtained. The results show that a fully automatic computer system was developed for the identification and interpretation of clustered microcalcitications in mammograms with the ability to differentiate most benign lesions from malignant ones in an automatically selected subset of cases.

Unlabelled: In patients with ischemic cardiomyopathy (CM), abnormal renograms may result not only from circulatory failure (which should reverse after transplantation) but also from intrinsic renal disease (which contraindicates heart transplantation). Here, the outcome of heart transplantation was related to preoperative renograms, and the differentiating and prognostic value of renography was analyzed., Methods: The study population consisted of 50 patients with ischemic CM expecting heart transplantation. Anatomical renal pathology was excluded in all patients. Dynamic renal scintigraphy was performed with 99mTc-mercaptoacetyltriglycine. Background-subtracted renograms were inspected visually and characterized numerically. Mean parenchymal transit time (mPTT), renal tracer content at 15 min (RTC15) and retention index (RI) were determined. The parametric renogram values were related to a normal reference group of 64 patients. The preoperative renograms were matched with the postoperative outcome., Results: Three characteristic types of symmetrical findings in the kidneys were found: no pathological findings, mildly delayed peak and excretion phase and severely delayed peak and excretion phase. Pathological renograms were observed in 36 of 50 (72%) patients. The mean parametric renogram values in ischemic CM were as follows: Group A (normal kidney function), mPTT = 142+/-26.6 sec, RTC15 = 22.3%+/-4.6% and RI = 24.7+/-11.9; Group B (mild dysfunction), mPTT = 210+/-44.0 sec, RTC15 = 42.6%+/-10.3% and RI = 101.4+/-50.5; Group C (severe dysfunction), mPTT = 320+/-94.2 sec, RTC15 = 79.6%+/-15.9% and RI = 347.7+/-194.7; and reference patients (normal kidney function), mPTT = 137+/-31.1 sec, RTC15 = 22.8%+/-3.8% and RI = 24.6+/-7.9. Postoperative serum creatinine levels were <1.5 mg/dl in all Group A patients, between 1.5 and 2.5 mg/dl in 78% of Group B patients and >2.5 mg/dl in 75% of Group C patients., Conclusion: Renography revealed abnormal kidney function when structural pathology was excluded. The renographic abnormalities in ischemic CM did not reflect simply the circulatory failure. The numerical grading of renograms allowed patient stratification, suggestive of possible renal insufficiency after cardiac transplantation and immunosuppressive therapy. With further experience, renography may become a useful tool for predicting postoperative outcome in ischemic CM.

Purpose: To evaluate the benefit of "Colour Doppler Energy" (CDE) or "Power Doppler" applications in healthy kidneys and in renal disease including paediatric assessment., Patients and Method: Ten healthy volunteers (range: neonate to adults) were studied using conventional colour Doppler sonography (CDS) and CDE in order to evaluate the visibility of intrarenal vasculature. In addition, ten children and ten adults with known renal disease were evaluated. The findings were compared to clinical, scintigraphic and biopsy results., Results: CDE showed far better visualisation of intrarenal vasculature than CDS. CDE demonstrated focal and diffuse reduced cortical perfusion with an overall accuracy of 95% and a sensitivity of 88%. In 7 healthy volunteers cortical vasculature was visualised throughout the kidney. In 3 infants incomplete visualisation was obtained because of motion artifacts. In the diseased kidneys, CDE findings correlated well with clinical findings, scintigraphy results and biopsy findings., Conclusion: CDE can be successfully applied to adults and infants demonstrating renal vasculature in healthy kidneys and in kidneys with focally or diffusely altered perfusion.

A 17-year-old girl known to suffer from essential thrombocytosis (ET) was admitted with severe abdominal pain that was due to sonographically verified portal and hepatic vein thrombosis. ET is a well-documented disease and portal vein thrombosis has often been reported in adults but not in children and adolescents suffering from ET. Coincidence of ET, urinary tract infection, oral contraception, and cessation of acetylsalicylic acid therapy might be responsible for the early manifestation of portal and hepatic vein thrombosis in our patient.

Twelve infants operated upon for choledochal cyst (CC) are reviewed with emphasis on the operative technique of biliary tract reconstruction, incidence of cholangitis, postoperative hypergastrinemia, biliary excretion, and upper gastrointestinal (GI) motility in a follow-up of 24 to 35 months. In 7 patients biliary reconstruction was performed with a Roux-en-Y hepaticojejunostomy (HJ), and in 5 with a hepaticoantrostomy (HAST). In the HJ group 4 patients had recurrent episodes of cholangitis and intermittent diarrhea and serum gastrin levels were significantly elevated in 5. Hepatobiliary scintigraphy showed unobstructed excretion of labelled bile through bile ducts into the Roux-en-Y loop, but with significantly delayed emptying of bile into the distal jejunum in all patients. Gastric emptying and upper intestinal passage were normal. In the HAST group no episode of cholangitis occurred and serum gastrin levels were within the normal range. Scintigraphically, hepatobiliary excretion, and duodenojejunal passage of labelled bile was normal, except in 1 patient who developed a postoperative stenosis of the left hepatic duct. Upper GI contrast studies demonstrated normal gastric emptying without reflux into the biliary system. These results suggest that biliary reconstruction with HAST can be performed safely with a low incidence of complications HAST offers a more physiologic method of biliary reconstruction after resection of a CC that allows bile to drain directly into the duodenum.

Objective: To evaluate the efficiency of colour Doppler energy (CDE) in comparison to conventional colour Doppler sonography (CDI) in the detection of renal blood flow signals in asymptomatic patients after renal transplantation., Subjects and Methods: Fifteen asymptomatic volunteer patients after renal transplantation were examined with CDI and CDE. The examination parameters were kept constant; only the Doppler-receiver gain was varied. Assessment and comparison of blood flow signals were obtained with a self defined score system., Results: CDI showed Doppler signals in the main stem vessels, segmental and interlobar vessels in all patients; in the arcuate arteries blood flow signals were detected in only 11 of 15 patients. There was no Doppler signal in peripherally located medullary and cortical vessels. CDE showed blood flow signals in the main stem, segmental and interlobar vessels and additionally in the arcuate, interlobular and medullary as well as in the cortical vessels in all patients., Conclusion: CDE is more sensitive than CDI and improves the detection of blood flow signals in peripheral medullary and cortical vessels of renal transplants.

In a long-term follow-up study we compared preoperative testicular position, age at orchiopexy, and morphology of testicular biopsies investigated at orchiopexy to sperm analysis results, testicular volume, and serum follicle-stimulating hormone and luteinizing hormone levels at follow-up in 46 men with a history of surgical correction of cryptorchidism in childhood. They had undergone orchiopexy at age 1.5-12.0 years, 24 for unilateral and 22 for bilateral cryptorchidism. Eleven (46%) of the 24 patients with unilateral and 7 (32%) of the 22 with bilateral undescended testes had a normal sperm analysis, whereas in men with impaired spermiogenesis oligo-asthenozoospermia was the predominant feature. Three (13.6%) patients with bilateral cryptorchidism showed azoospermia, but none of the patients with unilateral cryptorchidism did. Neither the age at orchiopexy nor the average germ-cell count per cross-sectioned seminiferous tubule of testicular biopsies examined at orchiopexy correlated significantly with subsequent sperm analysis results or gonadotropin levels at follow-up. The pretreatment testicular position ("testicular position value") has a high prognostic value for prediction of subsequent sperm analysis results and serum gonadotropin levels.

During a 16-year period, 60 neonates with gastroschisis were treated at the Department of Pediatric Surgery in Graz; 6 died and 54 (90%) survived. A questionnaire was sent to 45 patients, who were called for a medical examination; 31 patients (69%) came to follow-up, 26 of whom reported minor abdominal problems that could be related to gastroesophageal reflux (GER). Fifteen agreed to 24-h esophageal pH monitoring and/or upper gastrointestinal series; in 7 pathological GER could be demonstrated. Manometric studies in 6 patients revealed a motility disorder of the esophagus. Only 4 children were concerned by a disfiguring scar or the absence of a navel. Heigtt and weight were within normal limits and the children had developed normally.

This paper describes a method for SPET quality control that facilitates the determination of COR-offset, parallel y-shift and detector tilt by means of a single, comprehensive test using a special phantom consisting of three point sources. The evaluation of the method was performed by a series of measurements utilizing manually adjusted detector tilts and a simulation of y-shift by moving the phantom. The results show that y-shift and detector tilt are measured with reasonable accuracy, and that y-shift caused by variations in detector tilt can be differentiated from y-shift caused by other factors.

Two neonates, one with complete and one with incomplete birth-related transection of the cervico-thoracic spinal cord, form the basis of this report. Ultrasound and MRI findings in primary diagnosis and follow-up are described. The aim of this contribution is to bring this serious birth complication to the attention of the reader, to present the obstetrical risk factors, to describe the clinical presentation of the newborns and to make suggestions to expand the field of indications for spinal sonography. The value of spinal ultrasound in the first six months of life is stressed, especially in comparison to MRI. For definitive assessment of the lesion (transectional or nontransectional) follow-up ultrasound studies for several weeks are required.

The incidence and diagnostic value of roentgenographic and sonographic signs in necrotizing enterocolitis are presented. The current status in clinical application of Duplex-Doppler sonography and colour-coded Doppler sonography are discussed and a description of the different roentgenographic and sonographic signs including Doppler sonographic findings is given. Radiographic and sonographic indications for surgical treatment are proposed. The role of the different diagnostic imaging modalities in the early diagnosis and evaluation of progress in NEC is defined and a diagnostic algorithm for different stages depending on the severity of the disease is proposed. Routine application of sonography in such an algorithm can improve diagnostic accuracy in necrotizing enterocolitis.

The case of an 41 year old female is reported, who underwent surgical correction of a congenital cyst of the common bile duct 17 years ago. Because of repeated pain attacks in the right upper quadrant in connection with fever and serochemical signs of cholestasis the patient was admitted to our unit. The exploration with ERCP and CT now showed a common channel in combination with a congenital cyst of the common bile duct. The risk of the anomalous pancreaticobiliary junction upon either the biliary tract or the pancreatic duct will be discussed, also the fact of an higher incidence of malignant tumors of the biliary system. The therapeutic procedures will be discussed.

The following article describes a girl with right upper quadrant abdominal colic following Ceftriaxon therapy for purulent meningitis. Ultrasound made it possible to demonstrate sludge-balls, floating in the gallbladder, a follow up examination was normal. Moreover the features of gallbladder precipitations following Ceftriaxon therapy will be described, and the clinical consequences will be discussed.

Mechanical ventilation of mature or premature newborns is supposed to provide pulmonary gas exchange while causing minimal side effects to the respiratory system and circulation of the infants. A certain degree of alveolar ventilation, for example, can be achieved by different ventilator settings with different airway pressures (Fig. 1), and thus the corresponding effects on lung mechanics, barotrauma, and circulation differ. Parameters indicating optimal ventilator settings cannot be measured often enough in routine daily care and sometimes are difficult to interpret because of complex interactivity factors. The aim of the computer program "RespCalc" is to shorten the empirical steps of adapting respirator settings to the status of the ventilated patient by calculating the necessary data and drawing patient-specific nomograms. The computer program "RespCalc" makes use of the mathematical relationships characterizing the determinants of lung mechanics. The following data are necessary for use of the program: patient identification, weight, alveolar ventilation, recent paCO2, compliance, and resistance. By using the time-constant tau, the minimal inspiratory time as well as a maximal possible respirator rate are displayed without inducing inadvertent PEEP at a ratio of 1:1. Afterward, the planned figures of the different respirator rates and corresponding inspiration times must be typed in. The program simultaneously checks whether the previously calculated minimal figures for in- and exhalation time are maintained. If the above-mentioned figures and the typed-in ones differ, an optical and acoustical error message appears, and thus the user is forced to correct the problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Eight patients aged 1 month up to nine years with congenital diaphragmatic hernias (seven left sided postero-lateral, one right-sided antero-medial), who presented outside of the neonatal period, are reported, four are described in detail. Radiographic presentation was obvious in four patients, simulated inflammatory lung disease in one and pneumothorax in two. In one patient a Morgagni hernia was primarily missed. Two had previous normal chest X-rays. All cases with herniated bowel showed "connecting" bowel segments passing through the diaphragmatic defect. Primarily the lack of awareness of delayed presentation of congenital diaphragmatic hernia in children with uncharacteristic thoracic and/or abdominal symptoms led to an undesirable time delay between first chest X-ray and surgery up to 16 months in four of our cases. Life threatening complications can be the consequence of delayed diagnosis as in one of our cases.

A case of congenital arterioportal fistulas in a girl of 4 months of age is presented. Clinical signs of necrotising enteritis developed due to portal hypertension. The diagnosis was established via Doppler-duplex ultrasound showing a pulse-synchronous bidirectional flow pattern in the portal vein and its major branches. The diagnosis was confirmed by angiography.

Presenting one case of nephroblastomatosis (NB) the diagnostic approach by different imaging modalities is discussed. Ultrasound (US) of the kidneys as a basic examination showed one focus of NB but missed two further foci which were clearly shown by contrast enhanced CT and MR. Contrast enhanced CT has been considered to be the most sensitive method in primary diagnosis of NB and follow up. However, in our case contrast enhanced MR examinations showed the foci of NB more clearly than CT. Since the false negative rate of MR is not yet known, we recommend the use of a contrast enhanced MR study parallel to a basic CT examination. If MR findings are consistent with CT findings, no further CT examinations are necessary for follow-up. Since US can miss a considerable amount of foci of NB, basic evaluation of NB and associated lesions by US alone should be avoided.

In order to calculate the relationship between Spinning top urethra (STU) and bladder instability 160 voiding cystourethrogramms (VCU), performed in 102 girls, have been analysed retrospectively. 28 girls had STU, 16 of those had bladder instability as well (57%). We could not find the highly positive correlation between unstable bladder and STU as reported by other authors, although there was a statistically positive correlation between STU and bladder instability. However the confidence interval was very broad (38%-75%). We conclude that bladder instability may contribute to STU but cannot render the etiological explanation for all cases. STU seems to be a polyetiological sign. In our opinion only the combination of STU and bladder instability has a diagnostic impact, since several therapeutical concepts are available in cases of bladder instability. The finding of STU in the VCU should alert the examiner's attention to functional disorders of the lower urinary tract. If no instability can be found, STU should be considered to be a normal variant.