Diagnosis of moyamoya disease with additional renal artery stenosis by colour coded Doppler sonography

Moyamoya disease is a rare vascular anomaly of the cerebral arteries. The etiology of the disease has not yet been clearly identified. We report the noninvasive diagnosis of Moyamoya disease in a patient with a very early onset of symptoms in infancy. The diagnosis was made by colour coded Doppler sonography and confirmed by angiography at the age of 6 months, following two episodes of cerebral infarction. A bilateral encephalodurosynangiosis was performed at the age of 7 months with subsequent slight improvement of the neurological deficits. Colour Doppler sonography revealed early vascularisation from the fascia temporalis graft into the arachnoid space. At the age of 10 months the patient developed arterial hypertension caused by left renal artery stenosis. Our case suggests, that in infancy Moyamoya disease can be suspected noninvasively by colour Doppler sonography of the cerebral arteries. Patients should be carefully screened for possible extracranial arterial stenoses which may develop in the course of time. Encephalodurosynangiosis seems to be a good therapeutic option for patients with severe neurological symptoms.     

Doppler sonographic measurement of normal values of flow velocities in the internal carotid artery of premature infants, newborn infants and infants

In 121 healthy premature born infants, full-term newborns and older infants (gestational age: 29 to 45 weeks; weight at investigation: 1070 g to 3750 g), the flow velocities in the internal carotid arteries were measured by pulsed doppler sonography. All infants were investigated by computer sonography (Acuson 128) with a 5 MHz transducer. The following parameters were measured: The maximal systolic velocity, the end-systolic and end-diastolic velocity as well as the mean flow velocities, the pulsatility-index and the resistance-index. For all parameters the relationship to the gestational age and weight were analysed. All flow velocities increased linearly with increasing gestational age and weight. In contrast to the flow velocities neither the pulsatility-index nor the resistance-index changed with increasing gestational age and weight. As flow velocities in the internal carotid arteries increase with increasing gestational age and weight these parameters must be taken into consideration when pathologic flow velocities are analysed.     

Antibodies to Nipah-like virus in bats (Pteropus lylei), Cambodia

Serum specimens from fruit bats were obtained at restaurants in Cambodia. We detected antibodies cross-reactive to Nipah virus by enzyme immunoassay in 11 (11.5%) of 96 Lyle's flying foxes (Pteropus lylei). Our study suggests that viruses closely related to Nipah or Hendra viruses are more widespread in Southeast Asia than previously documented.     

Steady-state free precession projection MRI as a potential alternative to the conventional chest X-ray in pediatric patients with suspected pneumonia

Magnetic resonance imaging of the lung tissue is thought to be hardly possible due to physical limitations especially the low proton density, susceptibility, and motion artifacts. The objective of our study was to evaluate and refine a very fast MR technique at a low field strength which overcomes the limitations in MR lung imaging. Thirty-five investigations were performed in 30 pediatric patients with suspected pneumonia. The MR investigations were performed in coronal slice orientation without cardiac or respiratory triggering in a low-field MR system. An optimized true fast imaging with steady precession sequence was applied. The MR images and the corresponding conventional chest radiographs were evaluated. The examination time per slice was 1.6 s. No motion artifacts could be observed. The signal-to-noise ratio for pulmonary parenchyma ranged from 4.9 to 7.1. All pathological findings of the chest X-ray images were correctly identified by the MRI (κ=0.82–0.85). Effusions as well as small pneumonic infiltrates were more precisely detected by the MRI investigation (κ=0.82) as compared with X-ray. Low-field projection MRI is a promising alternative to pediatric chest X-ray. Due to its short examination time, it overcomes the physical limits of usual MRI methods and provides comparable diagnostic information. Electronic Publication     

Endometrial carcinoma with laparotomy wound recurrence: complete remission following surgery and chemotherapy consisting of paclitaxel and carboplatin

We present a patient with surgical stage I endometrial cancer who experienced laparotomy wound recurrence 4 years after primary treatment. She was treated successfully by complete surgical resection of recurrent tumors and chemotherapy. A 62-year-old white female with laparotomy wound recurrence of endometrial carcinoma with small-bowel involvement and concomitant subcutaneous metastasis in the abdominal wall underwent complete surgical resection of metastatic tumors followed by six cycles of chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (area under the curve 5). Since 24 months after resection of recurrence, she has no evidence of disease recurrence. Endometrial carcinoma with laparotomy wound recurrences, especially those with concomitant metastases, can be successfully treated by complete surgical resection followed by chemotherapy consisting of paclitaxel and carboplatin.