Young Investigator's Award 2005

Inhaltsübersicht

Chairmen: Prof. Jean-Yves Meuwly, Prof. David Evans;

From left: D. Seybold, Germany, L. J. Salomon. France, K. Nylund, Norway, P. Tittoto, Italy, L. V. Coutts, United Kingdom, R. Jaworski, Poland, S. Degischer, Switzerland

First Prize

CV Radoslaw Jaworski

My name is Radoslaw Jaworski, I was born on 30.3.1980 in Dobre Miasto in Poland. In 1999 I passed the high school exams and began medical study at the Medical University of Gdansk in Poland. Between 2002 and 2003 I continued my education at Medical Faculty of University of Cologne in Germany as a SOKRATES/ERASMUS scholarship fellow. In 2003 I took part in a neurosurgery course in St. Gallen in Switzerland led by Prof. G. Hilldebrandt. Also in 2003 I began a doctorate in surgical oncology with Prof. E. Bollschweiler at University of Cologne in Germany. I was member of both Surgical Oncology and Ultrasound Students Groups at Medical University of Gdansk in Poland. I am also a member of Academic Society of Oncology in Gdansk in Poland. I took part in some medical student conferences for example: 10th, 12th and 13th International Students` Scientific Conference for Students and Young Doctors in Gdansk in Poland, 13th and 15th European Students' Conference for Future Doctors and Young Scientists in Berlin in Germany. Currently I have ended my medical study and begun hospital internship with Prof. A. Kopacz in Surgical Oncology Department of Medical University of Gdansk in Poland. My medical attention centres upon surgical oncology especially gastrointestinal tracts tumors and ultrasonography especially interventional, contrast agents and preoperative staging sonography.

Summary

With the aim of making students more interested in medicine, two clinicians in Gdansk, Poland created scientific students group and started with scientific work. The aim of all studies was to show the strong connection between clinicians work and diagnostic tool-ultrasonography and of course to present results of our work at Euroson conference. What made us really happy were interests of many clinicians in gastroesophageal reflux in children - main subject of presented paper. Questions and suggestions were received, new ideas, how to plan further studies and the great atmosphere of Geneva. The Euroson 2005 Young Investigator's Award makes us really proud and gives us more eagerness for further investigations. We hope that thanks to our work clinicians will think about sonography more as first-line diagnostic tool in gastroesophageal reflux in children than as non-contributory in such cases. Finally, we would like to thank Congress Organisation Committees for a great conference, Geneva for a wonderful atmosphere and all the helpful people we met on the way preparing our presentation.

Abstract

Title: Why don't we use ultrasonography in children with gastroesophageal reflux? The ultrasonographic features of gastroesophageal reflux in children.

Authors: R. Jaworski¹, D. Swieton², W. Kosiak², N. Irga³

1) Students Scientific Ultrasonography Group, Dept. Pediatric Nephrology, Medical University of Gdansk, Poland

2) Dept. Pediatric Nephrology, Medical University of Gdansk, Poland

3) Dept. of Pediatric, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Poland

Gastroesophageal reflux (GER) is defined as the presence of gastric contents movement from stomach into the oesophagus. It may produce quite trivial symptoms like cough or irritability but it may also lead to really serious like oesophagitis, laryngitis or even sudden infants death syndrome. GER together with clinical symptoms is called as gastroesophageal reflux disease (GERD). There is no gold standard diagnostic tool in this disease entity. Many of them are not straightforward for children for example endoscopy, pH-metry or contrast radiography. In many guidelines sonography is not taken into account as a diagnostic tool. That is why the aim of our study was to determine usefulness of ultrasound examination in GER in children.

We examined sonographically 50 children with recurrent respiratory infections. As a main GER diagnostic feature we chose in accordance with GER definition the presence of gastric fluid movement into esophagus. Additionally we assessed the angle of His and subdiaphragmatic esophagus length. The subdiaphragmatic esophagus length was significantly shorter in the group of children with GER than in children without reflux shown on sonography. The angle of His was more often obtuse in children with GER than in children without GER. In all children with GER on the first examination we observed clinical improvement in follow-up study after two months.

Ultrasonography is in our opinion a useful method in GER diagnosis in children. The presence of the passage of gastric fluid into the abdominal oesophagus is the main feature of GER but we think that short subdiaphragmatic esophagus length and obtuse angle of His should be taken into consideration as characteristic features of GER. We do not know why clinicians do not use sonography in GERD diagnostics. It seems to be a noninvasive, simple, informative, quick, repetitive and safe method, providing morphologic and functional information. Ultrasonography should be a gold standard in diagnosis of paediatric GERD, especially when GERD symptoms are observed. We think, this method as a simple and useful tool should be promoted and employed in every situation in paediatric practice when GERD is suspected.

Second Prize

CV Dominik Seybold

Since graduating from the University of Witten/Herdecke in 2002, I have worked at a level I University Trauma Centre in Bochum. I have recently finished my 3rd year of specialisation in trauma and orthopaedics. Through my doctoral thesis I first came in touch with musculoskeletal ultrasound in my 2nd year of University. Being involved in several research projects led by Prof. Hamel we have established a standardised delineation of the tendon of the tibialis posterior muscle in healthy probands and in patients with diseased tendons. This standardised ultrasound investigation with evaluation of the intratendineal echopattern and the tendon diameter has become a helpful diagnostic tool for the foot surgeon. It enables the early differentiation between a healthy and degenerate tendon by ultrasound in an easy and quick way. Tibialis posterior dysfunction, if diagnosed early enough, is easier to treat than in later stages, and enables the patient to regain normal foot function. Presenting my results at the 28th Dreiländertreffen DEGUM, SGUM, ÖGUM in Hannover and at the Euroson in Geneva 2005 I had the chance to emphasise the importance of early diagnosis of the tibialis posterior tendon dysfunction by ultrasound. I appreciate very much winning the young investigators award and want to warmly thank everyone for their help and support especially to Prof. Hamel and the EFSUMB Committee.

• 2002-2005: Assistensarzt at the level I Trauma Centre Berg mannsheil, University Bochum

• 1996-2002: Private University of Witten/Herdecke. Pre-clinical Medical School and Clinical/Medical School including two Electives in Sheffield (UK) and New York (USA)

• 1996-2003: Rudolf Steiner School Stuttgart (Germany)

• 18.11.1974: Born in Stuttgart (Germany)

Abstract

Title: Standardized imaging of the posterior tibial tendon by ultrasound (13 MHz)

Author: D. Seybold

BG-Kliniken Bergmannsheil, Universitätsklinik Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, eMail: [e-mail]

Objectives: Tibialis posterior dysfunction is often diagnosed at a very late stage in its development. However the early diagnosis of tibialis posterior dysfunction is crucial for therapeutic aspects and especially for the operative prognosis. The morphological correlate of the tibialis posterior dysfunction according to the literature consists of degenerative changes and thickening of the posterior tibial tendon. By means of a high-frequency linear array transducer a standardized technique of examination as well as reference values of cross sections of posterior tibial tendon are to be introduced.

Material and Methods: Investigating 140 feet of 35 female and 35 male (the left and right sides were equally represented) without any foot deformities, standardized planes were defined by use of a 13 MHz linear array transducer in order to display the posterior tibial tendon. In exactly defined loci of the tendon a diameter was measured using two longitudinal sections proximal and distal to the medial malleolus. Likewise, two diameters and the resulting cross section of the tendon were determined, using two transverse sections at the level of the subtalar joint facet and the medial malleolus.

Results: A healthy tendon appears homogenous and echo-rich in orthogonal ultrasounds and displays average areas of 18.6 sq.mm. (SD 5.2 sq.mm.) for females and 20.9 sq.mm. (SD 5.8 sq.mm.) for males at subtalar joint facet level and 17.2 sq.mm. (SD 3.6 sq.mm.) for females and 21.6 sq.mm (SD 4.3 sq. mm.) for males at medial malleolus level in transverse sections. In 89% of all feet examined at the height of the medial malleolus, the tendon is surrounded by a hypoechoic halo which has a size smaller than twice the cross section of the flexor digitorum longus tendon.

Conclusion and clinical relevance: Reference values of tendon thickness and of intratendinal echostructure at reproducible loci facilitate delimitations from pathological tendon alterations. The exact delineation of intratendineal echos by high frequency array transducers and standardized examination techniques that measure tendons size is the prerequisite to enable an early assessment and registration of degenerative alterations of the posterior tibial tendon.