Pulmonary arteriovenous fistula in children (author''s transl)

In the Nude mouse: 1. Xenografts of human tumours often grew successfully. 2. There was very little growth in allografts of actively-growing normal tissue from Swiss mice. 3. Transplants of mature tissue from the toad failed to grow.     

Hemihypertrophy with wiedemann-Beckwith-syndrome (author''s transl)

Immunosuppressive agents were used to determine the relative importance of T and B lymphocytes in conferring protection to mice vaccinated with a live gal E mutant of Salmonella typhimurium, strain G30D. Lymphocyte transformation and serum agglutination tests showed that while cyclophosphamide (CPA) suppressed B lymphocytes, antilymphocyte sea (ALS) suppressed both T and B cells. The humoral response of vaccinated animals treated with ALS was therefore supplemented by the i.v. injection of serum from untreated vaccinated mice. CPA-treated mice could not control multiplication of the vaccinal strain which eventually killed them. There was little multiplication of the vaccinal strain in the controls and ALS-treated mice, all of which survived to challenge. The vaccinated controls and vaccinated ALS treated groups each survived infection with the challenge strain which was gradually eliminated. It was concluded that humoral immunity was of greater importance than cellular immunity in mice vaccinated i.p. with strain G30D.     

Eccrine-nevus (author''s transl)

The eccrine nevus is an exceptional entity, formed by well-differentiated adnexa which can be classified as hamartoma or organoid nevus. It is characterized by a high degree of structural maturation. The authors report a case of eccrine nevus observed in a 32-year-old woman and compare clinical and histological features of the lesion with literature data.     

Surgical treatment of pulmonary atresia with intact ventricular septum

Fifty-nine children with pulmonary atresia and intact ventricular septum underwent various forms of surgical treatment at the Hospital for Sick Children, Toronto, during 1950 to mid 1975. Twenty-three patients had pulmonary valvotomy, 15 direct, 2 indirect, and 6 both direct valvotomy and infundibulectomy. All died, 19 early and 4 late. Of 13 patients who received a systemic-pulmonary artery shunt, 4 combined with surgical atrial septectomy, there are only 2 long-term survivors both of whom were children who had had a Waterston anastomosis. Recently we have been treating infants with small right ventricles with balloon atrial septostomy at cardiac catherterization followed by a Potts anastomosis and pulmonary valvotomy. If the Potts anastomosis appears satisfactory the persistent ductus arteriosus is ligated. This scheme was used in 23 infants, with 4 early deaths and 2 late deaths. Of 17 survivors, further shunts were required in 4 children. One child has had a formal repair, with insertion of valves in both tricuspid and pulmonary areas. We believe that this operative combination of Potts anastomosis and pulmonary valvotomy offers the infant with pulmonary atresia and a small right ventricle a relatively low initial mortality and the possibility of right ventricular enlargement and subsequent repair.     

Infusiontherapy with colloidal volumesubstitutes (author''s transl)

All colloidal plasma substitutes carry the risk of anaphylactoid complications with a general incidence of 0.03%. This incidence seems low; however severe complications may occur after infusion of colloids, including also human albumin solutions. In spite of the risk of anaphylactoid reactions, however, colloids should not be ommited from volume replacement therapy. When choosing a colloid for volume replacement the solution-specific risk of anaphylactoid complications has to be taken into consideration. From an increasing number of recent case reports the impression of a rising rate of complications has emerged; this impression was not substantiated by a prospective controlled trial performed in 1975. Since dextran in addition to its safe volume effect possesses well documented antithrombotic properties, it cannot be replaced by any other colloid without the addition of another thromboprophylactic agent.     

Sacro-iliac osteochondritis (author''s transl)

Sacro-iliac osteochondritis is difficult to recognize, it is rather frequently a case of diagnosis by elimination, which can be only confirmed by the course. Its prognosis is excellent. The predominance of lesions on the iliac edge reflects the affinity of this epiphysitis for the accessory iliac ossification point.     

Vesicorenal reflux (author''s transl)

Antireflux procedures show high efficiency and relatively few technical complications. A tabulated comparison between the intravesical procedure (Politano-Leadbetter) and the extravesical procedure (Lich-Grégoir) reveals an overall success rate of 80%. To simplify the nomenclature, the term primary refluxing ureter is suggested for cases with a freely draining IVP and primary obstructive ureter for a dye collumnating dilated ureter. The indication for antirefluxplasty is divided into urgent cases and those with secondary priority, with immunologic tests providing helpful criteria.     

Boston corset (author''s transl)

Nine cases of bilateral femoral shaft fractures were seen in a series of 126 patients treated from 1973--1977. Patients were multitrauma cases from automobile accidents. Treatment by traction followed by cast-bracing resulted in a high percentage of unsatisfactory results, lengthy recoveries, and the necessity of secondary surgical procedures to improve the results.     

Kleinschmidt''s syndrome (author''s transl)

This is a case-report about a 4 year old boy with "cherry red" epiglottis, purulent meningitis and pleuropneumonia. Purulent meningitis and pleuropneumonia are not complications of treatment of "cherry red" epiglottis but an entity caused by Hemophilus influenzae-infection and is called Kleinschmidt's syndrome (Hemophilus influenzae type B-infection-syndrome). This severe illness is successfully treated if recognized early enough. At present, chloramphenicol is the therapy of choice. Intubation or tracheotomy are important but supportive measures.     

Bull''s-eye disease (author''s transl)

Thiamine deficiency was produced in young rats by feeding a thiamine deficient diet. At a time when neurological symptoms were severe, and cardiac and renal transketolase activities were decreased, the animals were sacrificed. Glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase activities, and flux through the pentose phosphate pathway were similar in pair-fed control and thiamine deficient rats. These data suggest that altered pentose phosphate pathway activity is not a vital feature of murine thiamine deficiency.     

Seckel syndrom (author''s transl)

The radiophysical properties of the material "Masonit" are examined by experimental methods. Indications are given as to atomic composition, density, effective atomic number, concentration of electrons, and linear attenuation coefficient. A comparison with water shows that "Masonit" is a suitable phantom material especially for the purposes of radiotherapy.     

Evaluation and management of pulmonary atresia with intact ventricular septum

The Consensus Conference of the American College of Medical Genetics has established guidelines regarding the evaluation of patients with mental retardation (MR) [Curry et al., Am. J. Med. Genet. 72:468-477, 1997]. They emphasized the high diagnostic utility of cytogenetic studies and of neuroimaging in certain clinical settings. However, data on the diagnostic yield of these studies in well-characterized populations of individuals with MR are scant. Majnemer and Shevell [J. Pediatr. 127:193-199, 1995] attained a diagnostic yield of 63%. However, this study included only 60 patients and the classification included pathogenetic and causal groups. The Stella Maris Institute has evaluated systematically patients with developmental delay (DD)/MR and performed various laboratory studies and neuroimaging in almost all patients. We report a retrospective analysis of the diagnostic yield of 120 consecutive patients observed at our Institute during the first 6 months of 1996. There were 77 males and 43 females; 47 were mildly delayed (IQ 70-50), 31 were moderately delayed (IQ 50-35), and 42 were severely delayed (IQ 35-20). Diagnostic studies (history, physical examination, standard cytogenetics, fragile X testing, molecular studies, electroencephalography, electromyography, nerve conduction studies, neuroimaging, and metabolic screening tests) yielded a causal diagnosis in 50 (41.6%) and a pathogenetic diagnosis in 47 (39.2%) of the 120 patients. Causal categories included chromosomal abnormalities (14), Fra(X) syndromes (4), known MCA/MR syndromes (19), fetal environmental syndromes (1), neurometabolic (3) disorders, neurocutaneous (3) disorders, hypoxic-ischemic encephalopathy (3), other encephalopathies (1), and congenital bilateral perisylvian syndrome (2). Pathogenetic categories included idiopathic MCA/MR syndromes (35), epileptic syndromes (10), and isolated lissencephaly sequence (2). Diagnostic yield did not differ across categories and degree of DD. Our results, while confirming the diagnostic utility of cytogenetic/molecular genetic, and neuroimaging studies, suggest the usefulness of accurate electroencephalogram recordings, and stress the importance of a thorough physical examination. Referral to a university child neurology and psychiatry service, where a comprehensive assessment with a selected battery of investigations is possible, yields etiologic findings in a high percentage of DD/MR patients, with important implications for management, prognosis and recurrence risk estimate.     

Outcome after operations for pulmonary atresia with intact ventricular septum

OBJECTIVE:Pulmonary atresia with intact ventricular septum is an anatomically heterogeneous anomaly with a variety of surgical strategies possible. We sought to compare the outcome of patients with a single ventricle approach to those with a biventricular repair and to compare outcome of patients with coronary abnormalities to those with normal coronary arteries. METHODS: A retrospective review of our surgical database revealed 67 patients with pulmonary atresia with intact ventricular septum operated on between 1981 and 1998. Patients were categorized on the basis of initial surgical strategy: strategy A, aortopulmonary shunt alone (n = 31); strategy B, right ventricular recruitment (n = 32); strategy C, heart transplantation (n = 4). Tricuspid valve size (Z-score) and coronary anatomy were determined. Right ventricular-coronary artery dependency was noted in 8 patients. RESULTS: Overall actuarial survivals at 1, 5, and 8 years were 82%, 76%, and 76%. Mortality was highest in infancy (10 of 16 deaths). Outcome was equivalent for all 3 strategies. There was no difference in tricuspid valve size between survivors and nonsurvivors (mean Z-score -2.0 (2.5) vs -2.0 (1.9), P =.83). There was no difference in survival based on severity of coronary abnormality. Only one third of patients had a successful biventricular repair, and the tricuspid valve was significantly larger in these than in patients who had Fontan operation (mean Z-score -0.53 [1.6], range -3.5 to 1, versus mean Z-score -3.03 [2.7], range -5.5 to 0, P =.002). CONCLUSIONS: Surgical outcome for patients born with pulmonary atresia with intact ventricular septum is satisfactory. The strategies of biventricular repair, single ventricle palliation, and heart transplantation allow for equal outcome among all anatomic subtypes.     

Experience with the locking nail (author''s transl)

Although difficult, recurrent forms of pterygium are seldom seen in central Europe, they cause considerable therapeutic problems because they cannot be cured by simple dissection and conjunctivoplasty. A useful method of treatment in these cases is the marginal, lamellar keratoplasty, which, according to the type of involvement, can take the shape of a sector, ring, horseshoe, or semicircle. If the pterygium is extensive and affects the center of the cornea, a subtotal, lamellar keratoplasty can be performed. The rate of recurrence in the group of 35 lamellar keratoplasties which we performed amounted to a satisfactory 31%. Only rarely did a pronounced astigmatism cause a decrease in the visual acuity postoperatively. Essential for the success of the procedures are exact surgical techniques and local use of atropine and cortison postoperatively. Just as with other surgical procedures, however, the lamellar keratoplasty cannot be considered the perfect method for all pterygiums.     

Hallucinantion and illusion (author''s transl)

The value of an anaesthetic attachment during the first two postgraduate years is considered under three major headings, the value to the recent graduate, the value to the specialty, and the value to the community. The anaesthetic attachment offers all recent graduates an opportunity to perfect practical skills which should from part of the armamentarium of all doctors, and for some there is the option to acquire the ability to administer a safe anaesthetic. Exposure to the specialty at this time is important for recruitment to the specialist ranks.     

Congenital arteriovenous shunts (author''s transl)

In 95 women taking reduced-level-oral contraceptives and in 24 same-aged women controls, the measure of erythrocyte and serum folate led to the following conclusions: 1) Folate levels in women consuming the pill were generally found to be of the same range as those of controls. 2) No significant difference could be shown between results for different kinds of contraceptives.     

Angiography in coxarthrosis (author''s transl)

The preparation of 125I-labelled tracer for digoxin radioimmunoassay (125I monoiodinated 3-succinyl digoxigenin-1-tyrosine) is described, and its performance in radioimmunoassay of plasma samples is compared with that obtained with tritiated digoxin. The accuracy levels were assessed through the evaluation of different potential sources of systematic errors, such as interference from digoxin-related molecules and plasma proteins and methodological artefacts possibly associated with the immunocomplex instability, and through a series of checks including the recovery and parallelism tests and the correspondence of results obtained with the two tracers. The slope and the repeatability with time of the calibration curves and the spread of replicate estimates were taken into consideration to assess the assay precision. An essential equivalence in terms of reliability of measurement was proved for the two methodological variants, so that practical aspects and economic factors remain the main criteria to evaluate the relative merits: from this point of view, the advantages of using 125I-labelled tracer, as an alternative to tritiated digoxin, are discussed.     

Otitis externa trichophytica (author''s transl)

A comparison of the plasma levels of tetracycline obtained whilst taking standard therapeutic doses of Tetrabid-Organon was made in twelve healthy volunteers. Two standard production batches were used in the study which was conducted under double-blind conditions. Sampling 12 hours and 8 hours after dosing showed no significant differences in plasma levels, with each batch. Even at these lowest levels satisfactory concentrations were rapidly obtained following initial administration, and were maintained when the drug was given at 12-hourly intervals. No side-effects of the drug were noted.