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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 154 (1995), S. 236-238 
    ISSN: 1432-1076
    Keywords: Primary ciliary dyskinesia ; Immotile cilia syndrome ; Kartagener syndrome ; Respiratory distress syndrome ; Newborn
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a newborn with respiratory distress and situs inversus totalis. The diagnosis of primary ciliary dyskinesia was confirmed by both ultrastructural and functional investigations. The immotile cilia syndrome was suspected because of respiratory distress, situs inversus, abnormal nasal discharge and hyperinflated chest X-ray. We suggest that ultrastructural and functional investigations of the respiratory mucosa should be done in any newborn with respiratory distress without explanation for the respiratory problems. Establishment of the correct diagnosis at an early stage may allow to improve the prognosis provided prophylactic physiotherapy, vaccinations, and aggressive antibiotic treatment of intercurrent respiratory infections are instituted. Conclusion Despite its rarity, primany ciliary dyskinesia should be considered in unexplained cases of neonatal distress
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Closed-loop controlled ventilation ; Human ; Initial settings ; Computer ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To test a method that allows automatic set-up of the ventilator controls at the onset of ventilation. Design Prospective randomized crossover study. Setting ICUs in one adult and one children's hospital in Switzerland. Patients Thirty intubated stable, critically ill patients (20 adults and 10 children). Interventions The patients were ventilated during two 20-min periods using a modified Hamilton AMADEUS ventilator. During the control period the ventilator settings were chosen immediately prior to the study. During the other period individual settings were automatically determined by the ventilator (AutoInit). Measurements and results Pressure, flow, and instantaneous CO2 concentration were measured at the airway opening. From these measurements, series dead space (V DS), expiratory time constant (RC), tidal volume (V T), total respiratory frequency (f tot), minute ventilation (MV), and maximal and mean airway pressure (P aw, max andP aw, mean) were calculated. Arterial blood gases were analyzed at the end of each period.P aw, max was significantly less with the AutoInit ventilator settings whilef tot was significantly greater (P〈0.05). The other values were not statistically significant. Conclusions The AutoInit ventilator settings, which were automatically derived, were acceptable for all patients for a period of 20 min and were not found to be inferior to the control ventilator settings. This makes the AutoInit method potentially useful as an automatic startup procedure for mechanical ventilation.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Key words Closed-loop controlled ventilation ; Human ; Initial settings ; Computer ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To test a method that allows automatic set-up of the ventilator controls at the onset of ventilation. Design: Prospective randomized crossover study. Setting: ICUs in one adult and one children’s hospital in Switzerland. Patients: Thirty intubated stable, critically ill patients (20 adults and 10 children). Interventions: The patients were ventilated during two 20-min periods using a modified Hamilton AMADEUS ventilator. During the control period the ventilator settings were chosen immediately prior to the study. During the other period individual settings were automatically determined by the ventilator (AutoInit). Measurements and results: Pressure, flow, and instantaneous CO2 concentration were measured at the airway opening. From these measurements, series dead space (V DS), expiratory time constant M28.6n(RC), tidal volume (V T), total respiratory frequency (f tot), minute ventilation (MV), and maximal and mean airway pressure (P aw,max and P aw,mean) were calculated. Arterial blood gases were analyzed at the end of each period. P aw,max was significantly less with the AutoInit ventilator settings while f tot was significantly greater (P〈0.05). The other values were not statistically significant. Conclusions: The AutoInit ventilator settings, which were automatically derived, were acceptable for all patients for a period of 20 min and were not found to be inferior to the control ventilator settings. This makes the AutoInit method potentially useful as an automatic start-up procedure for mechanical ventilation.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 20 (1994), S. 306-307 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1238
    Keywords: Neonatal lupus erythematosus ; Heart block ; Steroids ; Myocarditis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of neonatal lupus erythematosus (NLE) with congenital heart block and severe myocardial failure, which was followed from the 25th week of gestation because of fetal bradycardia. The child was delivered at the 37th week of gestation by elective cesarean section because of echocardiographically documented heart enlargement, pericardial effusion and moderate insufficiency of the mitral and tricuspid valves. In spite of immediate pacing, intubation and supportive treatment, the newborn developed progressive heart failure. Echocardiography showed endocarditis of the mitral valve and diffuse myocarditis. The heart failure resolved under steroid treatment. Our experience supports the early use of steroids in treating myocarditis due to NLE. Intrauterine steroid treatment in the presence of fetal hydrops and congenital heart block is discussed.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1238
    Keywords: Key words Neonatal lupus erythematosus ; Heart block ; Steroids ; Myocarditis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of neonatal lupus erythematosus (NLE) with congenital heart block and severe myocardial failure, which was followed from the 25th week of gestation because of fetal bradycardia. The child was delivered at the 37th week of gestation by elective cesarean section because of echocardiographically documented heart enlargement, pericardial effusion and moderate insufficiency of the mitral and tricuspid valves. In spite of immediate pacing, intubation and supportive treatment, the newborn developed progressive heart failure. Echocardiography showed endocarditis of the mitral valve and diffuse myocarditis. The heart failure resolved under steroid treatment. Our experience supports the early use of steroids in treating myocarditis due to NLE. Intrauterine steroid treatment in the presence of fetal hydrops and congenital heart block is discussed.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1076
    Keywords: Hyper-IgE-syndrome ; Multiple liver abscesses ; Percutaneous needle aspiration ; Oral chloramphenicol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a patient with Hyper-IgE-syndrome multiple liver abscesses developed in spite of prophylactic treatment with trimethoprim and sulfamethoxazol. Ultrasound confirmed the clinical diagnosis and percutaneous needle aspiration under ultrasonographic guidance and culture of the aspirated pus allowed specific antibiotic treatment by oral chloramphenicol alone without surgical drainage. The isolated Staph. aureus strain was resistant to trimethoprim and sulfamethoxazol.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 153 (1994), S. 291-296 
    ISSN: 1432-1076
    Keywords: Tracheostomy ; Children ; Complications ; Mortality ; Discharge home
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We reviewed the records of 108 patients who had a tracheostomy performed over a 10-year period from July 1979 to April 1989. Median age at tracheostomy was 6 months (1 week–15 years). Indications for surgery were acquired subglottic stenosis (31.4%), bilateral vocal cord paralysis (22.2%), congenital airway malformations (22.2%) and tumours (11.1%). No epiglottis and no emergency situation had to be managed by tracheostomy. Operation was uneventful in all, but 8 patients (7.4%) developed a pneumothorax in the postoperative period. Twenty-one (19.5%) had severe complications during the cannulation period (tube obstruction in 11 patients with cardiorespiratory arrest in 4; dislocation of the tube in 6 patients). Fifteen patients (13.8%) had severe complications after decannulation (2 had a cardiorespiratory arrest); all 15 had to be recannulated. At the end of the study period 85 patients (78.7%) were successfully decannulated with a median period of tracheostomy of 486 days (8 days–6.6 years). The median hospital stay was 159 days (13 days–2.7 years). All patients could be discharged. Eight patients (7.4%) died but no death was related to tracheostomy. In summary the mortality rate is lower than reported in previous reviews and tracheostomy is a safe operation even in small children but cannula-related complications may lead to life-threatening events. The management of tracheostomized small children and infants in a highly staffed and monitored intensive care unit has allowed better handling of complications and has resulted in a reduction in cannula-related deaths.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 153 (1994), S. 291-296 
    ISSN: 1432-1076
    Keywords: Key words: Tracheostomy – Children – Complications – Mortality – Discharge home
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We reviewed the records of 108 patients who had a tracheostomy performed over a 10-year period from July 1979 to April 1989. Median age at tracheostomy was 6 months (1 week – 15 years). Indications for surgery were acquired subglottic stenosis (31.4%), bilateral vocal cord paralysis (22.2%), congenital airway malformations (22.2%) and tumours (11.1%). No epiglottis and no emergency situation had to be managed by tracheostomy. Operation was uneventful in all, but 8 patients (7.4%) developed a pneumothorax in the postoperative period. Twenty-one (19.5%) had severe complications during the cannulation period (tube obstruction in 11 patients with cardiorespiratory arrest in 4; dislocation of the tube in 6 patients). Fifteen patients (13.8%) had severe complications after decannulation (2 had a cardiorespiratory arrest); all 15 had to be recannulated. At the end of the study period 85 patients (78.7%) were successfully decannulated with a median period of tracheostomy of 486 days (8 days – 6.6 years). The median hospital stay was 159 days (13 days – 2.7 years). All patients could be discharged. Eight patients (7.4%) died but no death was related to tracheostomy. In summary the mortality rate is lower than reported in previous reviews and tracheostomy is a safe operation even in small children but cannula-related complications may lead to life-threatening events. The management of tracheostomized small children and infants in a highly staffed and monitored intensive care unit has allowed better handling of complications and has resulted in a reduction in cannula-related deaths.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1076
    Keywords: Atypical Kawasaki disease ; Giant coronary aneurysm ; Myocardial infarction ; Peripheral gangrene ; Prostaglandin E1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe a 2-month-old girl with atypical Kawasaki disease (KD) complicated by peripheral gangrene and myocardial infarction. Peripheral ischaemia leading to gangrene is a rare but serious complication of KD in infants younger than 7 months of age. Treatment has been targeted at reducing arterial inflammation, arteriospasm and thrombosis. We report the first patient with incomplete KD and peripheral ischaemia in whom therapy with prostaglandin E1 (PGE1) as vasodilating and antithrombotic agent appeared successful, restoring hand and foot perfusion without significant long-term sequelae. However, PGE1 could have supported development of myocardial infarction by shunting blood away from ischaemic areas distal to a giant coronary artery aneurysm with beginning thrombosis. Conclusion Atypical KD with peripheral gangrene appears to react favourably to treatment with PGE1, but needs careful monitoring to detect early signs of cardiac ischaemia.
    Type of Medium: Electronic Resource
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