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  • 2010-2014
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  • Electronic Resource  (172)
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  • 1
    Electronic Resource
    Electronic Resource
    Age as a determinant of severity of dental fluorosis in children residing in areas with 0.5 and 2.5 mg fluoride per liter in drinking water (2000)
    Springer
    Clinical oral investigations 4 (2000), S. 157-161 
    Details
    ISSN: 1436-3771
    Keywords: Key words Age ; Children ; Dental fluorosis ; Severity ; Tooth eruption
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The purpose of this study was to investigate the influence of age on the severity of dental fluorosis in children exposed to drinking water with either low or high fluoride concentrations. The children selected for this study were aged 10–14 years, with 28 permanent teeth and at least 1 tooth pair with fluorosis. The children were permanent residents of districts in western Uganda with either 0.5 mg (n=33) or 2.5 mg fluoride/l in drinking water (n=186). All vestibular tooth surfaces were examined for fluorosis using the modified Thylstrup and Fejerskov (TF) index. In the high fluoride community, the proportion of teeth per child with TF scores ≥4, and ≥5 was significantly higher among children aged 13–14 years compared to those aged 10–12 years. Children’s chronological age correlated positively and significantly with the median TF scores for all teeth, including early erupting (first molars and incisors) and late erupting teeth (canines, premolars and second molars). In linear regression analyses, the median TF score for all teeth, as well as for early erupting and late erupting teeth, increased significantly with age. On the other hand, in the low fluoride community there was no significant association between age and the severity of fluorosis. This study showed a significant increase in the severity of fluorosis with increasing age in a high fluoride community, whereas no change in severity with age was observed in a low fluoride community.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010677
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  • 2
    Electronic Resource
    Electronic Resource
    Transcatheter therapy of gastric cancer metastatic to the liver: preliminary results (2000)
    Springer
    Journal of gastroenterology 35 (2000), S. 907-911 
    Details
    ISSN: 1435-5922
    Keywords: Key words: gastric cancer ; liver neoplasms ; secondary ; interventional radiology ; chemotherapy ; chemoembolization ; therapeutic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Little is known about the effectiveness of transcatheter chemotherapy in liver metastases from gastric cancer. The aim of this study was to evaluate the initial results of hepatic artery infusion and oily chemoembolization in these liver secondaries. Courses of transcatheter arterial infusion with 5-fluorouracil/doxorubicin (12 patients) and oily chemoembolization with doxorubicin-in-iodized oil and gelatin sponge (12 patients) were performed in 24 patients with histologically proven unresectable gastric cancer liver metastases. A positive effect of treatment (partial response + stabilization) was seen in 92% of the patients after chemoinfusion and in 50% after chemoembolization. The 1- and 2-year actuarial survival rates were 92% and 53% for infusion vs 50% and 17% for chemoembolization, respectively (log-rank test, P = 0.0009). For patients who had already died, the mean survival was 19.2 months vs 9.5 months (Student's t-test, P 〈 0.05) with median survivals of 23 months vs 8 months, respectively. The results with arterial infusion were very close to those reported for liver resection. Transcatheter therapy appears to be useful for the palliation of unresectable liver metastases from gastric cancer. If regional chemotherapy is used, arterial infusion should be the first-choice treatment, with oily chemoembolization being reserved for patients who do not respond to infusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005350070004
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  • 3
    Electronic Resource
    Electronic Resource
    Docetaxel (Taxotere®)–cisplatin (TC): An effective drug combination in gastric carcinoma (2000)
    Springer
    Annals of oncology 11 (2000), S. 301-306 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; docetaxel ; gastric cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose:A multi-centric trial was performed to explore theclinical activity, in terms of response and toxicity (primary objectives),duration of response and survival (secondary objectives), of docetaxel withcisplatin in advanced gastric cancer (AGC). Patients and methods:Patients with measurable unresectable and/ormetastatic gastric carcinoma, performance status ≤1, normal hematological,hepatic and renal functions and not pretreated for advanced disease bychemotherapy received up to eight cycles of TC (docetaxel 85 mg/m2d1, cisplatin 75 mg/m2 d1) q3w. Dose escalation to 100mg/m2 was performed in five patients and was discontinued forexcessive toxicity. Results:Forty-eight patients were accrued. A median of 5cycles/patient was given. We observed 2 complete and 25 partial responses foran overall intent to treat response rate of 56% (95% CI:41%–71%). Twelve patients had stable disease for ≥9weeks (3 cycles). The median time to progression and overall survival were 6.6and 9 months, respectively. Grade ≥3 toxicities were neutropenia81%, anemia 32%, thrombocytopenia 4%, alopecia36%, fatigue 9%, mucositis 9%, diarrhea 6%,nausea/vomiting 4%, neurologic 2%, and one anaphylaxisprecluding treatment administration. We recorded nine episodes of non-fatalfebrile neutropenia in eight patients, two of them with docetaxel at 100mg/m2. There were no direct treatment-related deaths. Conclusions:TC is active in AGC with a high response rate in amulticentric trial. Despite its hematotoxicity, this regimen is well toleratedand can be recycled as originally planned in 78% of the cases. Theseresults may serve as basis for further developments of docetaxel containingregimens in this disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008342013224
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  • 4
    Electronic Resource
    Electronic Resource
    A phase I–II study of concomitant chemoradiotherapy with paclitaxel (one-hour infusion), 5-fluorouracil and hydroxyurea with granulocyte colony stimulating factor support for patients with poor prognosis head and neck cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 721-728 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; concomitant chemoradiotherapy ; head and neck cancer ; paclitaxel ; radiation ; reirradiation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Concomitant chemoradiotherapy is an effectivetreatment modality for advanced head and neck cancer, but improved regimensare needed. We sought to define the toxicities, recommended phase II dose, andoutcome of a combination chemotherapy regimen with concomitanthyperfractionated radiotherapy in patients with poor prognosis cancers of thehead and neck, including those having received prior curative intentradiotherapy. Patients and methods:From 1995 until 1997, 54 patients weretreated, 25 of whom had received a prior full course of radiotherapy to thehead and neck. Patients were treated with 5-fluorouracil (5-FU) 600mg/m2/day continuous infusion × 5 days (days 1–5),hydroxyurea, 500 mg p.o. bid × 11 doses (days 1–6) and paclitaxel(60–150 mg/m2) by one-hour infusion on day 2 using a doseescalation strategy. Radiotherapy was given concomitantly on days 2–6,150 cGy bid. Each of 4–5 cycles was delivered every other week. Results:The MTD of paclitaxel was 100 mg/m2. Theregimen was feasible; radiotherapy was delivered at a median of 7300 cGy and83% of patients received ≥80% planned dose intensity.Hematological toxicity, with granulocyte colony stimulating factor, was verymild. Dose limiting toxicities were mucositis and dermatitis. Despite poorprognosis, two-year survival was 45%. Conclusions:The recommended phase II dose of this regimen is 5-FU600 mg/m2/day × 120 hours (days 1–5), hydroxyurea 500mg p.o. b.i.d. × 11 doses (days 1–6), paclitaxel 100mg/m2 over one hour on day 2, and radiotherapy 150 cGy b.i.d. days2–6. Concomitant chemotherapy and re-irradiation was feasible on thisprotocol and resulted in long-term survival in patients without other curativeintent options.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008324131519
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  • 5
    Electronic Resource
    Electronic Resource
    Spontaneous pneumothorax in malignancy: A case report and review of the literature (2000)
    Springer
    Annals of oncology 11 (2000), S. 887-889 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; lung metastases ; spontaneous pneumothorax
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Pneumothorax occurring in the absence of obvious lungdisease is defined as spontaneous pneumothorax. Spontaneous pneumothoraxoccurs in a variety of settings in patients with malignancies. Patients and methods:We present a case report of spontaneouspneumothorax in malignancy and review the literature. Results:No correlation was found between the occurrence ofpneumothorax with age, sex or smoking history. Pneumothorax occurred with avariety of primary tumors. However it was always associated with lungmetastases or lung involvement with tumor. In certain cases the metastaseswere detected after the occurrence of pneumothorax. Conclusions:The occurrence of pneumothorax in a patient withmalignancy should prompt a search for lung metastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008323632078
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  • 6
    Electronic Resource
    Electronic Resource
    Paclitaxel and carboplatin in combination with gemcitabine: A phase I–II trial in patients with advanced non-small-cell lung cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 1421-1426 
    Details
    ISSN: 1569-8041
    Keywords: carboplatin ; chemotherapy ; gemcitabine ; non-small-cell lung cancer ; paclitaxel
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:The combination of paclitaxel (P) and carboplatin (C)is an effective treatment for advanced NSCLC. Gemcitabine (G) is an active newdrug. We planned a phase I study to find the maximum tolerated dose (MTD) ofthe PCG combination. A phase II study was subsequently conducted to evaluatethe activity and toxicity of PCG. Patients and methods:Forty-five patients entered the study.Twenty-eight had stage IIIA–B disease, 17 stage IV. In the phase Istudy, with a fixed dose of C at AUC = 6 on day 1, P was escalated usingincrements of 25 mg/m2 starting from 175 mg/m2 on day1 and G with increments of 200 mg/m2 starting from 800mg/m2 on day 1 and 8. Results:Fourteen patients entered the phase I study. The MTD wasreached at P 200 mg/m2, C AUC = 6 and G 1000 mg/m2.Neutropenic fever and grade 3 diarrhea were the dose limiting toxicities.Thirty-one patients were treated in the phase II study with P 175mg/m2, C AUC = 6 and G 1000 mg/m2. Response rate was57% (68% in stage III and 47% in stage IV).Myelosuppression was the main toxicity, with grade 3–4 leukopeniaoccurring in 35% of cases. Grade 3 anemia was observed in 24%of cases and grade 3–4 thrombocytopenia occurred in 34% ofpatients. Non-hematological toxicity was mild. Median survival and one-yearactuarial survival were 20.5 months and 74% for stage III and 11.5months and 47% for stage IV. Conclusions:PCG is a promising regimen for treating advancedNSCLC. A phase III study comparing PCG to paclitaxel plus carboplatin inadvanced NSCLC is ongoing. On the other hand, we are planning to introduce thePCG regimen in the treatment of stage II–III patients in the setting ofa multimodality treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1026527004596
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  • 7
    Electronic Resource
    Electronic Resource
    Sleep apnea in childhood migraine (2000)
    Springer
    The journal of headache and pain 1 (2000), S. 169-172 
    Details
    ISSN: 1129-2377
    Keywords: Key words Migraine ; Sleep ; Sleep apnea ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In our previous study we found a high prevalence of disordered sleep breathing in migraine children vs. controls. Since no quantitative studies about sleep respiratory disorders have been carried out in migraine children, we performed a polysomnographic (PSG) study in 10 migraine patients (7 boys, 3 girls; mean age 8.11 years, range, 5.8–14.5) attending the Headache Center of our department, to evaluate the presence of sleep apnea. Mothers completed a headache diary and a sleep diary for at least 1 month and filled out a sleep questionnaire. PSG data showed a normal sleep architecture in 3 cases, an insomnia pattern in 2, a reduction of slow wave sleep in 3 and a reduction of REM sleep in 2. Respiratory analysis revealed that 2 of 10 patients had obstructive sleep apnea. These 2 patients presented habitual snoring and associated sleep disturbances such as restless sleep and hypnic jerks. Sleep apnea may be a subtle and often undiagnosed symptom in several migraine patients. The report of habitual snoring associated with other sleep disturbances such as restless sleep and other parasomnias may be a sign of sleep apnea in migraine children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101940070039
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  • 8
    Electronic Resource
    Electronic Resource
    HLA in migraine and coeliac children (2000)
    Springer
    The journal of headache and pain 1 (2000), S. S173 
    Details
    ISSN: 1129-2377
    Keywords: Key words Coeliac disease ; Headache ; Children ; HLA antigens
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The linkage between HLA antigens and disease susceptibility has been investigated in several diseases. Two different mechanisms are known to act in the relation between the HLA system and headache: linkage and association of alleles. Among neurological disorders associated with coeliac disease (CD) we focused on headache in 1997. From a group of 70 coeliac children, we studied 10 children with headache (3 boys and 7 girls). For each subject we evaluated clinical history and HLA antigens. The incidence of headache was not different with respect to the prevalence of headache in the general population. The HLA setting is not different between the 2 groups examined. However, we highlight 2 cases for the particular HLA setting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101940070014
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  • 9
    Electronic Resource
    Electronic Resource
    NCIC–CTG phase II study of gemcitabine in patients with malignant glioma (IND.94) (2000)
    Springer
    Annals of oncology 11 (2000), S. 315-318 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; gemcitabine ; malignant glioma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose:We conducted a phase II multicentre study of gemcitabinein patients with anaplastic astrocytoma and glioblastoma multiforme at firstrelapse. Patients and methods:Patients with anaplastic astrocytoma orglioblastoma multiforme receiving a stable dose of steroids and ECOGperformance status ≤3 were eligible for this study at the time of firstrelapse. One adjuvant chemotherapy regimen was permissible. Patients receivedgemcitabine 1000 mg/m2 i.v. weekly × 3, repeated on afour-weekly cycle. Results:Of 20 patients enrolled, 15 were evaluable for response,19 for non-hematological toxicity and 18 for hematological toxicity. Sevenpatients had anaplastic astrocytoma (AA) and twelve glioblastoma multiforme(GBM). Age ranged from 28–71 years (median 50). Fifteen patientsdiscontinued therapy due to disease progression. The median number of cyclesadministered was 1 (range 1–11); only two patients received more thanthree cycles. Hematologic toxicity was acceptable and no grade 4 toxicity wasseen. One patient developed Pneumocystispneumonia and eventualpulmonary embolism; one died of gastric hemorrhage related to steroid therapy.No objective responses were seen. Nine patients had stable disease (medianduration 2.7 months, range 0.9–11.2). Conclusions:Gemcitabine given in this dose and schedule seemswell tolerated but is not active in patients with recurrent high-gradegliomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008336607135
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  • 10
    Electronic Resource
    Electronic Resource
    Weekly administration of bendamustine: A phase I study in patients with advanced progressive solid tumours (2000)
    Springer
    Annals of oncology 11 (2000), S. 729-734 
    Details
    ISSN: 1569-8041
    Keywords: alkylating agents ; bendamustine ; chemotherapy ; phase I study ; solid tumours ; weekly chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:The cytotoxic agent bendamustine combines apurine-like benzimidazol and alkylating nitrogen mustard group. The clinicallytolerated dose for single bolus bendamustine is 215 mg/m2, forfractionated therapy on four consecutive days 85 mg/m2. The maximumtolerated dose of a day 1 and 8 (q4w) 30 min infusion schedule was recentlyfound to be 160 mg/m2, mouth dryness and fatigue weredose-limiting. Our current phase I trial was designed to define therecommended dose of a new weekly short infusion schedule. Patients and methods:Patients with refractory malignant tumoursqualified for the trial after written informed consent was obtained.Bendamustine was given as a 30-min i.v. infusion weekly for up to eightconsecutive weeks. Results:Twelve patients (8 male, 4 female, median age 57.5 years,range 42–64) were enrolled in this trial. At the starting dose of 80mg/m2, two patients had dose-limiting toxicity (fatigue grade 3,mouth dryness grade 3, fever grade 4 Common Toxicity Criteria). Nodose-limiting events were observed in six patients treated at 60mg/m2. An intermediate dose level of 70 mg/m2 wasstudied in three younger, less heavily pre-treated patients, was welltolerated and not associated with dose-limiting events. Haematologicaltoxicity was mild except for grade 3–4 lymphocytopenia, occurring in 11of 12 patients. Bendamustine was found to induce long-lastingpanlymphocytopenia with predominant B-cell cytotoxicity. Conclusions:The maximum tolerated dose of weekly bendamustinegiven as a 30-min i.v. infusion is 80 mg/m2, mouth dryness, fatigueand fever are dose-limiting. The recommended dose for phase II trials is 60mg/m2.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008309911008
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  • 11
    Electronic Resource
    Electronic Resource
    A dose-finding study of liposomal daunorubicin with CVP (COP-X) in advanced NHL (2000)
    Springer
    Annals of oncology 11 (2000), S. 691-695 
    Details
    ISSN: 1569-8041
    Keywords: anthracycline ; chemotherapy ; liposomal daunorubicin ; lymphoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Standard therapy for lymphoma consists of acyclophosphamide (C), doxorubicin, vincristine (V), and prednisone (P) (CHOP)combination regimen. Liposomal daunorubicin (DaunoXome®) is an alternativeto doxorubicin for patients with lymphoma because of its more favorable safetyprofile and potentially more selective uptake in lymphoma. The objectives ofthis study were to determine the maximum tolerated dose (MTD) of liposomaldaunorubucin with CVP (COP-X) and the tolerability of the regimen in patientswith indolent lymphoma. Patients and methods:Patients with low-grade andintermediate-grade lymphoma having adequate cardiac, hepatic, and renalfunction were enrolled. Patients received C 750 mg/m2, V 1.4mg/m2 (maximum 2.0 mg), and liposomal daunorubicin 50–100mg/m2 i.v. on day 1 and P 100 mg p.o. on days 1–5. MTD wasthe liposomal daunorubicin dose associated with 20% dose-limitingtoxicity (ANC 〈500/mm3 for 〉5 days or febrile neutropenia). Results:Twenty patients, median age 59 years, were treated. Theliposomal daunorubicin MTD combined with CVP was 70–80 mg/m2,depending on patient population. No significant non-hematologic toxicityoccurred. Response rate was 44% (2 complete and 5 partial responses). Conclusions:A liposomal daunorubicin dose of 80 mg/m2in the COP-X regimen was well tolerated with little non-hematologic toxicity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008361914894
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  • 12
    Electronic Resource
    Electronic Resource
    Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: A meta-analysis of published randomised trials (2000)
    Springer
    Annals of oncology 11 (2000), S. 837-843 
    Details
    ISSN: 1569-8041
    Keywords: adjuvant ; chemotherapy ; gastric cancer ; meta-analysis ; randomised clinical trial
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Several studies have investigated the possible roleof the adjuvant chemotherapy after curative resection for gastric cancerfailing to show a clear indication; previous meta-analyses suggested smallsurvival benefit of adjuvant chemotherapy, but the statistical methods usedwere open to criticisms. Materials and methods:Randomised trials were identified by meansof Medline and CancerLit and by selecting references from relevant articles.Systematic review of all randomised clinical trials of adjuvant chemotherapyfor gastric cancer compared with surgery alone, published before January 2000,were considered. Pooling of data was performed using the fixed effect model.Death for any cause was the study endpoint. The hazard ratio and its95% confidence intervals (95% CI), derived according to themethod of Parmar, were the statistics chosen for summarising the relativebenefit of chemotherapyversuscontrol. Results:Overall 20 articles (21 comparisons) were considered foranalysis. Three studies used single agent chemotherapy, seven combination of5-fluorouracil (5-FU) with anthracyclin, ten combination of 5-FU withoutanthracyclines. Information on 3658 patients, 2180 deaths, was collected. Chemotherapy reduced the risk of death by 18% (hazard ratio 0.82,95% CI: 0.75–0.89, P 〈 0.001). Association ofAnthracyclines to 5-FU did not show a statistically significant improvementwhen compared with the effect of the other regimens. Conclusions:Chemotherapy produces a small survival benefit inpatients with curatively resected gastric cancer. However, taking into accountthe limitations of literature based meta-analyses, adjuvant chemotherapy isstill to be considered as an investigational approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008377101672
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  • 13
    Electronic Resource
    Electronic Resource
    Chromosome aberrations after etoposide containing cisplatin-based chemotherapy for malignant germ-cell tumours (2000)
    Springer
    Annals of oncology 11 (2000), S. 897-898 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; chromosome aberrations ; malignant germ-cell tumours
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008311532043
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  • 14
    Electronic Resource
    Electronic Resource
    Evaluation of drug interactions in the established FEC regimen in primary cultures of tumour cells from patients (2000)
    Springer
    Annals of oncology 11 (2000), S. 1301-1307 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; drug interaction ; in vitroassay
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Chemotherapy using multi-drug regimens is consideredmore active than single-agent therapy. This may be due to synergisticinteractions or, simply, a higher probability of administering an activeagent. We investigated in vitrothe type of drug interactions in arecognized regimen in relationship to tumour type and drug sensitivity. Patients and methods: The possibility of synergistic and additiveinteractions between individual cytotoxic drugs was investigated for thecomponent drugs of the established FEC regimen, i.e., 5-fluorouracil,epirubicin and cyclophosphamide, in 243 patient tumour samples representingvarious drug sensitivity using the non-clonogenic fluorometric microculturecytotoxicity assay. Results: Using a cell survival of ≤50% as a limit fordrug activity and sample sensitivity, the overall response rates to the mostactive single drug (Dmax) and the combination were 56% and64%, respectively, with a distribution among diagnoses similar to thatin the clinic. For 86% of the samples there was concordance withrespect to judgement of activity using either Dmax or thecombination. For samples being sensitive to at least one single drug,95% were also sensitive to the combination whereas for samples withinsignificant Dmax effect, only 2% were sensitive to thecombination. In samples with modest Dmax effects, i.e., cellsurvival in the range 〉50%–≤80%, 45%responded to the combination. The effect of the combination was generally wellpredicted from the Dmax effect. Conclusions:The superior antitumour effect of drug combinationscompared with single drugs may be due to the higher chance of selecting anactive agent. However, for intermediately sensitive tumours, additionalinteraction effects of a combination may be of clinical significance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008332816407
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  • 15
    Electronic Resource
    Electronic Resource
    A phase I study of gemcitabine and epirubicin for the treatment of platinum-resistant or refractory advanced ovarian cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 613-616 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; ovarian cancer ; second-line
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Gemcitabine is active in patients with otherwiseresistant or refractory ovarian cancer. As the drug is well tolerated, studiesusing gemcitabine combined with other antineoplastic agents are needed. Theaim of the study was to determine the maximum tolerated dose (MTD) ofepirubicin combined with gemcitabine, with and without support of G-CSF. Patients and methods:Patients with platinum-resistant orrefractory ovarian cancer were eligible. Gemcitabine (G) (starting dose 800mg/m2 day 1 and 8; 200 mg/m2 escalation per level) andepirubicin (E) (starting dose 60 mg/m2 day 1; 15 mg/m2escalation per level) were given every 21 days for four to six cycles. G-CSF(filgrastim 5 µg/kg/die) was given in case of grade 4 neutropenia(levels without support) or from day 9 up to leukocyte count〉10,000/mm3 after nadir (levels with support). Cohorts of threepatients were enrolled at each level, and another three patients were planned,if one dose-limiting toxicity (DLT) was registered. MTD was determined firstwithout and then with G-CSF. Results:Four levels were studied (G 800 + E 60; G 1000 + E 60;G 1000 + E 75; G 1000 + E 75 + G-CSF) with four, four, three and threepatients enrolled, respectively. DLT (grade 4 febrile neutropenia) wasobserved in two patients at level 3. Thus, G1000 + E 60 mg/m2 wasthe MTD without G-CSF. The addition of prophylactic G-CSF did not allow afurther increase of the dose and grade 4 thrombocytopenia was the DLT at level4. Non-hematological toxicity was mild. Grade 2 mucositis was reported in fourpatients. Among the 13 patients with measurable or evaluable disease, 3partial responses were observed for an overall response rate of 23.1%. Conclusions:The combination of gemcitabine 1000 mg/m2(day 1, 8) and epirubicin at 60 mg/m2 (day 1) is a feasibletherapy. Grade 4 neutropenia is frequent and G-CSF support is often required.With prophylactic support of G-CSF, the DLT is thrombocytopenia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008344528791
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  • 16
    Electronic Resource
    Electronic Resource
    Primary cerebral lymphomas: Unsolved issues regarding first-line treatment, follow-up, late neurological toxicity and treatment of relapses (2000)
    Springer
    Annals of oncology 11 (2000), S. 39-44 
    Details
    ISSN: 1569-8041
    Keywords: brain tumor ; chemotherapy ; encephalopathy ; late neurological toxicity ; leucoencephalopathy ; primary cerebral lymphoma ; radiochemotherapy ; systematic follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Primary cerebral non-Hodgkin's lymphomas (NHL) inimmunocompetent patients (PCL) are located exclusively in the central nervoussystem, the eye, or meninges. Clinical management of these patients remainscontroversial. Patients and methods:Clinical characteristics of the patients andparameters influencing their outcome as of December 1998 were investigated andregistered in a database of 226 patients treated in the French Federation ofCancer Centers between 1980 and 1995. Results:Most PCL are diffuse large-cell NHL with a B phenotype.The incidence of PCL has been steadily increasing over the past 20 years insome but not all countries. The overall survival of primary cerebral lymphoma(PCL) patients in the published series, a median of 12–16 months and afive-year survival of 5%–20%, is poor. Several series havenow reported long-term survivals of more than 10 years and PCL may thereforebe a curable tumor in some patients. The optimal treatment of PCL is notknown. Complete resection of the tumor does not improve outcome andmultidisciplinary approaches combining chemotherapy and radiotherapy are nowcommonly used, although the superiority of combination over radiotherapy- orchemotherapy-alone has never been demonstrated in a phase III trial. Theoptimal chemotherapy regimen, the dose and even the usefulness of brainradiotherapy after chemotherapy are therefore still matters of debate.Recently, several authors have reported a relatively high incidence of lateneurological sequelae after PCL treatment. Conclusions:The optimal treatment of PCL patients remains to bedefined. Large cooperative international phase III trials are now required todefine and improve the optimal treatment of PCL and reduce its sequelae.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008364612406
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  • 17
    Electronic Resource
    Electronic Resource
    Treatment of Hodgkin's disease: Results and current concepts of the German Hodgkin's Lymphoma Study Group (2000)
    Springer
    Annals of oncology 11 (2000), S. 81-85 
    Details
    ISSN: 1569-8041
    Keywords: ABVD ; BEACOPP ; chemotherapy ; clinical trials ; COPP ; dose intensification ; Hodgkin's disease ; radiotherapy ; risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Treatment strategies in Hodgkin's disease (HD) arechanging fundamentally over the last decades. Both radiotherapy andcombination chemotherapy are effective treatment modalities. However, theoptimal choice of treatment or combinations of treatment is still debated fordifferent prognostic groups. Patients and methods:The German Hodgkin's Lymphoma Study Group(GHSG) initiated randomized clinical trials since 1978. Over the past 20years, more than 6000 patients with HD in all stages were randomized, treatedand followed by the GHSG. Patients are now being recruited from more than 300clinical centers. Results:As a consequence of different clinical trials, it is nowthe policy of the GHSG to tailor treatment to the individual risk of patients,giving favorable patients less intensive and less toxic therapy thanunfavorable patients. The treatment for early and intermediate stage HDbecomes quite similar with few cycles of polychemotherapy followed by involvedfield irradiation. In advanced stage HD, the introduction of dose intensifiedchemotherapy (BEACOPP), has improved treatment results and thus willsubstitute the MOPP or ABVD regimens. Conclusions:Although most of the patients with HD will be curedby modern treatment stategies, several questions are still subjects of ongoingclinical trials: 1) which chemotherapy regimen in which quantity will be thebest with respect to efficacy and toxicity and 2) which dose and field sizeof radiotherapy is adequate within the combined modality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008317426152
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  • 18
    Electronic Resource
    Electronic Resource
    Phase II study of the multitargeted antifolate LY231514 (ALIMTA™, MTA, pemetrexed disodium) in patients with advanced pancreatic cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 101-103 
    Details
    ISSN: 1569-8041
    Keywords: antifolate ; chemotherapy ; pancreatic cancer ; thymidylate synthase inhibitor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose:To determine the safety and activity of LY231514(ALIMTA™, MTA, pemetrexed disodium, Eli Lilly and Co.,Indianapolis, IN) in chemotherapy-naïve patients with advanced pancreaticcancer. Patients and methods:Patients with unresectable or metastaticpancreatic cancer received LY231514 600 mg/m2 as a 10–minuteinfusion every three weeks. Results:Forty-two patients were enrolled in this phase II trial.The median age was 60.3 (range 37–77) years; 79% had metastaticdisease. Neutropenia was common (40% of patients ≥ grade 3) butinfectious complications were rare. Significant anemia or thrombocytopeniaoccurred in 〈20% of patients. Non-hematologic toxicities includedgrade 2 or 3 skin reaction which was ameliorated by dexamethasone. Elevationsof bilirubin or transaminases were infrequent (〈25% of patients) anddid not require dose reductions or treatment delays. Thirty-five patientsreceived two cycles of therapy and were evaluable for response. One complete(duration 16.2 months) and one partial (duration 6.9 months) were observedresulting in an objective response rate of 5.7% for evaluable patients.In addition, 17 patients (40%) had stable disease that lasted ≥6months in 5 patients. The median survival was 6.5 months, with 28% ofpatients alive at one year. Conclusions:LY231514 is a well-tolerated agent with minimalobjective antitumor activity in pancreatic cancer. The median and one yearsurvival times, which may be important indicators in phase II trials of newagents, are of interest. Combination trials of LY231514 in pancreatic cancerare planned.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008305205159
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  • 19
    Electronic Resource
    Electronic Resource
    A phase II trial of gemcitabine in combination with 5-fluorouracil (24-hour) and folinic acid in patients with chemonaive advanced pancreatic cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 1267-1272 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; 5-FU ; folinic acid ; gemcitabine ; Gemzar® ; pancreas cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Gemcitabine (Gemzar®) and 5-fluorouracil (5-FU)plus folinic acid (FA) both have proven activity in the treatment of patientswith advanced pancreatic cancer. The present study was initiated toinvestigate the efficacy of gemcitabine in combination with 5-FU–FA. Patients and methods:Thirty-eight patients, median age 60 years(range 34–70) with inoperable, stage IV, pancreatic cancer were enrolledinto the study and treated on an outpatient basis. All except one patientreceived at least one cycle of treatment with gemcitabine (1000mg/m2), followed by FA (200 mg/m2) and 5-FU (750mg/m2) administered as a 24-hour continuous infusion on days 1, 8,15 and 22 of a 42-day schedule. No patient had received prior chemotherapy orradiotherapy. All 38 patients were assessed for efficacy, toxicity and timeto progressive disease. Results:Two patients (5%), achieved a partial response andthirty-four patients (89%) achieved stable disease. There were twoearly deaths (≤4 weeks). The median time to progression was 7.1 months(range 0.4–18.1+; 95% confidence interval (95% CI):5.3–7.9 months). Three patients had a progression-free interval ofgreater than 12 months and 12 of 38 patients (32%) survived longer than12 months. The median overall survival was 9.3 months (range 0.5–26.5;95% CI: 7.3–13.0 months). The incidence of grade 3 and 4toxicities was low. Conclusions:The combination of gemcitabine and 5-FU–FA isactive and well tolerated and seems to offer an improvement inprogression-free interval over both gemcitabine monotherapy and 5-FU–FAtherapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008364018881
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  • 20
    Electronic Resource
    Electronic Resource
    Hepatic arterial 5-fluorouracil in patients with liver metastases of colorectal cancer: Single-centre experience in 145 patients (2000)
    Springer
    Annals of oncology 11 (2000), S. 1563-1570 
    Details
    ISSN: 1569-8041
    Keywords: 5-fluorouracil ; arterial access device ; chemotherapy ; colorectal cancer ; hepatic arterial chemotherapy ; liver metastases ; port-a-cath
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Hepatic arterial chemotherapy for liver metastases ofcolorectal cancer is still under discussion. Mainly because of the technicalcomplications of this mode of treatment and the lack of a survival benefit inrandomized studies. We performed an analysis of hepatic arterial5-fluorouracil (5-FU) chemotherapy in 145 consecutive patients treated at asingle institution. Patients and methods:One hundred forty-five patients withinoperable liver metastases from colorectal cancer were included. 5-FU, 1000mg/m2/day continuous infusion for five days every three weeks, wasdelivered in the hepatic artery by percutaneous catheter or arterial accessdevice. Results:The response rate was 34% for all patients,40% in patients with extrahepatic disease, and 15% in patientswith i.v. 5-FU-based pretreatment. TTP and OS for all patients were 7.5 and14.3 months, respectively. In patients with extrahepatic disease or i.v.5-FU-based pretreatment, OS was significantly shorter compared to patientswithout extrahepatic disease or 5-FU-based pretreatment (9.7 vs. 19.3 monthsand 10.1 vs. 17.4 months, respectively). forty-seven percent of patientsstopped treatment because of a complication. Complications most often seen inpatients with arterial ports were hepatic artery thrombosis (48%) anddislocation of the catheter (22%). Conclusions:The results of our analysis are in line with previousphase III studies. Extrahepatic disease and i.v. 5-FU-based pretreatment wereprognostic for reduced OS. The complication rate of hepatic arterial deliverywas worrisome, although, no negative impact on survival could be established.There is a strong need for improvement of hepatic arterial delivery methodsbefore further evaluation of hepatic arterial 5-FU will be worthwhile.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008369520179
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  • 21
    Electronic Resource
    Electronic Resource
    High-dose therapy with autologous stem-cell transplantation (ASCT) after first progression prolonged survival of follicular lymphoma patients included in the prospective GELF 86 protocol (2000)
    Springer
    Annals of oncology 11 (2000), S. 1585-1590 
    Details
    ISSN: 1569-8041
    Keywords: autologous stem-cell transplantation ; chemotherapy ; follicular lymphoma ; progression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Among the 566 patients with follicular lymphomas (FL)included in the GELF 86 prospective trials from October 1986 to September1995, 372 with progressive/relapsing disease were analyzed retrospectively toidentify prognostic factors at first relapse. Patients and methods:For progressive FL, patients received mono-(22%) or polychemotherapy (78%) followed by high-dose therapy(HDT) with ASCT for 83 patients (22%). The median time toprogression from initial treatment was 23 months (range 3–102 months)and 24% of documented patients (52 of 217) had histologicaltransformation (HT). Salvage therapy produced an overall response in64% of patients and the five-year survival from progression was42%. Results:For patients who underwent HDT with ASCT compared tostandard treatment, five-year freedom from second failure was at 42%vs. 16% (P = 0.0001) and five-year survival was58% vs. 38% (P = 0.0005), respectively. Thebenefit of HDT and ASCT remained if we consider only patients less than 65years (five-year survival at 60% vs. 40%; P =0.001). Multivariate analysis of parameters significant according tounivariate analysis found that no ASCT at first progression, age at relapse〉50 years, progression on-therapy were adversely significant onsurvival. Conclusions:HDT with ASCT compared to standard treatmentprolonged remission and survival after first progression of FL patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008399623564
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  • 22
    Electronic Resource
    Electronic Resource
    Cost-effectiveness of second-line treatment with irinotecan or infusional 5-fluorouracil in metastatic colorectal cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 157-161 
    Details
    ISSN: 1569-8041
    Keywords: 5-fluorouracil ; chemotherapy ; colorectal cancer ; cost/effectiveness analysis ; irinotecan
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:It has been shown that irinotecan is superior toinfusional 5-fluorouracil (5-FU) in patients with advanced colorectal cancerafter 5-FU failure. In a recent trial, median survival was 10.8 months forpatients treated with irinotecan, compared to 8.5 months in patients receivinginfusional 5-FU. Considering the statistically significant but clinicallyrelatively small advantage of irinotecan over 5-FU, cost effectiveness shouldalso be part of treatment decision. Purpose:To relate the costs of each management approach tooverall survival in patients with metastatic colorectal cancer. Patients and methods:The healthcare costs and medical benefits(treatment-added survival) of second-line chemotherapy in patients (infusional5-FU: 129, irinotecan: 127) were compared. Data on overall survival were drawnfrom a multicenter randomised trial that compared infusional 5-FU (continuousinfusion, AIO, or LV5-FU2 regimens) to irinotecan alone. Costs were derivedfrom the accounting system in two university hospitals in Paris, France. Results:The range in total healthcare costs was 14,135 to 12,192US$ patient between management approaches, with irinotecan chemotherapycosting most and 5-FU-continuous infusion least. If survival was included asa treatment benefit, the cost-effectiveness ratio of irinotecan over 5-FUranged from 9,344 to 10,137 US$ per year of added survival. Conclusions:The least expensive management for metastaticcolorectal was 5-FU infusion but the additional cost of irinotecan wasbalanced by the added months of survival, with a cost-effectiveness ratioclose to that of other cancer treatments.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008358411251
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  • 23
    Electronic Resource
    Electronic Resource
    Phase II trial of gemcitabine in patients with previously untreated metastatic cancer of the esophagus or gastroesophageal junction (2000)
    Springer
    Annals of oncology 11 (2000), S. 1161-1164 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; esophageal cancer ; gemcitabine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:There were approximately 12,500 cases of esophageal carcinoma diagnosed in the US in 1992 and 12,200 deaths. The impact of chemotherapy on patients with metastatic disease is marginal with a median survival of only five months. Gemcitabine (LY188011,2,2,–difluorodeoxycytidine: dFdC), an analog of cytosine arabinoside (ara-C), is a pyrimidine antimetabolite. Gemcitabine has shown interesting clinical activity in initial phase II clinical trials in a variety of malignancies, including the aerodigestive malignancies, squamous-cell carcinoma of the head/neck and both non-small-cell and small-cell lung cancer. Patients and methods:A total of 21 patients with chemotherapy-naïve metastatic esophageal carcinoma were entered. Nineteen patients were evaluable for toxicity and seventeen patients were evaluable for response. Gemcitabine was administered intravenously at 1250 mg/m2 over 30–60 minutes on days 1, 8, and 15 followed by 1 week of rest. This four-week schedule defined a cycle of treatment. Patients may have received a maximum of six cycles. Results:Gemcitabine was well tolerated with minimal non-hematologic toxicity and grade 3–4 anemia, granulocytopenia, and thrombocytopenia occurring in 10.5%, 21%, and 0% of patients, respectively. No responses were seen in the seventeen evaluable patients. Conclusions:At the dose and schedule studied it would appear that gemcitabine has no activity in patients with chemotherapy-naïve esophageal carcinoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008369718242
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  • 24
    Electronic Resource
    Electronic Resource
    Kinder psychisch kranker Eltern Forschungsperspektiven am Beispiel von Kindern depressiver Eltern (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 164-172 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Psychisch kranke Eltern ; Depressive Eltern ; Entwicklungsbedingungen ; Psychosoziale Bedingungen ; Kinder ; Forschungsprobleme ; Forschungsaufgaben ; Forschungskriterien ; Key words Parents with psychiatric disorders ; Depressive parents ; Developmental conditions ; Psychosocial condition ; Children ; Research problems ; Research tasks ; Research criteria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Children of psychiatrically ill parents represent a risk group that has received growing attention during the last years. The risk for this group to develop a psychiatric illness is markedly increased due to genetic and psychosocial factors. The development of effective preventive concepts requires a thorough knowledge of the psychosocial factors. In this paper, deficits and problems of research in psychosocial transmission mechanisms are discussed taking the example of children of depressive parents. Conclusions from this exemplary considerations may serve as guidelines for future research. The authors suggest that the focus be rather placed on coping strategies and developmental psychopathology. Further, research criteria are formulated that refer to theoretical models as well as to study design.
    Notes: Zusammenfassung Kinder psychisch kranker Eltern stellen in psychiatrischer Hinsicht eine Risikogruppe dar, die in den letzten Jahren zunehmend in den Blickpunkt gerückt ist. Die Wahrscheinlichkeit für psychische Erkrankungen ist bei dieser Gruppe aufgrund von genetischen und psychosozialen Faktoren deutlich erhöht. Die Entwicklung von effektiven Präventionskonzepten setzt eine genaue Kenntnis der psychosozialen Faktoren voraus. In der vorliegenden Arbeit werden Defizite und Probleme bei der Erforschung der psychosozialen Transmissionsmechanismen am Beispiel der Kinder von depressiven Eltern diskutiert, und es werden Schlussfolgerungen herausgearbeitet, an denen sich die künftige Forschung orientieren sollte. Es wird vorgeschlagen, bewältigungsorientierte und entwicklungspsychopathologische Konzepte stärker zu berücksichtigen; darüber hinaus werden Forschungskriterien formuliert, die sich sowohl auf die theoretischen Modelle ebenso wie auf die Untersuchungsdesigns beziehen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050025
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  • 25
    Electronic Resource
    Electronic Resource
    91 dB Hörverlust – die Schwelle zum “Cochlear Implant”? (2000)
    Springer
    HNO 48 (2000), S. 828-831 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Cochlear Implant ; Resthörige Kinder ; Indikation ; Bildung ; Keywords Cochlear implant ; Children ; Indication ; Education ; Residual hearing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and objective. Recent indications for cochlear implant in children are bilateral total cochlear deafness and an age of 2 or more. Reports on successful implantations in adults with residual hearing pose the question of whether this indication might be expanded to children with residual hearing. Patients/Methods. In a retrospective analysis of 106 hearing-impaired children with binaural amplification, we were able to ask parents in 90 cases about their children's education. The pure-tone average of the frequencies of 1–4 kHz was correlated to education. Results. The results showed that all children except one with a pure-tone average of ≤90 dB could successfully attend regular school or kindergarten. However, those with a pure-tone average of ≥91 dB had to be educated in special units for children with impaired hearing. Conclusions. Our results indicate that amplification in children with profound hearing loss (pure-tone average ≥91 dB) is not sufficiently effective to enable them to attend regular schools or kindergarten. We conclude that the only chance to integrate these children into the world of hearing might be cochlear implantation.
    Notes: Zusammenfassung Hintergrund und Fragestellung. Die derzeit gültigen Richtlinien zur Indikation eines “Cochlear Implants” (CI) bei Kindern sind eine beidseitige cochleäre Taubheit sowie ein Lebensalter von über 2 Jahren. Berichte über die guten Hörerfolge nach Implantation von resthörigen, nicht tauben Erwachsenen werfen die Frage nach dieser Indikationserweiterung auch bei Kindern auf. Ziel unserer Arbeit war es, die Effizienz der Hörgeräteversorgung von schwerhörigen Kindern an Hand des Bildungsweges zu beurteilen um daraus Schlüsse zur Indikationserweiterung für ein CI zu ziehen. Patienten/Methodik. In einer retrospektiven Analyse von 106 beidseitig schwerhörigen, mit Hörgeräten versorgten Kindern konnte der Bildungsweg durch Befragung der Eltern in 90 Fällen erhoben werden. Ergebnisse. Durch Ermittlung der mittleren Hörschwelle in den Frequenzen 1–4 kHz und Vergleich mit dem Bildungsweg konnte gezeigt werden, dass nahezu alle Kinder (bis auf eines) mit einer Hörschwelle ≤90 dB Regelschulen oder -kindergärten mit Erfolg besuchen konnten. Alle Kinder mit einer Hörschwelle ≥91 dB mussten spezielle Einrichtungen für Hörbehinderte besuchen. Schlussfolgerungen. Da nach unseren Ergebnissen schwerhörige Kinder mit einer mittleren Hörschwelle ≥91 dB trotz Hörgeräteversorgung nicht in der Lage sind, Regelschulen oder -Kindergärten erfolgreich zu besuchen, schließen wir daraus, dass das Hauptziel einer Versorgung, nämlich der Erwerb einer ausreichenden Sprachkompetenz und -Produktion, nur durch ein CI erreicht werden kann.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050669
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  • 26
    Electronic Resource
    Electronic Resource
    Ambulante Rehabilitation nach Cochlear-Implant-Versorgung (2000)
    Springer
    HNO 48 (2000), S. 832-838 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Cochlear Implant ; Ambulante Rehabilitation ; Kinder ; Erwachsene ; Ergebnisse ; Keywords Cochlear implant ; Outpatient rehabilitation ; Cost effectiveness ; Results ; Children ; Adults
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and objective. This study compares the results of the outpatient-based program of the Cochlear Implant Center Ruhr with inpatient-based rehabilitation, which is almost exclusively performed in Germany. Patients/methods. The Department of Otorhinolaryngology at the University of Essen in Germany provided 52 patients with either 22- or 24-channel Nucleus cochlear implants from March 1996 to July 1999. Almost all patients (n=49) were rehabilitated on an outpatient basis, which is the standard in many cochlear implant centers outside Germany. Results. The longest follow-up period at the University of Essen Department of Otorhinolaryngology was 36 months. Minor complications occurred in 10% of the patients. After 24 months, the first three implanted patients were able to discriminate 100% of numbers and over 60% of syllables in the Freiburg speech discrimination test. The patients who developed an understanding of open speech were able to discriminate 31 words per minute with cochlear implant and without lipreading after 24 months. Children were seen to double their Schmid-Giovannini scores at 6 months postimplantation. Conclusions. The Essen outpatient-based cochlear implant program demonstrates results in speech development and speech understanding equal to those of centers providing inpatient rehabilitation. A special advantage is continuous rehabilitation with professionals known to the child for several years. In children especially, exhaustive commuting reduces school attendance and is a burden on the accompanying guardians. As an inpatient, however, the child is torn from his familiar environment. Parents with several children have particular difficulties in accompanying their child and indeed this may not always be possible.
    Notes: Zusammenfassung Hintergrund und Fragestellung. In dieser Arbeit werden die Ergebnisse der ambulanten Rehabilitation nach Cochlear-Implant-Versorgung mit denen der stationären Rehabilitation verglichen, die bisher in Deutschland fast ausschließlich durchgeführt wird. Von März 1996 bis Juli 1999 wurden an der Universitäts-Hals-Nasen-Ohren-Klinik Essen 52 taube oder an Taubheit grenzende Patienten mit einem 22-kanaligen bzw. 24-kanaligen Nucleuscochlear-Implant versorgt. Fast alle Patienten (n=49) konnten wohnortnah ambulant rehabilitiert werden, wie dies dem internationalen Standard entspricht. Ergebnisse. Der längste bisherige Nachbeobachtungszeitraum an der Universitäts-Hals-Nasen-Ohren-Klinik Essen sind 36 Monate. Nach 2 Jahren wurden von den 3 am längsten nachbeobachteten Patienten 100% der Zahlen und über 60% der Einsilber im Freiburger Sprachtest verstanden. Im “speech tracking” erreichten Patienten mit CI und ohne Lippenabsehen nach 24 Monaten 31 Wörter/min. Die Kinder zeigten 6 Monate nach Implantation eine Verdopplung des Scores im Test nach Schmid-Giovannini. Schlussfolgerungen. Das Essener Modell zeigt, dass eine ambulante Rehabilitation nach CI zu vergleichbaren Ergebnissen in der Sprachentwicklung und im Sprachverstehen führt, wie sie von anderen Zentren vorgelegt wurden, in denen fast ausschließlich stationär rehabilitiert wird. Besonders bei Kindern bedeuten lange Anfahrtswege mit einwöchigem stätionärem Aufenthalt Schulausfälle und eine Belastung für die begleitenden Eltern und Familienangehörigen zu Hause, sowie erhebliche Fahrtkosten. Stationäre Aufenthalte zur Rehabilitation reißen zudem das Kind aus seiner gewohnten Umgebung und sind für Eltern mit mehreren Kindern oft unmöglich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050670
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  • 27
    Electronic Resource
    Electronic Resource
    Angeborene Erkrankungen des Hörvermögens bei Kindern Teil 1: Erworbene Hörstörungen (2000)
    Springer
    HNO 48 (2000), S. 879-886 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Hörstörung ; Prävalenz ; Konnatale Hörstörungen ; Erworbene Hörstörungen ; Progredienz ; Infektionen ; Kinder ; Keywords Hearing loss ; Prevalence ; Connatal hearing loss ; Acquired hearing loss ; Progressive hearing loss ; Infections ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The results of international investigations on connatally acquired hearing loss are compared with the data of the German Registry on Childhood Hearing Loss (4058 cases). The connatal hearing disorders have shown a notable change in the last years regarding to aetiology and prevalence. In contrast to countries of the third world in developed nations the prevalence of permanent childhood hearing loss has been reduced down to 1 in 1.000 births. The results let assume a prevalence of approximately 1:1.200 births in Germany. For instance the number of rubella embryopathia decreased effectively. In contrast CMV infections and alcohol fetopathia are playing an increasing role. In the patients of the German Registry on Childhood Hearing Loss the percentage of certainly progressive hearing loss is 10.3 within the 4058 children with permanent hearing impairment. Diagnostic procedures first of all for the early diagnosis of CMV but also of toxoplasmosis are considerable because these infections may result in treatable hearing loss. Also consequent hearing tests are demanded in children with alcohol fetopathia.
    Notes: Zusammenfassung Im vorliegenden Beitrag werden die Daten internationaler Studien zu angeborenen erworbenen Hörstörungen mit den Ergebnissen aus 4058 Fällen im Deutschen Zentralregister für kindliche Hörstörungen (DZH) verglichen und ausgewertet. Die angeborenen Erkrankungen des Hörvermögens haben innerhalb der letzten Jahre bezüglich Ätiologie und Prävalenz einen deutlichen Wandel erlebt. Im Gegensatz zu Ländern der 3. Welt ist die Prävalenz permanenter kindlicher Hörstörungen in den westlichen Industrienationen auf ca. 1:1.000 gesunken. In Deutschland liegt die Prävalenz nach ersten Ergebnissen des DZH bei ca. 1,2:1.000. So ist beispielsweise der Anteil der Rötelnembryopathien stark zurückgegangen. Dagegen spielen heute die Zytomegalievirus-(CMV)-Infektion und die Alkoholfetopathie eine größere Rolle. Im Patientenkollektiv des DZH mit 4058 permanent hörgestörten Kindern beträgt der Anteil gesichert progredienter Verläufe 10,3%. Diagnostische Verfahren, vor allem zur Früherkennung von CMV und Toxoplasmose, gewinnen zunehmend an Bedeutung. Ebenso ist eine konsequente Hördiagnostik auch bei Kindern mit Alkoholfetopathie zu fordern.
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    URL: http://dx.doi.org/10.1007/s001060050684
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  • 28
    Electronic Resource
    Electronic Resource
    Psychische Belastung, Informiertheit und Behandlungserwartung von Eltern mit einem Cochlear Implant versorgten Kind (2000)
    Springer
    HNO 48 (2000), S. 675-683 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Cochlear Implant ; Kinder ; Eltern ; Psychische Belastung ; Erwartungshaltung ; Keywords Cochlear Implant ; Children ; Parents ; Psychosocial stress ; Expectations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Established knowledge. It is known that parents of hard-of-hearing children suffer from an increase in psychosocial stress. Scientific question. How does the psychosocial situation of parents with children who have cochlear implants change during rehabilitation? Aim of study. It was the aim of this study to demonstrate how parents evaluate retrospectively their own psychological well-being during the process of rehabilitation. Methods and results. We interviewed 87 parents by questionnaire which were mailed to them. Fifty-seven mothers and 46 fathers responded (59% return rate). Parents reported a significant increase in stress, as perceived by themselves, after the time of diagnosis. Of the parents, 25% continued to suffer from psychic stress during rehabilitation as could be demonstrated by the SCL-90-R questionnaire criteria. The expectations by parents were realistic prior to implantation but thereafter increased significantly with time. Conclusions. The psychological state of parents during the critical phase, after a diagnosis of deafness has been made for their child, has to be considered. Even after an initial phase of shock, parents seemed to be stressed to an extent that required therapeutic intervention.
    Notes: Zusammenfassung Bisheriges Wissen zum Thema. Eine generell erhöhte psychosoziale Belastung der Eltern hörbehinderter Kinder ist aus der Literatur bekannt. Wissenschaftliche Fragestellung. Wie verändert sich die psychosoziale Situation der Eltern von mit einem Cochlear Implant (CI) versorgten Kindern im zeitlichen Verlauf der Rehabilitation? Ziel der Arbeit. Ziel war es darzustellen, wie die Eltern ihr eigenes psychisches Befinden während der Rehabilitation ihres Kindes retrospektiv einschätzen. Methoden und Arbeitsergebnisse. 87 Elternpaare wurden getrennt in einer postalischen Fragebogenerhebung befragt; 57 Mütter und 46 Väter antworteten (59% Rücklauf). Die Eltern gaben ab dem Zeitpunkt der Diagnosestellung eine subjektiv deutlich erhöhte Belastung an. 25% der Eltern waren auch im weiteren Verlauf der Rehabilitation anhand der Beurteilungskriterien des SCL-90-R in einem klinisch relevanten Ausmaß psychisch belastet. Die Erwartung der Eltern vor der Implantation war realistisch und stieg im Verlauf der Rehabilitation statistisch signifikant an. Schlussfolgerungen. Die starke psychische Belastung in der Selbsteinschätzung der Eltern von CI-Kindern in der Phase der Diagnosestellung bestätigt die Theorie und klinische Praxis, dass die Eltern in dieser kritischen Phase besonderer Betreuung bedürfen. Auch über die Phase des initialen Schocks hinaus scheinen die Eltern in einem Ausmaß psychisch belastet zu sein, welches eine gezielte zusätzliche psychologische Betreuung der Eltern erforderlich machen könnte.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050638
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    Cholezystolithiasis bei Kindern und Jugendlichen Einfluss von Adipositas und anderen Risikofaktoren (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 600-604 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Epidemiologie ; Cholezystolithiasis ; Kinder ; Sonographie ; Risikofaktoren ; Key words Epidemiology ; Cholecystolithiasis ; Children ; Ultrasound ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Objective. To assess the prevalence of and risk factors (e. g., obesity and positive family history) for the development of cholecystolithiasis in a non-selected collective of children and adolescents. Design and participants. A series of 482 children and adolescents aged 6–18 years underwent upper abdominal diagnostic ultrasound examinations as part of a whole-community investigation (response rate: 78%) for Echinococcus multilocularis in a town in southern Germany. Results. Gallbladder stones were identified in three of 482 children, corresponding to a prevalence of 0.6%. None of the three children was overweight at the time of the examination. Additional risk factors (pronounced weight reduction and Wilson's disease) were present in one study subject. Conclusions. Findings of the present study do not confirm the significance of obesity as a risk factor for cholecystolithiasis in children and adolescents.
    Notes: Zusammenfassung Fragestellung. Ziel der Studie war es, Häufigkeit und Risikofaktoren der Cholezystolithiasis, insbesondere Adipositas und familiäre Belastung, an einem unselektierten Kollektiv von Kindern und Jugendlichen zu untersuchen. Methode und Studienkollektiv. Ein Studienkollektiv von 482 Kindern einer Gemeinde in Süddeutschland zwischen 6 und 18 Jahren wurde in einer Vollerhebung (Responserate: 78%) im Rahmen einer Screeninguntersuchung zu Echinococcus multilocularis sonographisch untersucht. Ergebnisse. Bei 3 von 482 Kindern, entsprechend einer Prävalenz von 0,6%, wurden Gallenblasensteine festgestellt. Keines der 3 Kinder war zum Zeitpunkt der Untersuchung übergewichtig. Als weitere Risikofaktoren fanden sich bei einem Studienteilnehmer eine starke Gewichtsreduktion sowie ein M. Wilson. Schlussfolgerungen. Adipositas konnte bei Kindern und Jugendlichen in der vorliegenden Studie nicht als Risikofaktor für die Cholezystolithiasis bestätigt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050602
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    Electronic Resource
    Beatmung in Bauchlage bei einem 5-jährigen Kind nach Polytrauma Effektive Therapie persistierender Atelektasen (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 787-790 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Thoraxtrauma ; Atelektasen ; Pädiatrie ; Bauchlage ; Keywords Thoracic trauma ; Atelectasis ; Children ; Prone position
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib fractures, rupture of liver and spleen). Under continuous analgosedation, the young patient was ventilated in prone position for 6 h, since acute lung injury and atelectasis persisted despite various therapeutic measures (artifical ventilation in the pressure controlled mode, fiberoptic bronchoscopy, reexpansion maneuver). After initiation of the prone position, we observed a rapid increase i narterial oxygenation, which persisted in the following period. The hemodynamic situation remained stable. The complete disappearance of atelectasis was demonstrated radiologically after supine repositioning. After cessation of analgosedation, the extubation was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapidly. Although there is a lack of experience with ventilation in prone position in pediatric intensive care, our report might be a recommendation for the indication of this technique in children.
    Notes: Zusammenfassung In dieser Kasuistik wird über die erfolgreiche Anwendung der Beatmung in Bauchlage bei einem 5-jährigen Mädchen berichtet, welches von einem Pkw überrollt worden war und sich Thorax- und Abdominalverletzungen (Rippenserienfraktur, Lungenkontusion, Leber- und Milzeinrisse) zugezogen hatte. Wegen des akuten Lungenversagens mit persistierenden Atelektasen, die durch wiederholte fiberoptische Bronchiallavagen und durch Reexpansionsmanöver nicht zu beheben waren, wurde der Entschluss zur 6-stündigen Lagerung auf den Bauch gefasst, obwohl über den Effekt dieser Lagerungsmaßnahme bei traumatisierten Kindern wenig bekannt ist und zu möglichen negativen Auswirkungen auf das schwerverletzte Abdomen eine Informationen vorliegen. Die Beatmung in Bauchlage führte zur raschen Verbesserung des pulmonalen Gesaustausches, die hämodynamische Situation wurde nicht beeinflusst. Die radiologische Kontrolle nach Rücklagerung zeigte eine vollständigen Rückgang der Atelektasen; die kleine Patientin konnte bald darauf extubiert werden. Weder laborchemisch noch klinisch wurde ein schädigender Einfluss auf das verletzte Abdomen gefunden. Die Beatmung in Bauchlage hat sich als Routineverfahren bei der Behandlung des Lungenversagens des Erwachsenen etabliert; nach der hier beschriebenen Erfahrung ist diese Maßnahme auch bei traumatisierten Kindern in Betracht zu ziehen, insbesondere wenn andere Maßnahmen nicht ausreichend sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050618
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    Electronic Resource
    Omeprazol in der Kinderheilkunde (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 113-117 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter ; Kinder ; Säuglinge ; Protonenpumpenhemmer ; Omeprazol ; Pharmakologie ; Gastroösophageale Refluxkrankheit ; Ösophagitis ; Helicobacter-pylori-Infektion ; Ulkus ; Key words ; Children ; Infants ; Omeprazole ; Gastroesophageal reflux disease ; Esophagitis ; Pharmacology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Proton pump inhibitors (omeprazole, lansoprazole, and pantoprazole) have revolutionized the therapy of peptic disease of the upper gastrointestinal tract and reduced the indications for surgical intervention. These substances inhibit the H+/K+-ATPase in the parietal cells with an acid suppressing potency that is much higher than that of H2-receptor-antagonists. The first proton pump inhibitor, omeprazole, has been introduced ten years ago. Since then, sufficient experience with this drug in children has accumulated. Omeprazole is released for children aged one year or older. A new formulation makes the drug applicable in tube fed patients. The main indications for the use of omeprazole are endoscopically verified peptic esophagitis and gastric and duodenal ulcerations of different etiologies. In the treatment of Helicobacter pylori-infection a sufficient acid suppression is essential for the efficacy of the antibiotics. The recommended pediatric dose ranges between 0,7–1,4 mg/kg bodyweight and day. However, some children with ulcerative esophagitis may need daily doses up to 3.5 mg/kg. Healing of the esophageal mucosa should be monitored by endoscopy. After remission, doses can often be reduced for maintenance therapy. Side effects are rare and do not seem to increase with higher doses. Possibly interactions with other medications, i.e. antiepileptic drugs, may occur. A long-term therapy lasting more than 6 months in a child should be monitored by an experienced pediatric gastroenterologist.
    Notes: Zusammenfassung Protonenpumpeninhibitoren (Omeprazol, Lansoprazol, Pantoprazol) haben die Therapie peptischer Erkrankungen im oberen Gastrointestinaltrakt revolutioniert und die Indikation für chirurgische Therapiemaßnahmen deutlich eingeschränkt. Diese Substanzen hemmen die H+-/K+-ATPase in den Parietalzellen und haben eine sehr viel stärkere säuresuppressive Wirkung als H2-Rezeptor-Antagonisten. Mit dem ersten Vertreter dieser Substanzklasse, Omeprazol, liegen nach 10jähriger Anwendung inzwischen ausreichend Erfahrungen bei Kindern vor. Die Substanz ist für Kinder ab dem 1. Lebensjahr zugelassen und in einer neuen Darreichungsform auch bei Sondenernährung anwendbar. Die wichtigsten Indikationen für den Einsatz von Omeprazol sind eine endoskopisch gesicherte peptische Ösophagitis und Ulzerationen verschiedener Genese im Magen und Duodenum. Für eine effektive Therapie der Helicobacter-pylori-Infektion ist die ausreichende Säuresuppression essentiell für die Wirksamkeit der eingesetzten Antibiotika. Die therapeutische Dosis liegt zwischen 0,7 und 1,4 mg/kg KG und Tag, in Einzelfällen werden zur Abheilung einer Refluxösophagitis bis zu 3,5 mg/kg und Tag benötigt. Die Abheilung erosiver und ulzeröser Läsionen muß endoskopisch kontrolliert werden. Für die Erhaltungstherapie nach Abheilung sind niedrigere Dosen angemessen. Bei kurzfristiger Anwendung sind Nebenwirkungen selten und scheinen nicht dosisabhängig zu sein. Potentielle Wechselwirkungen mit anderen Medikamenten, besonders Antikonvulsiva, müssen beachtet werden. Eine Langzeittherapie bei Kindern über Monate oder Jahre muß gut überwacht werden und gehört in die Hand eines damit erfahrenen Kindergastroenterologen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050020
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    Kreuzbandriß beim Kind (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S136 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Vordere Kreuzbandverletzung ; Kinder ; Rekonstruktion ; Indikation ; Key words ; ACL lesion ; Children ; Reconstruction ; Indications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract For ACL lesions in children near to the end of the growth phase the treatment can be treated identical to that in adults. For younger children (8–12 years) the treatment must be conservative, combined with controls at short intervals. Behaviour during sport should be modified. If instability is experienced in activities of daily life or during sport a reconstruction of the ACL should be done using a central tibial transepiphyseal hamstring reconstruction with a femoral over-the-top position to avoid possible growth disturbances.
    Notes: Zusammenfassung Kreuzbandverletzungen bei Kindern, die nahe ihres Wachstumsabschlusses sind (14. bis 17. Lebensjahr) können wie Kreuzbandverletzungen von Erwachsenen behandelt werden. Kreuzbandverletzungen bei Kindern, die 13 Jahre und jünger sind, sollten zunächst abwartend behandelt werden (Kniebandage, Koordinationstraining, Belastungsreduzierung). Stellt sich im täglichen Leben oder bei sportlicher Belastung eine Instabilität im Sinne eines Giving way heraus, so sollte das Kreuzband rekonstruiert werden. Dabei ist es nach allen vorliegenden Daten unbedenklich, die Tibia zentral mit einem 8-mm-Bohrloch zu durchbohren und ein ligamentäres Transplantat durchzuziehen. Femoral ist es aus Sicherheitsgründen eher sinnvoll, statt einer transossären Bohrung die Over-the-top-Position zu wählen. Auch andere, rein epiphysäre Verankerungsmethoden (Semitendinosusplastik mit transossärer Drahtfixation) sind möglich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014871
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    Electronic Resource
    Kreuzbandriß beim Kind (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S138 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Vorderes Kreuzband ; Kind ; Wachstumsfuge ; Fehlwachstum ; Key words ; Anterior cruciate ligament ; Children ; Growth plate ; Growth disturbance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Lesions of the anterior and posterior cruciate ligaments are relatively rare in childhood and adolescence; in this age group they need even more consistent and aggressive treatment than in adults as far as conservation of the menisci and definitive stabilization are concerned. Virtually no cases in which serious growth disturbance has arisen following transepiphyseal drilling are known from the literature. Thus, cruciate ligament suturing should also not be done in children, because the long-term efficacy has not been confirmed. The operative procedure is presented in detail and is related to bone age. Early transepiphyseal drilling is permissible.
    Notes: Zusammenfassung Ligamentäre Kreuzbandverletzung beim Kind und im Adoleszentenalter sind relativ selten, sie bedürfen im Vergleich zum Erwachsenen ¶einer noch konsequenteren und aggressiven Behandlung bezüglich Meniskuserhalt und definitiver Stabilisierung. In der Literatur sind praktisch keine Fälle bekannt, bei denen es tatsächlich zu einem gravierenden Fehlwachstum nach transepiphysärer Bohrung gekommen ist. Insofern sollte auch die Kreuzbandnaht beim Kind wegen der nicht bewiesenen Langzeiteffizienz unterlassen werden. Das Vorgehen im Einzelnen in Bezug zum Skelettalter wird dargestellt. Frühzeitige transepiphysäre Bohrungen sind erlaubt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014872
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    Clinicopathological correlations in nephrotic children with IgA nephropathy (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 318-322 
    Details
    ISSN: 1437-7799
    Keywords: Key words IgA nephropathy ; Nephrotic syndrome ; Children ; Age at onset
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. The prognostic significance of nephrotic syndrome (NS) in children with IgA nephropathy (IgAN) is unclear. Methods. NS was found in eight children with IgAN (mean onset age, 9.3 years). The clinicopathological findings of these eight children were investigated. Results. Five patients presented with macroscopic hematuria, while the remaining three were discovered in a school urinary screening program or by chance urinalysis. Six patients developed NS at the onset, and two developed NS later in the course of IgAN. All patients were treated with corticosteroids. At the end of follow-up, heavy proteinuria persisted in four children, one of whom had renal dysfunction at the onset of NS and developed end-stage renal failure, and two of whom developed NS after the onset of IgAN. Proteinuria decreased to less than 1 g/day 3 months after NS in four patients, two of whom showed disappearance of proteinuria afterward. Renal biopsy specimens revealed mesangial proliferation and crescent formation in all patients. The degree of persisting proteinuria was correlated with the presence of glomerular sclerosis, fibrous crescents, tubulo-interstitial changes on light microscopy, and depositions of C3 on immunofluorescence microscopy. Conclusions. Children who developed NS after the onset of IgAN developed renal dysfunction; the prognosis of those who showed chronic histopathological changes on renal biopsy specimens was poor, even in these young children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101570070008
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    Electronic Resource
    Major injuries from “domestic” animals in children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 589-591 
    Details
    ISSN: 1437-9813
    Keywords: Key words Domestic animals ; Children ; Injury ; Evaluation ; Prevention
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Domestic animals are a potential cause of serious injury to handlers and children. In developed countries dogs are the most common cause of such injuries, but in developing countries childhood injuries from domestic animals have not been given much attention. A retrospective analysis of major injuries from domestic animal attacks in children aged 12 years or less in a developing country showed 17 injuries in 16 children. The locations were the abdomen (6), head and neck (4), extremities (3), external genitalia (3), and back (1). A big-horned cow was the cause of injury in 11 patients, a donkey in 4 and a ram in 1. Children under 10 years were injured by provoked animals, mostly as bystanders, while older children were handlers. Four abdominal injuries were penetrating with evisceration and contusion of bowel and required a laparotomy. One blunt splenic injury was managed non operatively and one by partial splenectomy. Two head injuries were managed non operatively. All other injuries were examined and explored with the child under general anaesthesia. These injuries were debrided and closed primarily or closure was delayed when contamination was heavy or adequate debridement was limited by vital neighbouring structures. Broad-spectrum antibiotics and tetanus prophylaxis were given for all open wounds. The average duration of hospital stay was 7.3 days. Three patients had wound infections resulting in long hospitalizations. Two patients died (12.5%), 1 from a severe head injury and 1 from an overwhelming infection. The management of major injuries from domestic animals in children requires meticulous evaluation and examination during general anaesthesia to establish the extent of injury and avoid missed injuries. Prevention of these injuries requires public education about the proper and compassionate handling of domestic animals.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000419
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    Accurate localization of an insulinoma by preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 118-120 
    Details
    ISSN: 1437-9813
    Keywords: Key words Insulinoma ; Arterial stimulation ; Calcium ; Localization ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The role of pre- and intraoperative procedures for the localization of insulinomas has been extensively debated. We report a case of successful treatment using preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring. A 12-year-old boy with hypoglycemic attacks had a large insulinoma in the head of the pancreas on computed tomography. Preoperative selective angiography combined with arterial stimulation-venous sampling (ASVS) by intra-arterial injection of calcium revealed no other insulinomas in the body and tail of the pancreas. Elevation of serum glucose on intraoperative monitoring confirmed complete enucleation of the insulinoma. Preoperative ASVS can accurately localize an insulinoma, and may help to increase the success rate of surgery and avoid blind pancreatectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050036
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    Pleuropulmonary blastoma: four cases (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 595-598 
    Details
    ISSN: 1437-9813
    Keywords: Key words Pleuropulmonary blastoma ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pleuropulmonary blastoma (PPB) is a rare malignant neoplasm affecting children. A retrospective review was carried out of patients diagnosed as having PPB at one institute over a period of 16 years. The presentation, diagnosis, treatment, and family history were studied. PPB usually presents with symptoms and signs of respiratory tract infection, and the diagnosis may be delayed. There are no distinguishing clinical features or imaging studies. The diagnosis is made on histologic examination of tumour material and is sometimes difficult to differentiate from benign cystic lung lesions. The treatment is primarily complete excision of the tumour, followed in some cases by intense chemotherapy. PPB is a strong predictor of the presence of tumours in close relatives. Four patients treated at our institute are discussed along with a review of the literature.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000359
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    Sigmoid volvulus in childhood: report of six cases (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 132-133 
    Details
    ISSN: 1437-9813
    Keywords: Key words Sigmoid volvulus ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sigmoid volvulus is a common cause of large-bowel obstruction in elderly individuals, but is quite rare in childhood. We report six cases in patients under 20 years of age. One had Hirschprung's disease. Gangrenous sigmoid colon was found in three cases and resection was performed. Sigmoidopexy (one case) and extraperitonealization (two cases) were performed for viable sigmoid colon. There were no recurrences after 5.7 years of follow-up.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830070001
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  • 39
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    Electronic Resource
    Ultrasound-guided percutaneous sclerotherapy of hydatid liver cysts in children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 346-350 
    Details
    ISSN: 1437-9813
    Keywords: Key words Echinococcosis ; Liver/interventional procedure ; Cyst/percutaneous drainage ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the efficacy of ultrasound (US) guided percutaneous sclerotherapy in the pediatric population, 14 hydatid liver cysts (HLC) in eight male patients whose ages ranged between 6 and 16 years (mean 9.9 years) were treated. The maximum diameter was 110 mm. Albendazole was administered orally to all patients for 1 week before percutaneous treatment and for 3–6 months after the procedure to prevent dissemination of the disease. Cyst puncture was performed with 20 G Chiba needles using US guidance. More than one-half of the estimated cyst volume was aspirated, then 20% hypertonic saline (7 cysts) or sterile 96% alcohol (7 cysts) equivalent to one-third of the estimated cyst volume was injected into the cavity and left for 5–15 min. Finally, all the fluid in the cavity was reaspirated. Catheterization was not performed. Follow-up US examinations were performed every month during the first 6 months and every 3 months thereafter. The follow-up period ranged between 6 and 51 months (mean 15 months). No major complications were seen during or after the procedures. Two cysts in two patients completely disappeared. Volumes of the 11 cysts in five patients who were followed for 6–21 months were markedly reduced (22%–64% of the initial volume) and thick septations and solid debris-like structures were seen within the cyst cavities. There was no significant change in 1 cyst. US-guided percutaneous sclerotherapy is thus a safe and effective treatment of HLC in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000356
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  • 40
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    Electronic Resource
    Anorectal injuries in children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 388-391 
    Details
    ISSN: 1437-9813
    Keywords: Key words Anorectal injury ; Children ; Diagnosis ; Morbidity ; Mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Anorectal injuries (ARI) are uncommon in children in civil practice. In developed countries the injuries are mainly due to sexual abuse and firearms. This report reviews the experience in tropical Africa. A retrospective study of children aged 12 years or less managed for ARI over 10 years was undertaken. There were seven children, four girls and three boys. Four injuries were due to blunt trauma and three to penetrating trauma. Six patients presented within 6 h of injury and one after 24 h. Five had rectal bleeding, which was associated with vaginal bleeding in one girl. One girl each had vaginal bleeding and vaginal discharge without rectal bleeding. Diagnosis was by rectal examination and proctoscopy. In three patients a laparotomy was necessary to exclude an intraperitoneal rectal injury (IRI); this was positive in one case. One patient with abdominal findings had a laparotomy as the primary procedure. Overall, five patients had rectal injuries (extraperitoneal 3, intraperitoneal 2), which were associated with an anal injury in three while one patient had only an anal injury. An IRI was missed at initial assessment in one girl. Associated injuries were to the vaginal wall (3), urethra (1) and head (1). IRIs were treated by repair and proximal colostomy. Extraperitoneal injuries were treated by colostomy and drainage; in two patients the injuries were accessible and were repaired. Anal and external-sphincter injuries were repaired in two cases. Vaginal lacerations were repaired and other associated injuries treated accordingly. Three patients had wound infections. Faecal continence was maintained in all patients who had anal and external-sphincter injuries. One girl died of peritonitis from a missed IRI. It is concluded that ARI remains uncommon in children. Morbidity and mortality can, however, be high. Meticulous rectal palpation and visualisation is necessary to avoid missing injuries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000347
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  • 41
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    Electronic Resource
    Venous patency after open central-venous cannulation (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 411-413 
    Details
    ISSN: 1437-9813
    Keywords: Key words Central venous catheters ; Children ; Ultrasound assessment of venous patency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the value of Doppler ultrasound scan (USS) assessment of internal jugular vein (IJV) patency after previous open central-venous cannulation (CVC), a prospective study of 66 consecutive children (median age 4.5 years; range 4 months–17 years) who had previously undergone open insertion of at least one indwelling IJV line and required further CVC for completion of therapy was undertaken. All underwent Doppler USS examination prior to surgery. Where patency of the previously cannulated vein was suggested ultrasonographically, the accuracy of this finding was confined at open surgical exploration. Initial CVCs were in situ for a median of 9 months (1 month–4 years) prior to removal. The median interval to repeated CVC was 11 months (3 weeks–45 months). In 79 Doppler USS, 70 (88.6%) veins appeared patent, 3 (4.2%) stenosed, and 6 (7.6%) obliterated. Of the 70 “USS patent” veins, 66 were explored. Patency was confirmed surgically in 59 (89.4%) and a new CVC successfully inserted. Seven (10.6%) apparently patent veins on USS were found to be obliterated at open exploration. Review of USS images in these cases suggested that enlarged collateral veins were usually responsible. Overall, successful recannulation was possible in 74.6% of all previously accessed veins. In children requiring repeated CVC, Doppler USS of neck veins is a valuable but not entirely reliable guide to the presence of underlying vessel patency and should be interpreted with caution. At least three-fourths of previously cannulated IJVs remain patent after catheter removal and can be reused for CVC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000355
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  • 42
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    Electronic Resource
    Gastric wall erosion by an amebic liver abscess in a 3-year-old girl (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 429-430 
    Details
    ISSN: 1437-9813
    Keywords: Key words Amebic liver abscess ; Children ; Pediatric ; Stomach ; Rupture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The occurrence of an amebic liver abscess (ALA) rupturing into the stomach is reported. ALAs in children can have atypical presentations, resulting in delayed diagnosis and increased morbidity and mortality. Timely treatment is usually followed by complete recovery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900319
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  • 43
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    Electronic Resource
    Congenital spigelian hernia and cryptorchidism: cause or coincidence? (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 433-436 
    Details
    ISSN: 1437-9813
    Keywords: Key words Hernia ; Spigelian hernia ; Children ; Cryptorchidism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Congenital spigelian hernia (SH) is very rare in the pediatric age group. This is a report of two cases of SH in 1-week and 3-month-old male infants. A review of the literature revealed only 35 cases of SH in children younger than 17 years of age, bringing the total including our 2 cases to 37. There were 25 males and 12 females, a ratio of 2.1:1. Their ages ranged from 6 days to 17 years (mean 4.52 years). The hernia was situated on the right side in 13, the left side in 19, and was bilateral in 4. In one case the side of the hernia was not mentioned. In 29 cases the hernia was spontaneous while in 5 it was caused by trauma. In 3 children the hernia developed postoperatively, in 2 following repair of a congenital diaphragmatic hernia and in 1 following excision of a mediastinal neuroblastoma. Two children presented with a strangulated SH. Eleven of the 35 previously reported children had associated conditions; in 5 there was an ipsilateral undescended testis (UDT). Our two infants with SH also had an ipsilateral UDT. The significance of this association is discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900292
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  • 44
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    Electronic Resource
    Posttraumatic high-flow priapism: treatment with selective embolisation (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 454-456 
    Details
    ISSN: 1437-9813
    Keywords: Key words Priapism ; Children ; Arteries ; Fistula ; Embolisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Priapism is an uncommon problem in childhood. Most of the reported cases are in boys with sickle-cell disease or leukaemia. It occurs as a result of venous outflow obstruction, resulting in engorgement of the corpora cavernosa, and is termed “low-flow” priapism. In a small group of children priapism is due to uncontrolled arterial inflow, usually as a result of direct trauma. The authors report a case of post-traumatic arterial priapism in a child, successfully treated with selective embolisation of the internal pudendal artery. Recognition of this distinct entity is important, as it carries a good prognosis when appropriately treated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900320
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  • 45
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    Electronic Resource
    Urea kinetics and other dialysis indices in children undergoing ambulatory peritoneal dialysis (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 225-230 
    Details
    ISSN: 1437-7799
    Keywords: Key words Peritoneal dialysis ; Dialysis index ; Urea kinetics ; Adequacy ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Peritoneal dialysis (PD) is an established treatment for children with end-stage renal failure. Creatinine clearance and urea kinetics are used to quantitate the dialysis treatment, but the means to assess the adequacy of dialysis in children are still controversial. Methods. We studied serum chemistry, dietary protein intake (DPI), protein catabolic rate (PCR), weekly urea clearance/body water (Kt/Vurea), weekly creatinine clearance (Ccr/week), clinical signs and symptoms during PD treatment, and peritoneal transport function in 17 children (4 to 18 years of age) with end-stage renal disease treated with PD. Fourteen children were on continuous ambulatory peritoneal dialysis (CAPD) and 3 were on automated peritoneal dialysis. Results. The mean values of the parameters tested were: blood urea nitrogen, 71 mg/dl; creatinine, 9.8 mg/dl; total protein, 6.4 g/dl; albumin, 4.0 g/dl; total Ccr, 70 l/week per 1.73 m2; DPI, 1.76 g/kg per day; PCR, 1.17 g/kg per day, and total Kt/Vurea, 2.28/week. The mean patient's clinical assessment score was 11.7, out of 15 and the mean doctor's clinical assessment score was 11.7, out of 14. The correlation between Kt/Vurea and creatinine clearance was 0.84 (P 〈 0.0001). Kt/Vurea and clinical assessment scores (patient's and doctor's scores) did not show a good correlation (r = 0.32; P = 0.228, and r = 0.47; P = 0.064, respectively). Peritoneal function seemed to be preserved after an average duration of 32 months on PD. Conclusions. These patients appeared to be fairly well dialyzed, judging from the values for the various dialysis indices obtained in this study and comparing them with adult indices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101570070026
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  • 46
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    Electronic Resource
    Direct inguinal hernias in children: laparoscopic aspects (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 562-564 
    Details
    ISSN: 1437-9813
    Keywords: Key words Inguinal hernia ; Children ; Direct ; Recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Among 109 children treated laparoscopically for inguinal hernias, 5 had direct hernias, more than would normally be anticipated. Two of the hernias were recurrences of indirect hernias operated upon previously using the open technique. Direct hernias are easier to detect with the laparoscopic technique.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000431
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  • 47
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    Electronic Resource
    Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 50-52 
    Details
    ISSN: 1437-9813
    Keywords: Key words Intestinal volvulus ; Children ; Idiopathic ; Adhesion/bands ; Resection rate ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In developed countries, intestinal volvulus in children is most frequently due to malrotation. To review the experience in Nigeria, a retrospective analysis of 28 patients managed over 25 years at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. There were 22 boys and 6 girls with an age range of 4 days to 14 years (median 4 years). There were equal numbers over and less than 5 years of age. Vomiting (89%) and abdominal distension (79%) were the most prominent features. Thirteen children (46%) had fever, associated with bowel gangrene in 5, while 8 (29%) presented with severe dehydration and shock. A plain abdominal radiograph was the only investigation performed, but the features were not specific for volvulus. In 11 children (39%) the volvulus was idiopathic, in 9 (32%) due to adhesions or bands, in 5 (18%) to malrotation, and in 1 each a Meckel's diverticulum, internal herniation, and ventriculoperitoneal shunt. Twenty-three patients had a small-bowel, 4 sigmoid, and 1 caecal volvulus. The bowel resection rate for gangrene was 46% (small bowel 9, sigmoid 3, caecum 1). All patients with malrotation had Ladd's procedure performed. Wound infections occurred in 10 patients (36%), complete wound dehiscence in 1, and recurrence in 1 (idiopathic terminal ileal volvulus). The mortality was 21%, mostly from overwhelming infection (2 neonates, 11-year-old, 3 ≥ 5 years). Intestinal volvulus in our environment differs in aetiology from other reports. The resection rates are similar, however. This condition carries high morbidity and mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050013
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  • 48
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    Electronic Resource
    Management of pancreatic and duodenal injuries in pediatric patients (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 35-39 
    Details
    ISSN: 1437-9813
    Keywords: Key words Pancreatic trauma ; Duodenal trauma ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050009
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  • 49
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    Electronic Resource
    The treatment of pulled elbow: a prospective randomized study (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 336-337 
    Details
    ISSN: 1434-3916
    Keywords: Key words Pulled elbow ; Children ; Trauma ; Immobilization ; Nursemaid’s elbow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the effectiveness in decreasing recurrence of cast application after manual reduction of pulled elbow. Sixty-four children with pulled elbow were randomized into two treatment groups: Group A underwent manipulative reduction followed by splinting the elbow in a flexed and supinated position for 2 days; group B underwent manipulative reduction only. Both groups were examined 2, 5, and 10 days later. None of the 33 patients in group A had a pulled elbow at follow-up. Four (13%) of 31 patients in group B had a pulled elbow 2–5 days later. Immobilizing the elbow for 2 days after manipulative reduction improves the success of treatment of a pulled elbow.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050477
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  • 50
    Electronic Resource
    Electronic Resource
    Working memory resources and children's reading comprehension (2000)
    Springer
    Reading and writing 13 (2000), S. 81-103 
    Details
    ISSN: 1573-0905
    Keywords: Children ; Reading comprehension ; Working memory
    Source: Springer Online Journal Archives 1860-2000
    Topics: Education
    Notes: Abstract Working memory capacity is described as a pool of limited resources that carry out processing and storage functions. Its role has been emphasised in adults' reading comprehension. The present study had two aims: First, to study the relationship between working memory capacity and reading comprehension in fourth-grade children. Second, to study the nature of the working memory resources involved in reading comprehension, i.e., are they specific or general?To test the first point, the predictive power of working memory capacity was compared with two reading-related basic skills, vocabulary and decoding skills. To test the second point, different working memory tasks were devised using verbal, numerical and spatial materials. All the tasks were administered to 48 fourth-grade children. The results showed that working memory capacity was a direct predictor of reading comprehension when contrasted with vocabulary and decoding skills. Moreover, it seemed that working memory would be better described as a system specialised for the processing of symbolic information in that only the verbal and in a lesser extent the numerical working memory tasks were significant predictors of reading comprehension. The spatial task did not correlate with reading comprehension. The reasons accounting for the predictive power of working memory tasks were discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008088230941
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  • 51
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    Electronic Resource
    Tropisetron zur Prophylaxe von postoperativem Erbrechen bei Kindern (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 275-278 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Tropisetron ; postoperatives Erbrechen ; Adenotonsillektomie ; Antiemetika ; Kinder ; Key words Tropisetron ; PONV ; Adenotonsillectomy ; Antiemetics ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: Postoperative nausea and vomiting (PONV) after tonsillectomy is a common problem in children. Tropisetron is a new 5HT3 receptor antagonist and is successfully used in paediatric patients receiving cancer therapy. The aim of the study was to assess efficacy and safety of a single intravenous dose of tropisetron for prevention of PONV in paediatric patients at risk for postoperative vomiting. Methods: In a randomised, double-blind, placebo-controlled trial, we studied 98 children aged 2–12 years undergoing tonsillectomy or adenotonsillectomy. Patients received placebo or tropisetron 0.1 mg (=0.1 ml)/kg body weight immediately after induction of anesthesia. A standard general anesthetic technique (Sevoflurane/N2O/O2 without neuromuscular blockers or opioids) was used. Perioperative vital signs, grade of sedation and episodes of postoperative nausea and vomiting were recorded. Results: No vomiting episodes occurred in 65.3% of the tropisetron treated patients compared to 34.7% of the placebo group (p=0.0024). Only 10.2% of the tropisetron treated patients vomited more than 3 times compared to 22.4% of the control patients (p=0.0004). The need for antiemetic rescue medication was significantly lower in the study group (10.4%) compared to 28.6% (p=0.025). No significant adverse effects of the study medication were shown. Conclusion: A single intravenous prophylactic dose of tropisetron effectively reduces the incidence of PONV during the first 24 postoperative hours after tonsillectomy and/or adenoidectomy. Because of the low incidence of adverse effects, the prophylactic use of tropisetron seems to be safe and justified in paediatric surgical patients at high risk for postoperative vomiting.
    Notes: Zusammenfassung Fragestellung: Erbrechen und Übelkeit nach Tonsillektomien bei Kindern sind ein häufiges Problem. Aufgrund der positiven Erfahrungen mit Tropisetron, einem neueren 5HT3 Rezeptor-Antagonisten bei Chemotherapien in der pädiatrischen Onkologie und mit anderen 5HT3 Rezeptor-Antagonisten in der Kinderchirurgie, prüften wir die Wirksamkeit und Sicherheit einer Einzeldosis Tropisetron zur Prävention von postoperativem Erbrechen bei chirurgischen Kindern mit erhöhtem Risiko für postoperatives Erbrechen. Methodik: Bei 98 Kindern im Alter von 2– 12 Jahren, die eine Tonsillektomie oder Adenotonsillektomie benötigten, führten wir eine randomisierte, doppelblinde, plazebokontrollierte Studie durch. Die Patienten erhielten Tropisetron oder Plazebo in einer Dosis von 0,1 mg (=0,1 ml)/kg KG i.v. unmittelbar nach der Narkoseeinleitung. Die Narkose erfolgte standardisiert mit Sevofluran/N2O/O2 ohne Einsatz von Opioiden und Muskelrelaxanzien. Vitalparameter, Sedationstiefe, das Auftreten von postoperativem Erbrechen und unerwünschte Wirkungen wurden aufgezeichnet. Ergebnisse: In der Tropisetrongruppe zeigten 65,3% der Kinder kein postoperatives Erbrechen, im Gegensatz zu nur 34,7% der Kinder in der Plazebogruppe (P=0,0024). Mehr als 3 Episoden von postoperativem Erbrechen zeigten nur 10,2% der Patienten in der Tropisetrongruppe im Vergleich zu 22,4% der Patienten der Kontrollgruppe (P=0,0004). Auch der Bedarf an antiemetischer Zusatzmedikation war in der Tropisetrongruppe mit 10,4% signifikant niedriger als in der Kontrollgruppe mit 28,6% (P=0,025). Bedeutsame Nebenwirkungen der Studienmedikation konnten nicht dokumentiert werden. Schlussfolgerungen: Eine prophylaktische intravenöse Einzelgabe von Tropisetron reduziert bei Kindern wirksam das Auftreten von postoperativem Erbrechen während der ersten 24 h nach einer Tonsillektomie oder Adenotonsillektomie. Die geringe Inzidenz von Nebenwirkungen rechtfertigt unserer Ansicht nach die prophylaktische Anwendung von Tropisetron bei Kindern nach Tonsillektomien.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050828
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  • 52
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    Electronic Resource
    Longitudinal growth in HIV-negative boys with haemophilia (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 575-578 
    Details
    ISSN: 1432-1076
    Keywords: Key words Haemophilia ; HIV-negative patients ; Children ; Growth ; Body mass index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It has been shown that HIV-positive haemophilic children develop growth retardation. As not only the HIV infection but also other disease-related factors might compromise growth in these children, growth data were analysed in a longitudinal cross-sectional manner in 84 HIV-negative haemophilic patients from two university clinics. A total of 2–24 height and weight measurements (median 6) were recorded in each patient resulting in 683 single values collected between 1977–1995. Height SDS of all haemophilic boys was −0.31 ± 2.13 (mean ± SD, NS versus 0) and body mass index SDS was 0.21 ± 3.49 (mean SD, NS versus 0) at first measurement and remained unchanged throughout the observation period. Neither height nor body mass index differed with respect to the severity of haemophilia (mild/moderate/severe) or the study centre (Vienna/Prague). Conclusion Growth in HIV-negative patients with haemophilia is not affected in spite of the immunological abnormalities attributed to the substitution therapy or the bleeding episodes in the joints with the potential effect on the growth plate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310000447
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  • 53
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    Electronic Resource
    Preventive effect of 2 and 10 mg of sodium cromoglycate on exercise-induced bronchoconstriction (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 759-763 
    Details
    ISSN: 1432-1076
    Keywords: Key words Sodium cromoglycate ; Children ; Exercise-induced asthma ; Urinary eosinophil protein X excretion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This double-blind, randomised and cross-over study was designed to compare the preventive effect against exercise-induced bronchoconstriction (EIB), defined as the percentage decrease in FEV1≥15% after 6 min of exercise, of 2 mg and 10 mg of sodium cromoglycate (SCG), administered through a metered dose inhaler via spacer, in asthmatic children. Each of the 30 subject (age 11.6 ± 3.2 years) was tested on five occasions. For inclusion, EIB in test1 was required. In tests 2 to 5, all subjects inhaled 2 mg or 10 mg of SCG 20 min and 120 min before exercise in a randomised order. In order to assess excretion of eosinophil protein X (EPX) accompanying EIB, urine samples were collected before and after exercise. The mean percentage fall in FEV1 (±SD) in test 1 was 26.8 ± 9.8%. Inhalation of 2 mg and 10 mg of SCG 20 min before exercise provided a significant preventive effect in 83% and 77% and inhalation 120 min before exercise provided a preventive effect in 63% and 70%, respectively (n=30). Variance analysis did not reveal a statistically different absolute fall in FEV1 after exercise when both doses (120 min before exercise) were compared (P=0.356). In an unselected subgroup of 12 children, urinary EPX increased after the challenge without SCG premedication (test 1) (mean change: +48.7 μg/mmol creatinine, P=0.034), whereas no significant increase was found in case of SCG premedication (mean change in μg/mmol creatinine): 2 mg/20 min: +12.1; 2 mg/120 min: +8.5; 10 mg/20 min: −10.4 and 10 mg/120 min: −23.5; P 〉 0.1). Conclusion Administration of 10 mg of sodium cromoglycate is no more effective in preventing exercise-induced bronchoconstriction than 2 mg regardless of whether the medication is given 20 or 120 min before exercise. The preventive effect of sodium cromoglycate on exercise-induced bronchoconstriction in asthmatic children is associated with the inhibition of urinary eosinophil protein X excretion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008341
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  • 54
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    Electronic Resource
    Rapid appearance and onset of action of insulin aspart in paediatric subjects with type 1 diabetes (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 483-488 
    Details
    ISSN: 1432-1076
    Keywords: Key words Insulin aspart ; Insulin analogue ; Type 1 diabetes ; Pharmacokinetics ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pharmacokinetics of the novel, rapid-acting insulin aspart were compared with those of soluble human insulin following subcutaneous administration in nine children (aged 6–12 years) and nine adolescents (aged 13–17 years) with stable type 1 diabetes. The study had a randomised, double-blind, two-period crossover design. Each patient received a single subcutaneous dose of insulin aspart or human insulin (0.15 IU/kg body weight) 5 min before breakfast and the plasma insulin and glucose concentrations were measured at intervals during the following 5 h. The pharmacokinetic profile of insulin aspart differed significantly from that of human insulin with a higher mean maximum serum insulin (Cmax ins), 881 ± 321 (SD) pmol/l versus 422 ± 193 pmol/l for human insulin (P 〈 0.001); and with a shorter median serum insulin t max ins, 40.0 min (interquartile range: 40–50 min) versus 75.0 min (interquartile range: 60–120 min) for human insulin, (P 〈 0.001). An age-related effect on Cmax ins and area under the curve (AUC0–5h ins) was observed with higher values in adolescents than in children for both insulin aspart and human insulin. Postprandial glycaemic control was improved with insulin aspart; the baseline-adjusted ΔCmax glu being lower for insulin aspart compared with human insulin (increase of 7.6 ± 5.1 versus 9.4 ± 4.4 mmol/l respectively, P 〈 0.05). The incidence of adverse events was similar for the two insulin types. Conclusion The more rapid onset of action of insulin aspart versus human insulin, previously observed in adults, is confirmed in a paediatric population with type 1 diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051315
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  • 55
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    Electronic Resource
    Schistosomiasis in German children (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 530-534 
    Details
    ISSN: 1432-1076
    Keywords: Key words Schistosomiasis ; Children ; Travellers ; Ultrasonography ; Immunodiagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Reports on schistosomiasis in children growing up in Europe are rare despite increased travel activity. We report on eight male and three female German children aged 50 months to 15 years with schistosomiasis. Six children were asymptomatic, whereas two presented with typical signs of Katayama fever. Persisting haematuria, headache with eosinophilia and pyelonephritis were observed in one child each. An exposure was reported for six of the children. Two were examined solely because schistosomiasis was diagnosed in a family member. All had antibodies against schistosomal antigens in at least two of three screening tests. However, schistosomal ova (Schistosoma haematobium) were detected in urine and faecal specimens from only three children. A tumour-like lesion of the bladder was found by ultrasound in only one of the children who also exhibited haematuria. Neither eosinophilia nor elevated IgE levels were constant findings. Six to 12 months after praziquantel treatment, parasitological and ultrasound checks were negative and levels of specific antibodies decreased. However, 2 years later, elevated antibody levels were detected in one girl without evidence of any new exposure. She became antibody-negative 1 year after a second course of treatment. Conclusion In contrast to residents of endemic areas, parasitological and ultrasound examinations seem to be inferior to immunodiagnostics in children from non-endemic areas at temporary risk for schistosomiasis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051326
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  • 56
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    Electronic Resource
    Dermatologie im Primary Health Care-System Langzeitergebnisse eines Selbsthilfeprojekts bei Kindern im ländlichen Kenia (2000)
    Springer
    Der Hautarzt 51 (2000), S. 753-758 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Dermatologie ; Primary Health Care ; Langzeitergebnisse ; Kinder ; Kenia ; Keywords Dermatology ; Primary health care ; Long-term effects ; Children ; Kenya
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and Objective. In spite of the importance of skin diseases in Africa south of the Sahara, dermatology is insufficiently represented within the established primary health care systems. Aim of this study was to find out whether an integrated dermatology project could reduce the prevalence of dermatoses. Patients/Methods. Since 1994 trained community health workers have carried out regular weekly visits to schools and nurseries in 10 communities in rural western Kenya. Epidemiological studies were done in 13 schools in 4 communities involving 5780 and 4961 pupils one year before (1993) and 5 years (1999) following the introduction of the dermatology project. Results. Within this period the prevalence of bacterial skin infections fell from 12.7% to 11.3% (n.s.). Mycoses rose from 10.1% to 13.9% (p〈0.05), while arthropod infections (mainly scabies) remained unchanged with a prevalence of 8.3% in 1993 and 8.0% in 1999 (n.s.). Dermatitis also showed no changes (1.7% in both years). Conclusions. The prevalence of infective dermatoses depends not only on medical treatment but also far more on socio-economic factors.
    Notes: Zusammenfassung Hintergrund und Fragestellung. Trotz der großen Bedeutung der Dermatosen in Schwarzafrika ist die Dermatologie in den dort etablierten Basisgesundheitsdiensten völlig unzureichend repräsentiert. Untersucht werden sollten die Langzeitauswirkungen eines in das Primary Health Care-System integrierten Dermatologieprojekts in Bezug auf die Prävalenz von Hauterkrankungen. Patienten/Methodik. Seit 1994 besuchen ausgebildete Community Health Workers einmal wöchentlich Schulen und Vorschulkindergärten in 10 Gemeinden im ländlichen Westkenia. In 13 Schulen von 4 Gemeinden wurden 1 Jahr vor (1993) und 5 Jahre nach (1999) Projektinitiierung Reihenuntersuchungen an 5780 bzw. 4961 Kindern durchgeführt. Ergebnisse. Innerhalb dieses Zeitraums sank die Prävalenz bakteriell bedingter Dermatosen von 12,7% auf 11,3% (n.s.). Bei den Mykosen fand sich ein Anstieg von 10,1 auf 13,9% (p〈0,05). Arthropodenbedingte Infektionen (vorwiegend Skabies) blieben mit 8,3% 1993 und 8,0% 1999 (n.s.) im Wesentlichen gleich. Ekzeme wiesen zu beiden Zeitpunkten eine Prävalenz von 1,7% auf. Schlussfolgerungen. Die Prävalenz infektiöser Dermatosen hängt nur zu einem geringen Teil von der medizinischen Versorgung, sondern überwiegend von sozioökonomischen Faktoren ab.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050051209
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    Faecal occult blood in children with coeliac disease (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 832-834 
    Details
    ISSN: 1432-1076
    Keywords: Key words Coeliac disease ; Children ; Iron deficiency anaemia ; Occult blood ; AbbreviationsCD coeliac disease ; ID iron deficiency ; GFD gluten-free diet
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It has recently been suggested that in adults with coeliac disease, faecal blood loss may play a role in the development of iron deficiency. A group of 45 children diagnosed with coeliac disease during 1996 and 1997 were therefore prospectively evaluated for the presence of gluten in their diet, iron deficiency anaemia, and faecal occult blood. Sixty children admitted for elective surgery or asthma served as controls. Faecal occult blood was found in four iron deficient children on normal diet, of whom three were newly diagnosed. Occult blood loss disappeared in three of the four children when gluten was removed from their diet. Faecal occult blood was found in 26.7% of children on gluten-containing diet, but not in children on gluten-free diet (P=0.01), or in control children (P=0.001). Conclusion Our data suggest that the incidence of occult blood loss in coeliac disease occurs mainly in newly diagnosed cases and responds to a gluten-free diet. Occult blood testing may not be warranted in the absence of iron deficiency anaemia nor in children with iron deficiency anaemia who are on a gluten-free diet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008348
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    Direkte versus videovermittelte Elternschulung bei atopischem Ekzem im Kindesalter als Ergänzung fachärztlicher Behandlung Eine kontrollierte Pilotstudie (2000)
    Springer
    Der Hautarzt 51 (2000), S. 401-411 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Atopisches Ekzem ; Kinder ; Elternschulung ; Video ; Mütter ; Key words Atopic eczema ; Parental education ; Video ; Children ; Mothers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and Objective. Psychological problems in children and parents related to children's atopic eczema (AE) may impede the success of treatment. We studied the question, if behavior-based parental education in groups (DPE) or standardized video-education (VPE) could enhance dermatological treatment effects and reduce skin-damaging behaviors in children and stress in their mothers. Patients/Methods. 47 mothers attending the university outpatient-clinic for dermatology and their AE-children (mean age 4 years) participated in the study. 18 mothers underwent the DPE (10 sessions), 15 mothers worked with VPE at home. Dermatological standard treatment (CG; N=14) served as control for a 16-weeks-evaluation-period. Results. AE-symptoms improved overall, but the effectiveness of the treatments differed significantly, improval with parent education and was best with VPE. Psychological problems of mothers were equally reduced with DPE and VPE. Conclusions. It is suggested that VPE is a cost effective and less time consuming method for supporting dermatological therapy of AE in children.
    Notes: Zusammenfassung Hintergrund und Fragestellung. Das atopische Ekzem (AE) im Kindesalter kann psychologische Probleme bei Kind und Eltern zur Folge haben, die den Behandlungserfolg erschweren. Die Effektivität direkter verhaltensorientierter Elterngruppenschulungen (DES) bzw. standardisierter Videoschulungen (VES) gegenüber der dermatologischen Standardbehandlung (KG) zur Besserung des AE, des Kratzverhaltens der Kinder und krankheitsbedingter Belastungen der Mütter wurde überprüft. Patienten/Methodik. An der Studie nahmen 47 Mütter und deren AE-Kinder (Durchschnittsalter 4 Jahre) aus der Neurodermitisambulanz der Universitätshautklinik teil, 18 Mütter besuchten die DES (10 Gruppensitzungen), 15 Mütter arbeiteten mit der VES zu Hause. Die Behandlung der KG (n=14) erfolgte im vergleichbaren 4-Monats-Zeitraum. Ergebnisse. Das AE war über alle Behandlungsbedingungen gebessert, ihre Effekstärken unterschieden sich jedoch signifikant: Elternschulungen waren effektiver als Standardbehandlung, den stärksten Effekt hatte die VES. Belastungen der Mütter reduzierten sich nach beiden Schulungsformen. Schlussfolgerungen. Die Ergebnisse verweisen auf eine Zeit und Kosten sparende Möglichkeit, Videoschulungen für die Unterstützung der Therapie des AE im Kindesalter zu nutzen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050051141
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    Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia (2000)
    Springer
    Intensive care medicine 26 (2000), S. 942-949 
    Details
    ISSN: 1432-1238
    Keywords: Key words Ventilator-associated pneumonia ; Cardiac surgery ; Children ; Pediatric intensive care ; Complications ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children.¶Methods: Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP. Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation.¶Results: Median time to extubation was 3 days. VAP occurred in 26 patients (9.6 %). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6 %), and the need for secondary surgery (n = 51, 18.8 %; e. g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95 % CI 0.18–0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50).¶Conclusion: VAP accounts for a major delay of extubation in pediatric cardiac surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051285
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    Peritonitis as a risk factor of acute renal failure in nephrotic children (2000)
    Springer
    Pediatric nephrology 15 (2000), S. 248-251 
    Details
    ISSN: 1432-198X
    Keywords: Key words Nephrotic syndrome ; Acute renal failure ; Children ; Peritonitis ; Ischemic tubular necrosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Idiopathic acute renal failure (IARF) is an uncommon but severe complication in children with relapsing nephrotic syndrome and may require long-term dialytic support until recovery of renal function takes place. Due to limited understanding of the pathophysiology of IARF, specific guidelines for its prevention and therapy have not been developed. Among triggering factors, peritonitis was present in half of all pediatric patients with this complication described in the English literature over the past 15 years. We report an additional nephrotic child who developed IARF following spontaneous bacterial peritonitis. The renal biopsy showed tubular epithelial changes consistent with acute tubular necrosis. A discussion of related literature and possible pathogenesis of this association is presented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670000415
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    Calcium channel blockers: pharmacology and place in therapy of pediatric hypertension (2000)
    Springer
    Pediatric nephrology 15 (2000), S. 302-316 
    Details
    ISSN: 1432-198X
    Keywords: Key words Calcium channel blockers ; Children ; Pharmacokinetics ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The calcium channel blockers (CCBs) are a diverse group of antihypertensive medications with variable pharmacokinetics and clinical effects. Although CCBs have been widely applied to the treatment of hypertensive children, data regarding the pharmacokinetics, efficacy and safety of these agents in children are extremely limited. In this review we briefly summarize the mechanism of action of CCBs and then summarize pertinent pharmacokinetic information on each of the CCBs commonly used in children, including amlodipine, diltiazem, felodipine, isradipine, intravenous nicardipine, nifedipine and verapamil. Clinically important drug interactions and adverse effects are discussed, as well as the potential role of CCBs in renal protection. Available pediatric efficacy and safety data are summarized, and recommendations made regarding the rational use of CCBs in the management of pediatric hypertension.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670000480
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    Effect of dipyridamole on serum and urinary phosphate in X-linked hypophosphatemia (2000)
    Springer
    Pediatric nephrology 15 (2000), S. 57-59 
    Details
    ISSN: 1432-198X
    Keywords: Keywords X-linked hypophosphatemia ; Dipyridamole ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  X-linked hypophosphatemia (XLH) is characterized clinically by rickets, hypophosphatemia and hyperphosphaturia. Conventional treatment of XLH with oral phosphate and vitamin D is associated with hypercalcuria and nephrocalcinosis. Recently, intravenous and oral dipyridamole has been reported to decrease fractional excretion of phosphate in adults with idiopathic hyperphosphaturia. Our objective was to determine whether oral dipyridamole therapy reduces urinary phosphate excretion and increases serum phosphate concentration in children with XLH. A prospective study was performed in six children with XLH. The average age of the patients at the start of the study was 12.5±1.0 years. The effects of 12 weeks of oral dipyridamole therapy, at 4.4±0.4 mg/kg body weight per day, on serum phosphorous, parathyroid hormone (PTH), 1,25 (OH)2 vitamin D, osteocalcin, tubular maximum for phosphate reabsorption (TmP/GFR), urinary calcium excretion, and cyclic adenosine 3’,5’-monophosphate (cAMP) excretion, were compared to baseline levels. Our results show that there was no change in serum phosphorous concentration or TmP/GFR after 12 weeks of dipyridamole therapy. Dipyridamole therapy also had no effect on serum PTH, serum 1,25 (OH)2 vitamin D, alkaline phosphatase, osteocalcin levels, urinary calcium or cAMP excretion. We therefore concluded that in children with XLH, a 12-week course of dipyridamole had no effect on serum phosphorous or its urinary excretion. Dipyridamole therapy is unlikely to improve the bone disease in children with XLH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670000425
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    Nephrocalcinosis in children: a retrospective survey (2000)
    Springer
    Pediatric nephrology 14 (2000), S. 1016-1021 
    Details
    ISSN: 1432-198X
    Keywords: Key words Nephrocalcinosis ; Sonography ; Renal function ; Body growth ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We carried out a retrospective survey on 152 children and adolescents with nephrocalcinosis (NC) in 22 German centers of pediatric nephrology. Etiology, clinical manifestations, growth and development, sonographic appearance of NC and renal function were analyzed. The median age at the time of diagnosis was 3.3 (range 0.1–21) years and the median duration of follow-up was 4.1 years. In 34% of children NC was associated with idiopathic hypercalciuria (IHC) and in 32% with various hereditary tubular disorders. In 9% NC was observed subsequent to prophylactic bolus administration of vitamin D in infancy. A positive family history was found in 36%. Clinical manifestations were mainly failure to thrive during the 1st year of life (46%), psychomotor/mental retardation (28%) and urinary tract infection (34%). In 14% nephrolithiasis was associated. During the follow-up the proportion of patients with the most severe degree of NC (stages 2b or 3) increased from 40% to 55% and that of hypercalciuria decreased from 79% to 52%. Body height was 〈2 standard deviation scores (SDS) of normal in 41% at the time of diagnosis and in 32% at the last observation; the increase in relative height was significant only for IHC. Glomerular filtration rate (GFR) and urinary concentration capacity changed only slightly with time. At the last investigation GFR was 〈50 ml/min/1.73 m2 in 6% and concentration capacity 〈800 mosmol/kg in 48% of patients. The degree of NC was negatively correlated with GFR and concentration capacity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050065
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    Akutbehandlung des episodischen kindlichen Spannungskopfschmerzes mit Flupirtin und Paracetamol (2000)
    Springer
    Der Schmerz 14 (2000), S. 1-4 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter ; Kopfschmerz ; Kinder ; Akuttherapie ; Flupirtin ; Paracetamol ; Keywords ; Children ; Acute treatment ; Tension-type headache ; Flupirtine ; Paracetamol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: About 10% of all schoolchil- dren are suffering from migraine and 50% from tension-type headache. Headache of acute onset usually will be treated with analgesic substances like paracetamol, acetylsalicylic acid or ibuprofen, the first one being the reference drug for tension-type headache in childhood. In case of lacking improvement or side-effects there is demand for an alternative safe substance for the acute analgesic therapy. Methods: In a double-blind randomised investigation flupirtine and paracetamol were given in two consecutive attacks of episodic tension-type headache. 30 children, 6–12 years old, were included. Dosage was determined according to age and weight. The children documented the acute headache intensity and duration in a special diary. Results: Headache intensity was reduced during 2 h after intake in 89% of the 19 children treated. The reduction was 6,5 to 3,1 for flupirtine and 6,9 to 3,3/10 for paracetamol. There was no statistically significant difference between the two substances. Relevant side-effects could not be observed. Conclusion: Flupirtine has shown a convincing clinical effect treating acute episodic tension-type headache for children. The substance was well tolerated by the patients. In addition, flupirtine provides a high degree of safety.
    Notes: Zusammenfassung Hintergrund: Etwa 10% aller Schulkinder leiden nach neueren deutschen epidemiologischen Untersuchungen zumindest gelegentlich an Migräne und etwa 50% an Kopfschmerzen vom Spannungstyp. Häufig nehmen sie bei Spannungskopfschmerzen analgetische Monosubstanzen wie Paracetamol, Azetylsalizylsäure oder Ibuprofen ein. Bei nicht ausreichender Wirkung bzw. Unverträglichkeit besteht Bedarf nach weiteren Substanzen für die Akutanwendung. Methode: In einer doppelblindrandomisierten und gekreuzten Anordnung wurden Paracetamol bzw. das analgetisch und muskelrelaxierend wirksame Flupirtin 30 6- bis 12jährigen Kindern für 2 episodische Spannungskopfschmerzattacken angeboten. 10 Kinder benötigten nach dem Erstkontakt keine Medikation mehr, 1 Kind lehnte die Einnahme grundsätzlich ab. Ergebnisse: Die Kopfschmerzstärke verringerte sich laut Kopfschmerztagebuch innerhalb von 2 h nach der Einnahme auf einer numerischen Schmerzskala (0–10) von 6,5 auf 3,1 unter Flupirtin und von 6,9 auf 3,3 unter Paracetamol bei 89% der verbliebenen 19 Kinder. Statistisch signifikante Unterschiede zwischen beiden Substanzen bestanden nicht. Als Nebenwirkung trat 1-mal Erbrechen unter Paracetamol auf. Schlussfolgerung: Flupirtin hat sich in der Akutphase von episodischen Spannungskopfschmerzen beim Kind bewährt. Es verfügt über eine gute Verträglichkeit. Im Vergleich zu Paracetamol scheint v.a. bei akzidenteller Überdosierung eine größere Sicherheit zu bestehen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00009797
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    Messen und Erfassen von Schmerz (2000)
    Springer
    Der Schmerz 14 (2000), S. 302-308 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Schmerzmessung ; Diagnostik ; Instrumente ; Neugeborene ; Kinder ; Keywords Pain ; Measurement ; Assessment ; Instruments ; Neonates ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background. The assessment and measurement of pain is essential in the implementation and control of pain relieving strategies. The measurement of pain in infants and children should be based on the consideration of age, cognitive level, psychological status, intercurrent diseases and the social context in order to register the child's individual situation and to avoid misinterpretation. Diagnosis. In the preverbal infant, behavioral and physiological cues have to be interpreted by the caregivers. For the assessment of pain in children of four and older who have at least a basic understanding of the pain concept self assessment methods (as rating scales, specific pain interviews, diaries and questionnaires) can be used. In any case the instruments used should be age appropriate. The instruments used for the different age groups are presented with comments on quality and clinical applicability.
    Notes: Zusammenfassung Hintergrund. Voraussetzung zur Durchführung und Kontrolle einer adäquaten und effektiven Schmerztherapie sind die Erfassung und Quantifizierung des Schmerzes in seinen verschiedenen Dimensionen. Bei der Diagnostik des Schmerzes im Kindesalter müssen Alter, kognitiver Entwicklungsstand, psychologischer Status, interkurrierende Erkrankungen und der soziale Kontext berücksichtigt werden, um das Kind in seiner individuellen Situation erfassen zu können und Fehleinschätzungen zu vermeiden. Schmerzdiagnostik im Kindesalter. Im präverbalen Alter werden die physiologischen und verhaltensbezogenen Schmerzäußerungen von Neugeborenen, Säuglingen und Kleinkindern durch eine Fremdbeurteilung erfasst. Bei Kindern ab etwa 4 Jahren, die über ein einfaches Verständnis von Schmerz verfügen, sind Verfahren der Selbsteinschätzung wie einfache Ratingskalen, spezifische Schmerzinterviews, Tagebücher und Fragebögen die primär einzusetzenden Instrumente. In jedem Fall sollten die Instrumente altersgerecht gestaltet sein. Für die verschiedenen Altersgruppen werden Instrumente der Schmerzerfassung mit qualitativen Hinweisen auf deren Güte und klinische Anwendbarkeit vorgestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820070016
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    Schmerztherapie bei akuten pädiatrischen Erkrankungen und Impfungen (2000)
    Springer
    Der Schmerz 14 (2000), S. 319-323 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Schmerz ; Kinder ; Impfung ; Verbrennung ; Injektion ; Keywords Pain ; Children ; Vaccination ; Burn ; Injection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Phenomenon pain. While pain is one of the main reasons for an unscheduled visit to the paediatrician, pain due to painful procedures is of major importance in scheduled visits. Actual pain therapy is illustrated in the treatment of burns. Incomplete analgesia may have an unfavourable impact on morbidity and mortality. The pain score does not correlate with the extent of the burned area, and is regularly underestimated. General anaesthesia or analgo-sedation are warranted during the care of the burned patient. Unsufficient analgesia. Consequence of insufficient analgesia during primary care is an increased need of analgesics, and an increased pain treatment failure rate during subsequent procedures. Pain is interfering with anxiety, sleep disturbancies and post-tramatic psychologic alterations. All those symptoms must be treated adequately. Acute illness and injections. This article covers pain from otitis media, pharyngitis, Guillain-Barré syndrome, purpura fulminans, Toxic Epidermal Nekrolysis, as well as the usage of local anaesthesia during injections, not to forget the application of non-pharmacologic methods for pain therapy and prophylaxis.
    Notes: Zusammenfassung Phänomen Schmerz. Das Phänomen “Schmerz” begleitet fast alltäglich den Kontakt zwischen Arzt und krankem Kind. Auf der einen Seite sind Schmerzen der häufigste Grund für eine ungeplante Kinderarztkonsultation, auf der anderen Seite sind bei geplanten Kinderarztbesuchen häufig schmerzhafte Prozeduren durchzuführen. Anhand der starken Schmerzen bei den im Kleinkindalter häufigen Verbrennungen werden schmerztherapeutische Prinzipien konkretisiert: Schmerztherapeutische Prinzipien. Unzureichende Analgesie kann Morbidität und Mortalität ungünstig beeinflussen. Das Schmerzmaß korreliert nicht mit der Ausdehnung der Verbrennung und wird vom Behandler regelmäßig unterschätzt. In vielen Fällen der Erstversorgung sind Allgemeinanästhesie oder Analgosedierung gerechtfertigt, ähnliches gilt für den Verbandwechsel. Ungenügende Analgesie bei der Erstversorgung führt zu erhöhtem Analgetikaverbrauch und schmerztherapeutischen Misserfolgen bei Folgeeingriffen. Wechselwirkungen zwischen Schmerzen und anderen Symptomen wie Angst, Schlafstörungen oder postraumatischen psychischen Veränderungen sind zu beachten und adäquat zu therapieren. Akute Erkrankungen + Injektionen. Weiter wird auf Schmerzen bei Otitis media, Pharyngitis, Guillain-Barré-Syndrom, Purpura Fulminans und Toxischer Epidermaler Nekrolyse sowie den Einsatz von Lokalanästhetika bei Injektionen eingegangen. Schließlich haben auch nicht pharmakologische Methoden ihren Platz in Schmerztherapie und Prophylaxe.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820070019
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    Postoperative Schmerztherapie bei Kindern und Jugendlichen (2000)
    Springer
    Der Schmerz 14 (2000), S. 333-339 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Postoperative Schmerztherapie ; Schmerz ; Kinder ; Jugendliche ; Analgetika ; Keywords Postoperative pain therapy ; Pain ; Children ; Adolescents ; Analgesics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Treatment of pain. Undertreatment of postoperative pain in children is a problem in clinical practice. This is due to a lack of both knowledge about age-specific aspects of physiology and pharmacology, and routine pain assessment. For example, the fear of side-effects prevents the adequate usage of opioids. It is of major importance to select a route of drug administration where the child feels comfortable with (avoid intramuscular injections). Non-opioid analgesics. Non-opioid analgesics are recommended for basic pain treatment after minor surgical procedures. Instead of using the whole multitude of drugs available, the doctor should stick to those drugs he is familiar with (acetaminophen, ibuprofen, diclofenac, dipyrone). Opioids. Opioid usage requires individual dose titration and careful monitoring of side-effects (respiratory monitoring, sedation score). The strong opioids piritramide and morphine may advantageously be administered as either continuous, or patient-controlled iv- infusion (PCA). Forms of therapy. In addition to infiltration anesthesia, intraoperatively applied nerve blocks provide excellent pain relief. Epidural analgesia with local anesthetics and/or opioids via a thoracic or lumbar epidural catheter is a therapeutic option after thoracic or abdominal surgery, or after extensive orthopedic or urological interventions. Adjuvant analgesics and nonpharmacologic interventions, i. e. transcutaneous electrical nerve stimulation (TENS), are primarily indicated in patients suffering from neuropathic pain. Conclusion. The establishment of pain services and the comprehensive education of both the nursing and the medical staff should help to improve postoperative pediatric pain therapy.
    Notes: Zusammenfassung Schmerztherapie bei Kindern. Postoperative Schmerzen bei Kindern werden häufig wegen mangelnder physiologischer und pharmakologischer Kenntnisse und des Fehlens einer regelmäßigen standardisierten Schmerzmessung noch immer unzureichend behandelt. Die Angst vor Nebenwirkungen verhindert eine adäquate Opioidtherapie. Bei der Verwendung von Analgetika ist auf eine kindgerechte Applikationsweise (keine i.-m.-Injektionen!) zu achten. Nichtopioidhaltige Analgetika. Nichtopioidhaltige Analgetika (Parazetamol, Ibuprofen, Diclofenac, Metamizol) sind zur Basisschmerztherapie bei kleineren schmerzhaften Eingriffen geeignet. Opioide. Opioide müssen nach Wirkung titriert werden; Nebenwirkungen können nur bei sorgfältigem Monitoring von Atmung und Sedierungsgrad frühzeitig erkannt werden. Opioide (Tramadol, Piritramid, Morphin) können entweder kontinuierlich i. v. oder mittels PCA-Pumpe verabreicht werden. Therapieformen. Neben der Oberflächenanästhesie sind intraoperativ angelegte Nervenblockaden effektive therapeutische Möglichkeiten. Eine lumbale und thorakale Periduralanästhesie mittels Lokalanästhetika und/oder Opioiden bietet sich bei thorakoabdominalen Eingriffen an. Koanalgetika werden vornehmlich bei Nervenschmerzen verwendet und richten sich gegen die schmerzverursachende Pathophysiologie. Optimierung der Schmerztherapie. Die postoperative Schmerztherapie bei Kindern kann durch Einrichtung eines Akutschmerzdiensts und kontinuierliche Weiterbildung von Pflegepersonal und Ärzten optimiert werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820070021
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    Enalapril in paediatric patients with Alport syndrome: 2 years' experience (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 430-433 
    Details
    ISSN: 1432-1076
    Keywords: Key words Alport syndrome ; Angiotensin-converting enzyme inhibitors ; Proteinuria ; Children ; AbbreviationACEi angiotensin-converting enzyme inhibitor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Enalapril, a long-acting inhibitor of angiotensin-converting enzyme, was given for 2 years to seven children with Alport syndrome. Five patients had a classical X-linked form of the disease; two siblings had the autosomal recessive variant. Their age was between 5.15 and 13.75 years when enalapril was started. All patients had haematuria and proteinuria, creatinine clearance was 〉80 ml/min per 1.73 m2 in all, and only one patient was hypertensive. The starting dose of enalapril (0.1 mg/kg body weight per day) was increased progressively according to individual clinical tolerance. The median doses were 0.13, 0.12, 0.21 and 0.29 mg/kg at 6, 12, 18 and 24 months, respectively. Median values of mean blood pressure were 95 mmHg at the start and 84 mmHg after 24 months. Median daily proteinuria decreased from 52 mg/kg to 18 mg/kg at 6 months, 21 mg/kg at 12 months, 12 mg/kg at 18 months and 30 mg/kg at 24 months. Serum creatinine increased over time from a median of 0.64 mg/dl at baseline to 0.77 mg/dl at 24 months. Concomitantly, there was a decrease in GFR from 104 to 83 ml/min per 1.73 m2 at 18 months and an increase again to 95 ml/min per 1.73 m2 at 24 months. Analysis of the individual data showed three patterns: no response (n=2), temporary response (n=2) and sustained response (n=3). Conclusion When given enalapril at the dosages mentioned, Alport patients as a group display a marked reduction in urinary protein excretion with a nadir of 23% of the baseline figure at 18 months, a decrease that cannot be accounted for by the slight decrease in glomerular filtration rate. Although these are preliminary data, it is recommended to try an angiotensin-converting enzyme inhibitor in every paediatric Alport patient with proteinuria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051301
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    German cross-cultural adaptation of the Health Utilities Index and its application to a sample of childhood cancer survivors (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 283-288 
    Details
    ISSN: 1432-1076
    Keywords: Key words Health-related quality of life ; Health status ; Cross-cultural adaptation ; Children ; Health Utilities Index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Steady progress in developing effective treatments for childhood cancer and other severe pediatric diseases has established the need to consider the nature and frequency of late physical and psychological effects. The Health Utilities Index Mark 2 and Mark 3 (HUI2/3) systems were developed by Feeny, Furlong, Torrance et al. in Canada. These systems are generic multi-attribute measures of a person's health status and health-related quality of life. The first German version of the Canadian HUI2/3 questionnaire was created in our clinic, following recommended guidelines for cross-cultural adaptation of health-related quality of life measures. The usefulness of the resultant version was investigated using a sample of 142 patients who presented to our oncological outpatients' department for a routine health care visit after completion of treatment. The 15 items of the HUI2/3-questionnaire were answered independently by three groups of assessors – nurses, physicians, and parents or patients. Two additional questions covered ratings of the severity of treatment effects and the specification of these effects. The questionnaire was both easy to use and acceptable to the assessors. Percentage agreement between observers about levels for individual attributes ranged from 56% to 100%, with the lowest agreement on the subjective attributes of emotion, pain and cognition. These results are in accordance with previous studies using the original instrument. HUI2 global utility scores were significantly related to ratings of treatment sequelae, giving support to the discriminant validity of the measure. Conclusion The German version of HUI2/3 is a useful instrument with generally high inter-observer agreement and good suitability for outcome measurement in childhood cancer patients. Further research is needed to assess the usefulness of the instrument in other clinical populations and its sensitivity in longitudinal studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050071
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    Paediatric Behçet disease manifested as recurrent myositis: from an incomplete to a full-blown form (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 507-508 
    Details
    ISSN: 1432-1076
    Keywords: Key words Behçet disease ; Children ; Myositis ; Pustulosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 12-year-old boy presented with a limp and findings suggesting localised myositis of his right calf and a working diagnosis of Behçet disease was made. During 3 years of follow-up, he had another three episodes of calf myositis, all responsive to corticosteroids within days. Conclusion A case of recurrent localised myositis as a main manifestation of Behçet disease is reported. The evolution of incomplete Behçet disease, which is common in children, to the full blown form, with the emphasis on muscle involvement and the importance of early diagnosis of Behçet disease, is discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051320
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    Hearing loss in children with osteogenesis imperfecta (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 515-519 
    Details
    ISSN: 1432-1076
    Keywords: Key words Osteogenesis imperfecta ; Hearing loss ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Osteogenesis imperfecta (OI) is a genetic disorder of connective tissue. Progressive hearing loss is one of the principal symptoms of OI, affecting about 50% of adult patients. Hearing loss may also occur in childhood and results in additional disability in education and psychosocial adaptation and aggravates the physical handicap. This can be avoided by appropriate otological and audiological treatment. In a nationwide search, 254 Finnish patients with OI were identified indicating a prevalence of 4.9/100 000. Of the 60 children, 45 aged between 4 and 16 years accepting to participate the study on hearing, were evaluated by a questionnaire and clinical audiometry. Hearing loss was defined as pure tone average (PTA0.5–2 kHz) more than 20 dB hearing level (HL). A clinical geneticist determined the type of OI among the 45 patients. Two sporadic OI cases with conductive hearing loss were ascertained (4.4%): An 11-year-old girl with type IV OI with a PTA0.5–2 kHz of 35/40 dB HL and a 15-year-old boy with type IV OI with a PTA0.5–2 kHz of 27/18 dB HL. In addition, a 6-year-old girl with familial OI type I had either a congenital sensorineural deafness or early progressive deafness with PTA0.5–2 kHz of 97/103 dB HL, probably of unrelated aetiology. Conclusion Hearing loss in children with osteogenesis imperfecta is less frequent than generally suspected. Nevertheless, it is recommended that audiometry is performed in children with osteogenesis imperfecta even without symptoms of hearing loss at the age of 10 years, and repeated every 3 years thereafter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051322
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    Current evidence for the use of paediatric antiretroviral therapy – a PENTA analysis (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 649-656 
    Details
    ISSN: 1432-1076
    Keywords: Key words Antiretroviral therapy ; Children ; AIDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The introduction of combination antiretroviral therapy has been associated with a dramatic clinical improvement in children with human immunodeficiency virus infection. However, the uptake of antiretroviral therapy has been variable across Europe. The Paediatric European Network for the Treatment of AIDS Steering Committee has performed a systematic literature review of paediatric antiretroviral therapy trials. An analysis of the evidence base for the commencement and maintenance of antiretroviral therapy was produced. Suggestions for when to commence antiretroviral therapy, which drugs to start with and how to monitor and sequence drug regimens are given. Conclusion The aim of these guidelines is to help in obtaining equity of access to a uniformly high standard of care for children with human immunodeficiency virus infection in all European countries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008400
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    Therapeutic drug monitoring of once daily gentamicin in serum and saliva of children (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 697-698 
    Details
    ISSN: 1432-1076
    Keywords: Key words Gentamicin ; Once daily ; Children ; Saliva
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gentamicin is widely used in paediatric medicine and therapeutic monitoring is mandatory due to the narrow margin of safety. Saliva sampling may be of potential interest, especially in children in whom blood sampling is often difficult. Experience with once daily intravenous administration of aminoglycosides has grown in recent years. Gentamicin levels were measured in serum and saliva of 55 children treated with the drug (5 mg/kg per day), administered intravenously in three different regimens: thrice (n=19), twice (n=18), and once daily (n=18). No correlation was found between serum gentamicin concentrations and saliva levels when the drug was administered twice or thrice daily, however, there was good correlation when the drug was administered once daily (r 2=0.96, P 〈 0.0001). Conclusion In children with uncomplicated infections treated with once daily gentamicin, trough concentrations of the drug can be monitored in saliva.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310000532
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    Dubowitz-Syndrom und atopisches Ekzem (2000)
    Springer
    Der Hautarzt 51 (2000), S. 95-100 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Dubowitz-Syndrom ; Atopisches Ekzem ; Monozygote Zwillinge ; Kinder ; Keywords Dubowitz syndrome ; Atopic eczema ; Monozygotic twins ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Autosomal recessive inheritance, intrauterine growth retardation, short stature, microcephaly, distinct facial dysmorphism, psychomotoric retardation, and often uncharacterized eczematous skin lesions distinguish the rare Dubowitz syndrome. Here a pair of monozygotic twins with Dubowitz syndrome and clear-cut atopic eczema is presented.
    Notes: Zusammenfassung Autosomal rezessiver Erbgang, intrauterine Wachstumsretardierung, Kleinwüchsigkeit, Mikrozephalie, charakteristische Gesichtsdysmorphie, psychomotorischer Entwicklungsrückstand sowie häufig nicht näher charakterisierte ekzematöse Hautveränderungen kennzeichnen das seltene Dubowitz-Syndrom. Wir berichten über monozygote Zwillinge mit Dubowitz-Syndrom und eindeutigem atopischen Ekzem.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050050020
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    The importance of surgery in supratentorial ependymomas (2000)
    Springer
    Child's nervous system 16 (2000), S. 170-175 
    Details
    ISSN: 1433-0350
    Keywords: Key words Supratentorial ependymoma ; Children ; Radical surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In view of the widely recognized correlation between extent of surgical resection and length of survival of children with intracranial ependymoma and the statement that total resection is more likely to be achieved in supratentorial than infratentorial primaries, we decided to review our experience with supratentorial ependymomas and the pertinent literature to verify the importance of surgery in treating this subgroup of pediatric ependymal neoplasms. Of 23 patients operated on, 12 are still alive without evidence of disease 72–357 months after surgery (mean 227, median 237 months). One girl treated by surgery alone was lost to follow-up after 234 months when she, and 7 other patients in the series, had already passed the end of the period of risk for recurrence according to Collins’ law. Six surviving patients (2 with subependymoma and 4 with ependymoma) were treated by surgery alone and only 1, the oldest in the series, had to undergo a second operation for recurrence after 10 years. The idea of treating intracranial ependymoma by surgery alone was favored by eminent neurosurgeons in the past and has recently received renewed attention. This was in part the consequence of recognizing that unlike diffuse astrocytoma, in which neoplastic cells can be found up to several centimeters away from the apparent tumor borders, ependymoma has more or less well-defined margins and grows mainly by expansion. Early experience with the policy of electively deferring adjuvant therapy after radiologically controlled total resection of ependymoma seems encouraging, although postoperative MRI does not yet indicate absolute certainty. Close surveillance is recommended. The majority of ependymomas so far treated by surgery alone, with relatively good success, have been supratentorial. In conclusion, on the basis of our experience and a review of the literature we favor a change in attitude to the management of intracranial ependymomas, especially of the cerebrum, with radiologically controlled radical surgery alone followed by close surveillance with periodic MR imaging until the child passes the period of risk for recurrence according to Collins’ law as the initial option. In children less than 3 years old the period of surveillance should be doubled. In case of recurrence, reoperation should be considered first, particularly for supratentorial primaries. Radiotherapy continues to be a major option in malignant ependymoma and unresectable primary or recurrent benign ependymoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050487
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    Lumbar and radial bone mineral density in children and adolescents with X-linked hypophosphatemia: evaluation with dual X-ray absorptiometry (2000)
    Springer
    Skeletal radiology 29 (2000), S. 90-93 
    Details
    ISSN: 1432-2161
    Keywords: Key words Bone mineral density ; Dual energy X-ray absorptiometry ; Children ; Rickets ; X-linked hypophosphatemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To evaluate the bone mineral status of children being treated for X-linked hypophosphatemia, including potential differences between cortical bone in the radial diaphysis and combined cortical and trabecular bone in the lumbar spine. Design and patients. Forty-four bone mineral evaluations were performed in 11 children and adolescents with X-linked hypophosphatemia. Bone mineral density (BMD) of the lumbar spine and the radial diaphysis were measured by dual X-ray absorptiometry (DXA), second metacarpal cortical thickness was measured on hand radiographs, and these results were expressed as Z-scores (standard deviations from the mean). Results. For the 11 initial examinations, Z-scores (mean±SD) were: radial BMD, –2.73±1.15, lumbar BMD, +1.28±1.53; and cortical thickness, –2.21±0.95. Lumbar BMD Z-scores were significantly greater than those for radial BMD and cortical thickness. On follow-up examinations there was a mild increase in radial BMD and decrease in lumbar BMD. Although these changes were statistically significant, they were quite small and the discordance between radial and lumbar BMD was not corrected. Conclusions. Children and adolescents who are being treated for X-linked hypophosphatemia manifest a bone mineral disorder characterized by decreased BMD in the appendicular skeleton and increased BMD in the lumbar spine. Although current therapy is successful in its anti-rachitic effects, it does not correct this bone mineral disorder and additional therapeutic trials should be considered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050016
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    Analysis of risk factors following pediatric liver transplantation (2000)
    Springer
    Transplant international 13 (2000), S. S150 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Children ; Risk factors for survival ; Primary non-function ; Hepatic artery thrombosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Several recipient, donor and operation factors as well as postoperative complications related to patient survival after liver transplantation (LT) in children were studied by univariate and multivariate analyses . In a 13-year period, 103 patients under 15 years of age underwent 120 LT; the mean age was 63 months and 36 % were under 2 years of age. Indications for LT were cholestatic disease in 68 (56 %), metabolic diseases in 18 (14 %), fulminant hepatic failure in 8 (7.5 %), cirrhosis in 7 (5.8 %), and retransplants in 17 (14 %). Whole liver was transplanted in 79 % of cases and partial liver in 21 %. Actuarial survival at 1, 5, and 10 years was 70 %, 61 %, and 57 %, respectively. United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non-function (PNF) (RR = 13.9), and hepatic artery thombosis (HAT) (RR = 3.8) were independent factors for lower patient survival in multivariate analysis. Thus, in our experience, postoperative mortality as a consequence of the patient's condition before transplantation, or complications such as PNF or HAT, are the major causes of decreased survival in pediatric LT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050308
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    Circulating Epstein-Barr virus DNA to monitor lymphoproliferative disease following pediatric liver transplantation (2000)
    Springer
    Transplant international 13 (2000), S. S399 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Posttransplant lymphoproliferative disease ; Epstein-Barr virus ; Humans ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Epstein-Barr virus (EBV) infection can induce uncontrolled lymphocyte B proliferation in immunosuppressed transplant patients. Monitoring circulating EBV-infected lymphocytes can help in identifying patients at risk of posttransplant lymphoproliferative disease (PTLD). Circulating EBV genome levels were determined in 54 liver transplant pediatric recipients. Ten patients had more than 500 EBV genome/105 peripheral blood lymphocytes (PBL) and exhibited clinical manifestations of EBV infection; three developed PTLD. To treat EBV infection, the level of immunosuppression was reduced and acute rejection developed in 4 patients. Three were treated with steroid and one had to be switched from cyclosporine to tacrolimus. Treatment of acute rejection was associated with increases in circulating EBV genome. None of the patients with less than 500 EBV genome/105 PBL developed PTLD or EBV infection. Monitoring of EBV DNA is useful in the management of EBV infection and PTLD following pediatric liver transplantation. EBV infection should be treated in ways which do not expose patients to the risk of rejection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050370
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    Pediatric intractable epilepsy: the role of presurgical evaluation and seizure outcome (2000)
    Springer
    Child's nervous system 16 (2000), S. 278-285 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Intractable epilepsy ; Epilepsy surgery ; Outcome ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Surgical experience with long-term follow-up is limited in childhood intractable epilepsy, compared with adult epilepsy. To assess the role of each presurgical evaluation modality and to identify prognostic factors for favorable seizure control after epilepsy surgery, 38 children with intractable epilepsy who underwent surgery were retrospectively reviewed. Among the available preoperative evaluation modalities, PET and neuropsychological testing showed the highest rates of positive results, whereas MRI was the most concordant with EEG findings. During a follow-up period of at least 12 months, 26 of the 38 patients showed favorable seizure control (Engel classifications I and II). The best seizure control was achieved in patients with a temporal resection and discrete lesion on magnetic resonance imaging. In spite of the invasive study, the less satisfactory results followed an extratemporal resection. We conclude that epilepsy surgery benefits children with intractable epilepsy and that the role of invasive study should be re-established according to the area of resection and presence of discrete lesion on MRI.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050514
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    Gliomas in children: a review (2000)
    Springer
    Child's nervous system 16 (2000), S. 735-741 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Glioma ; Children ; Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The management and prognosis of gliomas are significantly different in children and in adults. Fortunately, the proportion of gliomas that are malignant is smaller in children than in the adult population. The different types of gliomas encountered in the pediatric population are reviewed, taking account of the most recent contributions on this subject. The importance of considering both localization and histological classification for better definition of the prognostic factors of each subgroup is emphasized. A brief review of the possible causes of gliomas is presented. Unfortunately, the information obtained by molecular and genetic study of these tumors has still not resulted in anything that can help the children suffering from gliomas in a concrete way. Surgery, with all its recent refinements, remains the best treatment for the majority of benign gliomas providing they can be removed without unacceptable sequelae. The role of chemotherapy has emerged recently for the treatment of nonresectable low-grade gliomas, such as hypothalamic- chiasmatic tumors, especially for infants, in whom the adverse effects of radiotherapy can be severe and irreversible. On the eve of the new millennium, there is renewed hope that the problem of malignant gliomas will be solved in the not-too-distant future.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000334
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    Electrophysiological studies of a child with presumed botulism (2000)
    Springer
    Child's nervous system 16 (2000), S. 84-86 
    Details
    ISSN: 1433-0350
    Keywords: Key words Botulism ; Electrophysiology ; Blink reflex ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Electrophysiological studies of a child with presumed botulism showed that the amplitude of the serially and electrically elicited blink reflexes Rl, R2 and R2’ was reduced during recovery. These findings suggest a conduction block of the facial nerves. Other nerve conduction studies and an incremental response to repetitive stimulation demonstrated a block of the presynaptic neuromuscular transmission. Results of the biological tests were negative, but those of electrodiagnosis and clinical examination favored a diagnosis of botulism. A combination of electrically elicited blink reflexes and rapid repetitive stimulation of the peripheral nerves was found to be a sensitive method of assessing the integrity of neuromuscular junctions and the subclinical impairment of muscle nerves.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050017
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    Moyamoya disease associated with a brain stem glioma (2000)
    Springer
    Child's nervous system 16 (2000), S. 251-255 
    Details
    ISSN: 1433-0350
    Keywords: Key words Moyamoya disease ; Brain stem glioma ; Children ; Surgical treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  An 8-year-old boy was found to have primary moyamoya disease associated with a brain stem glioma. For over 3 years the child had experienced transient ischemic attacks induced by hyperventilation. One month before referral to our hospital he had presented with progressive left facial nerve palsy. Magnetic resonance imaging showed a cystic mass in the lower pons. Angiography revealed severe bilateral stenosis of the internal carotid arteries and prominent moyamoya vessels in the basal ganglia. Partial resection of the tumor yielded a histological diagnosis of pilocytic astrocytoma. Local radiation therapy reduced the size of the tumor. Anastomosis of the superficial temporal arteries and middle cerebral arteries on both sides was then performed. After direct bypass surgery, the patient remained in a good condition for a 5-year follow-up period. Clinical investigation of the coincidence of primary moyamoya disease and brain stem glioma led the authors to conclude that these two diseases coexisted independently.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050508
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    Clinical feature and outcome of pediatric cerebrovascular disease: a neurosurgical series (2000)
    Springer
    Child's nervous system 16 (2000), S. 421-428 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Cerebrovascular disease ; Children ; Surgical outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To investigate the clinical features and surgical outcome of pediatric cerebrovascular disease (CVD), we retrospectively reviewed 280 children (up to 15 years of age) who underwent neurosurgical procedures for CVD between 1979 and 1998. Open surgery (n=448), endovascular procedures (n=22), and stereotactic radiosurgery (n=14) were the main neurosurgical procedures adopted. Clinical features and surgical outcomes were described according to the etiology of the CVD and the number of years of management. The mean duration of follow-up was 34 months. The mean age was 7.1 years, and the male-to-female ratio was 1.2:1. The most frequent CVD was moyamoya disease (62%). The surgical mortality related to CVD was 0.7%. Eighty-seven percent had Karnofsky Performance Scale scores of more than 70. We demonstrate increasing detection rates and improving outcomes in recent years. The clinical course in this study shows that recovery from CVD in children is good after neurosurgical procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007286
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    Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury (2000)
    Springer
    Child's nervous system 16 (2000), S. 25-34 
    Details
    ISSN: 1433-0350
    Keywords: Key words Child abuse ; Shaken baby syndrome ; Brain injury ; Infants ; Children ; Neuroimaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Acute CT/MRI findings were examined in a prospective, longitudinal study of 60 children 0–6 years of age hospitalized for moderate to severe traumatic brain injury (TBI). TBI was categorized as either inflicted (n=31) or noninflicted (n=29). Glasgow Coma Scale scores and perinatal history were comparable in both groups. Acute CT/MRI studies were visually inspected by a radiologist blind to group membership. Compared with the noninflicted TBI group, the inflicted TBI group had significantly elevated rates of subdural interhemispheric and convexity hemorrhages as well as signs of pre-existing brain abnormality, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly. Intraparenchymal hemorrhage, shear injury, and skull fractures were more frequent after noninflicted TBI. Subarachnoid hemorrhage and infarct/edema occurred with comparable frequency in both groups. Characteristic acute neuroimaging findings of inflicted TBI included multiple extraaxial hemorrhages in addition to the mild atrophy, subdural hygromas, and ventriculomegaly that suggest prior brain abnormality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050006
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  • 85
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    Electronic Resource
    Brain death in children: clinical, neurophysiological and radioisotopic angiography findings in 125 patients (2000)
    Springer
    Child's nervous system 16 (2000), S. 40-46 
    Details
    ISSN: 1433-0350
    Keywords: Key words Brain death ; Children ; Electroencephalogram ; Etiology ; Evoked potentials ; Radioisotopic angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The objective of this study was to determine the main clinical, neurophysiological and angiographic findings in brain death (BD) in children seen at the Instituto Nacional de Pediatría, a third-level facility in Mexico City, between 1991 and 1996. The following variables were retrospectively analyzed: sex, age, etiology, associated morbidity, duration of stay in hospital, and the results of two of three confirmatory studies (electroencephalogram, evoked potentials, radioisotopic angiography). In all, 125 patients were studied [78 male; median age 2 years (range: 18 days to 17 years)]. The most frequent etiology was infection (34%); 57% of the children developed associated morbidity. In 111 of 122 patients electrocerebral silence was observed; 100 of 107 had brain stem and somatosensory evoked potentials affording conclusive evidence of BD; and 83 of 90 patients had a positive radioisotopic angiography indicating BD. In 76 patients all three confirmatory studies were performed: for 15 there was at least one false-negative test result. Our age cohort showed a predominance of children less than 2 years old. BD etiologies in developing countries differ from those reported in developed countries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050010
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  • 86
    Electronic Resource
    Electronic Resource
    Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases (2000)
    Springer
    Child's nervous system 16 (2000), S. 707-718 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Syringomyelia ; Chiari I malformation ; Foramen magnum decompression ; Children ; Scoliosis ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The authors studied the role of the sole posterior fossa bony decompression in the management of symptomatic children affected by Chiari type I anomalies. The series in the pediatric literature on this subject were reviewed and compared with that presented in this article. From May 1994 to December 1998, 53 patients (3 months to 26 years) were observed. They were divided into: asymptomatic patients (27), who received no surgical treatment and were only subject to clinical observation; symptomatic patients (brain stem compression 16, syringomyelia 10, including 7 with holocord). All the symptomatic patients were treated with the same surgical approach: bony decompression of posterior fossa with removal of the posterior arch of C-1 and the outer layer of the dura without dural opening. In all 16 (100%) of the 16 patients with brain stem compression the symptoms resolved or improved; in patients with syringomyelia the symptoms were resolved or improved in 94.4% of cases. Two children required further surgery after 13 and 24 months, respectively.This series seems to demonstrate that even a simple extradural surgical approach, with a lower rate of postoperative complications and short stay in hospital, is sufficient to arrest the disease and to improve the symptomatology in a high percentage of cases (97.2%), which is comparable to that achieved with other, more aggressive, procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000338
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  • 87
    Electronic Resource
    Electronic Resource
    Surgical technique for the insertion of grids and strips for invasive monitoring in children with intractable epilepsy (2000)
    Springer
    Child's nervous system 16 (2000), S. 724-730 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Epilepsy ; Children ; Invasive monitoring ; Subdural electrodes ; Surgical technique ; Infection ; Morbidity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Despite improved imaging, and electrical and magnetic external mapping, there are a large number of children with intractable epilepsy in whom a focus cannot be defined by non-invasive techniques. Invasive monitoring with depth electrodes, electrode grids and/or strips is required in up to 50% of children with a suspected focal seizure disorder. In children with suspected temporal lobe epilepsy the invasive techniques are required to identify which temporal lobe is the primary focus, to separate temporal from frontal foci, and to define the extent of involvement of the lateral temporal cortex. In children and infants with non-temporal epilepsy, invasive monitoring is required to define the epileptogenic zone and to map areas of cortical specialization. The current techniques used for surgical implantation are described here. In a correctly selected population invasive monitoring will define the epileptogenic focus or foci in 90% of children; 80% will have surgically treatable epilepsy. Infection rates are less than 1% for subdural strips and 6% for grids. In 88 cases no incidence of meningitis occurred.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000336
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  • 88
    Electronic Resource
    Electronic Resource
    Imaging after head trauma: why, when and which (2000)
    Springer
    Child's nervous system 16 (2000), S. 755-759 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Head trauma ; Children ; CT scan ; MRI scan ; Follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  CT scanning is the current first imaging technique to be used after head injury, in those settings where a CT scan is available. The first scan is usually done without contrast enhancement. The value of CT is the demonstration of scalp, bone, extra-axial hematomas and parenchymal injury. It is rapid and easily done in the presence of the multiple monitors that many trauma patients have in place. It can be used to demonstrate the bony anatomy of the spine and is good for evaluation of abdominal and chest trauma also. MRI is more sensitive for all post-traumatic lesions other than skull fracture and subarachnoid hemorrhage, and can demonstrate parenchymal spinal cord injury. The cons are a longer scanning time, interference of the imaging by certain ICP monitors and problems with the positions of the monitoring equipment and ventilators outside the MRI magnetic field. MRI will be used increasingly to study early head injury because of its ability to measure cerebral blood flow, cerebral blood volume and the location and extent of cerebral edema. If the CT does not demonstrate pathology adequate to account for the clinical state, MRI is warranted. Follow up is best done with MRI as it is more sensitive to parenchymal change than is CT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00013720
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  • 89
    Electronic Resource
    Electronic Resource
    The occipital transtentorial approach for cerebellar arteriovenous malformation in a child (2000)
    Springer
    Child's nervous system 16 (2000), S. 129-133 
    Details
    ISSN: 1433-0350
    Keywords: Key words Arteriovenous malformation ; Brain stem ; Cerebellum ; Children ; Quadrigeminal plate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This report presents a case of arteriovenous malformation (AVM) in the region of the superior vermis and quadrigeminal plate, which was partially embolized using a endovascular technique and subsequently surgically excised. An occipital transtentorial approach was employed to excise the AVM, and the patient did well without neurological complications postoperatively. Comparing various surgical approaches, we believe the occipital transtentorial approach is the best for the AVM of this region.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050478
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  • 90
    Electronic Resource
    Electronic Resource
    Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: prognostic factors and interpretation of postoperative neuroimaging (2000)
    Springer
    Child's nervous system 16 (2000), S. 161-168 
    Details
    ISSN: 1433-0350
    Keywords: Key words Hydrocephalus ; Endoscopic III ventriculostomy ; Outcome ; MRI ; Cine-MRI ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In order to analyze the surgical outcome according to clinical characteristics and to evaluate the correlation between clinical improvement and neuroimaging changes, we retrospectively reviewed 32 children who had undergone endoscopic III ventriculostomy (ETV) from February 1994 to May 1998. There were 15 boys and 17 girls, with a mean age of 5.2 years (range: 1 month to 13 years). The etiology of the hydrocephalus was primary aqueductal stenosis in 18 patients, secondary aqueductal stenosis caused by tumors in 5, IV ventricle outlet obstruction in 5, and hydrocephalus associated with meningomyelocele in 4. The mean duration of follow-up was 19.4 months (range 1–50 months). Overall, surgical outcome was regarded as good in 21 of 29 patients. Surgical outcome was poor in patients younger than 1 year (P〈0.05). Neuroimaging 1 month after ETV showed a decrease in ventricular size in 11 of the 16 patients with good surgical outcomes. Five showed minimal changes only. In patients with good outcomes, ventricular size tended to decrease as time passed. Resolution of periventricular edema, flow void in the III ventricle on T2-weighted axial images, and cine-MR imaging were sensitive indicators of good outcome. We suggest that ETV be considered as a primary treatment option in patients older than 1 year of age with noncommunicating hydrocephalus. In addition, time factors should be taken into consideration when surgical outcome is judged. Changes in ventricular size could not predict surgical outcome completely in themselves. Therefore, a comprehensive postoperative assessment should be made with the help of T2-weighted MRI and cine-MRI.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050485
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  • 91
    Electronic Resource
    Electronic Resource
    Infusional ECarboF in patients with advanced breast cancer: A very active and well-tolerated out-patient regimen (2000)
    Springer
    Annals of oncology 11 (2000), S. 1557-1561 
    Details
    ISSN: 1569-8041
    Keywords: breast cancer ; carboplatinum ; chemotherapy ; continuous 5-fluorouracil
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We performed a trial using the combination of epirubicin 50mg/m2/day 1, carboplatinum AUC 5/day 1 and continuous5-fluorouracil (5-FU) 200 mg/m2/day (every 4 weeks for6 months) to confirm the efficacy and low toxicity profile of thisregimen in breast cancer. In 51 patients with metastatic(n = 33) or locally advanced (n = 18)breast cancer the overall response rate was 86% (95% confidenceinterval (95% CI): 73%–94%): 94% in locallyadvanced and 81% metastatic disease. Grade 3–4 toxicity was low:4% of patients presented with febrile neutropenia, 16% withsevere palmar-plantar syndrome, 10% with Port-a-cath thrombosis. This study confirms the high efficacy of infusional 5-FU-based regimens andjustifies further research into novel promising oral 5-FU derivatives.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008378220547
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  • 92
    Electronic Resource
    Electronic Resource
    Intra-arterial chemotherapy for unresectable pancreatic cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 569-573 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; intra-arterial ; liver metastasis ; unresectable pancreatic cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:A phase II trial of a new intra-arterial chemotherapyregimen for unresectable pancreatic cancer (UPC). Patients and methods:Ninety-six patients with UPC were treatedwith intra-arterial chemotherapy at three-weekly intervals. The schedule usedwas FLEC: 5-fluorouracil 1000 mg/m2, folinic acid 100mg/m2, carboplatin 300 mg/m2; epirubicin 60mg/m2. Results:The overall response rates by CT-scan evaluation were:15% partial response (PR), 44% stable disease (SD), 17%progressive disease (PD). The overall median survival was 9.9 months, and 10.6and 6.8 for UICC stage III and IV, respectively. Pain reduction occurred in42% of patients. A weight gain 〉7% from baseline occurred in8% of patients. A total of 341 courses of FLEC were administered. Grade3–4 hematological toxicity was seen in 25% of patients;ematemesis in 4%; grade 3 gastrointestinal toxicity in 3%; andgrade 3 alopecia in 16%. One sudden death, a pre-infarction angina, anda transitory ischemic attack were observed. The only complication related tothe angiographic procedure was an intimal dissection of the iliac artery. Conclusions:The intra-arterial FLEC regimen was well toleratedand active. It requires only one day of hospitalization. Efficacy could onlybe assessed in a randomized study against a gemcitabine containing regimen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008335331516
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  • 93
    Electronic Resource
    Electronic Resource
    Ifosfamide plus oral etoposide salvage chemotherapy for platinum-resistant paclitaxel-pretreated ovarian cancer (2000)
    Springer
    Annals of oncology 11 (2000), S. 607-612 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; combination ; etoposide ; ifosfamide ; ovarian cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:The prognosis of platinum resistant ovarian cancer isvery poor and the treatment of choice has not been clearly defined. Patients and methods:We conducted a phase II study with thecombination of ifosfamide i.v. at 2.25 g/m2 (days 1, 2) andetoposide per os at 100 mg daily (days 1–10) every four weeks. To beeligible for the study patients had to be resistant to platinum and paclitaxelpretreated. Results:Forty-one patients entered the study. The median intervalfrom the previous chemotherapy was 3.9 months. The median number of previouschemotherapeutic regimens was 2. Severe toxicities included neutropenia(41% of patients), leukopenia (29%) and thrombocytopenia(13%). Thirty-five patients are assessable for response. Nine patientsresponded (22% of the eligible, 26% of the assessable), four ofthemdemonstrated complete response to chemotherapy (10% and 12%,respectively), while three patients demonstrated stabilization of theirprogressive disease. After a median follow-up of 18 months, time toprogression is 3 months (range 0.9–14.4), duration of response is 9months (2.5–11) and median survival is 13 months (2.5–37.4+). Conclusions:The combination of ifosfamide with oral etoposideappears to have significant but manageable toxicity and encouraging efficacyin platinum resistant ovarian cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008327412571
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  • 94
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    Electronic Resource
    Recurrent squamous-cell carcinoma of the head and neck: Overview of current therapy and future prospects (2000)
    Springer
    Annals of oncology 11 (2000), S. 11-16 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; gene therapy ; head and neck cancer ; immunotherapy ; radiotherapy ; recurrent ; surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Locoregional recurrence is the most common cause of failure after head andneck cancer surgery. It is a disease which causes significant morbidityespecially on speech and swallowing. There are many different treatmentsavailable including surgery, reirradiation and chemotherapy. However, none ofthese have produced any significant survival benefit. Because of this, therehas been considerable interest in the development of new biological therapiessuch as gene therapy and immunotherapy for this disease. The objectives ofthis article are to provide an overview of the currently available therapiesfor recurrent head and neck cancer including gene therapy and immunotherapy.Prevention of recurrent disease by the detection and treatment of minimalresidual disease is also discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008330026617
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  • 95
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    Electronic Resource
    A phase II study of pegylated liposomal doxorubicin for treatment of advanced hepatocellular carcinoma (2000)
    Springer
    Annals of oncology 11 (2000), S. 113-114 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; hepatocellular carcinoma ; liposomal doxorubicin ; phase II
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Pegylated liposomal doxorubicin has an enhancedefficacy and reduced toxicity compared with free doxorubicin. The efficacy andtoxicity of pegylated liposomal doxorubicin was investigated in patients withhepatocellular carcinoma. Patients and methods:Patients with histologically confirmed,locally advanced or metastatic hepatocellular carcinoma and a Karnofsky index〉60% were included in this prospective single-arm study. Exclusioncriteria were liver cirrhosis stage Child–Pugh C, previous chemotherapy,or chemoembolization. Pegylated liposomal doxorubicin was given in a dose of30 mg/m2 every three weeks until progression of disease. Afterinclusion of five patients the dose could be escalated to 40 mg/m2in absence of toxicity grade 3 and 4. Results:Sixteen patients were evaluable for response. Noobjective response was achieved. The median survival time was 140 days(95% confidence interval: 126–154 days). Treatment toxicitiesgrade ≥3 comprised increased liver enzymes in patients with preexistinggrade 1 or 2 elevation (n = 6), hematologic toxicity (n =5), and hypersensitivity (n = 2). Conclusions:Pegylated liposomal doxorubicin is not effective fortreatment of advanced hepatocellular carcinoma. The favorable toxicity profilewas confirmed even in patients with underlying liver disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008386822906
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  • 96
    Electronic Resource
    Electronic Resource
    A phase I–II study of gemcitabine and paclitaxel in advanced non-small-cell lung cancer patients (2000)
    Springer
    Annals of oncology 11 (2000), S. 109-112 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; gemcitabine ; non-small-cell lung cancer ; paclitaxel
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thirty patients with chemotherapy-naïve advanced non-small-cell lungcancer (NSCLC) were given escalating doses of paclitaxel (150, 175, 200mg/m2) on day 1 in three consecutive cycles, together with a fixeddose of gemcitabine 1000 mg/m2 on days 1 and 8; cycles wererepeated every three weeks. The dose escalation of paclitaxel was feasible inthe majority of patients. Subsequently, 30 other NSCLC patients received adose of 200 mg/m2 paclitaxel with gemcitabine 1000 mg/m2in a phase II study. The major side effect was mild myelosuppression. Aresponse rate of 24% was achieved in 49 fully evaluable patients. Thisregimen proved to be safe and easy to administer on an out-patient setting,and constitutes now one of the arms of the current EORTC randomized study foradvanced NSCLC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008321000887
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  • 97
    Electronic Resource
    Electronic Resource
    Acute hematologic toxicity and practicability of dose-intensified BEACOPP chemotherapy for advanced stage Hodgkin's disease (2000)
    Springer
    Annals of oncology 11 (2000), S. 1105-1114 
    Details
    ISSN: 1569-8041
    Keywords: BEACOPP ; chemotherapy ; dose intensification ; hematotoxicity ; Hodgkin's disease ; practicability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Evidence is recently accumulating that the novelBEACOPP (bleomycin (B), etoposide (E), adriamycin (A), cyclophosphamide (C),vincristine (O), procarbazine (P), prednisone (P)) chemotherapy is a highlyeffective treatment for advanced stage Hodgkin's disease. Two dose variantsof BEACOPP are currently tested in a phase III randomized multicenter trialof the GHSG. To enable more extensive testing of BEACOPP we characterized itspracticability regarding schedule adherence, acute hematotoxicity and need forsupportive treatment. Patients and methods:Data of 858 patients (6592 therapy cycles)from 184 participating institutions were evaluated. Planned total drug dosesof the baseline variant (arm 1) were 80, 2400, 200, 5200, 11.2, 5600 and 4480mg/m2 for B, E, A, C, O, P and P, respectively. Compared to arm 1,the doses of E, A and C in the dose-intensified variant (arm 2) were escalatedby factor 2.0, 1.4, 1.92, respectively, using G-CSF assistance. Stepwise dosereductions were specified in case of dose-limiting toxicities. Both variantsare given in eight three-weekly courses. Results:Median dose adherence (dose actually given relative toplanned arm 1 dose) in arm 1 was 1.0 for all drugs. Relative dose escalationof E, A, and C actually maintained in arm 2 was 1.83, 1.37 and 1.77 (medians),respectively, and 70% of patients maintained elevated dose levelsthroughout the entire treatment. Dose-limiting toxicities occurred in25% of cycles in arm 2, most frequently due to leukocytopenia andthrombocytopenia. Time courses of leukocytes in arm 2 showed more severe butnot more prolonged leukocytopenia compared with arm 1. WHO grades 3–4infections were documented in 2.1% (arm 1) and 3.1% (arm 2) ofall cycles. Erythrocytes were transfused in 6% (arm 1) and 28%(arm 2), platelets in 〈1% (arm 1) and 6% (arm 2) of allcycles. Conclusions:Both BEACOPP schemes are practicable in a largemulticenter setting. Despite increased hematotoxicity, moderate doseescalation is safe for the majority of the patients with G-CSF assistance andstandard supportive treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008301225839
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  • 98
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    Electronic Resource
    Radiation myositis: The possible role of gemcitabine (2000)
    Springer
    Annals of oncology 11 (2000), S. 1615-1616 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; gemcitabine ; radiotherapy ; radiation myositis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008353224251
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  • 99
    Electronic Resource
    Electronic Resource
    A phase II trial of docetaxel in platinum pre-treated patients with advanced epithelial ovarian cancer: A Japanese Cooperative Study (2000)
    Springer
    Annals of oncology 11 (2000), S. 1531-1537 
    Details
    ISSN: 1569-8041
    Keywords: advanced ovarian cancer ; chemotherapy ; docetaxel ; phase II trial
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:This phase II study was conducted to evaluate theefficacy and toxicity of docetaxel in Japanese patients with advanced ovariancancer. Patients and methods:Docetaxel was administered at a dose of 70mg/m2 intravenously to patients with platinum pre-treated advancedovarian cancer. Treatment was repeated every three weeks. No routinecorticosteroid premedication was given. Results:Ninety patients with advanced ovarian cancer were enteredand sixty were assessable for response. The overall response rate was28% in the assessable patients (95% confidence interval(95% CI): 17.5%–41.4%). CA125 responses were seenin 8 (24%) of 34 assessable patients for CA125 criteria. The 36platinum-refractory patients had a response rate of 25% compared with33% in the platinum-sensitive patients. The predominant toxicity wasneutropenia, with 86% of the patients experiencing grade 3 or 4.Hypersensitivity reactions occurred in 37% of the patients and were notlife threatening. Edema was mild and infrequent. Conclusion:Docetaxel at 70 mg/m2 demonstratedeffectiveness as a treatment of both platinum-sensitive andplatinum-refractory ovarian cancer patients, with a low incidence of severehypersensitivity reactions and edema.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008337103708
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  • 100
    Electronic Resource
    Electronic Resource
    Is `one cycle every three or four weeks' obsolete? A critical review of dose-dense chemotherapy in solid neoplasms (2000)
    Springer
    Annals of oncology 11 (2000), S. 133-149 
    Details
    ISSN: 1569-8041
    Keywords: chemotherapy ; dose ; dose-density ; dose-intensity ; high-dose chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Shortening the interval between cycles is one meansof increasing the dose intensity of chemotherapy, and can be supported bybiological and mathematical rationales. Our objective was to assess theclinical relevance of the rapid repetition of regimens (so-called `dose-densechemotherapy') in various solid neoplasms. Design:The medical literature was reviewed in accord withMulrow's recommendations. Randomised studies comparing frequently-repeatedchemotherapy to standard regimens as well as open studies are described andcritically examined. Results:Dose-dense regimens were widely found to be feasible. In small-cell lung cancer, survival of patients receiving dose-denseregimens was better than that of patients treated by standard chemotherapy inthree trials, two of which reached significance, when these intensive regimensallowed better dose intensity. In poor-prognosis germ-cell tumors, a dose-dense regimen was not betterthan standard therapy, perhaps because of an excessively high toxicity-relateddeath rate. However, recent phase II studies have provided encouragingresults. In early breast cancer, the one published randomized study in the adjuvantsetting showed only a trend towards better disease-free survival innode-positive women receiving a weekly-repeated regimen. Two randomized trialsfailed to show any benefit in the neoadjuvant setting with a dose-denseregimen. No evidence of a benefit was provided in metastatic breast cancer. In advanced colorectal cancer, evidence of an improvement in survival withweekly or bi-weekly 5-FU–leucovorin compared to a classic monthlyschedule has recently been shown in two randomized trials, and dose-denseregimens are recognized as standard therapy in many countries. Phase II studies of dose-dense regimens have also shown high response ratesand long survival in many neoplasms, including Ewing's sarcoma, gestationaltrophoblastic disease, ovarian carcinoma and gastric cancer. Conclusions:A considerable amount of experience has been gainedwith frequently-repeated regimens. A few randomized trials have demonstrateda benefit for survival on standard chemotherapy in small-cell lung cancer andadvanced colorectal cancer. However, this benefit appears to be weak. Thecombination of dose-dense chemotherapy regimens with new anti-cancerstrategies based on our insights into the mechanisms of oncogenesis is achallenge on the eve of the millennium.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008344014518
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