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  • 1
    Electronic Resource
    Electronic Resource
    Facial trauma in children and adolescents (1998)
    Springer
    Clinical oral investigations 2 (1998), S. 120-124 
    Details
    ISSN: 1436-3771
    Keywords: Key words Facial injury ; Children ; Adolescents ; Fracture ; Dental trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Most studies on facial trauma in the pediatric age group focus on special subgroups. This investigation encompasses all traumatic facial injuries, minor and major, of children and adolescents. Epidemiological data of the type and pattern of injury of trauma patients less than 19 years of age, treated during a 3-year-period in a large metropolitan trauma centre were reevaluated. Of the 1385 patients, 68% had soft tissue injuries, 24% had dental trauma, and 8% fractures of facial bones. More than 90% suffered from minimal or minor trauma. The leading cause of injury was a fall, predominantly at the toddler stage. In adolescents an adult mechanism of trauma prevailed: over 60% of injuries were sequelae of an assault or altercation. The male sex predominated through all age groups and for all types of injuries. The bulk of soft tissue injuries are located within a small falling zone, extending from the nose to the mental area. There was a rising incidence of fractures of facial bones towards older age groups, mandibular fractures being the most common. Condylar fractures, with their potential impact on further growth of the mandible, are seen frequently in children and adolescents, making up 80% of the fractures of the lower jaw.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007840050056
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  • 2
    Electronic Resource
    Electronic Resource
    Open-heart surgery without homologous blood transfusion in infants and children under simple deep hypothermia (1998)
    Springer
    Journal of anesthesia 12 (1998), S. 125-129 
    Details
    ISSN: 1438-8359
    Keywords: Open-heart surgery ; Simple deep hypothermia ; Blood transfusion ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose To investigate the hematological changes during the perioperative period of open-heart surgery without homologous blood transfusion under simple deep hypothermia in infants and small children, and to define the limits of body weight for open-heart surgery without homologous blood transfusion under simple deep hypothermia. Methods We performed open-heart surgery without homologous blood transfusion under simple deep hypothermia on eight children, four infants, and a neonate with diagnoses of atrial septal defect, ventricular septal defect, on total anomalous pulmonary venous return (TATVR). All patients except for one with TAPVR were surface-cooled with ice water under deep ether anesthesia. Hematological examinations were performed seven times during the perioperative period. Results The body weight of the patients ranged from 2.5 to 15.0 kg (mean±SD, 9.5±3.5 kg) and the blood loss from 0.7 to 7.1g·kg−1 (4.6±2.0g·kg−1) The lowest values of the hematological findings in each case after surgery were as follows: Hb ranged from 7.6 to 10.9g·dl−1 (8.8±1.0g·dl−1), blood platelet count from 158×103 to 337×103 cells·µℓ−1-agonist (271±88 ×103 cells·µℓ−1-agonist, and total protein from 4.3 to 5.5 g·dl−1 (5.0±0.4g·dl−1) Conclusion Severe anemia and hypoproteinemia were not detected in any case, and, in particular, the reduction of the platelet count was slight. No events occurred as a result of decreased Hb concentration, serum protein, or both.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02480089
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  • 3
    Electronic Resource
    Electronic Resource
    Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density (1998)
    Springer
    Rheumatology international 18 (1998), S. 45-49 
    Details
    ISSN: 1437-160X
    Keywords: Key words Osteoporosis ; Systemic lupus erythematosus ; Steroid treatment ; Densitometry ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Peak bone mass is an important determinant of future bone mass and of the risk of osteoporosis and subsequent fractures. Although some information concerning bone mineral density (BMD) in adults affected with systemic lupus erythematosus (SLE) is available, few data on children and adolescents have been reported. Many variables, such as duration and activity of the disease, reduced sun exposure, and steroid therapy have been suggested as risk factors in the pathogenesis of osteoporosis in SLE. In this study, we longitudinally evaluated, by dual energy X-ray absorptiometry (DEXA), the BMD of 20 young patients affected with juvenile SLE (JSLE), in order to establish the degree of osteoporosis and the influence of steroid treatment, among other clinical variables. At baseline, the mean BMD in JSLE patients was 0.978 g/cm2 and in controls 1.038 g/cm2 (P=0.31). At 1 year (time 2), this value became 0.947 g/cm2 in JSLE children; the mean individual difference was 0.28 g/cm2 (3.4%). Only in those patients aged 19–25 years BMD was significantly lower than in controls, both at baseline and at time 2. Considering the steroid treatment, no significant difference between the two groups was found either at baseline or at time 2; however, the mean yearly BMD loss in the steroid patients was 0.031 g/cm2 (3.5%) vs. 0.005 g/cm2 (0.5%) in those who had not taken steroids. A significantly inverse correlation between BMD and the cumulative dosage of corticosteroids has been detected. BMD produced a significantly inverse correlation to the cumulative dosage of corticosteroids; no significant correlation has been found between BMD and disease activity or duration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002960050056
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  • 4
    Electronic Resource
    Electronic Resource
    Lithiumsalze in der Kinder- und Jugendpsychiatrie (1998)
    Springer
    Der Nervenarzt 69 (1998), S. 935-943 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Lithiumsalze ; Kinder ; Jugendliche ; Affektive Störungen ; Aggressivität ; Selbstverletzendes Verhalten ; Rezidivprophylaxe ; Key words Lithium ; Children ; Adolescents ; Affective disorders ; Aggressivity ; Self-injurious behavior ; Lithium prophylaxis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Lithium is – besides neuroleptics – the drug of choice for the treatment of manic episodes. If the use of antidepressive drugs, during unipolar depressive illness, does not lead to a positive response, the additional administration of lithium is appropriate, even during a depressive episode. Lithium is also considered as the drug of choice for prophylactic treatment of bipolar affective disorders. This holds true also for adolescents. In contrast to the indications in adults, in adolescents an early administration is desirable to reduce risk factors of psychosocial development. Additional indications may be the presence of severe aggressivity in conduct disordered children. In these cases, a treatment with lithium salts can result in a behavioral improvement. This may be also the case in impulsive self-injurious behavior. The dosage and serum levels of lithium, as well as its adverse effects are comparable with those known from adults. At present, lithium treatment cannot be recommended for children under 12 years of age – except under in-patient conditions.
    Notes: Zusammenfassung Lithiumsalze sind – neben Neuroleptika – die Mittel der Wahl zur Behandlung manischer Episoden. Bei unipolaren depressiven Episoden ist bei Nicht- oder ungenügendem Ansprechen auf eine Antidepressivamedikation schon während einer depressiven Episode die zusätzliche Gabe von Lithiumsalzen sinnvoll. Lithiumsalze gelten auch im Jugendalter als Mittel erster Wahl zur Rezidivprophylaxe bipolarer affektiver Störungen. Im Gegensatz zur Indikationsstellung im Erwachsenenbereich ist – im Sinne der Vermeidung ungünstiger psychosozialer Entwicklungsbedingungen während des Jugendalters – ein frühzeitiger Einsatz empfehlenswert. Ein weiterer Indikationsbereich betrifft das Vorliegen stark ausgeprägter explosibel auftretender aggressiver Verhaltensexzesse. Hier kann eine Medikation mit Lithiumsalzen Verbesserungen erbringen, ebenso bei impulshaft vorkommenden selbstverletzenden Verhaltensweisen. Dosierung und Serumkonzentration der Lithiumsalze wie auch Nebenwirkungen und Kontraindikationen entsprechen der Erwachsenentherapie. Bei Kindern unter 12 Jahren kann eine Lithiumsalzmedikation z.Z. – außer unter stationären Bedingungen – nicht empfohlen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050367
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  • 5
    Electronic Resource
    Electronic Resource
    Arachnoidalzyste als Ursache eines Hypernatriämie-Hypodypsie-Syndroms (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 603-607 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hypernatriämie ; Hypernatriämie-Hypodypsie-Syndrom ; Arachnoidalzyste ; Stereotaxie ; Kinder ; Key words Hypernatremia ; Hypodipsic-hypernatremia-syndrome ; Arachnoid cyst ; Stereotactic surgery ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background: In rare cases a hypernatremia is caused by cerebral dysregulation. Case: We describe a 3,5 year old girl who had a hypodipsic-hypernatremia-syndrome (serum sodium concentration 194 mmol/l) caused by an arachnoid cyst in front of the pons. Therapy: In a stereotactic puncture a catheter was implanted. Aspiration of the cyst liquid did reduce the size of the cyst. For two years now no other treatment is given. Hypernatremia did not occur again. Discussion: To our knowledge this is the first case of a hypodipsic-hypernatremia-syndrome caused by an arachnoid cyst, which was cured by a single operation.
    Notes: Zusammenfassung Hintergrund: In seltenen Fällen werden Hypernatriämien durch zerebrale Regulationsstörungen verursacht. Fall: Wir berichten von einem 3,5 Jahre alten Mädchen, bei dem ein Hypernatriämie-Hypodypsie-Syndrom (Serumnatrium 194 mmol/l) durch eine präpontine Arachnoidalzyste verursacht wurde. Therapie: Durch eine stereotaktische Operation wurde ein Katheter implantiert. Der Zysteninhalt wurde aspiriert und die Zyste dadurch verkleinert. Seit 2 Jahren trat ohne medikamentöse Therapie keine Hypernatriämie mehr auf. Diskussion: In diesem Fall konnte nach unserem Wissen erstmals ein Hypernatriämie-Hypodypsie- Syndrom, das durch eine Arachnoidalzyste verursacht wurde, durch eine Operation geheilt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050300
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  • 6
    Electronic Resource
    Electronic Resource
    24-h-Blutdruckmessung nach Lebertransplantation im Kindesalter (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 310-314 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Blutdruckprofile ; Lebertransplantation ; Kinder ; Key words Blood pressure profiles ; Liver transplantation ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Problem: An arterial hypertension is frequently observed in adults after organ transplantation due to the treatment with the hypertensiogenic drugs Cyclosporin A, FK 506 or prednisolone. Hardly any data exist about the blood pressure profile of children after orthotopic liver transplantation. Method: Therefore we studied ambulatory blood pressure (ABP) in 19 children aged 0.9 to 18.3 years (median value: 10.9 yrs) who had received an orthotopic liver transplant 0.28 to 12.3 yrs before ABP measurement. All patients received prednisolone (1,12–7,3 mg/m2/d); additionally, 13 patients received cyclosporine (91–45 mg/m2/d); the other 6 were given tacrolimus (FK 506) in doses from 0.6 to 4 mg/m2/d for prevention of graft rejection. For ABP recording, automatic measurements were taken every 15 minutes during the daytime (i.e., between 6.00 and 22.00 h), and every half hour in the night (i.e., between 22.00 and 6.00 h). From these measurements, mean systolic and diastolic blood pressures for the day and for the night were calculated separately. These calculated mean values were compared to 95th centiles for normotensive paediatric populations of comparable body length. Results: Eight out of the 19 liver graft recipients had pathologically elevated mean blood pressure values. Arterial hypertension had been known to exist before the ABP measurement in only three of them. Mean systolic and diastolic blood pressure values were elevated in the day and in the night in four children. In one child both mean values for the day plus the mean diastolic value at night were elevated. One child had elevated mean systolic values at day and night. In two children, only one value was above the 95th centile: in one the mean systolic pressure at day, and in the other the mean systolic pressure at night. Four of the six children with 2–4 elevated mean blood pressure values had raised values for serum creatinine and/or an abnormally low glomerular filtration rate. Conclusion: Arterial hypertension after paediatric orthotopic liver transplantation is relatively frequent although less than after renal transplantation. It is associated with a reduced glomerular filtration rate. Thus a cyclosporine-induced renal lesion might be one of the factors causing hypertension after liver transplantation.
    Notes: Zusammenfassung Fragestellung: Eine arterielle Hypertonie wird nach Organtransplantationen bei Erwachsenen als Folge der Behandlung mit den hypertensiogenen Medikamenten Cyclosporin A, Tacrolimus (FK 506) oder Prednisolon häufig beobachtet. Über das Verhalten des Blutdrucks bei Kindern nach Lebertransplantation liegen bislang kaum Untersuchungen vor. Methode: Wir haben deshalb bei 19 lebertransplantierten Kindern im Alter von 0,9–18,3 Jahren (Median: 10,9 Jahre) 24-h-Blutdruckmessungen durchgeführt. Die Lebertransplantation lag bei der Untersuchung 0,28–12,3 Jahre (Median: 3,5 Jahre) zurück. Alle Patienten erhielten Prednisolon (1,12–7,3 mg/m2 und Tag), 13 erhielten zusätzlich Cyclosporin (91–245 mg/m2 und Tag) und 6 Tacrolimus (FK 506, Dosis 0,6–4,0 mg/m2 und Tag) als Immunsuppressiva. Die Blutdruckmessung wurde zwischen 6 und 22 Uhr im 1/4stündigen und zwischen 22 und 6 Uhr im 1/2stündigen Rhythmus durchgeführt. Daraus wurden mittlere systolische und diastolische Blutdruckwerte für den Tag und die Nacht getrennt berechnet. Diese Werte wurden mit körperlängenbezogenen 95. Perzentilen aus pädiatrischen Normalkollektiven verglichen. Ergebnisse: Pathologisch erhöhte Werte zeigten 8 von 19 lebertransplantierten Kindern. Nur bei 3 dieser Kinder war vorher ein Hypertonus bekannt. Die mittleren systolischen und diastolischen Blutdruckwerte waren bei 4 Kindern am Tag und in der Nacht erhöht. Bei 1 Kind waren beide Tagesmittelwerte und der nächtliche mittlere diastolische Blutdruck erhöht, bei 1 weiteren der mittlere systolische Blutdruck am Tag und in der Nacht. Bei 2 Kindern war jeweils ein Wert erhöht: bei 1 der nächtliche mittlere systolische Blutdruck, bei dem anderen der mittlere systolische Blutdruck am Tag. Ein erhöhtes Serumkreatinin und/oder eine erniedrigte glomeruläre Filtrationsrate hatten 4 der 6 Kinder mit 2- bis 4fach erhöhten Blutdruckwerten. Schlußfolgerung: Eine arterielle Hypertonie ist nach Lebertransplantation im Kindesalter ein relativ häufiges Ereignis, jedoch ist sie seltener als nach Nierentransplantation. Sie ist mit einer Einschränkung der glomerulären Filtrationsrate assoziiert. Daher könnte ein Nierenschaden als Folge der erforderlichen Immunsuppression mit Cyclosporin für die Hypertonie mitverantwortlich sein.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050274
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  • 7
    Electronic Resource
    Electronic Resource
    Pneumocystis-carinii- Pneumonie bei HIV-infizierten Kindern Umfrage an deutschen Kinderkliniken* (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 315-322 
    Details
    ISSN: 1433-0474
    Keywords: SchlüsselwörterPneumocystis-carinii-Pneumonie ; PCP ; HIV ; Kinder ; Überlebenszeit ; Key wordsPneumocystis-carinii pneumonia ; PCP ; HIV ; Children ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The aim of the study was to record retrospectively the events of Pneumocystis carinii-Pneumonia (PCP) among HIV-infected children (〈18 years) in Germany. The patients were evaluated with regard to prophylaxis, course of disease and prognosis. Methods: A questionnaire was sent to 16 centers in Germany that care for HIV- infected children. Results: From January 1989 to December 1995 21 patients with PCP were treated in 6 centers (1–5 cases/year). The remaining 10 centers did not treat any patients with PCP during this period. Infection with HIV was caused by perinatal transmission in 17 children, 4 children were infected by blood or bloodproducts. Among perinatally infected patients the median age at PCP diagnosis was 5 months. 15/21 children received no PCP prophylaxis. 10 of the 15 patients were not covered by the respective Centers for Disease Control recommendation at the time of diagnosis and in 5 patients infection with HIV was not known before. Overall in-hospital-mortality was 29%. 33% of the patients had to be ventilated mechanically for respiratory failure and 71% of these children died. In June 1996 the mean survival for all patients was 20.3±19.1 months. PCP in the first year of life was associated with a shorter survival than in older children (14.8±18.4 months vs. 27.6±18.5 months) but the difference did not reach significance. According to Kaplan-Meier analysis the estimated survival after one year was 66%. Conclusions: PCP in children is a rare disease with a poor prognosis. Although, there is an effective prophylaxis, PCP still occurs, particularly in children with unrecognized HIV-infection. Compared with international studies, the survival data in this study were rather good.
    Notes: Zusammenfassung Fragestellung: Retrospektive Auswertung der Erkrankungen HIV-infizierter Kinder (〈18 Jahre) an einer Pneumocystis-carinii-Pneumonie. Erfaßt wurden Prophylaxesituation, Krankheitsverlauf und Prognose. Methode: Ein Fragebogen wurde an alle 16 pädiatrischen Zentren in Deutschland, die HIV-infizierte Kinder betreuen, verschickt und deskriptiv ausgewertet. Ergebnisse: Von Januar 1989 bis Dezember 1995 wurden aus 6 klinischen Zentren 21 Patienten mit Pneumocystis-carinii-Pneumonie mitgeteilt (1–5 Erkrankungen pro Jahr). In den übrigen 10 Zentren wurden in diesem Zeitraum keine Patienten mit Pneumocystis-carinii-Pneumonie behandelt. 17 Kinder erwarben die HIV-Infektion prä- und perinatal, 4 Kinder durch Blut oder Blutprodukte. Das Alter der vertikal infizierten Kinder betrug im Median 5 Monate. 15/21 Kindern erhielten keine Pneumocystis-carinii-Prophylaxe. Davon wurden 10 Patienten zum Zeitpunkt der Diagnosestellung nicht durch die aktuell geltenden Prophylaxerichtlinien der Centers for disease control erfaßt, und bei 5 Kindern wurde die HIV-Exposition erst mit Diagnosestellung der Pneumocystis-carinii-Pneumonie bekannt. Die akute Letalität betrug 29%, die Letalität der beatmeten Kinder 71%. Bis Juni 1996 betrug die mittlere Überlebenszeit aller Patienten 20,3±19,1 Monate. Die Überlebenszeit der bereits im 1. Lebensjahr erkrankten Kinder war mit 14,8±18,4 Monaten deutlich, aber nicht signifikant kürzer als diejenige der später erkrankten Kinder (27,6±18,5 Monate). Die nach Kaplan-Meier geschätzte 1-Jahres-Überlebenszeit betrug 66%. Schlußfolgerungen: Die Pneumocystis-carinii-Pneumonie bei HIV-infizierten Kindern ist in Deutschland eine seltene Erkrankung mit ernster Prognose. Obwohl eine effektive Prophylaxe zur Verfügung steht, treten immer wieder Pneumocystis-carinii-Pneumonien auf, insbesondere bei Kindern, deren HIV-Exposition nicht rechtzeitig erkannt wurde. Die in dieser Umfrage ermittelten Überlebenszeiten sind im internationalen Vergleich eher günstig.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050275
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  • 8
    Electronic Resource
    Electronic Resource
    Primäre pulmonale Hypertonie bei einem Kind mit primär sklerosierender Cholangitis Diagnostik und Verlauf vor und nach Lebertransplantation (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 1039-1043 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Primäre pulmonale Hypertension ; Leber ; Zirrhose ; Kinder ; Lebertransplantation ; Key words Primary pulmonary hypertension ; Liver ; Cirrhosis ; Children ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A child who suffered from primary sclerosing cholangitis presented with severe portal hypertension over years. At age eleven, symptoms of right ventricular decompensation were noted. After stabilization, orthotopic liver transplantation was performed and resulted in severe decompensation with an increase of right ventricular pressure up to 95 mmHg. At further investigation, primary pulmonary hypertension with plexiform pulmonary arteriopathy was diagnosed. After ten months under oxygen and nifedipine treatment, the patient reached a stable cardiopulmonary state comparable to the pre-transplant period (right ventricular pressure 45 mmHg) but did not improve further. Discussion: Primary pulmonary hypertension in children can occur in association with severe portal hypertension. As this complication will considerably alter prognosis and management of children with chronic liver disorders, it must be actively searched for and monitored with regular ECG, chest X-ray and echocardiography. To prove the diagnosis and evaluate treatment response, cardiac catheterization is required.
    Notes: Zusammenfassung Bei einem an einer primär sklerosierenden Cholangitis erkrankten Mädchen bestand über Jahre ein schwerer portaler Hypertonus. Mit 11 Jahren traten klinische Symptome einer Rechtsherzdekompensation auf. Die orthotope Lebertransplantation, 1 Jahr später durchgeführt, führte zu einer Dekompensation mit Anstieg des rechtsventrikulären Drucks bis 95 mmHg. Die Diagnostik ergab eine primäre pulmonale Hypertonie mit plexiformer pulmonaler Arteriopathie. Unter Sauerstofftherapie und Nifedipin kam es im Verlauf von 10 Monaten zu einer Besserung der rechtsventrikulären Belastung etwa auf den Status vor der Transplantation (rechts-ventrikulärer Druck um 45 mmHg), jedoch nicht zu einer weitergehenden Remission. Diskussion: Eine primäre pulmonale Hypertonie in Assoziation mit einer portalen Hypertension kann auch im Kindesalter auftreten und hat erhebliche Bedeutung für die Prognose und das therapeutische Vorgehen. In der Betreuung chronisch leberkranker Kinder muß bei regelmäßigen Verlaufskontrollen von EKG, Röntgenthorax und Echokardiografie bewußt auf diese oft zunächst asymptomatische Komplikation geachtet werden. Im Verdachtsfall ist eine Herzkatheteruntersuchung zur Diagnosesicherung und zum Austesten des Therapieansprechens erforderlich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050360
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  • 9
    Electronic Resource
    Electronic Resource
    Altbekannte Schadstoffe und neuentdeckte Toxaphene im Fettgewebe von Kindern (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 235-240 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Chlorkohlenwasserstoffe ; Toxaphene ; Fettgewebe ; Kinder ; Langzeitstudie ; Key words Chlorinated hydrocarbons ; Toxaphenes ; Adipose tissue ; Children ; Longitudinal study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Rationale: Did concentrations of chlorinated hydrocarbons (CHC) change in the adipose tissue of children in the last 14 years? Are there yet other noxae stored in fat other than those already known? Method: Concentrations of CHC were determined quantitatively by means of gas chromatography and mass spectrometry and expressed in relation to the fat content (µg/kg fat=ppb) in specimens of adipose tissue from 1267 infants, children and adolescents from Western and Eastern Germany as well as Saratov/Russia. Results: The concentrations of hitherto known CHC have all declined substantially during recent years. However, so far unknown CHC were also detected in the adipose tissue, namely small amounts of two toxaphenes (parlar 26 and parlar 50). Conclusion: The exposure of our children to hitherto known CHC has decreased substantially in recent years. However, more sensitive methods of detection led to the identification of so far unknown potential noxae in adipose tissue, so that a complete ”all-clear” is not yet justified.
    Notes: Zusammenfassung Fragestellung: Wie haben sich die Konzentrationen der Chlorkohlenwasserstoffe (CKW) im Fettgewebe von Kindern während der letzten 14 Jahre verhalten? Sind noch andere als die bisher bekannten Schadstoffe im Fett abgelagert? Methode: In Fettgewebsproben von 1267 Säuglingen, Kindern und Adoleszenten aus West- und Ostdeutschland sowie aus Saratow, Rußland, wurden die Konzentrationen der CKW mittels Gaschromatographie bzw. Massenspektrometrie quantitativ bestimmt und auf den Fettgehalt bezogen angegeben (µg/kg Fett=ppb). Ergebnisse: Die Konzentrationen der bisher bekannten CKW sind während der letzten Jahre alle stark zurückgegangen. Es wurden aber auch bisher unbekannte CKW im Fettgewebe entdeckt, nämlich 2 Toxaphene (Parlar 26 und 50) in geringer Menge. Schlußfolgerung: Zwar ist die Belastung unserer Kinder mit den bisher bekannten CKW während der letzten Jahre deutlich zurückgegangen, doch führten empfindlichere Nachweismethoden zum Nachweis bisher unbekannter potentieller Schadstoffe im Fettgewebe, so daß eine völlige Entwarnung z.Z. noch nicht gerechtfertigt ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050269
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  • 10
    Electronic Resource
    Electronic Resource
    Primäre Prävention von Adipositas in der Kindheit (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. S88 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Adipositas bei Säuglingen ; Kindern ; Jugendlichen ; Primäre Prävention ; Persistenz ; Prognose ; Key words Obesity ; Infants ; Children ; Adolescents ; Primary prevention ; Persistence ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The prevalence in paediatric obesity is increasing in many industrialised and developing countries and growing to a world-wide medical and socio-economic problem. In a recent report of the WHO the world-wide epidemic of obesity was addressed as a problem of highest priority. Inadequate long-term results of weight reduction in children and adolescents and the increasing socio-economic burden to the health systems, as well as the high grade of persistence of obesity aggravate the problem and demand primary prevention efforts.Future directions of primary prevention measures could be the time of onset of obesity, the ”early adiposity rebound”, intrauterine malnutrition, weight gain during infancy, low energy expenditure in infants, familial adiposity, composition of food and modification of fat intake. Several risk groups, which are predestined for overweight and obesity can be identified and could be included in preventive programs. Besides the risk-group strategy, however, population based strategies are needed for countries with high prevalence rates. However, the basis for successful programs will be to create a awareness for the neglected problem of obesity and to raise funds for successful prevention programs.
    Notes: Zusammenfassung Hintergrund: Steigende Prävalenzzahlen für Übergewicht machen Adipositas zu einem weltweiten ernährungsmedizinischen und gesellschaftspolitischen Problem. In einem jüngst erschienenen Report der WHO wird dem Problem der Adipositas mit seinem epidemischen Auftraten höchste Bedeutung und höchster Stellenwert zugeordnet. Die schlechten Therapieerfolge bei Kindern und Jugendlichen, besonders aber bei Erwachsenen, die massiv steigenden Kosten für das Gesundheitssystem sowie der hohe Persistenzgrad der Adipositas mit zunehmendem Alter machen Präventivprogramme dringend notwendig. 〈Prävention: Mögliche Ansatzpunkte für eine primäre Prävention der Adipositas im Kindesalter sind: Zeitpunkt der Manifestation der Adipositas, früher „adiposity rebound”, intrauterine Mangelernährung. Gewichtsentwicklung im Säuglingsalter, niedriger Energieverbrauch im Säuglingsalter, familiäres Umfeld und elterliches Übergewicht, Nährstoffgehalt und -zusammensetzung der Nahrung und damit verbundene Ernährungsmodifikation im Sinn einer Fettrestriktion. 〈Diskussion: Einzelne Risikogruppen, die besonders prädestiniert für Übergewicht und Adipositas sind, könnten durch individuelle präventivmedizinische Maßnahmen erfaßt und betreut werden. Dennoch scheint aufgrund der Häufigkeit des Problems aber darüber hinaus auch eine Gesamtpopulationsstrategie für die industrialisierten Länder mit hoher Prävalenz von Adipositas unbedingt notwendig und sinnvoll. Voraussetzung dafür sind die Schaffung eines Problembewußtseins für dieses, auch in weiten Kreisen von Medizinern vernachlässigte und ignorierte medizinische Anliegen und neben dem gesundheitspolitischen Willen auch noch entsprechende finanzielle Mittel.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014771
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  • 11
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    Laparoscopic treatment of recurrent inguinal hernia in children (1998)
    Springer
    Pediatric surgery international 14 (1998), S. 182-184 
    Details
    ISSN: 1437-9813
    Keywords: Key words Recurrent inguinal hernia ; Laparoscopy ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors report their experience with the laparoscopic treatment of recurrent inguinal hernia in children. Between April 1993 and January 1998, 225 boys aged 8 months to 14 years (mean 4.4 years) were treated laparoscopically for a hydrocele, spermatic-cord cyst, or hernia. Ten boys had recurrent inguinal hernias after conventional surgery, in one case bilateral. The technique requires 3 trocars: a 0°, 5-mm telescope inserted through the umbilicus and two 3-mm trocars placed 3–4 cm below the umbilicus on either side. Simple patency of the peritoneal vaginal duct (dpv) was found in eight cases and a direct inguinal hernia in three. In cases with an open dpv, we opened the external hemicircumference of the neck in order to bring the conjoined tendon closer to the crural arch with a non-resorbable 4/0 suture, and then placed a 3/0 resorbable pursestring suture around the peritoneum of the internal orifice of the inguinal canal. In direct inguinal hernias the orifice was closed by placing 2–3 nonabsorbable 3/0 sutures between the two muscular sides of the hernial defect. There were no intra- or postsurgical complications. All patients, at a maximum follow-up of 3 years showed total recovery from the hernia. Our early results suggest that laparoscopic surgery is a feasible and safe technique for the treatment of recurrent inguinal hernia in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050481
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  • 12
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    Electronic Resource
    Gastric inflammatory myofibroblastic proliferation in children (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 95-99 
    Details
    ISSN: 1437-9813
    Keywords: Key words Inflammatory myofibroblastic proliferation ; Inflammatory pseudotumor ; Stomach ; Children ; Helicobacter pylori
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gastric inflammatory myofibroblastic proliferation (IMP) is an extremely rare entity in children, which to our knowledge has only been mentioned in case reports. We describe the ninth pediatric case and review the literature concerning the etiology, clinical and laboratory features, pathology, treatment, and outcome. There has been a predominance in preschool females. Abdominal pain, upper gastrointestinal hemorrhage, and an abdominal mass, either isolated or associated, have been the main clinical features. Iron-deficiency anemia has been a constant finding. Lesions are elevated and involve the full thickness of the gastric wall, usually with ulceration of the luminal surface; extragastric extension suggesting malignancy is frequent. Diagnosis is made by histology after surgical excision. There was no mortality directly related to gastric IMP, and only one case recurred after surgical excision. The pathogenesis is controversial, but the finding of Helicobacter pylori in our case may indicate an inflammatory origin. Awareness of this benign lesion and its mimicry of malignancy is important so that inappropriately aggressive therapy can be avoided.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050257
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  • 13
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    Nonoperative management of intra-abdominal bleeding due to blunt trauma in children: the risk of missed associated intestinal injuries (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 108-111 
    Details
    ISSN: 1437-9813
    Keywords: Key words Abdominal trauma ; Intra-abdominal bleeding ; Children ; Nonsurgical treatment ; Intestinal injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nonoperative management of intra-abdominal bleeding (IAB) from blunt injuries in children has been advocated for many years. Nonoperatively managed patients, however, are at risk for missed associated intestinal injuries. To evaluate this question, we reviewed the charts of 120 children who had traumatic IAB; 106 were initially managed nonoperatively and observation failed in 2. Fourteen underwent emergency operation. Forty patients had isolated liver and/or splenic injuries while the others had injuries associated with several organs. During observation peritonitis developed in 3 patients and further radiologic examinations failed to confirm an intestinal injury. Diagnostic peritoneal lavage demonstrated contaminated blood and fecal particles from injured intestines in 3 patients; they underwent emergency operation at 10, and 26 h after admission. There was no mortality or morbidity associated with delayed treatment. These data suggest that the majority of patients with IAB may be successfully treated nonoperatively, but associated intestinal injuries should be suspected in all cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050260
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  • 14
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    The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 352-354 
    Details
    ISSN: 1437-9813
    Keywords: Key words Laparoscopy ; Ventriculo-peritoneal shunt ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ventriculo-peritoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. Abdominal complications of VPS are now a rare event; however, their frequency varies from 5% to 47% according to reports. Anything that causes an obstruction or impediment of the VP derivation system will lead to intracranial hypertension, which requires immediate surgery. From 1985 to 1995 at the Division of Pediatric Surgery of the Federico II University of Naples, ten laparoscopies were performed in ten children with VPS complications. Cerebrospinal fluid pseudocysts were found in four infants. There was one case of abdominal wall perforation by the tip of the catheter at the umbilical level, two bowel obstructions, and one catheter was lost in the abdominal cavity. Finally, two children had malfunctioning of the peritoneal limb of the catheter. The laparoscopic technique was curative in all ten cases, thus avoiding a conventional laparotomy and the consequent risk of adhesions, which could cause further complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050337
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  • 15
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    Torsion of the adnexa in children: the value of laparoscopy (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 384-387 
    Details
    ISSN: 1437-9813
    Keywords: Key words Adnexal torsion ; Prenatal diagnosis ; Ovarian cyst ; Children ; Laparoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Experience with adnexal torsion in neonates and children is often disappointing. Delay between the first symptoms and operation is important, and adnexal loss the rule. The authors reviewed their experience and the literature to assess the appropriate diagnostic and therapeutic approach. Diagnostic procedures (standard ultrasonography [US], color Doppler US, computed tomography, magnetic resonance imaging, endorectal US, and diagnostic laparoscopy) are discussed; for neonates and premenarcheal girls a specific surgical approach is proposed. Twenty-seven adnexal torsions treated between 1985 and 1995 in the same institution were retrospectively reviewed. Neonatal (7) and premenarcheal cases (20) were separated. The neonatal cases (7) were all operated upon: 4 adnexectomies, 2 oophorectomies, and 1 detorsion with cystectomy were performed. In the premenarcheal group (20) 8 adnexectomies, 6 oophorectomies, 5 detorsions with cystectomy, and 1 salpingectomy were performed. There were only 6 salvaged adnexa in this series. In the neonatal group, US seemed accurate in predicting complicated cases. Prenatal puncture of large (〉40 mm) ovarian cysts is possible. The authors advocate a laparoscopic approach in the first days of life of all uncomplicated cysts independent of size in order to increase the percentage salvaged. In ultrasonic complicated cases a delayed operation is proposed in the premenarcheal group, endorectal US will probably become the diagnostic method of choice for complicated ovaries; other methods were disappointing. In order to increase adnexal salvage, the authors recommend a laparoscopic approach in the emergency situation if a clinical examination is positive as well as better medical (pediatricians, gynecologists) and general (girls, parents) information. They suggest controlateral oophoropexy in cases of torsion of a normal adnexum.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050345
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  • 16
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    Electronic Resource
    Open gastrostomy performed through the umbilicus (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 454-454 
    Details
    ISSN: 1437-9813
    Keywords: Key words Gastrostomy ; Umbilicus ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A new variation of open gastrostomy placement is described in which a Stamm gastrostomy is performed via a supraumbilical incision around the circumference of the umbilicus. Access to the stomach is good and the cosmetic result is superior to that obtained with the conventional incision.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050369
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  • 17
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    Electronic Resource
    Hemisplenectomy for giant splenic cysts in children (1998)
    Springer
    Pediatric surgery international 14 (1998), S. 116-118 
    Details
    ISSN: 1437-9813
    Keywords: Key words Hemisplenectomy  ; Epithelial cysts  ;  Splenic cysts  ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To analyse the clinical features and outcome following surgery of giant splenic cysts in␣children, all patients presenting to a children's hospital over the years 1987–1996 were reviewed. Variables analysed included presenting symptoms, method of diagnosis, operative procedure, and complications. Six patients (aged 8–16 years) presented with abdominal pain or a large abdominal mass. Ultrasound examination demonstrated large (〉5 cm) unilocular splenic cysts. Five of the six children underwent hemisplenectomy without complication or blood transfusion. The remaining patient had an infected cyst, for which total splenectomy was necessary because of major intraoperative haemorrhage. Hemisplenectomy is based on accurate dissection of the splenic hilum with clear knowledge of the intracapsular vascular anatomy of the spleen. Preoperative vaccination is recommended in the event that splenectomy is required. This retrospective review concludes that hemisplenectomy for splenic cysts is a safe procedure in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050455
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  • 18
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    Incarceration of umbilical hernias in children: a rare but important complication (1998)
    Springer
    Pediatric surgery international 14 (1998), S. 231-232 
    Details
    ISSN: 1437-9813
    Keywords: Key words Umbilical hernia ; Children ; Abdominal wall defects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Umbilical hernia (UH) is a common condition in infants and young children, especially in those of Afro-Caribbean origin. Spontaneous closure occurs in a majority of cases before the age of 4 years unless the neck of the sac is greater than 2 cm in diameter. Complications are rare, and conservative management is therefore advised during this time. We present three cases of incarcerated UH in boys under 4 years old, all of whom presented with small-bowel obstruction. Interestingly, in two of them undigested vegetable matter in the small bowel appeared to have precipitated the obstruction. A survey of the literature suggests that the incidence of this complication is approximately 1:1,500 UHs. We conclude that the present policy of expectant management is safe for the vast majority of children, but parents and general practitioners should be aware of the small risk and early symptoms of incarceration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050497
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  • 19
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    Electronic Resource
    Bronchial mucoepidermoid tumor in a 3-year-old child (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 524-525 
    Details
    ISSN: 1437-9813
    Keywords: Key words Mucoepidermoid carcinoma ; Bronchial adenoma ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 3-year-old girl was evaluated for persistent middle lobe atelectasis. Fiberoptic bronchoscopy revealed a spherical mass occupying␣the middle-lobe bronchus. The biopsy specimen disclosed a low-grade mucoepidermoid carcinoma. A lobectomy was performed. The patient is in good condition 2 years after the operation. Mucoepidermoid tumors are rare bronchial adenomas comprising 1% of all lung neoplasms. Children are very infrequently affected. The clinical behavior of these tumors is controversial. Surgical resection of the low-grade-type tumor has an excellent prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050390
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  • 20
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    Intraluminal hamartoma of the ileum in a child: a rare cause of intestinal occlusion (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 431-432 
    Details
    ISSN: 1437-9813
    Keywords: Key words Intraluminal hamartoma ; Intestinal neoplasm ; Children ; Intestinal obstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case of small-intestinal obstruction in a 12-year-old boy caused by an intraluminal hamartoma of the ileum is reported. The rarity of the lesion, its location, symptomatology, histology, and diagnosis are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050359
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  • 21
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    Electronic Resource
    Traumatic injuries of the alimentary tract in children (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 104-107 
    Details
    ISSN: 1437-9813
    Keywords: Key words Alimentary tract perforations ; Traumatic ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Traumatic alimentary tract (AT) perforations in children secondary to instrumentation, though rare, can occur at any age, especially in neonates and young infants. Awareness of such a possibility is essential for prompt management to be initiated. Over a 10-year period (1986–1995), eight pediatric patients with AT perforations secondary to instrumentation were managed at the American University of Beirut Medical Center. Five had upper AT injuries that included three hypopharyngeal, one esophageal, and one gastric lesion. The remaining three patients had lower AT injuries involving the transverse colon in one and the rectum in two. All the patients but two (one with a hypopharyngeal and one with an esophageal injury) were managed surgically and all survived. These rare injuries are discussed in addition to the preventive measures to be taken.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050259
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  • 22
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    High urinary excretion level of citrate and magnesium in children: potential etiology for the reduced incidence of pediatric urolithiasis (1998)
    Springer
    Urological research 26 (1998), S. 209-213 
    Details
    ISSN: 1434-0879
    Keywords: Key words Citrate ; Magnesium ; Calcium oxalate crystallization ; Children ; Inhibitory activity ; Metastable limit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It is well known that the incidence of calcium oxalate (CaOX) urolithiasis is much lower in children than in adults [2, 21]. One purpose of this study was to compare the inhibitory activity on CaOX crystal growth and nucleation of urine from children (ufC) with that of urine from adults (ufA). Another was to measure low molecular weight urinary substances related to CaOX lithiasis, including citrate and magnesium, which have been identified as stone inhibitors. The excretion volume per body weight of uric acid, phosphorus, magnesium and citrate was all significantly higher in 24-h ufC than in 24-h ufA, but that of calcium and oxalate was not. The growth inhibitory activities against CaOX crystals of ufC and ufA were measured in a whole urine system. The diameter of the crystals produced in this system was smaller for ufC (3.68 μm) than for ufA (4.66 μm). We also examined the metastable limit for CaOX with fresh spot urine, which was 3.15 mmol/l in ufC and 0.41 mmol/l in ufA. These results indicate that ufC has a more powerful inhibitory effect on CaOX crystal growth and nucleation than ufA. We also found that the excretion rate of citrate and magnesium in ufC was much higher than in ufA. We suggest that these two stone inhibitors are very likely to elevate the inhibitory activity of ufC against CaOX crystal growth and nucleation. The lower incidence of CaOX lithiasis in children might thus be partly attributed to citrate and magnesium.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002400050048
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  • 23
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    Developmental associations between verbal and visual short-term memory and the acquisition of decoding skill (1998)
    Springer
    Reading and writing 10 (1998), S. 519-540 
    Details
    ISSN: 1573-0905
    Keywords: Children ; Decoding ; Development ; Reading acquisition ; Verbal short-term memory ; Visual short-term memory
    Source: Springer Online Journal Archives 1860-2000
    Topics: Education
    Notes: Abstract This study longitudinally investigated the relationships between verbaland visual short-term memory (STM) and the acquisition of decoding from thepre-reading through the early acquisition stages in 63 Hebrew-speakingchildren Test waves occurred in kindergarten, first grade and second grade.IQ, visual and verbal STM and decoding ability were assessed. The dataindicated that while both verbal and visual STM in kindergarten were significantlycorrelated to later decoding skill, pre-reading visual STM was a stronger predictor.The results further showed that pre-reading performance on the WISC-R BlockDesign test predicted later decoding ability, while performance on theWISC-R Vocabulary test did not. Lastly decoding skill in grade 1 was foundto predict only visual in grade 2. These results indicate that visualparameters may make a crucial contribution to the acquisition of decodingskills. The size of pre-reading visual STM capacity appears to play a rolein this process. The relationship between visual STM and decoding may bebidirectional, as learning to decode appears to develop visual STM. It issuggested that either language-related or task-related factors may accountfor these counter-to-mainstream results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007915517339
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  • 24
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    Das präoperative EKG als Routineuntersuchung bei Kindern (1998)
    Springer
    Der Anaesthesist 47 (1998), S. 373-378 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Präoperatives EKG ; Kinder ; Key words Preoperative ECG ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objective: The aim of this study is to examine whether a routine preoperative ECG is necessary in children to assess the risks in anaesthesia and surgery. Methods: We examined the records of 3030 children anaesthetized in our hospital in 1990 and compared records of complications with preoperative ECGs. We also evaluated questionnaires on this subject which we had sent to 51 large pediatric hospitals in Germany in 1991. Results: During 3030 anaesthetic procedures there were 93 complications, 67 of which were not of cardiac origin. Of the 26 cardiac complications only 4 needed therapy (AV-Block 2°, fall in blood pressure). Preoperative ECGs were recorded in 180 cases: 152 were normal, 8 showed harmless deviations from normal and 16 were recorded because of known cardiac defects. None of the 180 children developed complications during anaesthesia. Our questionnaire was returned completed carefully by 36 of the 51 hospitals. In most hospitals a preoperative ECG is only recorded when heart disease is known or suspected. Conclusion: Routine preoperative ECGs are unnecessary in children unless there are clinical symptoms of heart disease or heart disease is suspected.
    Notes: Zusammenfassung Fragestellung: Es soll geklärt werden, inwieweit ein präoperatives EKG bei Kindern für die Risikoabschätzung vor einer Narkose notwendig ist. Methode: Wir überprüften die Narkoseprotokolle von 3030 Kindern, bei denen im Jahr 1990 in unserer Klinik eine Narkose durchgeführt wurde, und stellten die Komplikationen bei diesen Narkosen den Ergebnissen der präoperativen EKGs gegenüber. Außerdem werteten wir Fragebögen zu diesem Thema aus, die wir 1991 an 51 große Kinderkliniken in Deutschland verschickt haben. Ergebnisse: Bei 3030 Narkosen traten 93 Komplikationen auf, von denen 67 nicht kardial bedingt waren. Von den 26 kardialen Komplikationen waren nur 4 behandlungsbedürftig (AV-Block 2°, Blutdruckabfall, Schock). Von 180 präoperativ geschriebenen EKG waren 152 normal; 8 zeigten harmlose Normvarianten, 16 wurden wegen bekannter Herzfehler durchgeführt. Keines dieser Kinder hatte Komplikationen bei der Narkose. Die Fragebögen wurden von 36 der 51 angeschriebenen Kinderkliniken sorgfältig ausgefüllt zurückgeschickt. In den meisten Kliniken wird nur bei Hinweisen auf eine mögliche oder bestehende Herzerkrankung ein präoperatives EKG geschrieben. Schlußfolgerung: Es gibt bei Kindern keine Indikation für ein präoperatives EKG als Routinemaßnahme. Nur wenn sich aus Anamnese und körperlicher Untersuchung Hinweise auf eine Herzerkrankung ergeben, ist ein EKG und – bei Bedarf auch ein Echokardiogramm – eine sinnvolle Untersuchung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050572
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  • 25
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    Electronic Resource
    Thrombosis in congenital deficiencies of AT III, protein C or protein S: a study of 44 children (1998)
    Springer
    Hematology and cell therapy 39 (1998), S. 295-299 
    Details
    ISSN: 1279-8509
    Keywords: Venous thrombosis ; Protein C ; Protein S ; AT III ; LA ; APC resistance ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Abstract. Congenital deficiency in coagulation inhibitors is a cause of hereditary thrombotic disease. The severity of symptoms is variable and depends on the type of deficit. In this paper, 44 children suffering from deep venous thrombosis, with a mean age of 5 years, were studied. A search for Lupus anticoagulant (LA) and coagulation inhibitor deficiency showed: 3/44 cases (6.8%) had protein S deficiency, 2/44 cases (4.5%) had protein C deficiency, 1/44 cases (2.3%) had deficiencies in both protein C and S; no cases of AT III deficiency and LA was positive in 2/44 cases (4.5%). Only 1 case of APC resistance out of 13 studied was found. Four family studies were performed and confirmed the congenital origin of the disorder.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00282-997-0295-x
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  • 26
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    Acute changes in urine protein excretion may predict chronic ifosfamide nephrotoxicity: a preliminary observation (1998)
    Springer
    Cancer chemotherapy and pharmacology 41 (1998), S. 413-416 
    Details
    ISSN: 1432-0843
    Keywords: Key words Ifosfamide ; Proteinuria ; Tamm-Horsfall protein ; Nephrotoxicity ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To evaluate proteinuria occurring early after ifosfamide therapy and to assess the use of changes in proteinuria in the prediction of severe chronic nephrotoxicity. Methods: One-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis was used to characterize urine protein excretion in 12 children with solid tumours before and after the first course of ifosfamide treatment, and in 24 healthy children. Chronic nephrotoxicity was evaluated at 6 months after ifosfamide treatment and graded as none, mild, moderate or severe. Results: Urine from healthy children and from 10 of 12 patients before ifosfamide therapy showed a protein band with a molecular weight (95.4 kDa) corresponding to that of Tamm-Horsfall protein but no lower molecular weight proteins. After the first course of ifosfamide this 95.4-kDa protein was lost in six of ten patients with a concomitant appearance of a low molecular weight proteinuria (〈70 kDa) in eight. Tamm-Horsfall protein was lost in two of five patients who subsequently developed no or mild nephrotoxicity and in four of five patients who subsequently developed moderate or severe nephrotoxicity. Conclusions: Early subclinical changes in urine protein excretion after ifosfamide, manifested by a loss of Tamm-Horsfall protein excretion, may be predictive of subsequent chronic nephrotoxicity.
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    URL: http://dx.doi.org/10.1007/s002800050759
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  • 27
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    Middle ear effusion among children diagnosed and treated actively for acute otitis media (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 731-734 
    Details
    ISSN: 1432-1076
    Keywords: Key words Acute otitis media ; Middle ear effusion ; Upper respiratory tract infection ; Tympanometry ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We assessed the point prevalence of middle ear effusion among day care children in an area where acute otitis media is diagnosed, treated and followed actively. Minitympanometry was used to screen 850 day care centre attendants aged 0.6 to 6.9 years (mean 3.7 years). Tympanometry was performed by two trained nurses at the day care centres and pneumatic otoscopy was done by a paediatrician when effusion was suspected. We found 60 (7.1%) children to have middle ear effusion, which was bilateral in 23 (2.7%) cases. Of the children with bilateral effusion 13 had respiratory symptoms fulfilling the criteria of acute otitis media, 8 of them had experienced acute otitis media during the past 3 weeks and were diagnosed to have otitis media with effusion, and only 2 (0.2%) were asymptomatic children not identified earlier. Of the 37 (4.4%) children with unilateral effusion, 14 had acute otitis media and 23 otitis media with effusion, of whom 12 children (1.4%) had not been identified earlier. The point prevalence of acute otitis media was 3.2% and that of otitis media with effusion 3.9%. Conclusion We conclude that active diagnosis and treatment of acute otitis media practically eliminates such middle ear effusion that could cause significant hearing impairment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050924
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  • 28
    Electronic Resource
    Electronic Resource
    Pulse oximetry for assessment of pulsus paradoxus: a clinical study in children (1998)
    Springer
    Intensive care medicine 24 (1998), S. 242-246 
    Details
    ISSN: 1432-1238
    Keywords: Key words Pulsus paradoxus ; Pulse oximetry ; Plethysmography ; Status asthmaticus ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the relationship between intraarterial measured pulsus paradoxus (PP) and photoplethysmographic wave changes. Setting: Tertiary pediatric intensive care unit. Patients: 62 nonintubated children with or without respiratory disorders. Design: Prospective, clinical study. Measurements and results: Simultaneous paper recordings of photoplethysmographic wave, arterial blood pressure, breathing cycle and electrocardiogram. The respiratory dependent changes of the plethysmographic respiratory wave (delta pleth, mm) were defined as the difference between the highest value of the upper peak of the wave (in expiration) and the lowest value of the upper peak (in inspiration). In each patient, ten consecutive breaths were averaged for analysis. Five recordings could not be evaluated (movement artifacts). In 57 children (median age 2.4 years, range 7 days to 17 years), the photoplethysmographic fluctuations (delta pleth, mm) correlated with PP (mm Hg): r = 0.85; 95 % confidence interval (CI), 0.76 to 0.91. The sensitivity to detect a PP of 〉 10 mm Hg with a plethysmographic fluctuation of 〉 8 mm was 89 % (95 % CI, 77 to 100 %) and the specificity was 90 % (95 % CI, 79 to 100 %). Conclusions: Pulse oximetry appears to be a rapid and easily performed, noninvasive method for the objective estimation of the degree of PP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050557
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  • 29
    Electronic Resource
    Electronic Resource
    Weaning from mechanical ventilation in pediatric intensive care patients (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1070-1075 
    Details
    ISSN: 1432-1238
    Keywords: Key words Weaning ; Mechanical ventilation ; Children ; Weaning indices
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The development of weaning predictors in mechanically ventilated children has not been sufficiently investigated. The purpose of this study was to evaluate the accuracy of some weaning indices in predicting weaning failure. Design: Prospective, interventional study. Setting: University-affiliated children's hospital with a 19-bed intensive care unit. Patients: 84 consecutive infants and children requiring mechanical ventilation for at least 48 h and judged ready to wean by their primary physicians. Interventions: Patients who met the criteria to start weaning underwent a trial of spontaneous breathing lasting up to 2 h. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of spontaneous breathing. The primary physicians were blinded to those measurements, and the decision to extubate a patient at the end of the spontaneous breathing trial or reinstitute mechanical ventilation was made by them. Failure to wean was defined as the requirement for mechanical ventilation at any time during the trial of spontaneous breathing (trial failure) or needing reintubation within 48 h of extubation (extubation failure). Measurements and main results: Seventy-five patients had neither signs of respiratory distress nor deterioration in gas exchange during the trial and were extubated. Twelve patients required reintubation within 48 h. In 9 patients, mechanical ventilation was reinstituted after a median duration of the spontaneous breathing trial of 35 min. The only independent predictor of trial failure was tidal volume indexed to body weight [odds ratio 2.60, 95 % confidence interval (CI) 1.40 to 24.9]. The only independent predictor of extubation failure was frequency-to-tidal volume ratio indexed to body weight (odds ratio 1.23, 95 % CI 1.11 to 1.36). The sensitivity, specificity, and positive and negative predictive values to predict weaning failure were calculated for each of the above variables. These values were 0.48, 0.86, 0.53, and 0.83, respectively, for a frequency-to-tidal volume ratio higher than 11 breaths/min per ml per kg and 0.43, 0.94, 0.69, and 0.83, respectively, for a tidal volume lower than 4 ml/kg. Conclusions: Three-quarters of ventilated children can be successfully weaned after a trial of spontaneous breathing lasting 2 h. Both tidal volume and frequency-to-tidal volume ratio indexed to body weight were poor predictors of weaning failure in the study population.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050718
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  • 30
    Electronic Resource
    Electronic Resource
    Exposure to lead and other metals in children from Katowice district, Poland (1998)
    Springer
    International archives of occupational and environmental health 71 (1998), S. 180-186 
    Details
    ISSN: 1432-1246
    Keywords: Key words Blood lead ; Toxic metals ; Essential elements ; Children ; ICP-MS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To assess the exposure to toxic metals and to evaluate its possible association with essential elements and socioeconomic status in children from the town of Bytom in the Katowice area; this area is one of the most polluted industrialized regions in Poland. Methods: Concentrations of lead, cadmium, mercury, selenium, magnesium, copper, and zinc were determined in whole blood of 211 children aged 9 years. The samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Information on socioeconomic factors was collected using questionnaires. Concentrations of trace elements in the blood of 24 Swedish children aged 9–10 years were used for comparisons. Results: The concentrations of lead detected in the blood of the Polish children ranged from 0.09 to 1.9 μmol/l, with the median value being 0.27 μmol/l. Statistically significant associations were found between lead and such socioeconomic factors as the number of siblings, trips outside the region, maternal smoking, playing outdoors, and apartment standard. The average blood lead level was about 3 times higher in the Polish children than in the Swedish group. The median blood concentration of cadmium found in the Polish children was 3.4 nmol/l (range 1.1–41 nmol/l; almost 3 times higher than that detected in the Swedish children), and that of mercury was 3 nmol/l (range 0.5–11 nmol/l). The median blood levels and ranges of the essential elements were 1.1 (0.7–2.0) μmol/l for selenium, 1.5 (1.2–1.9) mmol/l for magnesium, 17 (13–22) μmol/l for copper, and 78 (54–104) μmol/l for zinc, respectively. The concentrations of selenium and magnesium were significantly lower in the Polish group as compared with the Swedish children. Conclusions: In all, 7% of the Polish children had blood lead levels exceeding 0.5 μmol/l, the concentration above which negative effects on mental development have been reported. However, the findings indicate a decrease in lead exposure during recent years among the Bytom children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004200050268
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  • 31
    Electronic Resource
    Electronic Resource
    Development of prehension movements in children: a kinematic study (1998)
    Springer
    Experimental brain research 122 (1998), S. 424-432 
    Details
    ISSN: 1432-1106
    Keywords: Key words Prehension ; Arm movement ; Children ; Grasp ; Motor learning
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To evaluate the normal development of functional hand motor skill, the kinematics of prehension movements were analyzed in 54 healthy children (age 4–12 years). The subjects repeatedly reached out for cylindrical target objects and grasped them with a precision grip of their dominant hand. The trajectory of the reaching hand and the finger aperture were monitored by optoelectronic motion analysis. To obtain comparable conditions for the different age groups, the experimental setup was scaled according to the individual body proportions of each subject. Within the investigated age range, neither the movement duration nor the normalized (according to body proportions) peak spatial velocity of the reaching hand changed significantly. However, the hand trajectory straightened and the coordination between hand transport and grip formation improved, resulting in smooth and stereotyped kinematic profiles at the age of 12 years. The younger children opened their grip relatively wider than the older ones, thus grasping with a higher safety margin. The dependence on visual control of the movement declined during motor development. Only the oldest childen were able to scale the grip aperture adequately, according to various sizes of the target objects, when visual control of the movement was lacking. The results suggest that the development of prehensile skills during childhood lasts until the end of the first decade of life. This functional maturation is discussed in relation to the development of neuronal pathways.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002210050530
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  • 32
    Electronic Resource
    Electronic Resource
    Fast FLAIR MRI in childhood white-matter abnormalities (1998)
    Springer
    Neuroradiology 40 (1998), S. 355-358 
    Details
    ISSN: 1432-1920
    Keywords: Key words Magnetic resonance imaging ; White matter diseases ; Children ; Pulse sequences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We compared a fast fluid-attenuated inversion recovery (FLAIR) pulse sequence with a dual-echo short tau fast inversion-recovery (DESTTIR) sequence in 20 children with white matter abnormalities. Although the overall image quality of DESTTIR images was better, the lesion-to-background contrast was significantly higher with the fast FLAIR pulse sequence and lesion detection was more accurate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050598
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  • 33
    Electronic Resource
    Electronic Resource
    MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children (1998)
    Springer
    Neuroradiology 40 (1998), S. 359-363 
    Details
    ISSN: 1432-1920
    Keywords: Key words Cervical spine ; trauma ; Magnetic resonance imaging ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We carried out a retrospective analysis of imaging and clinical findings in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of injury or instability, or as further assessment of the extent of soft-tissue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was positive in 16 (31 %) of 52 patients. Posterior soft-tissue or ligamentous injury was the most common finding in the 10 patients with mild to moderate trauma, while acute disc bulges and longitudinal ligament disruption, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six patients with more severe trauma. MRI specifically influenced the management of all four patients requiring surgery by extending the level of posterior stabilization. No patients with normal MRI or any of the 10 with radiographically stable soft-tissue injury on MRI, developed delayed clinical or radiographic evidence of instability or deformity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050599
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  • 34
    Electronic Resource
    Electronic Resource
    Cerebellar arteriovenous malformations in children (1998)
    Springer
    Neuroradiology 40 (1998), S. 324-331 
    Details
    ISSN: 1432-1920
    Keywords: Key words Arteriovenous malformation ; Cerebellum ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We review the presentation, imaging findings and outcome in 18 children with cerebellar arteriovenous malformations (AVM). This group is of particular interest because of the reported poor outcome despite modern imaging and neurosurgical techniques. All children had CT and 15 underwent catheter angiography at presentation. Several of the children in the latter part of the study had MRI. Of the 18 children, 17 presented with a ruptured AVM producing intracranial haemorrhage. The remaining child presented with temporal lobe epilepsy and was shown to have temporal, vermian and cerebellar hemisphere AVM. This child had other stigmata of Osler-Weber-Rendu syndrome. Three other children had pre-existing abnormalities of possible relevance. One had a vascular malformation of the cheek and mandible, one a documented chromosomal abnormality and another a midline cleft upper lip and palate. Six of the 17 children with a ruptured cerebellar AVM died within 7 days of the ictus. Vascular pathology other than an AVM was found in 10 of the 14 children with a ruptured cerebellar AVM who had angiography: 4 intranidal aneurysms, 5 venous aneurysms and 2 cases of venous outflow obstruction (one child having both an aneurysm and obstruction). The severity of clinical presentation was directly related to the size of the acute haematoma, which was a reasonable predictor of outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050593
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  • 35
    Electronic Resource
    Electronic Resource
    A model for the determination of carbamazepine clearance in children on mono- and polytherapy (1998)
    Springer
    European journal of clinical pharmacology 54 (1998), S. 359-362 
    Details
    ISSN: 1432-1041
    Keywords: Key words Carbamazepine ; Population pharmacokinetics ; Children ; NONMEM
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: To derive a model describing carbamazepine (CBZ) clearance in children, in terms of individual patient characteristics. Methods: One hundred and eighteen steady-state serum carbamazepine concentration measurements were gathered during normal routine care of 72 compliant out-patients (2.3–16.3 years old). Levels were obtained from patients receiving monotherapy (55%), concomitant valproate (26%), or concomitant inducers (phenytoin, phenobarbitone; 19%). A one-compartment model was used to fit the data with the computer programme Nonlinear Mixed Effects Model (NONMEM). Results: Weight, age and concomitant medication were all important determinants of clearance. The final model for clearance (l · h−1) was: CL = [0.7(WT)0.4] · M, where WT is patient weight (kg) and M is a scaling factor for concomitant medication, with a value of 1 for patients on CBZ monotherapy or concomitant valproate and 1.4 for those receiving concomitant inducers. For the purposes of this analysis, bioavailability (f) was assumed to be complete, i.e., f is thus included in the term CL. Conclusions: CBZ clearance decreased with increasing age. As age and weight were correlated, either variable was a satisfactory predictor. The influence of both the inducers and valproate on CBZ clearance was as expected. This model, which describes clearance in terms of patient-specific details, can be used when predicting the maintenance dose required to achieve a target mean steady-state CBZ concentration in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050475
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  • 36
    Electronic Resource
    Electronic Resource
    Pediatric pancreas: an overview (1998)
    Springer
    European radiology 8 (1998), S. 1236-1244 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Pancreas ; anatomy ; Pancreas ; congenital abnormalities ; Pancreatitis ; Pancreas ; neoplasms ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Pancreatic disorders are not rare in children. Modern imaging equipment allows recognition of many pancreatic diseases that were difficult to identify in the past and therefore were considered to be unusual. Within the scope of this article we include information on imaging modalities for studying the pancreas and a description of the radiologic manifestations of the most common congenital, inflammatory, tumoral, traumatic and systemic disorders.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050541
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  • 37
    Electronic Resource
    Electronic Resource
    Pathophysiology of meningococcal sepsis in children (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 869-880 
    Details
    ISSN: 1432-1076
    Keywords: Key words Meningococcal infection ; Sepsis ; Children ; Pathophysiology ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Septic shock with purpura is a syndrome frequently diagnosed in children and predominantly caused by Neisseria meningitidis. Despite improvements in management and therapy the mortality and morbidity in these patients are still high. During the last few years much effort has been put into understanding of the systemic host response during this acute infectious disease. This host response can be divided into the process of recognition of endotoxin, the cascade of pro- and counter inflammatory mediators, the endothelial damage resulting in capillary leakage and inappropriate vascular tone, and the procoagulant state. Conclusion This paper reviews the recent insights in the pathophysiology of the host response and their possible consequences for novel therapies in meningococcal sepsis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050958
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  • 38
    Electronic Resource
    Electronic Resource
    Safety and efficacy of interferon retreatment in children with chronic hepatitis B (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 382-385 
    Details
    ISSN: 1432-1076
    Keywords: Key words Chronic hepatitis B ; Children ; Alpha-interferon ; Non-responder ; Retreatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract More than 50% of children with chronic hepatitis B do not respond to treatment with alpha-interferon. Since these patients continue to display high viral replication and progressive liver disease, retreatment should be considered. To date it has not been well evaluated whether a second course of treatment could increase the response rate. In two alpha-interferon retreatment trials in adult patients the response rate, defined by seroconversion from HBeAg to anti-HBe, ranged between 11% and 44%. One beta-interferon retreatment study in children reported a seroconversion rate of 32%. Regrettably, none of the studies included a control group observing the `spontaneous' seroconversion rate after a first interferon cycle. Thus, a nonrandomized alpha-interferon retreatment study in children including control patients was performed. Alpha-interferon for retreatment was administered 3 times a week for 16–24 weeks in 15 children (5–16 years) at least 6 months after ceasing the first cycle. Four children received 5 MU/m2 of a natural alpha-interferon and 11 children 9 MU/m2 recombinant alpha-interferon 2b. Follow up was 18–47 months after initial treatment. In parallel, a control group of 19 un-retreated children with comparable clinical and demographic data was followed for 12–39 months. HBeAg seroconversion was observed in 5 (33%) of the retreated children and in 5 (26%) of the control patients during follow up. The difference is not significant. In the initially nonresponding children, those with high ALT levels before the first treatment showed late HBeAg seroconversion more frequently than those with low ALT levels (P = 0.017) irrespective of retreatment. The ALT level before retreatment was not a predictor for response. Conclusions A second cycle of alpha-interferon during the 3 years following the first treatment in nonresponding children with chronic hepatitis B can be safely performed but did not increase HBeAg/anti-HBe seroconversion compared with the spontaneous seroconversion rate of patients without retreatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050834
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  • 39
    Electronic Resource
    Electronic Resource
    Changes in attention with hypo- and hyperglycaemia in children with insulin dependent diabetes mellitus (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 802-805 
    Details
    ISSN: 1432-1076
    Keywords: Key words Insulin-dependent diabetes mellitus ; Cognitive function ; Attention ; Blood glucose level ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We compared the results of a computerized attention test (TOVA) in 38 children with insulin dependent diabetes mellitus in relation to various spontaneously occurring blood glucose levels. Testing was performed at the following blood glucose levels: 〈3.3 mmol/l (hypoglycaemia), 3.3–8.3 mmol/l (normoglycaemia) and 〉8.3 mmol/l (hyperglycaemia) . The attention (sum of errors and response time) varied significantly with the blood glucose level (P=0.002). The highest number of errors of omission and the longest response time was observed during the test run with hypoglycaemia. Age, sex, age at manifestation of the disease, metabolic control and the results of the intelligence test had no significant influence on these results. We found that attention in children with diabetes was significantly reduced compared to TOVA norms especially during mild hypoglycaemia (P〈0.001). Irrespective of the blood glucose levels, reaction time and the variability of the reaction time differed significantly between TOVA norms and diabetic children (P〈0.01). Conclusion In children with diabetes mellitus a significant reduction in attention was found at mild hypoglycaemia but as well at low normal blood glucose levels. Attention deficits due to transient lowering of blood glucose may therefore occur in diabetic children even before they are aware of hypoglycaemic symptoms.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050939
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  • 40
    Electronic Resource
    Electronic Resource
    Recommendations on the use of colony-stimulating factors in children: conclusions of a European panel (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 955-966 
    Details
    ISSN: 1432-1076
    Keywords: Key words Granulocyte ; Neutropenia ; Children ; Growth factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract During 1996 and 1997 a panel of European haematologists, oncologists, and neonatologists developed specific paediatric guidelines for the use of colony stimulating factors based on published literature and the clinical experience of these specialists within each of 13 countries. Well established indications for use comprise intervention in patients with life-threatening infection, adjunctive therapy post autologous bone marrow transplantation (BMT), mobilization of peripheral blood progenitor cells for autologous BMT, patients with acquired aplastic anaemia on anti-lymphocyte globulin and cyclosporin regimen, and severe congenital neutropenia. Less clear indications include primary prophylaxis to support dose intensification in children with high risk/advanced malignancies, secondary prophylaxis to prevent neutropenia in patients with a history of severe neutropenia, support therapy in cases of poor marrow function following BMT and for deteriorating marrow function following successful BMT, in neonatal sepsis and non infectious neonatal neutropenia, in drug induced neutropenia and in HIV-positive patients. Treatment is generally well tolerated and granulocyte colony stimulating factor appears better tolerated than granulocyte and macrophage colony stimulating factor. Economically colony stimulating factors have not been shown to induce excessive costs for a given patient. Conclusion In general the adult guidelines are applicable to children but additional considerations (aggressive or very progressive childhood neoplasms, specific indications, neonatal use, congenital disorders) must be taken into account.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050978
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  • 41
    Electronic Resource
    Electronic Resource
    Antineutrophil cytoplasmic antibodies in children (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 987-991 
    Details
    ISSN: 1432-1076
    Keywords: Key words Antineutrophil cytoplasmic antibodies ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To define the diagnostic meaning of antineutrophil cytoplasmic antibodies (ANCA) positivity in children, we analysed 1485 consecutive sera sent for routine immunological investigation to our department from January to August 1996. Using this large screening, we identified the most typical clinical disorders associated with ANCA in childhood. Out of 1485 indirect immunofluorescence (IIF) tests for ANCA, 143 were ANCA positive, 70 had a cytoplasmic IIF pattern (c-ANCA), and 73 a perinuclear IIF pattern (p-ANCA). The ANCA associated diseases in childhood were cystic fibrosis (CF) (31 c-ANCA, 7 p-ANCA positive out of 71 CF children investigated), juvenile chronic arthritis (JCA) (21 p-ANCA positive out of 78), auto-immune hepatitis (AIH) (4 c-ANCA and 12 p-ANCA positive out of 19), and ulcerative colitis (UC) (2 c-ANCA, 5 p-ANCA positive out of 15). In cases of c-ANCA positivity we determined the antigenic specificity of ANCA for proteinase 3 and/or bactericidal/permeability increasing protein. Borderline anti-proteinase 3 levels were found in CF, and in high levels in one boy with Wegener granulomatosis. Bactericidal/permeability increasing protein was characteristic target antigen in children with CF. p-ANCA positive children were further tested for the specificity for myeloperoxidase, which was detected mostly in children with JCA. Conclusion The spectrum of diseases associated with ANCA in children includes, besides the diagnostic associations typical for adults, several typical pediatric entities, mainly juvenile chronic arthritis and cystic fibrosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050983
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  • 42
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    Electronic Resource
    Prepubertal girls with insulin-dependent diabetes mellitus have higher exogenous insulin requirement than boys (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 708-711 
    Details
    ISSN: 1432-1076
    Keywords: Key words Insulin dose ; Insulin sensitivity ; Gender ; Type 1 diabetes ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a population based study, the prescribed insulin dose of 348 prepubertal children with insulin-dependent diabetes mellitus (IDDM) was analysed 2 years after the diagnosis of diabetes. Girls had an insulin dose 13.6% higher than that in boys. When children younger than 5 years of age at diagnosis were analysed separately, the difference in insulin dose between boys and girls remained. The increased insulin dose in girls was not explained by possible differences in endogenous insulin secretion, body mass index, metabolic control or the number of daily insulin injections. Our observations indicate that prepubertal girls with IDDM have a poorer insulin sensitivity than boys.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050919
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  • 43
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    Electronic Resource
    Imaging of constipation in infants and children (1998)
    Springer
    European radiology 8 (1998), S. 248-258 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Infants ; Children ; Constipation ; Diagnostic imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aims of this review article are to present epidemiology, important definitions, clinical considerations, and etiologic and pathogenetic aspects of constipation in infants and children. Anatomy, physiology, and pathophysiology of the the anorectum are described. Special attention is given to the indications for diagnostic imaging, imaging techniques, and imaging findings with different causes of constipation. Other diagnostic modalities, such as anorectal manometry, electromyography, and biopsy techniques are briefly discussed. The central question as to whether diagnostic imaging is needed for the diagnostic workup of infants and children suffering from constipation can be answered affirmatively. Especially the combination of barium enema or defecography and anorectal manometry allows definition of those infants and children who do not need biopsy and surgery for Hirschsprung's disease. The special role of defecography in this context is underlined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050373
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  • 44
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    Electronic Resource
    Unilateral femoral deformity due to a focal fibrous tether (1998)
    Springer
    European radiology 8 (1998), S. 603-605 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Femur abnormalities ; congenital ; Femur deformities ; Children ; Skeletal system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The purpose of this paper is to assess the radiological features of the unilateral angular deformity of the distal end of the femur secondary to a focal fibrous tether. Only five cases of this entity have been reported in the literature. We report another two patients. Magnetic resonance study was performed on one of them, which has not been used in previous cases. Both cases are described with illustrations of the typical radiographic appearances supplemented by CT and MR imaging.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050443
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  • 45
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    Electronic Resource
    Pulmonary alveolar proteinosis in a child: HRCT findings before and after bronchoalveolar lavage (1998)
    Springer
    European radiology 8 (1998), S. 1680-1682 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Lungs ; Pulmonary alveolar proteinosis ; Children ; Bronchoalveolar lavage ; High-resolution CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We demonstrate the high-resolution computed tomography (HRCT) findings of pulmonary alveolar proteinosis in a child before and after bronchoalveolar lavage. The CT pattern in our case differs from the pattern described in previous reports. We found a more homogeneous distribution of the pulmonary changes and a “crazy paving” pattern. High-resolution CT may be helpful in the differential diagnosis of this rare disease and in the follow-up of the pulmonary changes after bronchoalveolar lavage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050612
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  • 46
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    Electronic Resource
    Intra-urban variation of antibiotic utilization in children: influence of socio-economic factors (1998)
    Springer
    European journal of clinical pharmacology 54 (1998), S. 653-657 
    Details
    ISSN: 1432-1041
    Keywords: Key words Antibiotic utilization ; Intra-urban variation ; Children ; Socio-economic ; Ecological
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: The aim of this study was to investigate the intra-urban variation of antibiotic utilization in children in Malmö and to evaluate the influence of socio-economic factors on this variation. Methods: In an ecological analysis, the variations in antibiotic utilization in children, expressed as defined daily dose (DDD) or as the number of prescriptions per 1000 inhabitants per day, were compared with variations in socio-economic and demographic factors in the 17 administrative districts of the Swedish city of Malmö (235 000 inhabitants). Results: There were large between-area differences in antibiotic utilization, especially in children aged 0–6 years. Socio-economic factors reflecting a privileged situation correlated positively with antibiotic utilization. Thus, in districts with a high median family income and a high employment rate, the utilization of antibiotics was higher than in other districts. Conversely, in districts with a high proportion of blue-collar workers, people with foreign backgrounds and recipients of social benefit, antibiotic utilization was comparatively low. In contrast, the utilization of penicillin V relative to other antibiotics showed an opposite pattern, including positive correlations with the proportion of social benefit, immigrants and blue-collar workers and a negative correlation with employment rate. Conversely, the utilization of macrolides in relation to other antibiotics in children aged 0–6 years was highest in districts inhabited by those who were socio-economically privileged. Interpretation: The findings suggest that utilization of antibiotics in children may vary considerably within a city, that it may increase with the degree of parental affluence, and that such affluence may reduce the utilization of penicillin V relative to other antibiotics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050529
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  • 47
    Electronic Resource
    Electronic Resource
    Trends in aspirin, paracetamol and non-steroidal anti-inflammatory drug use in children between 1981 and 1992 in France (1998)
    Springer
    European journal of clinical pharmacology 54 (1998), S. 659-664 
    Details
    ISSN: 1432-1041
    Keywords: Key words Drug utilization ; Aspirin ; Paracetamol ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: Antipyretic/analgesic drugs (AADs) are among the most commonly used drugs in children. Their efficacy and adverse effects have often been debated and new AADs have been introduced over the past few years. The aim of this study was to assess the characteristics of the use of AADs in children in France, and their trends. Methods: Two surveys on household health care consumption were undertaken in France, in 1981 and in 1992. They included 5060 and 4841 children, respectively. The AADs studied were aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Results: The proportion of children exposed to AADs increased significantly between 1981 and 1992 (+28% in 11 years). Among them, the percentage of subjects treated with aspirin decreased (−27%). In contrast, the percentage increased for paracetamol (+19%) and for NSAIDs (+179%). Aspirin was the AAD most used in 1981 (57.4%) and it was replaced by paracetamol in 1992 (71.6%). Nasopharyngitis was the main reason for AAD prescription under the age of 11 years; for older children it was influenza-like syndrome, irrespective of the study year. A change in AAD choice occurred in nasopharyngitis, acute bronchitis and influenza-like syndrome irrespective of the age group, and in otitis/sinusitis between 4 and 10 years. In all these cases aspirin prescription decreased, in contrast with paracetamol and NSAIDs. Self-medication of AAD was uncommon (8.3% for aspirin and 10.3% for paracetamol in 1992) and decreased (−29% and −33%). It was used principally for nasopharyngitis, influenza-like syndrome and pain. Conclusion: The consumption of AADs in children is high and is increasing. Paracetamol and NSAIDs tend to replace aspirin prescription in children and physicians have played the main role in this change.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050530
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  • 48
    Electronic Resource
    Electronic Resource
    Data about 154 children and adolescents reporting sexual assault (1998)
    Springer
    Archives of gynecology and obstetrics 261 (1998), S. 61-70 
    Details
    ISSN: 1432-0711
    Keywords: Key words: Sexual assault ; Children ; Adolescents
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Sexual assaults on girls occur at an alarming rate representing a significant public health problem, but difficulties in correctly identifying the problem, managing the child and reporting for legal purposes have been recognized. We describe data obtained on 154 recent cases of child and adolescent sexual assault. Results indicate that those at highest risk of sexual assault are girls at age of 11–15 years having a stepfather, although the most girls at age of 〉15 were assaulted by strange men with higher incidence of cross-race assault. Over a quarter of girls showed signs of physical trauma with face and neck as most common site of contact. A total of 17.5% reported threat of violence or with weapons and 9.7% had alcoholic influence. Pattern and incidence of genital injuries were described.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004040050200
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  • 49
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    Electronic Resource
    Diffuse brain stem gliomas Are we improving outcome? (1998)
    Springer
    Child's nervous system 14 (1998), S. 578-581 
    Details
    ISSN: 1433-0350
    Keywords: Key words Brain stem glioma ; Children ; Chemotherapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We reviewed our experience with diffuse brain stem glioma (dBSG) to evaluate whether any improvement of outcome had occurred in our patients over the years. Of the 24 children referred to our department with suspected dBSG from 1981 to 1997, 5 had a different final diagnosis based on the clinical course. Mean survival in the remainder was 16±9.8 months from diagnosis. Survival increased with a longer interval from onset of symptoms to diagnosis (12.9±9.0 months with an interval of 1–4 weeks; 19.50±10.8 months with a longer interval). Visual symptoms at presentation were associated with a poorer prognosis. Survival was better in the 3- to 5-year age group (at diagnosis). Overall, a trend toward a slight improvement in survival was seen over the years, which we presumptively attribute to the introduction of intensive chemotherapy for these patients. We suggest that chemotherapy may be important in the management of dBSG until a better modality is found.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050275
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  • 50
    Electronic Resource
    Electronic Resource
    Late neuropsychological and behavioural outcome of children surgically treated for craniopharyngioma (1998)
    Springer
    Child's nervous system 14 (1998), S. 179-184 
    Details
    ISSN: 1433-0350
    Keywords: Key words Craniopharingyoma ; Children ; Surgery ; Neuropsychological outcome ; Personality ; Frontal behaviour
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Late outcome in 12 children treated by radical surgery for craniopharyngioma is presented. None of the patients presented underwent fractionated traditional or stereotactic radiotherapy. The results show no neurological (except visual dysfunction in 6 subjects), cognitive or short-term memory deficits. Three children were found to have a minor attention deficit. In 5 cases “frontal lobe” malfunctioning was disclosed, and in 5 there were bursts of unpredictable anger. Three children showed worsening of functioning at school: a combination of various causes is suggested to explain the worsening of academic performances. The size of the sample calls for a careful evaluation of results, with due consideration for the influence of various factors on outcome. Multicentre studies are required to increase the sample size and achieve more general conclusions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050207
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  • 51
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    Electronic Resource
    Severe head injury in children – analyzing the better outcome over a decade and the role of major improvements in intensive care (1998)
    Springer
    Child's nervous system 14 (1998), S. 195-202 
    Details
    ISSN: 1433-0350
    Keywords: Key words Brain injury ; severe ; Children ; Prognosis ; Intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We suggest a few possible explanations, including improvement of intensive care, as the main cause, for the improved outcome after severe head injury in children and present the predictors of outcome observed in a contemporary series. From January 1984 to June 1988 we saw 117 children (ages 0–14) with postresuscitation GCS (Glasgow Come Scale) scores of 3–8. The more recent cohort of children seen in 1994–1996 was made up of 152 patients. Apart from standard statistics we used a segmentation method called CHAID (SSPS software). Previously known predictors of outcome are found still to apply in our series. Although in the recent period there was a lower proportion of patients with GCS 3–4 (11% versus 32%), a higher percentage had suffered multiple trauma (56% versus 33%). The rates of craniotomy and of ICP monitoring were similar (66% and 61%). Comparison of the two cohorts for outcome at discharge and through 1 year shows that mortality fell from 33% to 10% and the proportion achieving improvement of neurological status increased from 24% to 56%. CHAID analysis showed that the mortality rates of patients within specific groups declined significantly over the two periods: (1) a significant reduction in mortality was seen in patients with GCS 5–7, especially those with diffuse axonal injury (DAI) (17.3% to 0%); (2) no child admitted in shock survived in the earlier period, whereas 7 with GCS 4–6 survived during the recent period. The best model for mortality prediction includes GCS, and in the GCS 4–7 subgroup, the presence of subdural hematoma. It seems that the trend toward better immediate outcome is continuous, and this is the more striking when the severity of injury is taken into consideration. Our belief is that the modern medical and surgical techniques, although incurring higher costs and necessitating ongoing intensity, are well worth the effort.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050210
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  • 52
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    Electronic Resource
    Posterior fossa tumors in children – indications for ventricular drainage and for V-P shunting (1998)
    Springer
    Child's nervous system 14 (1998), S. 227-229 
    Details
    ISSN: 1433-0350
    Keywords: Key words Posterior fossa tumors ; Children ; V-P shunt ; Ventricular drainage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A clinical analysis of 95 patients with posterior fossa tumors treated in the Department of Neurosurgery of the Medical University in Gdansk over a period of 16 years (1979–1995) is presented. The following preoperative factors were studied: localization, size and suspected type of tumor, size of the ventricular system, and presence or absence of the “halo” symptom. The indications for ventricular drainage (Fisher) versus V-P shunting as a preliminary treatment are discussed. Finally, the advantages of each of these procedures are emphasized.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050217
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  • 53
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    Electronic Resource
    Neurosurgical perspectives in pediatric neurooncology (1998)
    Springer
    Child's nervous system 14 (1998), S. 94-96 
    Details
    ISSN: 1433-0350
    Keywords: Key words Brain neoplasm ; Chemotherapy ; Children ; Ependymoma ; Medulloblastoma ; Radiation therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This communication describes one pediatric neurosurgeon's personal view of the neurosurgical perspectives in pediatric neurooncology. Various roles of surgery, including histological verification, maximum cytoreduction, neurodecompression and restoration of the cerebrospinal fluid pathway, are emphasized. A pediatric neurosurgeon, who is the first person to make decisions on diagnosis and treatment relating to children with brain tumors, should be up to date with advances in diagnostic and therapeutic methods. Particularly, he or she should be familiar with both the efficacy and the side effects of radiation therapy and chemotherapy to allow selection of the optimum treatment for such children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050185
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  • 54
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    Electronic Resource
    Pattern of electroencephalographic abnormalities in children with hydrocephalus A study of 68 patients (1998)
    Springer
    Child's nervous system 14 (1998), S. 124-126 
    Details
    ISSN: 1433-0350
    Keywords: Key words Hydrocephalus ; EEG ; Children ; Saudi Arabia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pattern of electroencephalographic (EEG) abnormalities was studied in 68 patients (41 male, 27 female, age range 1 month to 17 years) with hydrocephalus. They all had standardized EEG recordings, which were read by the same electroencephalographer. In 48 children the EEG was performed after ventriculo-peritoneal shunting. The EEG abnormalities in the shunted group included slow waves in 26 patients [focal 2 (4.2%), generalized asynchronous 22 (45.8%), generalized synchronous 2 (4.2%)]; amplitude abnormalities in 2 (focal 1, generalized 1); epileptiform activity in 26 [partial 11 (22.9%), generalized 15 (31.3%)] and hypsarrhythmia in 4 (8.3%). Only 4 (8.3%) traces were normal, giving an overall percentage abnormality of 92%. In the unshunted group generalized asynchronous slow waves were found in 12 patients (60%), generalized amplitude abnormality in 1, focal epileptiform activity in 3 (15%), and generalized epileptiform activity in 6 (30%); 2 tracings in this group were normal, giving an overall percentage abnormality of 90%. Hydrocephalus in children, regardless of the cause, may be associated with generalized or focal EEG abnormalities. This may reflect the heterogeneity of the neural generator in the underlying disease process.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050193
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  • 55
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    Electronic Resource
    Long-term socioeconomic outcome following surgical intervention in the treatment of refractory epilepsy in childhood and adolescence (1998)
    Springer
    Child's nervous system 14 (1998), S. 362-365 
    Details
    ISSN: 1433-0350
    Keywords: Key words Social outcome ; Epilepsy ; Surgery ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgical treatment of refractory epilepsy in childhood and adolescence has been shown to be effective in reducing the seizure frequency. This paper examines the question: “Does this result in a better socioeconomic outcome in later years?” Patients who underwent a surgical procedure for the treatment of their medically refractory epilepsy at our hospital, had more than 2-years' follow-up, and were less than 18 years old at time of survey were included. From a retrospective chart review, age at onset and at surgery, duration of seizures prior to surgery, years of follow-up, type of surgery, and neurological status were obtained. From a telephone survey, seizure frequency after surgery, marital, financial and driving status, level of education, and employment status were ascertained. Sixty-four patients in our epileptic surgical series meet entry criteria. Significantly higher levels of education, employment status and independence were found in patients with a class I Engel outcome compared to other Engel outcomes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050245
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  • 56
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    Electronic Resource
    Meningiomas of the lateral ventricles of the brain in children (1998)
    Springer
    Child's nervous system 14 (1998), S. 350-353 
    Details
    ISSN: 1433-0350
    Keywords: Key words Meningioma ; Brain neoplasm ; Intraventricular tumour ; Operative approach ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Meningiomas of the lateral ventricles of the brain are rare tumours, accounting for approximately 0.5–5% of all intracranial meningiomas. Their natural history and symptomatology and the possibilities of early diagnosis are presented. The intraventricular location of the slow-growing benign mass provides a compensatory mechanism in the form of reserve space, which contributes to the delay in clinical demonstration of symptoms and signs. This makes the choice of diagnostic procedure an essential problem. CT and MRI are useful in detecting these masses, and magnetic resonance angiography (MRA) has also proved to be of great value in demonstrating the vascular supply of the tumour. This paper deals with two cases. In case 1 CT, MRI and MRA and in case 2 CT examination proved to be very useful. The tumours were removed by a transcortical approach in the posterior area.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050242
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  • 57
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    Electronic Resource
    Intramedullary anaplastic oligodendroglioma in a child (1998)
    Springer
    Child's nervous system 14 (1998), S. 127-130 
    Details
    ISSN: 1433-0350
    Keywords: Key words Anaplastic oligodendroglioma ; Intramedullary spinal cord tumor ; Children ; Radiation therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Primary intramedullary anaplastic oligodendroglioma is a rare tumor, only four cases of which have been reported. The authors present the case of a 38-month-old boy with primary intramedullary anaplastic oligodendroglioma. He underwent partial removal of the tumor and spinal radiation therapy. The residual tumor disappeared 12 months after radiation, and 48 months after treatment there was no evidence of recurrence. This case shows that in primary intramedullary anaplastic oligodendroglioma, postoperative radiation therapy confined to the spinal cord can yield an optimal result.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050194
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  • 58
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    Electronic Resource
    Unusual presentation of a sinonasal carcinoma mimicking an aneurysm rupture (1998)
    Springer
    Child's nervous system 14 (1998), S. 338-342 
    Details
    ISSN: 1433-0350
    Keywords: Key words Aneurysm ; Sinonasal carcinoma ; Skull base tumor ; Subarachnoid hemorrhage ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although the association of subarachnoid hemorrhage (SAH) and tumoral lesions in adult is well known, hemorrhage from a sinonasal carcinoma extending to the intracranial cavity is exceedingly rare. In this paper, the authors report on a 12-year-old girl who presented with SAH caused by a sinonasal carcinoma located in the anterior skull base area. To our knowledge, this is the first report of a sinonasal carcinoma concomitant with SAH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050239
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  • 59
    Electronic Resource
    Electronic Resource
    Surgically treated traumatic synchondrotic disruption of the odontoid process in a 15-month-old girl (1998)
    Springer
    Child's nervous system 14 (1998), S. 85-87 
    Details
    ISSN: 1433-0350
    Keywords: Key words Odontoid fracture ; Synchondrosis ; Spinal cord injury ; Cervical spine ; Pediatric spine ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case of traumatic synchondrotic disruption in a 15-month-old girl is reported; she was treated with interlaminar wiring of C1–C2 without grafting. Reduction of the dislocation and angulation and stability were achieved without evidence of growth disturbance. However, the child's initial poor neurological status with tetraplegia below the level of C7 remained unchanged. Besides our case, there are only three other cases in the literature of young children primarily operated on for a traumatic odontoid synchondrotic disruption. Even though the dorsal interlaminar wiring of C1–C2 without grafting is an easy and safe procedure even in the very young, the optimal form of treat-ment for this rare injury is still unsettled.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050182
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  • 60
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    Electronic Resource
    Outcomes and failure patterns in childhood craniopharyngiomas (1998)
    Springer
    Child's nervous system 14 (1998), S. 558-563 
    Details
    ISSN: 1433-0350
    Keywords: Key words Craniopharyngioma ; Brain neoplasms ; Children ; Surgery ; Radiotherapy ; Relapse
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Past studies of craniopharyngiomas in children have shown overall survival (OS) up to 95% at 5 years and 80% progression-free survival (PFS) at 5 years, although many of these series predate modern neuroimaging and current therapeutic management. Moreover, little mention has been made of failure patterns for craniopharyngioma in children. To obtain a contemporary assessment of outcome among pediatric craniopharyngioma patients, and also to determine the failure patterns for this tumor, we completed a retrospective study of a consecutive cohort of all children with craniopharyngioma diagnosed at the Johns Hopkins Hospital from 1980 to 1996. Resection was performed in 30 children, in 8 of whom gross total resection (GTR) was achieved. Initial treatment took the form of GTR followed by observation for 8, subtotal resection (STR) plus observation in 11, and STR followed immediately by radiotherapy in 8. The timing of radiotherapy following STR was unclear for 3. OS was 95.2% (SE= 4.7%) at 5 years, with only 2 children dying after 4 years from diagnosis. Five-year PFS was 59.4% (SE=10.2%). Before surgery, 19 children had visual loss and 15, endocrine deficits; after surgery, 21 children had visual loss and 29, endocrine deficits. Median time to relapse was 0.98 years (SD=2.5 years). Radiographic (n=4) and clinical (n=7) relapses did not differ in time to progression (P=0.32), but radiographic relapses were significantly associated with age at diagnosis less than 5 years (P=0.02). Degree of resection was not significantly associated with PFS (P=0.32) or with postoperative visual or endocrine deficits. Absence of calcification on diagnostic neuroimaging (n=8) was significantly associated with improved PFS [5-year PFS 100% vs. 42.9% (SE=14.7%), P=0.02], even when adjusted for extent of resection (P=0.03). Preoperative visual loss was predictive of postoperative visual loss (P=0.03). Survival for children diagnosed with craniopharyngioma in the current era is outstanding, even with relapse, although postoperative visual and endocrinological morbidities are high. Failures occurred both radiographically and clinically, typically in the first 3–4 years after surgery, suggesting a need for close surveillance initially with neuroimaging, particularly in younger children, and also clinical examination. The short times to relapse observed here may stem from a tendency to delay radiotherapy until recurrence. Lack of calcification at diagnosis is associated with a tendency to remain free of relapse.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050272
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  • 61
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    Electronic Resource
    Pilot neuropsychological findings from a treatment regimen consisting of intensive chemotherapy and bone marrow rescue for young children with newly diagnosed malignant brain tumors (1998)
    Springer
    Child's nervous system 14 (1998), S. 587-589 
    Details
    ISSN: 1433-0350
    Keywords: Key words Brain tumor ; Children ; Treatment ; Neuropsychology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ten children (6 girls and 4 boys) who completed a protocol in which their localized brain tumors were successfully treated without cranial irradiation were referred for neuropsychological assessment. At the time of testing, they were disease free without any neuroaxis dissemination or leptomeningeal disease. Tumor types included pineoblastoma, glioblastoma, ependymoma, PNET and medulloblastoma. They had a mean age of 5 years and 8 months (SD = 1.86; range = 2.1–8.9 years) and were an average of 37.8 months post bone marrow transplant (SD = 16.42; range = 14–58 months). Neuropsychological data from this study reveal that the mean scores for this nonradiated group of children were within the average range for the following domains: academic achievement tests of reading, spelling and mathematics, verbal and visual memory, visual-motor integration, social-emotional and behavioral functioning. Furthermore, this group of children were performing within the low average range of overall Intelligence, as well as both verbal IQ/verbal reasoning and performance IQ/abstract visual reasoning. On tasks of fine motor dexterity, this group was within the low average range when using their dominant hand; however, they performed within the borderline range when using their non-dominant hand. Of note, this group of children demonstrated significant deficits within the borderline to impaired ranges on language tasks of expressive picture naming and receptive picture vocabulary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050277
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  • 62
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    Electronic Resource
    Effectiveness of pediatric practice consultation on missed opportunities for immunization (1998)
    Springer
    Journal of urban health 75 (1998), S. 123-134 
    Details
    ISSN: 1468-2869
    Keywords: Vaccination ; Immunization ; Missed opportunities ; Children ; Primary care ; Tracking system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the effectiveness of pediatric practice consultation in reducing missed-opportunity rates at eight pediatric sites in Baltimore, Maryland. The overarching goal was to decrease the occurrence of missed opportunities from 33% to 15% for the first, second, and third diphtheria and tetanus toxoids and pertussis vaccines during visits at which children were eligible for the vaccines. Design The effect of an in-office educational program alone at four sites is compared with the educational program and a consultation on office vaccination practices at four matched sites. All eight sites received a small grant ($2,000) to fund practice changes. The medical records of children making visits before and after the interventions were audited to determine missed-opportunity rates. The policies and operations and the knowledge, attitudes, and practices of physicians and nurse practitioners at each site were also assessed. Results The four education-consultation sites experienced a statistically significant 14% net reduction in the missed-opportunity rate relative to the education-only sites. This positive effect, however, was largely due to an increase in missed opportunities at one education-only site. There was a 10% increase in the missed-opportunity rate among the education-only sites and a 4% decrease among the education-consultation sites; neither change was statistically significant. Two of the three sites that reduced missed opportunities were matched health maintenance organizations (HMOs). Shortly after the interventions, both HMOs implemented tracking and follow-up information systems, which were planned before the interventions. Conclusions There is no evidence that either the educational program alone or the educational program and consultation combination reduced missed opportunities. The findings suggest that improved tracking and follow-up data systems and vaccination of children at sick visits may reduce missed opportunities.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02344934
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  • 63
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    Electronic Resource
    Incidence of type 1 diabetes mellitus in children in Slovenia during the years 1988–1995 (1998)
    Springer
    Acta diabetologica 35 (1998), S. 112-114 
    Details
    ISSN: 1432-5233
    Keywords: Key words Type 1 diabetes ; Incidence ; Children ; Slovenia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The incidence of type 1 diabetes mellitus in Slovenian children aged 0 – 14 years was studied between 1 January 1988 and 31 December 1995. The crude annual incidence rate of the disease (per 100 000) over this 8-year period was 8.00 (95% C. I. 6.98 – 9.02) for both sexes (7.18 for boys and 8.87 for girls). Thus, the incidence standardized to the world population was 7.59 (95% C. I. 6.57 – 8.61). Male/female ratios were 1.33 in the age group 0 – 4 years, 0.66 in the age group 5 – 9 years, and 0.83 in the age group 10 – 14 years. The study has proven that the incidence of type 1 diabetes in Slovenia is similar to that in other central European countries where the population is of different ethnic origin. However, a remarkably higher incidence of the disease in girls than boys except in the age group below 5 years of age was found which needs further investigation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005920050115
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  • 64
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    Electronic Resource
    Does tacrolimus cause more severe anemia than cyclosporine A in children after renal transplantation? (1998)
    Springer
    Transplant international 11 (1998), S. S328 
    Details
    ISSN: 1432-2277
    Keywords: Key words Tacrolimus ; Cyclosporine A ; Renal transplantation ; Anemia ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Initial reports indicated the possibility of severe anemia associated with tacrolimus (TC) therapy. We investigated the degree of anemia under TC treatment in comparison to cyclosporine A (CsA) treatment in children after renal transplantation. A cross-sectional analysis of 95 children successfully transplanted for at least 3 months was performed. Eighty-five children received CsA and 10 TC. TC-treated patients were compared with CsA-treated patients who were matched according to age, gender, creatinine clearance, and time after transplantation. No patient received additional therapy with mycophenolate mofetil or azathioprine. The creatinine clearance of the whole group of transplanted children was 58 ml/min per 1.73 m2. The patients within the matched-pair analysis had a lower creatinine clearance (TC 46 and CsA 48 ml/min per 1.73 m2). The hemoglobin was 10.3 g/dl for the TC-treated children and 10.4 g/dl among the CsA-treated patients. Numerically, EPO was higher and iron lower in the TC group than in the CsA group. Among children with functioning renal grafts, a correlation exists between Hb and creatinine clearance. A significant difference in the degree of anemia between TC- and CsA-treated children could not be found.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050490
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    Electronic Resource
    Short-term anabolic effects of recombinant human growth hormone in young patients with a renal transplant (1998)
    Springer
    Transplant international 11 (1998), S. S69 
    Details
    ISSN: 1432-2277
    Keywords: Key words Recombinant human growth hormone ; Renal transplantation ; Children ; Nitrogen balance ; Body composition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Renal-transplanted children may present stunted growth, negative nitrogen balance (Nb), and alterations in body composition. Recombinant human growth hormone (rhGH) is a potent anabolic agent which improves nutritional status and Nb. In renal-transplanted children, rhGH increases growth velocity but its effect on nutritional status has not been reported. We evaluated the effect of 6 months of rhGH treatment on Nb, urea nitrogen appearance (UNA), anthropometric indexes, and growth velocity in 14 pediatric patients with a renal transplant. Nb improved significantly (P = 0.02) and was accompanied by a decrease of UNA. A significant improvement was observed also in mid-arm muscle circumference (P = 0.002), arm muscle are (P = 0.001), and arm fat are (P = 0.017). Growth velocity increased in prepubertal patients (P = 0.003). Creatinine clearance and the number of rejection episodes were not affected by rhGH treatment. In conclusion, short-term administration of rhGH improves Nb and UNA as well as the main indexes of body composition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050429
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  • 66
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    Electronic Resource
    Technetium-99m mercaptoacetyltriglycine clearance values in children with minimal renal disease: can a normal range be determined? (1998)
    Springer
    European journal of nuclear medicine 25 (1998), S. 760-765 
    Details
    ISSN: 1619-7089
    Keywords: Key words: Technetium-99m mercaptoacetyltriglycine ; Clearance values ; Children ; Minimal renal disease ; Normal ranges
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Use of technetium-99m labelled mercaptoacetyltriglycine (99mTc-MAG3) simplifies and improves the quantification of renal clearance in children by virtue of its permanent availability, good imaging properties and low radiation exposure. Due to the lack of reference values for 99mTc-MAG3 clearance in children, the Paediatric Task Group of the EANM initiated a multicentre study to evaluate 99mTc-MAG3 clearance values in children with minimal renal disease. One hundred and twenty-five children aged between 12 months and 17 years, classified as renally healthy using defined diagnostic criteria, were included in the study. 99mTc-MAG3 clearance was calculated using an algorithm on the basis of a single blood sample taken at any time between 30 and 40 min after tracer injection. In addition, the absolute 99m-Tc-MAG3 clearance values were normalized to body surface area. For further evaluation the children were classified into several groups according to age. There was a continuous increase in non-corrected 99mTc-MAG3 clearance values from the age of 1 year up to the age of 17 years (mean value 〈2 years: 98±57 ml/min; mean value 〉8 years: 208±66 ml/min). Normal clearance values for adults were achieved by the age of 8 years. Analysis of the relationship between non-corrected clearance and age yielded a correlation coefficient of r=0.7. When these absolute clearance values were normalized to body surface area, we found nearly constant clearance values for all age groups, with a mean clearance value of 315±114 ml/min×1.73 m2. The correlation coefficient for the relationship between normalized clearance and age was r=0.28. In conclusion, the clearance of 99mTc-MAG3 increases continuously throughout childhood into adolescence due to the maturation and growth of the kidney. After normalization of the absolute clearance to body surface area, no correlation between clearance and age could be proven.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002590050280
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  • 67
    Electronic Resource
    Electronic Resource
    Spatial inequality and poverty among American children (1998)
    Springer
    Population research and policy review 17 (1998), S. 91-109 
    Details
    ISSN: 1573-7829
    Keywords: Children ; Poverty ; Spatial inequality ; USA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Sociology
    Notes: Abstract National-level statistics often mask extreme spatial differentiation in child poverty. Using county-level data from the 1990 US decennial census summary tape file, we show that child poverty is distributed unevenly over geographic space. Child poverty is concentrated in counties in Appalachia, the Mississippi Delta, and the southern ‘black belt’. Child poverty rates are strongly influenced by the local industrial composition (e.g., agriculture and manufacturing), but the effects are largely indirect, operating primarily through reduced employment opportunities among adult workers. High county unemployment and underemployment rates contribute directly to children's economic deprivation, as well as indirectly by undermining the formation and stability of two-parent families. Our results highlight existing spatial differentiation and inequality in children's economic well-being, and provide a point of departure for additional research on the geography of child poverty.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005740205017
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  • 68
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    Electronic Resource
    The effects of a hospital staff training program on the treatment practices of postoperative pain in children under 8 years. (1998)
    Springer
    Pharmacy world & science 20 (1998), S. 66-72 
    Details
    ISSN: 1573-739X
    Keywords: Adenoidectomy ; Children ; Day case surgery ; Dosage forms ; Education, professional ; Home care ; Medication ; Pain, postoperative ; Personnel, hospital ; Tonsillectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The widespread use of day case surgery for minor operations in children places increased emphasis on home care, parental responsibility and attention to suitable analgesia. This study evaluated a training program for doctors and nurses on postoperative analgesia in children by following up parental perceptions of pain relief after discharge. The main objective of our study was to determine the effects of a training program on treatment practices in the hospital and on the home care instructions provided. The study was carried out in two phases. A questionnaire was sent to parents of children aged under 8 years who had undergone a minor otorhinolaryngological operation (tonsillectomy, adenoidectomy, irrigation of maxillary sinus, insertion of grommets, or paracentesis) at the Day Case Unit in Kuopio University Hospital. The parents of 115 children returned the questionnaire in the preintervention study and those of 112 children in the postintervention study (response rates: 79% and 86% respectively). The training program for personnel (intervention) was organized between the two studies. It started with a one‐hour lecture on postoperative pain and pain treatment in children, and the lecture was followed by two weeks of bedside teaching. The overall standard of pain treatment in the hospital was good. Most of the children had no pain or only mild pain on discharge (93% before the intervention and 90% after the intervention). The intervention had no effect on the likelihood of children receiving pain medication. Noticeable changes occurred in the selection of pain medicines and dosage forms, and in the increased number of home care instructions provided for parents. We conclude that the training program for both professional groups (doctors and nurses) can be beneficial in changing the treatment practice (especially the use of medicines and dosage forms). Such training programs also make it possible to emphasize the importance of proper instructions for home care and thus to improve the quality of information provided for parents.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008612922281
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  • 69
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    Electronic Resource
    Clinical Evaluation of Attention-Deficit Hyperactivity Disorder by Objective Quantitative Measures (1998)
    Springer
    Child psychiatry & human development 28 (1998), S. 179-188 
    Details
    ISSN: 1573-3327
    Keywords: Actigraph ; Attention-Deficit Hyperactivity Disorder ; Children ; Continuous Performance Test ; Diagnosis ; Matching Familiar Figures Test
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study assessed the diagnostic potential of the actigraph, the Continuous Performance Test, and the Matching Familiar Figures Test in diagnosing attention-deficit hyperactivity disorder (ADHD). Twenty boys previously diagnosed with ADHD and 52 controls were examined. By these measures the boys with ADHD were differentiated from the controls with sensitivity and specificity above 75%. We were able to classify ADHD into eight subtypes by combining the scores of the actigraph and the CPT: “hyperactive-impulsive”, “hyperactive-inattentive”, “impulsive-inattentive”, “hyperactive”, “impulsive”, “inattentive”, “mixed”, and “unspecified” type. These classifications may be useful in diagnosing ADHD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1022885827086
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  • 70
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    Electronic Resource
    Kniegelenkarthroskopie bei Kindern und Jugendlichen (1998)
    Springer
    Arthroskopie 11 (1998), S. 34-43 
    Details
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Knie ; Arthroskopie ; Kinder ; Jugendliche ; Key words Knee ; Arthroscopy ; Children ; Adolescents
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: We report on 1952 arthroscopies of the knee in children aged up to 13 years and on 6464 arthroscopies in adolescents aged 14 to 17. At the same time operative arthroscopy was performed in 64% of the children and in 73% of the adolescents. The preoperative diagnosis was shown to be incorrect in 25% of the children and 24% of adolescents. Hemarthrosis was found in 35% of the children and in 29% of the adolescents. The most frequent pathology was in the patella (30% of the children and 41% of the adolescents). In the upper recessus, the distribution was 29% and 24% respectively, and 21% and 24% respectively, at the medial capsule and 16% and 14% at the medial femur condyle. A lesion of the ACL was obvious in 15% of the children and in 26% of the adolescents. A lesion of the medial meniscus was documented in 8% of the children and in 15% of the adolescents and in the lateral meniscus in 10% and 11% respectively. The most frequent operation was carried out on the synovia in 26% of the children and in 22% of the adolescents and on the plica in 23% and 24% respectively. A lateral release was performed in 19% of the children and in 18% of the adolescents, followed by operations on the joint space in 16% and 13%, respectively, on the patella in 16% and 19% respectively and on the medial condyle in 16% and 8% respectively. Operations on the medial meniscus were performed in 10% of the children in 18% of the adolescents, on the lateral meniscus in 10% and 12% respectively, and on the cruciate ligaments in 4% and 10% respectively. Diagnostic problems occurred in 1.4% of the children and in 1.2% of the adolescents and operative problems in 1.8% and 1.4% respectively. The intraoperative complication rate was found to be 2% in children and adolescents. Only rarely does diagnostic and operative arthroscopy in children and adolescents have problems and complications. Therefore, we conclude that either diagnostic or operative arthroscopy can be recommended under the following circumstances: In hemarthrosis, if ligament or meniscal lesions are suspected, after acute or recurrent patella dislocation, in knee joint effusion or pain for an unknown reason, for lavage of septic knee joints and if clinical examination or NMR is not possible because of pain or fear.
    Notes: 1952 Arthroskopien bei Kindern im Alter bis zu 13 Jahren und 6464 Arthroskopien bei Jugendlichen im Alter von 14–17 Jahren wurden retrolektiv ausgewertet. Dabei handelte es sich in 64% bei Kindern und 73% bei Jugendlichen um eine therapeutische Arthroskopie. Die Einweisungsdiagnose wurde in 25% der Fälle bei Kindern und 24% der Jugendlichen durch die Arthroskopie nicht bestätigt. Bei Kindern betrug die Hämarthrosrate 35% und bei Jugendlichen 29%. Der häufigste pathologische Befund fand sich bei Kindern mit 30% und Jugendlichen mit 41% an der Patella, in 29% bzw. 24% im oberen Recessus, in 21% bzw. 24% an der medialen Kapsel und in 16% bzw. 14% am medialen Femurkondylus. Eine Pathologie am vorderen Kreuzband bestand bei Kindern in 15% und bei Jugendlichen in 26% der Fälle, während ein Schaden am medialen Meniskus bei Kindern in 8% und Jugendlichen in 15% und am lateralen Meniskus in 10% bzw. 11% der Fälle dokumentiert wurde. Am häufigsten erfolgte eine Operation an der Synovialis bei Kindern in 26% und Jugendlichen in 22%, an den Plicae in 23% bzw. 24% der Fälle. Das laterale Release wurde bei Kindern in 19% und bei Jugendlichen in 18% der Fälle durchgeführt. Es folgten bei Kindern und Jugendlichen in 16% bzw. 13% Operationen im Gelenkraum, in 16% bzw. 19% an der Patella, in 16% bzw. 8% am medialen Kondylus. Operationen am medialen Meniskus wurden bei Kindern in 10% und bei Jugendlichen in 18% und am lateralen Menikus in 10% bzw. 12% und am Kreuzband in 4% bzw. 10% der Fälle durchgeführt. Diagnostische Probleme traten bei Kindern in 1,4% und bei Jugendlichen in 1,2% auf und operative Probleme in 1,8% bzw. 1,4%. Die intraoperative Komplikationsrate betrug bei Kindern und Jugendlichen 2%. Die diagnostische und therapeutische Arthroskopie ist bei Kindern und Jugendlichen eine problem- und komplikationsarme Operation und ist aus diagnostischer und therapeutischer Sicht indiziert beim Hämarthros, bei vermuteter Band- und Meniskusläsion, bei akuter und rezidivierender Patelladislokation, beim Kniegelenkerguß und Schmerz aus unklarer Ursache, zur Therapie des septischen Kniegelenks und falls die klinische und kernspintomographische Untersuchung schmerz- oder angstbedingt nicht möglich ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001420050007
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    Wertigkeit der diagnostischen Arthroskopie am kindlichen Kniegelenk im Vergleich zur Magnetresonanztomographie (1998)
    Springer
    Arthroskopie 11 (1998), S. 2-10 
    Details
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Arthroskopie ; Kinder ; Magnetresonanztomographie ; Diagnostik ; Key words Arthroscopy ; Children ; MRI ; Diagnostic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Improved preoperative diagnostic techniques have resulted in a change in the indication for surgery in children. This applies in particular to diagnostic arthroscopies, the number of which is decreasing. The increased availability and improved technique of magnetic resonance imaging has provided us with a more accurate diagnosis of intraarticular lesions, especially anterior cruciate ligament ruptures and cartilage and bone lesions, which can be diagnosed noninvasively. The sensitivity of magnetic resonance imaging for meniscus and anterior cruciate ligament injuries varies between 72% and 95% and the specificity between 79% and 97%. Arthroscopy in children should therefore focus on therapeutic procedures. Diagnostic arthroscopy should only be performed in children with severe disability and normal imaging findings.
    Notes: In der Kinderarthroskopie haben die verbesserten präoperativen diagnostischen Möglichkeiten zu einem Wandel in der Indikationsstellung geführt. Dieser betrifft insbesondere die diagnostischen Arthroskopien die aufgrund differenzierter Indikationsstellungen rückläufig sind. Die Verbreitung und Weiterentwicklung der magnetresonanztomographischen Technik hat dazu geführt, daß viele Kniebinnenschäden, insbesondere traumatische Veränderungen mit Rissen der Kreuzbänder sowie Korpel- und Knochenschäden, nichtinvasiv diagnostiziert werden können. Die Sensitivität der Magnetresonanztomographie für Meniskus- und Kreuzbandverletzungen liegt bei 72–95% und die Spezifität bei 79–97%. In der Kinderarthroskopie sollte daher der Schwerpunkt auf dem operativ-therapeutischen Eingriff liegen. Die Arthroskopie sollte nur noch bei starken Beschwerden und unauffälligen bildgebenden Verfahren zu diagnostischen Zwecken eingesetzt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001420050002
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  • 72
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    Assessing health-related quality of life in chronically ill children with the German KINDL: first psychometric and content analytical results (1998)
    Springer
    Quality of life research 7 (1998), S. 399-407 
    Details
    ISSN: 1573-2649
    Keywords: Children ; quality of life; ; KINDL questionnaire; ; diabetes; ; asthma.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Health-related quality of life is increasingly being considered as a relevant end-point and outcome criterion in evaluating the effects of medical treatment. While in adults quality of life instruments have been developed in terms of generic as well as disease-specific measures, quality of life assessment and children is a relatively new area. The current paper describes the application of a German generic quality of life instrument for children (the KINDL) in a group of 45 chronically ill children suffering from diabetes or asthma in comparison to 45 age- and gender-matched healthy children. The results of psychometric testing in these populations showed that the German KINDL is a reliable, valid and practical instrument to assess the health-related quality of life of children which should be supplemented by disease-specific modules and needs to be further tested in clinical populations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008853819715
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  • 73
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    Electronic Resource
    Clinical presentation of a sphenochoanal polyp (1998)
    Springer
    European archives of oto-rhino-laryngology and head & neck 255 (1998), S. 138-139 
    Details
    ISSN: 1434-4726
    Keywords: Key words Chronic sinusitis ; Sphenochoanal polyp ; Endoscopic sinus surgery ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the sphenoid sinus is a rare entity. In this report, an unusual case of a large choanal polyp taking origin from the sphenoid sinus is presented. The reasons for its development and methods of management are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050030
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  • 74
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    Electronic Resource
    Toxicity of antirheumatic and anti-inflammatory drugs in children (1998)
    Springer
    Clinical rheumatology 17 (1998), S. 505-510 
    Details
    ISSN: 1434-9949
    Keywords: Children ; DMARD ; NSAID ; Toxicity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the study was to describe the longterm toxicity of antirheumatic and anti-inflammatory drugs in a paediatric rheumatology clinic population. One hundred and seventeen children were studied on first admission to a paediatric rheumatology clinic and after a mean of 8.6±0.4 years of follow-up. Medical records from the intermediate period were reviewed. The patients had 155 exposures to non-steroidal anti-inflammatory drugs (NSAIDs), 88 exposures to disease-modifying antirheumatic drugs (DMARDs) and 12 exposures of prednisolone during a total of 682 patient years. Drug toxicity was measured in terms of the number of toxic events, number of drug discontinuations due to toxicity, number of side-effects per patient year of drug exposure and as a toxicity index. Side-effects were seen in 69 (27%) of the drug exposures, corresponding to 0.10 toxic events per patient year of exposure. Abdominal pain was the most common side-effect, and was reported in 21 (14%) of the exposures to NSAIDs. Five severely toxic events, all leading to hospitalisation, occurred. The toxicity of NSAIDs was not significantly different from that of DMARDs with regard to the number of toxic events (21% and 31%, respectively, NS) and drug discontinuations due to toxicity (17% and 14%, respectively, NS). Piroxicam tended to be more toxic than ibuprofen (46% versus 18% toxic events,p〈0.05; 36% versus 16% discontinuations due to toxicity, NS; 0.33 versus 0.05 side-effects per patient year and a toxicity index of 1.45 versus 0.20 units per patient year). Gold tended to be more toxic than antimalarials (41% versus 15% toxic events,p〈0.05; 24% versus 12% discontinuations, NS; 0.37 versus 0.08 side-effects per patient year and a toxicity index of 1.56 versus 0.23 units per patient year). It was concluded that antirheumatic and anti-inflammatory drugs led to side-effects in 27% of the exposed children during 9 years of follow-up. There was an overlap of the toxicity of certain NSAIDs and the most commonly employed DMARDs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01451288
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  • 75
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    Electronic Resource
    Outreach and the State Children's Health Insurance Program (1998)
    Springer
    Maternal and child health journal 2 (1998), S. 127-129 
    Details
    ISSN: 1573-6628
    Keywords: Children ; State Children's Health Insurance Program ; outreach ; implementation tools ; uninsured
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The National Center for Education in Maternal and Child Health has developed three new tools for use by policymakers, program managers, and communities that are implementing the new State Children's Health Insurance Program legislation. These documents provide a philosophy and offer technical assistance for a broad definition of outreach that emphasizes finding, enrolling, and serving low-income uninsured children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1022949008164
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  • 76
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    Electronic Resource
    Structure and Dynamics of Hydrogen Chelates. Part 1. NMR-spectroscopic studies in the quinazoline-2-acetonitrile series (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 236-250 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: To get informations on both the structure and dynamics of hydrogen chelates 1 of heteroaromatic systems, a great variety of quinazoline-2-acetonitrile chelates were synthesized (see 2-4). Similarly to the situation of the corresponding H-chelates in the pyrimidine-2-acetonitrile series, the investigation of these new derivatives 2-4 by NMR spectroscopic methods (DNMR, COSY, NOESY, ROESY, EXSY, HMQC, HMBC) confirms the presence of an equilibrium of the two possible H-chelate structures (two ‘rotamers’ I and II, i.e., (E)/(Z) isomers; see Scheme). The corresponding equilibria I ⇌ II were determined by complete 1H-NMR signal assignment at low temperatures (after freezing the rotational processes). In addition, the tautomer equilibria A ⇌ B (relative energies of the two minima of the nonsymmetrical double-well potential) for both ‘rotamers’ are ascertained by H,H and C,H couplings. The results are an important basis for the interpretation of both the UV/VIS absorptions and the dependence of fluorescence and fluorescence quantum yields on temperature.
    Additional Material: 4 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810206
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  • 77
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    Stereoselective Reactions of Phthalimido-Substituted Radicals Derived from (±)-Threonine: A comparison with reactions of N-phthaloyliminium ions (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 268-284 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Stereoselective reactions of phthalimido-substituted radicals derived from (±)-threonine with different radical traps are reported (Scheme 3, Table 1). A strong influence of the nature of the radical trap on the stereoselectivity was noticed. Small nucleophilic radical traps gave preferentially the syn products. The observed selectivities are explained with the A1,3 strain model and depend on steric and electronic effects (Fig. 2). Reactions with electrophilic radical traps such as diphenyl diselenide gave the anti diastereoisomers with moderate stereocontrol, presumably due to stereoelectronic effects. The same stereochemical outcome, i.e., preferential formation of the anti products, was observed for the reactions of the related N-phthaloyliminium ion (Scheme 5, Table 2). The stereochemistry of the ionic reaction is rationalized by a Felkin-Anh model (Fig. 3).
    Additional Material: 3 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810208
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  • 78
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    Cyclopalladation of 1,1′-Azonaphthalene (= Di(naphthalen-1-yl)diazene): Isolation and characterization of two isomeric complexes (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 307-316 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The cyclopalladation of 1,1′-azonaphthalene (= di(naphthalen-1-yl)diazene; 2) with bis(hexafluoroacetyl-acetonato)palladium(II) (3; [Pd(hfa)2]) yields the ortho-palladated complex (1,1,1,5,5,5-hexafluoropentane-2,4-dionato-κ2O,O′)[1-(naphthalen-1-ylazo-κN2)naphthalen-2-yl-κC2]palladium(II) (4) as well as the peri-palladated complex (1,1,1,5,5,5-hexafluoropentane-2,4-dionato-κ2O,O′)[8-(naphthalen-1-ylazo-κN2)naphthalen-1-yl-κC1]-palladium(II) (5); their structures were corroborated by X-ray analyses. The formation of the novel peri-metallated product 5 containing a six-membered palladacycle strongly depends upon the reaction conditions.
    Additional Material: 2 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810211
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  • 79
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    The Photoisomerization Behavior of the (4-Hydroxycinnamoyl)-spermidines (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 342-352 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The photoisomerization behavior of three mono[(E)-3-(4-hydroxyphenyl)prop-2-enoyl]spermidines, 1, 2, and 3, and three bis[(E)-3-(4-hydroxyphenyl)prop-2-enoyl]spermidines, 4, 5, and 6, are investigated. The synthetic product (E)-1 could be almost quantitatively (〉 96%) converted into its isomer (Z)-1 under UV light irradiation. In the cases of (E)-2 and (E)-3, a mixture of (E)/(Z) ca. 1:2 was obtained, when the same conditions were applied. The comparison of their UV spectra provides the possible explanation for these different behaviors. Furthermore, it was noticed that the (Z) → (E) isomerization of the C=C bond took place during the purification by reverse-phase high-performance liquid chromatography (RP-HPLC), and the (E)/(Z)-mixture is thus inseparable. The same feature could be observed during the isolation of the (Z,Z)-N,N′-bis[3-(4-hydroxyphenyl)prop-2-enoyl]-spermidines, (Z,Z)-4, (Z,Z)-5, and (Z,Z)-6. Nevertheless, the fractions of (Z,Z)-5 and (Z,Z)-6 were in almost pure state collected, and their 1-NMR spectra are presented.
    Additional Material: 5 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810215
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    Preparation and Absolute Configuration of (-)-(E)-α-trans-Bergamotenone (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 153-162 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The synthesis, absolute configuration, and olfactive evaluation of (-)-(E)-α-trans-bergamotenone (= (-)-(1′S,6′R,E)-5-(2′,6′-dimethylbicyclo[3.1.1]hept-2′-en-6′-yl)pent-3-en-2-one; (-)-1), as well as its homologue (-)-19 are reperted. The previously arbitrarily attributed absolute configuration of 1 and of (-)-α-trans-bergamotene (= (-)-(1 S,6R)-2,6-dimethyl-6-(4-methylpent-3-enyl)bicyclo[3.1. 1]hept-2-ene; (-)-2), together with those of the structurally related aldehydes (-)-3a,b and alcohols (-)-4a,b, have been rigorously assigned.
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    URL: http://dx.doi.org/10.1002/hlca.19980810114
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  • 81
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    New Synthesis and Chirality of (-)-4,4,4,4′,4′,4′-Hexafluorovaline (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 182-186 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: (-)-(R)-4,4,4,4′,4′,4′-Hexafluorovaline hydrochloride ((R)-5) of 98% ee is prepared from β,β-bis(trifluoromethyl)acrylic acid (= benzyl 4,4,4-trifluoro-3-(trifluoromethyl)but-2-enoate; 1) in 4 steps with an overall yield of 9.6%. Key step is the separation of the TsOH salts of the diastereoisomers obtained by anti-Michael addition of (+)-(R)-1-phenylethylamine (2) to 1 (→ (R,R)-3). In contrast to the published (S)-chirality, the X-ray structure analysis of (R,S)-6 reveals, that (R)-chirality has to be assigned to the levorotatory (-)-4,4,4,4′,4′,4′-hexafluorovaline hydrochloride.
    Additional Material: 2 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810117
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  • 82
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    Tripodal Dodecadentate Ligands with Salicylamide and bipyridine binding sites for iron(II) and iron(III) coordination (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 207-218 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The synthesis and characterization of tripodal dodecadentate ligands with salicylamide and bipyridine binding sites for iron(II) and iron(III) are presented.
    Additional Material: 1 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810203
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  • 83
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    N,N-Dialkylcarbamato Complexes of the d10 cations of copper, silver, and gold (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 219-230 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The reaction of CuO'Bu with CO2, and iPr2NH in the presence of PPh3, gives the dialkylcarbamato complex [Cu(O2CNiPr2)(PPh3)2] (1). The CO2/R2NH system (R = Me, Et) in an appropriate organic medium reacts with Ag2O giving the corresponding N,N-dialkylcarbamato complexes of analytical formula [Ag(C2CNR2)] (R = Me, 2; R = Et, 3). The methyl derivative 2 was characterized by X-ray diffraction methods. Crystal data of 2: for [Ag2(O2CNMe2)2], C6H12Ag2N2O4, mol. wt. 391.9; monoclinic, space group P21/c, a = 12.08(1), b = 3.797(2), c = 11.316(7) Å, β = 113.37(6)°, V = 476.3 Å3, Z = 2, Dc = 2.732 g cm-3; μ(MoKα) = 40.64 cm-1, F(000) = 376.0; R = 0.059, Rw = 0.067; g.o.f. 1.27. The structure consists of dinuclear [(Ag2OCNMe2)2] units with slightly distorted linearly two-coordinated Ag-atoms containing bridging carbamato groups to form a substantially planar eight-membered ring with an intra-annular Ag—Ag distance of 2.837(2) Å; the dinuclear units are further joined by Ag—O bonds to form an infinite array. Compound 3, which is presumably dinuclear, as suggested by cryoscopic measurements in benzene, undergoes a structural fission with PPh3, giving the mononuclear triphenylphosphine derivative [Ag(O2CNEt2)(PPh3)2] (4). The amine-catalyzed conversion of Ag2O into Ag2CO3, in the presence of the iPr2NH/CO2 system, is also reported. Cl-Exchange from [AuCl(PPh3)] with [Ag(O2CNEt2)] (3) gives the first N,N-dialkylcarbamato complex of gold, namely [Au(O2CNEt2)(PPh3)] (5), which crystallizes in the monoclinic system: C23H25AuNO2P · 0.5 C7H16, mol. wt. 625.5, space group P21/c; a = 13.212(5), b = 12.25(1), c = 16.795(6) Å, β = 109.09(2)°, V = 2568(2) Å3, Z = 4, Dc, = 1.618 g cm-3; μ(AgKα) = 31.40 cm-1, F(000) = 1236.0; R = 0.058; Rw = 0.064; g.o.f. 2.121. The compound contains two-coordinated Au-atom, namely to the P-atom and to the O-atom of the monodentate carbamato group, the P—Au—O bond angle being 174.7(3)°. The reaction with MeI showed these compounds to react predominantly at the carbamato O-atom giving the corresponding urethanes R2NCO2Me. Evidence was gathered for the transient coordination of CO to Ag in 3.
    Additional Material: 2 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810204
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    1,3-Oxathiole and Thiirane Derivatives from the Reactions of Azibenzil and α-diazo amides with thiocarbonyl compounds (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 285-302 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The reactions of α-diazo ketones 1a,b with 9H-fluorene-9-thione (2f) in THF at room temperature yielded the symmetrical 1,3-dithiolanes 7a,b, whereas 1b and 2,2,4,4-tetramethylcyclobutane-1,3-dithione (2d) in THF at 60° led to a mixture of two stereoisomeric 1,3-oxathiole derivatives cis- and trans-9a (Scheme 2). With 2-diazo-1,2-diphenylethanone (1c), thio ketones 2a-d as well as 1,3-thiazole-5(4H)-thione 2g reacted to give 1,3-oxathiole derivatives exclusively (Schemes 3 and 4). As the reactions with 1c were more sluggish than those with 1a,b, they were catalyzed either by the addition of LiClO4 or by Rh2(OAc)4. In the case of 2d in THF/LiClO4 at room temperature, a mixture of the monoadduct 4d and the stereoisomeric bis-adducts cis- and trans-9b was formed. Monoadduct 4d could be transformed to cis- and trans-9b by treatment with 1c in the presence of Rh2(OAc)4 (Scheme 4). Xanthione (2e) and 1c in THF at room temperature reacted only when catalyzed with Rh2(OAc)4, and, in contrast to the previous reactions, the benzoyl-substituted thiirane derivative 5a was the sole product (Scheme 4). Both types of reaction were observed with α-diazo amides 1d,e (Schemes 5-7). It is worth mentioning that formation of 1,3-oxathiole or thiirane is not only dependent on the type of the carbonyl compound 2 but also on the α-diazo amide. In the case of 1d and thioxocyclobutanone 2c in THF at room temperature, the primary cycloadduct 12 was the main product. Heating the mixture to 60°, 1,3-oxathiole 10d as well as the spirocyclic thiirane-carboxamide 11b were formed. Thiirane-carboxamides 11d-g were desulfurized with (Me2N)3P in THF at 60°, yielding the corresponding acrylamide derivatives (Scheme 7). All reactions are rationalized by a mechanism via initial formation of acyl-substituted thiocarbonyl ylides which undergo either a 1,5-dipolar electrocyclization to give 1,3-oxathiole derivatives or a 1,3-dipolar electrocyclization to yield thiiranes. Only in the case of the most reactive 9H-fluorene-9-thione (2f) is the thiocarbonyl ylide trapped by a second molecule of 2f to give 1,3-dithiolane derivatives by a 1,3-dipolar cycloaddition.
    Additional Material: 3 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810209
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    Masthead (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998) 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810301
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  • 86
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    Synthesis of Chiral C2-Symmetric Binucleating Ligands (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 491-506 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The synthesis of a series of chiral enantiomerically pure C2-symmetric binucleating ligands is reported. Ligands of type 1-4, which consist of a phenolic or heterocyclic unit bridging two chiral dihydrooxazole rings. are readily accessible from chiral amino alcohols. Ligands 5a and 5b are composed of a cyclic urea or thiourea unit, respectively, and two 3,4-dihydro-2H-pyrrole rings containing a stereogenic center next to the N-atom. Compounds of this type are readily assembled from ethane-1,2-diamine and an imidothioic ester derived from pyroglutamic acid. These new ligands, which can coordinate two metals in close proximity to each other, are of interest regarding possible applications in asymmetric catalysis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810304
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  • 87
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    Stability and Lability of Dicopper Double-Stranded Helicates in Solution (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 548-557 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Stability constants have been measured for a series of ligands based on a 2,2′-(pyridine-2,6-diyl)bis[1H-benzimidazole] unit which forms dinuclear double-stranded helical complexes with copper(I). Variation of different structural parameters confirms the importance of the coordinate bond, the stacking interactions, and the weakly bridging pyridine units observed by X-ray crystallography. The stabilities of the complexes depend strongly on the solvent, and in MeCN, which is a good solvent for copper(I), the complexes are less stable and assemble in a stepwise manner. The interconversion of the enantiomers may be followed by 1H-NMR and takes place on a millisecond time scale around room temperature. The trends in lability are similar to those found for the stability of the complexes.
    Additional Material: 3 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810308
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  • 88
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    7-Deazapurine Oligodeoxyribonucleotides: The effects of 7-deaza-8-methylguanine on dna structure and stability (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 570-583 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Oligodeoxyribonucleotides containing 7-deaza-2′-deoxy-8-methylguanosine (m8c7Gd; 2b) were prepared. For this purpose, the phosphonate 3a and the phosphoramidite 3b were synthesized and employed in solidphase oligodeoxyribonucleotide synthesis. The structures and the thermodynamic data of duplex formation of oligodeoxyribonucleotides containing 2b were investigated by temperature-dependent CD and UV spectra and compared with those containing 7-deaza-2′-deoxy-7-methylguanosine (m7c7Gd) or 7-deaza-2′-deoxy-guanosine (c7Gd; 2a). In general, compound 2b reduces the duplex stability. In case of the sequence d(m8c7G-C)4 (18), the B → Z transition was facilitated by the incorporation of 2b. Moreover, a single 7-deaza-8-methylguanine residue present in an oligodeoxyribonucleotide tract of guanine residues destabilizes the dG quadruplex significantly. This destabilization is more pronounced than in the case of 7-deazaguanine or 7-deaza-7-methyl-guanine.
    Additional Material: 5 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810310
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  • 89
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    Absolute rate Constants for the Addition of Malonyl Radicals to Alkenes in Solution (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 770-780 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Absolute rate constants and their Arrhenius parameters are obtained for the addition of a cyclic malonyl radical derived from Meldrum's acid to 20 mono- or 1,1-disubstituted alkenes in (±)-propylene oxide and for the addition of the open-chain di(tert-butyl)malonyl radical to six mono- or 1,1-disubstituted alkenes in 1,1,2-trichloro-1,2,2-trifluoroethane by time-resolved electron spin resonance spectroscopy. At room temperature, the radicals add at the unsubstituted C-atoms with rate constants ranging from 1.1. 105 M-1S-1 (acrolein) to 2.4. 106 M-1S-1 (1,1-diphenylethene). The frequency factors are in the narrow ranges of log (A/M-1S-1) = 8.7 ± 0.1 for the cyclic and log (A/M-1S-1) = 8.2 ± 0.2 for the open-chain malonyl species, whereas the activation energies vary from 12.9 kJ/mol (1,1-diphenylethene) to 21.7 kJ/mol (acrylonitrile). They correlate with the alkene ionization potentials and, more weakly, with the reaction enthalpy. No correlation was found between the activation energies and the alkene electron affinities. Hence, the results confirm and quantify the electrophilic nature of malonyl radicals in addition reactions.
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    URL: http://dx.doi.org/10.1002/hlca.19980810327
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  • 90
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    Synthesis of the Spermidine Alkaloid (-)-(4R)-Dihydroisomyricoidine (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 1303-1318 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: An asymmetric synthesis of (-)-(4R)-dihydroisomyricoidine (28), a 13-membered amino lactam of type A, was performed by a diastereoselective Michael addition between the spermidine derivative 3 and the commercially available optically active ethyl carboxylate 4, and the cyclization of the resulting ω-amino acid 7 using diethyl phosphorocyanidate ((EtO)2POCN), followed by a Wittig reaction to introduce the (Z)-side chain. Some side reactions are also discussed.
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    URL: http://dx.doi.org/10.1002/hlca.19980810541
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  • 91
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    New Types of Potentially Antimalarial Agents: Epidioxy-substituted norditerpene and norsesterpenes from the marine sponge Diacarnus levii (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 1285-1292 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Natural free carboxylic acids from the hadromerid sponge Diacarnus levii (Kelly-Borges and Vacelet) were esterified to yield the new cyclic norditerpene peroxides ent-muqubilin benzyl ester (= (αR,3S,6R)-α,6-dimethyl-6-[(E)-4-methyl-6-(2,6,6-trimethyl-cyclohex-1-en-1-yl)hex-3-enyl]-1,2-dioxan-3-acetic acid benzyl ester; 6, diacarnoate B methyl ester(= (αS,3R,6R)-α,6-dimethyl-6-{2-(4aS,8aS)-3,4,4a,5,6,7,8,8a-octahydro-3-oxo-2,5,5,8a-tetramethylnaphthalen-1-yl)ethyl}-1,2-dioxan-3-acetic acid methyl ester; 9), and deoxydiacarnoate B benzyl ester (= (αS,3R,6R)-α,6-dimethyl-6-{2-[(4aS,8aS)-3,4,4a,5,6,7,8,8a-octahydro-2,5,5,8a-tetramethyl-1-naphthalenyl]ethyl}-1,2-dioxan-3-acetic acid benzyl ester; 10), which were isolated following extensive chromatography. The relative configuration of the peroxide/α-methylacetate moiety of 6, 9, and 10, was directly determined from their NMR spectra. The absolute configurations of the peroxide/α-methylacetate moiety was deduced from comparative 1H-NMR data of the (S)- and (R)-phenylglycine methyl ester derivatives 7 and 8 as well as 11/13 and 12/14, all obtained from a mixture of the precursors of 3, 6, and 10. The absolute configuration at the carbobicyclic moiety of enone 9 and of 10, is identical, as established by chemical interconversion, 9 and 10 belong to the normal labdane series according to empirical CD rules, applied either directly to 9 or to the parent (+)-sclareolide-derived enone 20. In contrast, molar rotation additivity rules suggest the ent-labdane configuration for 9 and 10. The epidioxides 1-3, 6, and 10 proved active in vitro against the malaria parasite Plasmodium falciparum; especially the previously isolated methyl 3-epinuapapuanoate (2) was active against a chloroquine-resistant strain, and this with a good security index.
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    URL: http://dx.doi.org/10.1002/hlca.19980810539
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    3-Hydroxy-2-cyanoalk-2-enamides, and 2-Cyano-2-(tetrahydrofuran-2-ylidene)- and 2-Cyano-2-(tetrahydropyran-2-ylidene)acetamides: Synthesis, structure, and solvent-dependent (Z)/(E)-isomerismDedicated to Professor D. Seebach on the occasion of his 60th birthday (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 1319-1328 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: 3-Hydroxy-2-cyanoalk-2-enamides, and 2-cyano-2-(tetrahydrofuran-2-ylidene)- and 2-cyano-2-(tetrahydropyran-2-ylidene)acetamides with N-alkyl and N-aryl substituents have been synthesized in three steps from cyanoacetic acid. Their conformations were investigated by X-ray crystallography and 1H-NMR ROESY spectroscopy at room temperature. The enolic compounds 1-3 adopt an extended conformation stabilized by a strong intramolecular O—H … O=C bond both in the solid state and in (D6)DMSO solution. In contrast, the structure of the cyclic derivatives 5a,b-8a,b is solvent-dependent. In the solid state and in CDCl3 solution, the compounds adopt an extended conformation of type I or III, while, in (D6)DMSO solution, their structures undergo time-dependent (Z)/(E)-isomerization structures (of type II or IV). This observation is compatible with a dipolar transition state of rotation. The kinetics of the isomerization are controlled by the N-substituent, the N-(t-Bu) derivatives 7a and 7b having the highest barrier of rotation around the C=C bond. The whole body of experimental evidence together with the results of molecular-mechanics calculations with I-IV, indicate that, in DMSO, two (E)/(Z)-isomers with two conformations are present, and that they undergo interconversion at room temperature with four different constants. The very fast exchange rates kI,II and kIII,IV in the NMR time-scale might be responsible for the detection of only two isomers.
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    URL: http://dx.doi.org/10.1002/hlca.19980810542
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  • 93
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    Monoterpene Dimers from Lisianthius seemannii (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 1393-1403 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: A new acylated dimeric secoiridoid glycoside, seemannoside A (2), has been isolated from the aerial parts of Lisianthius seemannii (GRISEB) O. KUNTZE (Gentianaceae). The structure was established by spectroscopic analysis (UV, MS, 1H- and 13C-NMR, and 2D-NMR experiments) and chemical reactions as (E-4′-O-p-coumaroyl)lisianthioside. The structure of the (Z)-isomer (seemannoside B, 3), also present in the plant, was confirmed by LC/UV/1H-NMR analysis. The active principle, 6, responsible for the antifungal activity of the apolar extract against Cladosporium cucumerinum, has been isolated. Its structure has been established by NMR spectroscopy and X-ray crystallographic analysis as a rare type of aglycone monoterpene dimer.
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    URL: http://dx.doi.org/10.1002/hlca.19980810548
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  • 94
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    Asymmetric synthesis of pentono- and 6-deoxyhexono-δ-lactams via hetero-Diels-Alder reactions with nitroso dienophile (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 1417-1428 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Asymmetric Diels-Alder reaction of the pentadienoic and hexadienoic acids 2a,b with the chiral chloronitroso derivative 3 gave the primary adducts 4a,b with good-to-excellent enantioselectivity. Subsequent as- or trans-dihydroxylation and hydrogenolytic cleavage of the N—O bond led to the 5-amino-5-deoxypentono-δ-lactams 13a, 14, 15a, and 16 in the D-ribose, L-arabinose, D-xylose, and L-lyxose series, respectively, and to the 5-amino-5,6-dideoxyhexono-δ-lactams 13b and 15b in the D-allose and D-glucose series, respectively.
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    URL: http://dx.doi.org/10.1002/hlca.19980810550
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  • 95
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    Distamycin-NA: A DNA Analog with an Aromatic Heterocyclic Polyamide Backbone. Part 1. Synthesis and structural analysis of monomers and dimers containing the nucleobase uracil (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 14-34 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The synthesis of the monomeric building block 13 and its constitutional isomer 12 of a new type of DNA analog, distamycin-NA, is presented (Schemes 1 and 2). This building block consists of a uracil base attached to a thiophene core unit via a biaryl-like axis. Next to the biaryl-like axis on the thiophene chromophore, a carboxy and an amino substituent are located allowing for oligomerization via peptide coupling. The proof of constitution and the conformational preferences about the biaryl-like axis were established by means of X-ray analyses of the corresponding nitro derivatives 10 and 11. Thus, the uracil bases are propeller-twisted relative to the thiophene core, and bidentate H-bonds occur between two uracil bases in the crystals. The two amino-acid building blocks 12 and 13 were coupled to give the dimers 15 and 16 using dicyclohexylcarbodiimide (DCC) in THF/LiCl and DMF, respectively. While the dimer 15 showed no atropisomerism on the NMR time scale at room temperature, its isomer 16 occurred as distinct diastereoisomers due to the hindered rotation around its biaryl-like axis. Variable-temperature 1H-NMR experiments allowed to determine a rotational barrier of 19 ± 1 kcal/mol in 16. The experimental data were complemented by AM1 calculations.
    Additional Material: 10 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810103
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  • 96
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    [2+3] Cycloadditions of ‘Thiocarbonyl Ylides’ (= (Alkylidenesulfonio)methanides) and diazoalkanes with N,N′-(thiocarbonyl)diimidazole (= 1,1′-(carbonothioyl)bis[1H-imidazole])Part of the planned Ph.D. Thesis of T.G., University of Łódź.Dedicated to Professor Romuald Bartnik (University of Łódź) on the occasion of his 60th birthday (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 66-77 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Heating of a mixture of N,N′-(thiocarbonyl)diimidazole (= 1,1′-(carbonothioyl)bis[1H-imidazole]; 1) and 2,5-dihydro-1,3,4-thiadiazole 2a or 2b gave the 1,3-dithiolanes 4a and 4b, respectively, via a regiospecific 1,3-dipolar cycloaddition of the corresponding ‘thiocarbonyl methanides’ 3a,b onto the C=S group of 1 (Schemes 1 and 2). The adamantane derivative 4b was not stable in the presence of 1H-imidazole and during chromatographic workup. The isolated 1,3-dithiole 5 is the product of a base-catalyzed elimination of 1H-imidazole from the initial cycloadduct 4b. The formation of the S,N-acetal 6 can be rationalized by a protonation of the ‘thiocarbonyl ylide’ 3b followed by a nucleophilic addition of 1H-imidazole. With the diazo compounds 8a-e (Scheme 3) 1 underwent a regiospecific 1,3-dipolar cycloaddition to give the corresponding 2,5-dihydro-1,3,4-thiadiazole derivatives 9, which spontaneously eliminated 1H-imidazole to yield (1H-imidazol-1-yl)-1,3,4-thiadiazoles 10. The structures of 10a and 10d were established by X-ray crystallography. In the case of diazodiphenylmethane (8f), the initial cycloadduct 9f decomposed via a ‘twofold extrusion’ of N2 and S to give 1,1′-(2,2-diphenylethenylidene)bis[1H-imidazole] (11; Scheme 3).
    Additional Material: 1 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810108
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  • 97
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    Synthesis of New Nucleosides by coupling of chloropurines with 2- and 3-deoxy derivatives of N-methyl-D-ribofuranuronamide (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 145-152 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The synthesis of new deoxyribose nucleosides by coupling chloropurines with modified D-ribose derivatives is reported. The methyl 2-deoxy-N-methyl-3-O-(p-toluoyl)-α-D-ribofuranosiduronamide (α-D-8) and the corresponding anomer β-D-8 were synthesized starting from the commercially available 2-deoxy-D-ribose (1) (Scheme 1). Reaction of α-D-8 with the silylated derivative of 2,6-dichloro-9H-purine (9) afforded regioselectively the N9-(2′-deoxyribonucleoside) 10 as anomeric mixture (Scheme 2), whereas β-D-8 did not react. Glycosylation of 9 or of 6-chloro-9H-purine (17) with 1,2-di-O-acetyl-3-deoxy-N-methyl-β-D-ribofuranuronamide (13) yielded only the protected β-D-anomers 14 and 18, respectively (Scheme 3). Subsequent deacetylation and dechlorination afforded the desired nucleosides β-D-11, β-D-12,15, and 16. The 3′-deoxy-2-chloroadenosine derivative 15 showed the highest affinity and selectivity for adenotin binding site vs. A1 and A2A adenosine receptor subtypes.
    Additional Material: 1 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810113
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  • 98
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    Asymmetric Synthesis of (S)-5,5,5,5′,5′,5′,5′-Hexafluoroleucine (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 174-181 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: (S)-5,5,5,5′,5′,5′-Hexafluoroleucine ((S)-13) of 81 % ee is prepared from hexafluoroacetone (l) and ethyl bromopyruvate (= ethyl 2-oxopropanoate) in 7 steps with an overall yield of 18% (Schemes 1 and 2). Key step in this sequence is the highly enantioselective reduction of the carbonyl group in α-keto ester 4 either by bakers' yeast (91 % ee) or by ‘catecholborane’ 6 utilizing an oxazaborolidine catalyst, yielding hydroxy ester (R)-5 with 99% ee. The absolute configuration was determined by X-ray analysis of the HCl adduct (S,R)-9b of (2S)-N-[(R)- l-phenylethyl]-5,5,5,5′,5′,5′-hexafluoroleucine ethyl ester.
    Additional Material: 2 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810116
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  • 99
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    Electronic Resource
    Masthead (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998) 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/hlca.19980810201
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  • 100
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    Preparation of N-Fmoc-Protected β2- and β3-Amino Acids and their use as building blocks for the solid-phase synthesis of β-peptidesPartially published in a preliminary communication [1]; β2 means that the NH2, group ist at C(3)(= C(β)) and the side chain at C(2) of the amino acid, and β3 indicates that both the NH2 group and the side chain are at C(3)( = C(β)). Fmoc = (9H-Fluoren-9-ylmethoxy)carbonyl.Dedicated to Professor A. I. Meyers, University of Colorado, Fort Collins, on the occasion of his 65th birthday (1998)
    New York, NY : Wiley-Blackwell
    Helvetica Chimica Acta 81 (1998), S. 187-206 
    Details
    ISSN: 0018-019X
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: N-Fmoc-Protected (Fmoc = (9H-fluoren-9-ylmethoxy)carbonyl) β-amino acids are required for an efficient synthesis of β-oligopeptides on solid support. Enantiomerically pure Fmoc-β3-amino acids β3: side chain and NH2 at C(3)(= C(β)) were prepared from Fmoc-protected (S)- and (R)-α-amino acids with aliphatic, aromatic, and functionalized side chains, using the standard or an optimized Arndt-Eistert reaction sequence. Fmoc-β2- Amino acids (β2 side chain at C(2), NH2 at C(3)(= C(β))) configuration bearing the side chain of Ala, Val, Leu, and Phe were synthesized via the Evans' chiral auxiliary methodology. The target β3-heptapeptides 5-8, a β3- pentadecapeptide 9 and a β2-heptapeptide 10 were synthesized on a manual solid-phase synthesis apparatus using conventional solid-phase peptide synthesis procedures (Scheme 3). In the case of β3-peptides, two methods were used to anchor the first β-amino acid: esterification of the ortho-chlorotrityl chloride resin with the first Fmoc-β-amino acid 2 (Method I, Scheme 2) or acylation of the 4-(benzyloxy)benzyl alcohol resin (Wang resin) with the ketene intermediates from the Wolff rearrangement of amino-acid-derived diazo ketone 1 (Method II, Scheme 2). The former technique provided better results, as exemplified by the synthesis of the heptapeptides 5 and 6 (Table 2). The intermediate from the Wolff rearrangement of diazo ketones 1 was also used for sequential peptide-bond formation on solid support (synthesis of the tetrapeptides 11 and 12). The CD spectra of the β2- and β3-peptides 5, 9, and 10 show the typical pattern previously assigned to an (M) 31 helical secondary structure (Fig.). The most intense CD absorption was observed with the pentadecapeptide 9 (strong broad negative Cotton effect at ca. 213 nm); compared to the analogous heptapeptide 5, this corresponds to a 2.5 fold increase in the molar ellipticity per residue!
    Additional Material: 1 Ill.
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    URL: http://dx.doi.org/10.1002/hlca.19980810202
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