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  • Electronic Resource  (388)
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  • 101
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Atopisches Ekzem ; Kinder ; Elternschulung ; Video ; Mütter ; Key words Atopic eczema ; Parental education ; Video ; Children ; Mothers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and Objective. Psychological problems in children and parents related to children's atopic eczema (AE) may impede the success of treatment. We studied the question, if behavior-based parental education in groups (DPE) or standardized video-education (VPE) could enhance dermatological treatment effects and reduce skin-damaging behaviors in children and stress in their mothers. Patients/Methods. 47 mothers attending the university outpatient-clinic for dermatology and their AE-children (mean age 4 years) participated in the study. 18 mothers underwent the DPE (10 sessions), 15 mothers worked with VPE at home. Dermatological standard treatment (CG; N=14) served as control for a 16-weeks-evaluation-period. Results. AE-symptoms improved overall, but the effectiveness of the treatments differed significantly, improval with parent education and was best with VPE. Psychological problems of mothers were equally reduced with DPE and VPE. Conclusions. It is suggested that VPE is a cost effective and less time consuming method for supporting dermatological therapy of AE in children.
    Notes: Zusammenfassung Hintergrund und Fragestellung. Das atopische Ekzem (AE) im Kindesalter kann psychologische Probleme bei Kind und Eltern zur Folge haben, die den Behandlungserfolg erschweren. Die Effektivität direkter verhaltensorientierter Elterngruppenschulungen (DES) bzw. standardisierter Videoschulungen (VES) gegenüber der dermatologischen Standardbehandlung (KG) zur Besserung des AE, des Kratzverhaltens der Kinder und krankheitsbedingter Belastungen der Mütter wurde überprüft. Patienten/Methodik. An der Studie nahmen 47 Mütter und deren AE-Kinder (Durchschnittsalter 4 Jahre) aus der Neurodermitisambulanz der Universitätshautklinik teil, 18 Mütter besuchten die DES (10 Gruppensitzungen), 15 Mütter arbeiteten mit der VES zu Hause. Die Behandlung der KG (n=14) erfolgte im vergleichbaren 4-Monats-Zeitraum. Ergebnisse. Das AE war über alle Behandlungsbedingungen gebessert, ihre Effekstärken unterschieden sich jedoch signifikant: Elternschulungen waren effektiver als Standardbehandlung, den stärksten Effekt hatte die VES. Belastungen der Mütter reduzierten sich nach beiden Schulungsformen. Schlussfolgerungen. Die Ergebnisse verweisen auf eine Zeit und Kosten sparende Möglichkeit, Videoschulungen für die Unterstützung der Therapie des AE im Kindesalter zu nutzen.
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  • 102
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 26 (2000), S. 942-949 
    ISSN: 1432-1238
    Keywords: Key words Ventilator-associated pneumonia ; Cardiac surgery ; Children ; Pediatric intensive care ; Complications ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children.¶Methods: Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP. Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation.¶Results: Median time to extubation was 3 days. VAP occurred in 26 patients (9.6 %). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6 %), and the need for secondary surgery (n = 51, 18.8 %; e. g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95 % CI 0.18–0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50).¶Conclusion: VAP accounts for a major delay of extubation in pediatric cardiac surgery.
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  • 103
    Electronic Resource
    Electronic Resource
    Springer
    Pediatric nephrology 15 (2000), S. 248-251 
    ISSN: 1432-198X
    Keywords: Key words Nephrotic syndrome ; Acute renal failure ; Children ; Peritonitis ; Ischemic tubular necrosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Idiopathic acute renal failure (IARF) is an uncommon but severe complication in children with relapsing nephrotic syndrome and may require long-term dialytic support until recovery of renal function takes place. Due to limited understanding of the pathophysiology of IARF, specific guidelines for its prevention and therapy have not been developed. Among triggering factors, peritonitis was present in half of all pediatric patients with this complication described in the English literature over the past 15 years. We report an additional nephrotic child who developed IARF following spontaneous bacterial peritonitis. The renal biopsy showed tubular epithelial changes consistent with acute tubular necrosis. A discussion of related literature and possible pathogenesis of this association is presented.
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  • 104
    Electronic Resource
    Electronic Resource
    Springer
    Pediatric nephrology 15 (2000), S. 302-316 
    ISSN: 1432-198X
    Keywords: Key words Calcium channel blockers ; Children ; Pharmacokinetics ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The calcium channel blockers (CCBs) are a diverse group of antihypertensive medications with variable pharmacokinetics and clinical effects. Although CCBs have been widely applied to the treatment of hypertensive children, data regarding the pharmacokinetics, efficacy and safety of these agents in children are extremely limited. In this review we briefly summarize the mechanism of action of CCBs and then summarize pertinent pharmacokinetic information on each of the CCBs commonly used in children, including amlodipine, diltiazem, felodipine, isradipine, intravenous nicardipine, nifedipine and verapamil. Clinically important drug interactions and adverse effects are discussed, as well as the potential role of CCBs in renal protection. Available pediatric efficacy and safety data are summarized, and recommendations made regarding the rational use of CCBs in the management of pediatric hypertension.
    Type of Medium: Electronic Resource
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  • 105
    Electronic Resource
    Electronic Resource
    Springer
    Der Pathologe 21 (2000), S. 433-440 
    ISSN: 1432-1963
    Keywords: Schlüsselwörterα1-Antitrypsin-Mangel PiZ ; Lebermorphologie ; Immunhistochemie ; “Single-strand conformational polymorphism” ; DNA-Sequenzierung ; Keywords Alpha-1-antitrypsin deficiency PiZ ; Liver morphology ; Immunohistochemistry ; Single-strand conformational polymorphism ; DNA sequencing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Whether heterozygotes with alpha-1-antitrypsin (AAT) deficiency type PiZ bear an increased risk for chronic liver disease is controversial. On the basis of liver tissue from 1,030 autopsies (autopsy series), 1,847 biopsies (biopsy series) and 317 primary liver carcinomas (tumor series), we analysed the effect of heterozygous state PiZ for the development of liver diseases. The PiZ status was screened immunohistochemically and verified in selected cases by SSCP analysis and by sequencing DNA extracted from paraffin embedded tissue. The PiZ frequency in the biopsy series (3.4%) and tumor series (5.99%) was significantly higher than in the autopsy series (1.8%). Hepatic PiZ deposits in heterozygotes sometimes were as extensive as in homozygotes. The amount of PiZ deposits correlated positively with the inflammatory activity and stage of fibrosis, as well as with the age of patients. Patients with concurrent liver disease such as hepatitis and alcoholic liver disease showed significantly higher scores of inflammatory activity, stage of fibrosis and amount of PiZ deposits than those without additional liver disease. Cholangiocarcinomas and combined hepato-cholangiocarcinomas were seen significantly more frequently in patients with PiZ-associated liver carcinoma than in genetic healthy individuals (p=0.004). Three out of 19 PiZ-associated liver carcinomas had developed in cirrhotic liver tissue. Heterozygotes of type PiZ have an enhanced risk for chronic liver disease including primary liver carcinoma. PiZ-associated liver diseases will become clinically manifest in middle or old aged adults. Rarely this genetic defect causes liver cirrhosis even without concurrent liver disease. PiZ-associated liver carcinomas are frequently characterized by cholangiocellular differentiation and may develop often in non-cirrhotic liver tissue. Immunohistochemistry is a specific method to detect hepatic PiZ deposits.
    Notes: Zusammenfassung Bisher ist umstritten, ob heterozygote Patienten mit α1-Antitrypsin (AAT)-Mangel Typ PiZ ein erhöhtes Risiko für Lebererkrankungen aufweisen. An Leberproben von 1030 Autopsien (Autopsie-Serie), 1847 Biopsien (Biopsie-Serie) und 317 primären Leberkarzinomen (Tumor-Serie) sollte der Einfluss des heterozygoten PiZ-Status auf die Leber untersucht werden. Die PiZ-Bestimmung erfolgte immunhistochemisch, teilweise ergänzt durch SSCP-Analyse und DNA-Sequenzierung von DNA-Extrakten aus paraffineingebettetem Material. Die PiZ-Häufigkeit der Biopsie-Serie (3,4%) und der Tumor-Serie (5,99%) war signifikant höher als die der Autopsie-Serie (1,8%). PiZ-Ablagerungen waren bei manchen heterozygoten Merkmalsträgern ebenso umfangreich wie bei homozygoten. Ihr Ausmaß korrelierte positiv mit Entzündungsaktivität und Fibrosegrad der Leber sowie mit dem Patientenalter. Patienten mit konkurrierenden Lebererkrankungen wie Hepatitis oder Alkoholschädigung wiesen eine signifikant stärkere Entzündung, Fibrose und mehr PiZ-Ablagerungen auf als diejenigen ohne zusätzliche Lebererkrankungen. Cholangiokarzinome und kombinierte Hepatocholangiokarzinome traten signifikant häufiger bei Patienten mit PiZ-Mutation als bei genetisch Gesunden (p=0,004) auf. Nur 3 der 19 PiZ-assoziierten Leberkarzinome waren in einer Leberzirrhose entstanden. Patienten mit heterozygotem AAT-Mangel Typ PiZ tragen nach den hier vorgestellten Ergebnissen ein erhöhtes Risiko für chronische Lebererkrankungen einschließlich primärer Leberkarzinome. Wenn überhaupt, manifestiert sich dieser genetische Defekt erst in mittlerem oder höherem Lebensalter. Er kann in seltenen Fällen selbst ohne konkurrierende Lebererkrankung zur Zirrhose führen. PiZ-assoziierte Leberkarzinome sind häufig cholangiozellulär differenziert und entstehen mehrheitlich ohne Leberzirrhose. Hepatische PiZ-Ablagerungen lassen sich immunhistochemisch zuverlässig identifizieren.
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  • 106
    Electronic Resource
    Electronic Resource
    Springer
    Der Pathologe 21 (2000), S. 39-54 
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Chronische myeloische Leukämie ; Megakaryozyten ; Fasern ; Erythropoese ; Makrophagen ; Klinische Befunde ; Immunhistochemie ; Knochenmarkbiopsie ; Key words Chronic myelogenous leukemia ; Megakaryocytes ; Fibers ; Erythroid precursors ; Macrophages ; Clinical findings ; Immunohistochemistry ; Morphometry ; Bone marrow biopsies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary An immunohistochemical and morphometric study was performed on bone marrow biopsies in 604 patients with chronic myelogenous leukemia (CML) to compare morphological and clinical features and to evaluate effects of interferon (IFN) and chemotherapy. Following morphometry significant correlations were calculated between number of CD61+ megakaryocytes, including their precursors with fiber density. This finding is in line with the close functional relationship between megakaryopoiesis and fibroblasts regarding the complex pathomechanism of myelofibrosis. The latter was observed in about 28% of patients already at diagnosis. In a similar way, the frequency of CD68+ macrophages was correlated with the amount of Ret40f+ nucleated erythroid precursors, implicating an involvement of this cell lineage in iron turnover, hemoglobin synthesis, and degradation of the expelled nuclei from normoblasts. The (α-D-galactosyl residue-expressing) Pseudo-Gaucher cells were detectable in 30% of pretreatment specimens. Moreover, significant associations were calculable between reduction in erythropoiesis or increase in fibers with clinical features such as hemoglobin level, percentages of myelo- and erythroblasts in the peripheral blood, and spleen size. These variables are in keeping with more advanced stages of CML. Based on our morphometric evaluations, a classification into three different histological subgroups: granulocytic, megakaryocytic, and myelofibrotic was carried out. This simplified staging system was correlated with corresponding sets of hematological data. Sequential biopsies in 173 patients with monotherapy by IFN, hydroxyurea (HU), or busulfan (BU) revealed a fibrogenic effect of IFN in contrast to a fiber-reducing property of HU. The dynamics of myelofibrosis and changes of major cell lineages during treatment were readily demonstrable by calculating corresponding indices. These included the ratios between quantitative differences of corresponding variables at repeated examinations and time. Thus, in patients with complete hematological remission following IFN administration, regeneration of erythropoiesis was found to be accompanied by an increase in the total number of CD68+ macrophages, including activated subpopulations. Histological subgroups showed a transition from a (nonfibrotic) granulocytic and megakaryocyte pattern to the myelofibrotic subtype in about 40% of patients. This change was opposed to a numerical reduction in the myelofibrotic subtype which occurred in 17 patients (36%), but predominantly in those under HU therapy. In conclusion, the striking heterogeneity of bone marrow features in CML warrants a careful morphological evaluation of trephine biopsies and appropriate means of processing to achieve relevant correlations with clinical data and, thus, allows a more elaborate insight into the dynamics of the disease process.
    Notes: Zusammenfassung Bei 604 Patienten mit einer chronischen myeloischen Leukämie (CML) wurde anhand von Beckenkammbiopsien eine immunhistochemische und morphometrische Studie durchgeführt, um morphologische und klinische Befunde miteinander zu vergleichen und die Auswirkungen der Interferon- (IFN) und Chemotherapie abzuklären. Anhand der morphometrischen Analyse konnten signifikante Korrelationen zwischen der Anzahl CD61+-Megakaryozyten einschließlich ihrer Vorläuferzellen mit der Faserdichte berechnet werden. Dieser Befund spiegelt die enge funktionelle Beziehung zwischen der Megakaryopoese und den Fibroblasten im Hinblick auf den komplexen Pathomechanismus der Myelofibroseentstehung wider. Diese war bei etwa 28% der Patienten bereits zum Diagnosezeitpunkt zu beobachten. In ähnlicher Weise war die Anzahl der CD68+-Makrophagen mit der Menge an Ret40f+-kernhaltigen erythropoetischen Vorläuferzellen korreliert, was durch die Einbindung dieser Zellinie in den Eisenstoffwechsel, die Hämoglobinsynthese sowie den Abbau der ausgestoßenen Normoblastenkerne in Zusammenhang gebracht werden kann. Die (α-D-Galaktosylreste-expremierende) Pseudo-Gaucherzellen ließen sich in 30% der Biopsien vor Behandlung nachweisen. Weiterhin konnten signifikante Beziehungen zwischen einer Reduktion der Erythropoese oder einer Zunahme der Verfaserung mit klinischen Parametern wie dem Hämoglobinspiegel, dem Anteil an Myelo- und Erythro-Normoblasten im peripheren Blut und der Milzgröße berechnet werden. Diese Variablen kennzeichnen offensichtlich mehr fortgeschrittene Stadien der CML. Entsprechend unserer morphometrischen Auswertung wurde eine Klassifikation in drei unterschiedliche histologische Subgruppen vorgenommen: granulozytisch, megakaryozytisch und myelofibrotisch. Dieser vereinfachten histologischen Einteilung waren entsprechende hämatologische Daten zuzuordnen. Sequenzbiopsien an 173 Patienten, die eine Monotherapie mit IFN, Hydroxyurea (HU) oder Busulfan (BU) erhielten, zeigten einen fibrogenetischen Effekt von IFN im Gegensatz zu einer eher faserreduzierenden Eigenschaft von HU. Die Dynamik der Myelofibroseentwicklung und die entsprechende Veränderungen der hauptsächlichen Zellinien während der Behandlung ließen sich am besten durch eine Kalkulation von Indizes verdeutlichen. Diese beinhalteten das Verhältnis aus quantitativen Unterschieden der einzelnen Variablen in den wiederholt durchgeführten Entnahmen und den zugeordneten zeitlichen Differenzen. So war bei Patienten mit einer kompletten hämatologischen Remission nach IFN-Gabe die Regeneration der Erythropoese zusammen mit einem Anstieg in der Anzahl CD68+-Makrophagen einschließlich ihrer aktivierten Subpopulation auszumachen. Die histologischen Subgruppen ließen bei fortlaufenden Untersuchungen einen Übergang sowohl von einem (nicht verfaserten) granulozytären wie auch megakaryozytären Subtyp in eine myelofibrotische Gruppe bei etwa 40% der Patienten erkennen. Dieses Phänomen stand im Gegensatz zu einer anzahlmäßigen Reduzierung des myelofibrotischen Typs vor allem bei Patienten unter HU-Therapie in 17 Fällen (36%). Zusammengefaßt erfordert die auffallende Heterogenität der Knochenmarkbefunde bei der CML eine sorgfältige morphologische Auswertung von Biopsien mit geeigneten Methoden, um relevante Korrelationen zwischen klinischen Daten zu berechnen und somit einen besseren Einblick in die Dynamik der Krankheitsentwicklung zu gewinnen.
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  • 107
    Electronic Resource
    Electronic Resource
    Springer
    Pediatric nephrology 15 (2000), S. 57-59 
    ISSN: 1432-198X
    Keywords: Keywords X-linked hypophosphatemia ; Dipyridamole ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  X-linked hypophosphatemia (XLH) is characterized clinically by rickets, hypophosphatemia and hyperphosphaturia. Conventional treatment of XLH with oral phosphate and vitamin D is associated with hypercalcuria and nephrocalcinosis. Recently, intravenous and oral dipyridamole has been reported to decrease fractional excretion of phosphate in adults with idiopathic hyperphosphaturia. Our objective was to determine whether oral dipyridamole therapy reduces urinary phosphate excretion and increases serum phosphate concentration in children with XLH. A prospective study was performed in six children with XLH. The average age of the patients at the start of the study was 12.5±1.0 years. The effects of 12 weeks of oral dipyridamole therapy, at 4.4±0.4 mg/kg body weight per day, on serum phosphorous, parathyroid hormone (PTH), 1,25 (OH)2 vitamin D, osteocalcin, tubular maximum for phosphate reabsorption (TmP/GFR), urinary calcium excretion, and cyclic adenosine 3’,5’-monophosphate (cAMP) excretion, were compared to baseline levels. Our results show that there was no change in serum phosphorous concentration or TmP/GFR after 12 weeks of dipyridamole therapy. Dipyridamole therapy also had no effect on serum PTH, serum 1,25 (OH)2 vitamin D, alkaline phosphatase, osteocalcin levels, urinary calcium or cAMP excretion. We therefore concluded that in children with XLH, a 12-week course of dipyridamole had no effect on serum phosphorous or its urinary excretion. Dipyridamole therapy is unlikely to improve the bone disease in children with XLH.
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  • 108
    Electronic Resource
    Electronic Resource
    Springer
    Der Pathologe 21 (2000), S. 16-23 
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Lymphknötchen ; Reaktive Infiltrate ; Maligne Lymphome ; Histotopographie ; Immunhistochemie ; Retikulinfasern ; Knochenmarkbiopsie ; Key words Lymphoid nodules ; Reactive infiltrates ; Malignant lymphomas ; Histotopography ; Immunohistochemistry ; Reticulin fibers ; Bone marrow biopsies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Differentiation of focal or extended lymphoid bone marrow infiltrates presents a diagnostic challenge and therefore warrants systematic evaluation of those features which affect this. One of the basic requirements is an appropriate technique of processing the bone marrow specimens. This includes the possibility of enzyme evaluation (naphthol-AS-D-chloroacetate esterase) and immunohistochemistry (set of monoclonal antibodies) and comparison with the corresponding lymph node histology. A number of histological parameters have emerged with a distinctive property for distinguishing between reactive focal lymphoid aggregates and malignant lymphomas. Amongst these the pattern of infiltrates, i.e., histotopography (subcortical infiltrates, paratrabcular–endosteal localization, margination, tandem-like extension between adipocytes and cribriform appearance), content of reticulin fibers, cytology (small lymphocytes versus large blast cells) and, finally, immunohistochemistry (monoclonal versus polyclonal expression of cytoplasmic immunoglobulins, uniform versus mixed population of B or T lymphocytes) are most important. In conclusion, synoptic consideration of several parameters, in particular histotopography and immunohistochemistry provides a most promising approach to differentiate neoplastic from reactive lymphoid lesions in the bone marrow.
    Notes: Zusammenfassung Die Differentialdiagnose herdförmiger oder ausgedehnter lymphoider Knochenmarkinfiltrate stellt noch immer eine diagnostische Herausforderung dar, die eine systematische Analyse entsprechender diskriminierender Faktoren erfordert. Eine der grundsätzlichen Voraussetzungen ist dabei eine Technik mit entsprechender Möglichkeit einer enzym- (Naphthol-AS-D-Chlorazetatesterase) und immunhistochemischen Aufarbeitung (monoklonale Antikörper) des Biopsiematerials und der Vergleich mit der zugeordneten Lymphknotenhistologie. Hinsichtlich der Unterscheidung zwischen reaktiven, herdförmigen lymphoiden Läsionen und malignen Lymphomen hat sich eine Anzahl histologischer Parameter als von wegleitendem diagnostischen Wert herausgestellt. Dazu gehören einmal das Infiltrationsmuster bzw. die Histotopographie (subkortikales Infiltrat, paratrabekulär-endostale Lokalisation, Abgrenzung, tandem-artige Ausbreitung zwischen den Adipozyten und kribriformes Muster), Faserdichte im Infiltrat sowie die Zytologie (kleine Lymphozyten gegenüber großen blastären Zellelementen) und schließlich die Immunhistochemie (mono-gegenüber polyklonaler Expression zytoplasmatischer Immunglobuline, uniforme gegenüber gemischtzelliger B- oder T-Lymphozytenpopulation). Zusammengefaßt verspricht eine gemeinsame Beachtung dieser verschiedenen Merkmale, insbesondere jedoch die Histotopographie und Immunhistochemie, am ehesten eine erfolgreiche Differenzierung zwischen reaktiven und neoplastischen lymphoiden Läsionen des Knochenmarks.
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  • 109
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Harnblase ; WHO-Klassifikation ; Flache und papilläre urotheliale Läsionen/Tumoren ; Histologie ; Immunhistochemie ; Keywords Urothelial bladder tumors ; WHO classification ; Flat and papillary urothelial lesions/tumors ; Histology ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Recently the World Health Organization published a new classification of urinary bladder tumors which is intended to take into account better the biology of the various lesions and to better distinguish between clearly benign and malignant lesions. We examine the possible diagnostic and clinical impact of the new classification, including recent immunohistochemical findings. Papillary urothelial lesions include papillomas, papillary neoplasms of low malignant potential, and papillary carcinomas. Flat urothelial lesions include hyperplasia, reactive atypia/atypia of unknown significance, dysplasia, and carcinoma in situ. Invasive patterns of papillary carcinomas are discussed, with special emphasis on lamina muscularis mucosae substaging. The most important feature of the new classification is its differentiation of two types of low-grade, noninvasive papillary urothelial lesions: papillary neoplasm of low malignant potential vs. papillary carcinoma. Long-term follow-up studies are needed to determine the clinical significance of this differentiation.
    Notes: Zusammenfassung Grund für die Aktualisierung der WHO-Klassifikation urothelialer Läsionen bzw. Tumoren der Harnblase war, der Biologie der verschiedenen Läsionen besser gerecht zu werden sowie eine schärfere Trennung zwischen benignen und malignen urothelialen Prozessen zu vollziehen. Die Bedeutung für Diagnostik und Klinik im Alltag unter Berücksichtigung aktueller immunhistochemischer Befunde wird kritisch betrachtet. Zwei Hauptgruppen werden unterschieden. Papilläre urotheliale Läsionen umfassen Papillome, papilläre urotheliale Neoplasien niedrig malignen Potentials sowie papilläre Karzinome. Flache urotheliale Läsionen umfassen flache Hyperplasien, Atypien (reaktiv oder von unklarer Bedeutung), Dysplasien sowie das Carcinoma in situ (CIS). Verschiedene Invasionsmuster papillärer Karzinome werden unter besonderer Berücksichtigung der Lamina muscularis mucosae diskutiert. Der kritischste Punkt der neuen Klassifikation sowohl für die Diagnostik als auch für die Klinik dürfte die Unterscheidung zweier Gruppen nichtinvasiver papillärer “low-grade”-Tumoren (papilläre urotheliale Neoplasie niedrig malignen Potentials vs. pTa-GI-Tumor) darstellen. Langzeit-follow-up-Studien müssen zeigen, ob diese Unterteilung ihre Berechtigung findet.
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  • 110
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    Der Pathologe 21 (2000), S. 456-459 
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Undifferenziertes kleinzelliges Hepatoblastom ; Immunhistochemie ; Keywords Undifferentiated small-cell hepatoblastoma ; Immunohistochemistry ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Undifferentiated small-cell hepatoblastoma (HB) is a rare malignant tumor of childhood. The cell of origin is supposed to be a pluripotential, probably entodermal, stem-cell. Differential diagnosis of this type of HB is difficult among the group of small round and blue cell malignant tumors of children. The immunohistochemically determined coexpression of cytokeratin 8, 18, and 19 and of vimentin and actin, regularly in the absence of α-fetoprotein expression may be diagnostically helpful. We present the case of an undifferentiated small-cell HB of a 15-month-old girl with agenesis of the right kidney. As morphological peculiarity the tumor presented disseminated histiocytic giant cells.
    Notes: Zusammenfassung Undifferenzierte kleinzellige Hepatoblastome (HB) zählen zu den seltenen malignen Tumoren der Leber im Kindesalter. Da der Tumor in der Regel kein α-Fetoprotein exprimiert, ist der Nachweis von Zytokeratin 8, 18 und 19 sowie Vimentin und Aktin diagnostisch wegweisend. Als Ausgangszelle wird eine pluripotente, wohl entodermale Stammzelle vermutet. In der Gruppe der klein-, rund- und blauzelligen malignen Tumoren des Kindesalters bietet diese Variante des HB differenzialdiagnostische Schwierigkeiten. Wir berichten über ein undifferenziertes kleinzelliges HB eines 15 Monate alten weiblichen Kleinkindes mit Agenesie der rechten Niere. Als morphologische Besonderheit des Tumors werden disseminierte histiozytäre Riesenzellen beschrieben.
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  • 111
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    Pediatric nephrology 14 (2000), S. 1016-1021 
    ISSN: 1432-198X
    Keywords: Key words Nephrocalcinosis ; Sonography ; Renal function ; Body growth ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We carried out a retrospective survey on 152 children and adolescents with nephrocalcinosis (NC) in 22 German centers of pediatric nephrology. Etiology, clinical manifestations, growth and development, sonographic appearance of NC and renal function were analyzed. The median age at the time of diagnosis was 3.3 (range 0.1–21) years and the median duration of follow-up was 4.1 years. In 34% of children NC was associated with idiopathic hypercalciuria (IHC) and in 32% with various hereditary tubular disorders. In 9% NC was observed subsequent to prophylactic bolus administration of vitamin D in infancy. A positive family history was found in 36%. Clinical manifestations were mainly failure to thrive during the 1st year of life (46%), psychomotor/mental retardation (28%) and urinary tract infection (34%). In 14% nephrolithiasis was associated. During the follow-up the proportion of patients with the most severe degree of NC (stages 2b or 3) increased from 40% to 55% and that of hypercalciuria decreased from 79% to 52%. Body height was 〈2 standard deviation scores (SDS) of normal in 41% at the time of diagnosis and in 32% at the last observation; the increase in relative height was significant only for IHC. Glomerular filtration rate (GFR) and urinary concentration capacity changed only slightly with time. At the last investigation GFR was 〈50 ml/min/1.73 m2 in 6% and concentration capacity 〈800 mosmol/kg in 48% of patients. The degree of NC was negatively correlated with GFR and concentration capacity.
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    Pediatric nephrology 14 (2000), S. 629-635 
    ISSN: 1432-198X
    Keywords: Key words Histomorphometry ; In situ hybridization histochemistry ; Molecular morphometry ; Immunohistochemistry ; Bone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Quantitative histomorphometric assessment of bone biopsies represents a powerful and informative method for the study of metabolic bone diseases. It is the gold standard against which the noninvasive ”diagnostic” markers of bone metabolism as well as newly available therapeutic modalities are tested. With the rapid progress in technology of molecular biology, identification of systemic and local biomolecules known to regulate bone metabolism can now be achieved. The study of localization, levels of expression, and synthesis of these factors in bone and its microenvironment is possible through applications of in situ hybridization histochemistry (ISHH) and immunohistochemistry (IHC). Application of ISHH allows study of specific mRNA expression. IHC determines the presence and distribution of target protein in cells. These two methodologies provide the link between the cellular processes of mRNA transcription and translation to the working protein. Combining the established bone histomorphometric techniques with ISHH and IHC elevates the study of bone to new heights, i.e., cellular and molecular mechanistic issues can now be studied.
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  • 113
    ISSN: 1432-2129
    Keywords: Schlüsselwörter ; Kopfschmerz ; Kinder ; Akuttherapie ; Flupirtin ; Paracetamol ; Keywords ; Children ; Acute treatment ; Tension-type headache ; Flupirtine ; Paracetamol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: About 10% of all schoolchil- dren are suffering from migraine and 50% from tension-type headache. Headache of acute onset usually will be treated with analgesic substances like paracetamol, acetylsalicylic acid or ibuprofen, the first one being the reference drug for tension-type headache in childhood. In case of lacking improvement or side-effects there is demand for an alternative safe substance for the acute analgesic therapy. Methods: In a double-blind randomised investigation flupirtine and paracetamol were given in two consecutive attacks of episodic tension-type headache. 30 children, 6–12 years old, were included. Dosage was determined according to age and weight. The children documented the acute headache intensity and duration in a special diary. Results: Headache intensity was reduced during 2 h after intake in 89% of the 19 children treated. The reduction was 6,5 to 3,1 for flupirtine and 6,9 to 3,3/10 for paracetamol. There was no statistically significant difference between the two substances. Relevant side-effects could not be observed. Conclusion: Flupirtine has shown a convincing clinical effect treating acute episodic tension-type headache for children. The substance was well tolerated by the patients. In addition, flupirtine provides a high degree of safety.
    Notes: Zusammenfassung Hintergrund: Etwa 10% aller Schulkinder leiden nach neueren deutschen epidemiologischen Untersuchungen zumindest gelegentlich an Migräne und etwa 50% an Kopfschmerzen vom Spannungstyp. Häufig nehmen sie bei Spannungskopfschmerzen analgetische Monosubstanzen wie Paracetamol, Azetylsalizylsäure oder Ibuprofen ein. Bei nicht ausreichender Wirkung bzw. Unverträglichkeit besteht Bedarf nach weiteren Substanzen für die Akutanwendung. Methode: In einer doppelblindrandomisierten und gekreuzten Anordnung wurden Paracetamol bzw. das analgetisch und muskelrelaxierend wirksame Flupirtin 30 6- bis 12jährigen Kindern für 2 episodische Spannungskopfschmerzattacken angeboten. 10 Kinder benötigten nach dem Erstkontakt keine Medikation mehr, 1 Kind lehnte die Einnahme grundsätzlich ab. Ergebnisse: Die Kopfschmerzstärke verringerte sich laut Kopfschmerztagebuch innerhalb von 2 h nach der Einnahme auf einer numerischen Schmerzskala (0–10) von 6,5 auf 3,1 unter Flupirtin und von 6,9 auf 3,3 unter Paracetamol bei 89% der verbliebenen 19 Kinder. Statistisch signifikante Unterschiede zwischen beiden Substanzen bestanden nicht. Als Nebenwirkung trat 1-mal Erbrechen unter Paracetamol auf. Schlussfolgerung: Flupirtin hat sich in der Akutphase von episodischen Spannungskopfschmerzen beim Kind bewährt. Es verfügt über eine gute Verträglichkeit. Im Vergleich zu Paracetamol scheint v.a. bei akzidenteller Überdosierung eine größere Sicherheit zu bestehen.
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    Der Schmerz 14 (2000), S. 302-308 
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Schmerzmessung ; Diagnostik ; Instrumente ; Neugeborene ; Kinder ; Keywords Pain ; Measurement ; Assessment ; Instruments ; Neonates ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background. The assessment and measurement of pain is essential in the implementation and control of pain relieving strategies. The measurement of pain in infants and children should be based on the consideration of age, cognitive level, psychological status, intercurrent diseases and the social context in order to register the child's individual situation and to avoid misinterpretation. Diagnosis. In the preverbal infant, behavioral and physiological cues have to be interpreted by the caregivers. For the assessment of pain in children of four and older who have at least a basic understanding of the pain concept self assessment methods (as rating scales, specific pain interviews, diaries and questionnaires) can be used. In any case the instruments used should be age appropriate. The instruments used for the different age groups are presented with comments on quality and clinical applicability.
    Notes: Zusammenfassung Hintergrund. Voraussetzung zur Durchführung und Kontrolle einer adäquaten und effektiven Schmerztherapie sind die Erfassung und Quantifizierung des Schmerzes in seinen verschiedenen Dimensionen. Bei der Diagnostik des Schmerzes im Kindesalter müssen Alter, kognitiver Entwicklungsstand, psychologischer Status, interkurrierende Erkrankungen und der soziale Kontext berücksichtigt werden, um das Kind in seiner individuellen Situation erfassen zu können und Fehleinschätzungen zu vermeiden. Schmerzdiagnostik im Kindesalter. Im präverbalen Alter werden die physiologischen und verhaltensbezogenen Schmerzäußerungen von Neugeborenen, Säuglingen und Kleinkindern durch eine Fremdbeurteilung erfasst. Bei Kindern ab etwa 4 Jahren, die über ein einfaches Verständnis von Schmerz verfügen, sind Verfahren der Selbsteinschätzung wie einfache Ratingskalen, spezifische Schmerzinterviews, Tagebücher und Fragebögen die primär einzusetzenden Instrumente. In jedem Fall sollten die Instrumente altersgerecht gestaltet sein. Für die verschiedenen Altersgruppen werden Instrumente der Schmerzerfassung mit qualitativen Hinweisen auf deren Güte und klinische Anwendbarkeit vorgestellt.
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    Der Schmerz 14 (2000), S. 319-323 
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Schmerz ; Kinder ; Impfung ; Verbrennung ; Injektion ; Keywords Pain ; Children ; Vaccination ; Burn ; Injection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Phenomenon pain. While pain is one of the main reasons for an unscheduled visit to the paediatrician, pain due to painful procedures is of major importance in scheduled visits. Actual pain therapy is illustrated in the treatment of burns. Incomplete analgesia may have an unfavourable impact on morbidity and mortality. The pain score does not correlate with the extent of the burned area, and is regularly underestimated. General anaesthesia or analgo-sedation are warranted during the care of the burned patient. Unsufficient analgesia. Consequence of insufficient analgesia during primary care is an increased need of analgesics, and an increased pain treatment failure rate during subsequent procedures. Pain is interfering with anxiety, sleep disturbancies and post-tramatic psychologic alterations. All those symptoms must be treated adequately. Acute illness and injections. This article covers pain from otitis media, pharyngitis, Guillain-Barré syndrome, purpura fulminans, Toxic Epidermal Nekrolysis, as well as the usage of local anaesthesia during injections, not to forget the application of non-pharmacologic methods for pain therapy and prophylaxis.
    Notes: Zusammenfassung Phänomen Schmerz. Das Phänomen “Schmerz” begleitet fast alltäglich den Kontakt zwischen Arzt und krankem Kind. Auf der einen Seite sind Schmerzen der häufigste Grund für eine ungeplante Kinderarztkonsultation, auf der anderen Seite sind bei geplanten Kinderarztbesuchen häufig schmerzhafte Prozeduren durchzuführen. Anhand der starken Schmerzen bei den im Kleinkindalter häufigen Verbrennungen werden schmerztherapeutische Prinzipien konkretisiert: Schmerztherapeutische Prinzipien. Unzureichende Analgesie kann Morbidität und Mortalität ungünstig beeinflussen. Das Schmerzmaß korreliert nicht mit der Ausdehnung der Verbrennung und wird vom Behandler regelmäßig unterschätzt. In vielen Fällen der Erstversorgung sind Allgemeinanästhesie oder Analgosedierung gerechtfertigt, ähnliches gilt für den Verbandwechsel. Ungenügende Analgesie bei der Erstversorgung führt zu erhöhtem Analgetikaverbrauch und schmerztherapeutischen Misserfolgen bei Folgeeingriffen. Wechselwirkungen zwischen Schmerzen und anderen Symptomen wie Angst, Schlafstörungen oder postraumatischen psychischen Veränderungen sind zu beachten und adäquat zu therapieren. Akute Erkrankungen + Injektionen. Weiter wird auf Schmerzen bei Otitis media, Pharyngitis, Guillain-Barré-Syndrom, Purpura Fulminans und Toxischer Epidermaler Nekrolyse sowie den Einsatz von Lokalanästhetika bei Injektionen eingegangen. Schließlich haben auch nicht pharmakologische Methoden ihren Platz in Schmerztherapie und Prophylaxe.
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    Der Schmerz 14 (2000), S. 333-339 
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Postoperative Schmerztherapie ; Schmerz ; Kinder ; Jugendliche ; Analgetika ; Keywords Postoperative pain therapy ; Pain ; Children ; Adolescents ; Analgesics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Treatment of pain. Undertreatment of postoperative pain in children is a problem in clinical practice. This is due to a lack of both knowledge about age-specific aspects of physiology and pharmacology, and routine pain assessment. For example, the fear of side-effects prevents the adequate usage of opioids. It is of major importance to select a route of drug administration where the child feels comfortable with (avoid intramuscular injections). Non-opioid analgesics. Non-opioid analgesics are recommended for basic pain treatment after minor surgical procedures. Instead of using the whole multitude of drugs available, the doctor should stick to those drugs he is familiar with (acetaminophen, ibuprofen, diclofenac, dipyrone). Opioids. Opioid usage requires individual dose titration and careful monitoring of side-effects (respiratory monitoring, sedation score). The strong opioids piritramide and morphine may advantageously be administered as either continuous, or patient-controlled iv- infusion (PCA). Forms of therapy. In addition to infiltration anesthesia, intraoperatively applied nerve blocks provide excellent pain relief. Epidural analgesia with local anesthetics and/or opioids via a thoracic or lumbar epidural catheter is a therapeutic option after thoracic or abdominal surgery, or after extensive orthopedic or urological interventions. Adjuvant analgesics and nonpharmacologic interventions, i. e. transcutaneous electrical nerve stimulation (TENS), are primarily indicated in patients suffering from neuropathic pain. Conclusion. The establishment of pain services and the comprehensive education of both the nursing and the medical staff should help to improve postoperative pediatric pain therapy.
    Notes: Zusammenfassung Schmerztherapie bei Kindern. Postoperative Schmerzen bei Kindern werden häufig wegen mangelnder physiologischer und pharmakologischer Kenntnisse und des Fehlens einer regelmäßigen standardisierten Schmerzmessung noch immer unzureichend behandelt. Die Angst vor Nebenwirkungen verhindert eine adäquate Opioidtherapie. Bei der Verwendung von Analgetika ist auf eine kindgerechte Applikationsweise (keine i.-m.-Injektionen!) zu achten. Nichtopioidhaltige Analgetika. Nichtopioidhaltige Analgetika (Parazetamol, Ibuprofen, Diclofenac, Metamizol) sind zur Basisschmerztherapie bei kleineren schmerzhaften Eingriffen geeignet. Opioide. Opioide müssen nach Wirkung titriert werden; Nebenwirkungen können nur bei sorgfältigem Monitoring von Atmung und Sedierungsgrad frühzeitig erkannt werden. Opioide (Tramadol, Piritramid, Morphin) können entweder kontinuierlich i. v. oder mittels PCA-Pumpe verabreicht werden. Therapieformen. Neben der Oberflächenanästhesie sind intraoperativ angelegte Nervenblockaden effektive therapeutische Möglichkeiten. Eine lumbale und thorakale Periduralanästhesie mittels Lokalanästhetika und/oder Opioiden bietet sich bei thorakoabdominalen Eingriffen an. Koanalgetika werden vornehmlich bei Nervenschmerzen verwendet und richten sich gegen die schmerzverursachende Pathophysiologie. Optimierung der Schmerztherapie. Die postoperative Schmerztherapie bei Kindern kann durch Einrichtung eines Akutschmerzdiensts und kontinuierliche Weiterbildung von Pflegepersonal und Ärzten optimiert werden.
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    European journal of pediatrics 159 (2000), S. 430-433 
    ISSN: 1432-1076
    Keywords: Key words Alport syndrome ; Angiotensin-converting enzyme inhibitors ; Proteinuria ; Children ; AbbreviationACEi angiotensin-converting enzyme inhibitor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Enalapril, a long-acting inhibitor of angiotensin-converting enzyme, was given for 2 years to seven children with Alport syndrome. Five patients had a classical X-linked form of the disease; two siblings had the autosomal recessive variant. Their age was between 5.15 and 13.75 years when enalapril was started. All patients had haematuria and proteinuria, creatinine clearance was 〉80 ml/min per 1.73 m2 in all, and only one patient was hypertensive. The starting dose of enalapril (0.1 mg/kg body weight per day) was increased progressively according to individual clinical tolerance. The median doses were 0.13, 0.12, 0.21 and 0.29 mg/kg at 6, 12, 18 and 24 months, respectively. Median values of mean blood pressure were 95 mmHg at the start and 84 mmHg after 24 months. Median daily proteinuria decreased from 52 mg/kg to 18 mg/kg at 6 months, 21 mg/kg at 12 months, 12 mg/kg at 18 months and 30 mg/kg at 24 months. Serum creatinine increased over time from a median of 0.64 mg/dl at baseline to 0.77 mg/dl at 24 months. Concomitantly, there was a decrease in GFR from 104 to 83 ml/min per 1.73 m2 at 18 months and an increase again to 95 ml/min per 1.73 m2 at 24 months. Analysis of the individual data showed three patterns: no response (n=2), temporary response (n=2) and sustained response (n=3). Conclusion When given enalapril at the dosages mentioned, Alport patients as a group display a marked reduction in urinary protein excretion with a nadir of 23% of the baseline figure at 18 months, a decrease that cannot be accounted for by the slight decrease in glomerular filtration rate. Although these are preliminary data, it is recommended to try an angiotensin-converting enzyme inhibitor in every paediatric Alport patient with proteinuria.
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  • 118
    ISSN: 1432-1076
    Keywords: Key words Health-related quality of life ; Health status ; Cross-cultural adaptation ; Children ; Health Utilities Index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Steady progress in developing effective treatments for childhood cancer and other severe pediatric diseases has established the need to consider the nature and frequency of late physical and psychological effects. The Health Utilities Index Mark 2 and Mark 3 (HUI2/3) systems were developed by Feeny, Furlong, Torrance et al. in Canada. These systems are generic multi-attribute measures of a person's health status and health-related quality of life. The first German version of the Canadian HUI2/3 questionnaire was created in our clinic, following recommended guidelines for cross-cultural adaptation of health-related quality of life measures. The usefulness of the resultant version was investigated using a sample of 142 patients who presented to our oncological outpatients' department for a routine health care visit after completion of treatment. The 15 items of the HUI2/3-questionnaire were answered independently by three groups of assessors – nurses, physicians, and parents or patients. Two additional questions covered ratings of the severity of treatment effects and the specification of these effects. The questionnaire was both easy to use and acceptable to the assessors. Percentage agreement between observers about levels for individual attributes ranged from 56% to 100%, with the lowest agreement on the subjective attributes of emotion, pain and cognition. These results are in accordance with previous studies using the original instrument. HUI2 global utility scores were significantly related to ratings of treatment sequelae, giving support to the discriminant validity of the measure. Conclusion The German version of HUI2/3 is a useful instrument with generally high inter-observer agreement and good suitability for outcome measurement in childhood cancer patients. Further research is needed to assess the usefulness of the instrument in other clinical populations and its sensitivity in longitudinal studies.
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  • 119
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    European journal of pediatrics 159 (2000), S. 507-508 
    ISSN: 1432-1076
    Keywords: Key words Behçet disease ; Children ; Myositis ; Pustulosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 12-year-old boy presented with a limp and findings suggesting localised myositis of his right calf and a working diagnosis of Behçet disease was made. During 3 years of follow-up, he had another three episodes of calf myositis, all responsive to corticosteroids within days. Conclusion A case of recurrent localised myositis as a main manifestation of Behçet disease is reported. The evolution of incomplete Behçet disease, which is common in children, to the full blown form, with the emphasis on muscle involvement and the importance of early diagnosis of Behçet disease, is discussed.
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    European journal of pediatrics 159 (2000), S. 515-519 
    ISSN: 1432-1076
    Keywords: Key words Osteogenesis imperfecta ; Hearing loss ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Osteogenesis imperfecta (OI) is a genetic disorder of connective tissue. Progressive hearing loss is one of the principal symptoms of OI, affecting about 50% of adult patients. Hearing loss may also occur in childhood and results in additional disability in education and psychosocial adaptation and aggravates the physical handicap. This can be avoided by appropriate otological and audiological treatment. In a nationwide search, 254 Finnish patients with OI were identified indicating a prevalence of 4.9/100 000. Of the 60 children, 45 aged between 4 and 16 years accepting to participate the study on hearing, were evaluated by a questionnaire and clinical audiometry. Hearing loss was defined as pure tone average (PTA0.5–2 kHz) more than 20 dB hearing level (HL). A clinical geneticist determined the type of OI among the 45 patients. Two sporadic OI cases with conductive hearing loss were ascertained (4.4%): An 11-year-old girl with type IV OI with a PTA0.5–2 kHz of 35/40 dB HL and a 15-year-old boy with type IV OI with a PTA0.5–2 kHz of 27/18 dB HL. In addition, a 6-year-old girl with familial OI type I had either a congenital sensorineural deafness or early progressive deafness with PTA0.5–2 kHz of 97/103 dB HL, probably of unrelated aetiology. Conclusion Hearing loss in children with osteogenesis imperfecta is less frequent than generally suspected. Nevertheless, it is recommended that audiometry is performed in children with osteogenesis imperfecta even without symptoms of hearing loss at the age of 10 years, and repeated every 3 years thereafter.
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    European journal of pediatrics 159 (2000), S. 649-656 
    ISSN: 1432-1076
    Keywords: Key words Antiretroviral therapy ; Children ; AIDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The introduction of combination antiretroviral therapy has been associated with a dramatic clinical improvement in children with human immunodeficiency virus infection. However, the uptake of antiretroviral therapy has been variable across Europe. The Paediatric European Network for the Treatment of AIDS Steering Committee has performed a systematic literature review of paediatric antiretroviral therapy trials. An analysis of the evidence base for the commencement and maintenance of antiretroviral therapy was produced. Suggestions for when to commence antiretroviral therapy, which drugs to start with and how to monitor and sequence drug regimens are given. Conclusion The aim of these guidelines is to help in obtaining equity of access to a uniformly high standard of care for children with human immunodeficiency virus infection in all European countries.
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  • 122
    ISSN: 1432-1076
    Keywords: Key words Gentamicin ; Once daily ; Children ; Saliva
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gentamicin is widely used in paediatric medicine and therapeutic monitoring is mandatory due to the narrow margin of safety. Saliva sampling may be of potential interest, especially in children in whom blood sampling is often difficult. Experience with once daily intravenous administration of aminoglycosides has grown in recent years. Gentamicin levels were measured in serum and saliva of 55 children treated with the drug (5 mg/kg per day), administered intravenously in three different regimens: thrice (n=19), twice (n=18), and once daily (n=18). No correlation was found between serum gentamicin concentrations and saliva levels when the drug was administered twice or thrice daily, however, there was good correlation when the drug was administered once daily (r 2=0.96, P 〈 0.0001). Conclusion In children with uncomplicated infections treated with once daily gentamicin, trough concentrations of the drug can be monitored in saliva.
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  • 123
    ISSN: 1432-1459
    Keywords: Key words Creutzfeldt-Jakob disease ; Alzheimer's disease ; Prion ; Presenilin ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe a patient who was clinically diagnosed with familial early-onset Alzheimer disease (AD) carrying both the E318G substitution in presenilin 1 (PSEN1) and an insertion of 7 octapeptide coding repeats in the prion protein gene (PRNP). Neuropathological examination revealed elongated cerebellar prion protein deposits in the absence of AD pathology. Further analysis of other family members showed that the Creutzfeldt-Jakob disease phenotype in this family was caused solely by the PRNP insertion. This observation is consistent with our previous finding that PSEN1 E318G is not causally related to AD.
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    Der Hautarzt 51 (2000), S. 95-100 
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Dubowitz-Syndrom ; Atopisches Ekzem ; Monozygote Zwillinge ; Kinder ; Keywords Dubowitz syndrome ; Atopic eczema ; Monozygotic twins ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Autosomal recessive inheritance, intrauterine growth retardation, short stature, microcephaly, distinct facial dysmorphism, psychomotoric retardation, and often uncharacterized eczematous skin lesions distinguish the rare Dubowitz syndrome. Here a pair of monozygotic twins with Dubowitz syndrome and clear-cut atopic eczema is presented.
    Notes: Zusammenfassung Autosomal rezessiver Erbgang, intrauterine Wachstumsretardierung, Kleinwüchsigkeit, Mikrozephalie, charakteristische Gesichtsdysmorphie, psychomotorischer Entwicklungsrückstand sowie häufig nicht näher charakterisierte ekzematöse Hautveränderungen kennzeichnen das seltene Dubowitz-Syndrom. Wir berichten über monozygote Zwillinge mit Dubowitz-Syndrom und eindeutigem atopischen Ekzem.
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    Child's nervous system 16 (2000), S. 170-175 
    ISSN: 1433-0350
    Keywords: Key words Supratentorial ependymoma ; Children ; Radical surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In view of the widely recognized correlation between extent of surgical resection and length of survival of children with intracranial ependymoma and the statement that total resection is more likely to be achieved in supratentorial than infratentorial primaries, we decided to review our experience with supratentorial ependymomas and the pertinent literature to verify the importance of surgery in treating this subgroup of pediatric ependymal neoplasms. Of 23 patients operated on, 12 are still alive without evidence of disease 72–357 months after surgery (mean 227, median 237 months). One girl treated by surgery alone was lost to follow-up after 234 months when she, and 7 other patients in the series, had already passed the end of the period of risk for recurrence according to Collins’ law. Six surviving patients (2 with subependymoma and 4 with ependymoma) were treated by surgery alone and only 1, the oldest in the series, had to undergo a second operation for recurrence after 10 years. The idea of treating intracranial ependymoma by surgery alone was favored by eminent neurosurgeons in the past and has recently received renewed attention. This was in part the consequence of recognizing that unlike diffuse astrocytoma, in which neoplastic cells can be found up to several centimeters away from the apparent tumor borders, ependymoma has more or less well-defined margins and grows mainly by expansion. Early experience with the policy of electively deferring adjuvant therapy after radiologically controlled total resection of ependymoma seems encouraging, although postoperative MRI does not yet indicate absolute certainty. Close surveillance is recommended. The majority of ependymomas so far treated by surgery alone, with relatively good success, have been supratentorial. In conclusion, on the basis of our experience and a review of the literature we favor a change in attitude to the management of intracranial ependymomas, especially of the cerebrum, with radiologically controlled radical surgery alone followed by close surveillance with periodic MR imaging until the child passes the period of risk for recurrence according to Collins’ law as the initial option. In children less than 3 years old the period of surveillance should be doubled. In case of recurrence, reoperation should be considered first, particularly for supratentorial primaries. Radiotherapy continues to be a major option in malignant ependymoma and unresectable primary or recurrent benign ependymoma.
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  • 126
    ISSN: 1432-2161
    Keywords: Key words Bone mineral density ; Dual energy X-ray absorptiometry ; Children ; Rickets ; X-linked hypophosphatemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To evaluate the bone mineral status of children being treated for X-linked hypophosphatemia, including potential differences between cortical bone in the radial diaphysis and combined cortical and trabecular bone in the lumbar spine. Design and patients. Forty-four bone mineral evaluations were performed in 11 children and adolescents with X-linked hypophosphatemia. Bone mineral density (BMD) of the lumbar spine and the radial diaphysis were measured by dual X-ray absorptiometry (DXA), second metacarpal cortical thickness was measured on hand radiographs, and these results were expressed as Z-scores (standard deviations from the mean). Results. For the 11 initial examinations, Z-scores (mean±SD) were: radial BMD, –2.73±1.15, lumbar BMD, +1.28±1.53; and cortical thickness, –2.21±0.95. Lumbar BMD Z-scores were significantly greater than those for radial BMD and cortical thickness. On follow-up examinations there was a mild increase in radial BMD and decrease in lumbar BMD. Although these changes were statistically significant, they were quite small and the discordance between radial and lumbar BMD was not corrected. Conclusions. Children and adolescents who are being treated for X-linked hypophosphatemia manifest a bone mineral disorder characterized by decreased BMD in the appendicular skeleton and increased BMD in the lumbar spine. Although current therapy is successful in its anti-rachitic effects, it does not correct this bone mineral disorder and additional therapeutic trials should be considered.
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  • 127
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Children ; Risk factors for survival ; Primary non-function ; Hepatic artery thrombosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Several recipient, donor and operation factors as well as postoperative complications related to patient survival after liver transplantation (LT) in children were studied by univariate and multivariate analyses . In a 13-year period, 103 patients under 15 years of age underwent 120 LT; the mean age was 63 months and 36 % were under 2 years of age. Indications for LT were cholestatic disease in 68 (56 %), metabolic diseases in 18 (14 %), fulminant hepatic failure in 8 (7.5 %), cirrhosis in 7 (5.8 %), and retransplants in 17 (14 %). Whole liver was transplanted in 79 % of cases and partial liver in 21 %. Actuarial survival at 1, 5, and 10 years was 70 %, 61 %, and 57 %, respectively. United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non-function (PNF) (RR = 13.9), and hepatic artery thombosis (HAT) (RR = 3.8) were independent factors for lower patient survival in multivariate analysis. Thus, in our experience, postoperative mortality as a consequence of the patient's condition before transplantation, or complications such as PNF or HAT, are the major causes of decreased survival in pediatric LT.
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  • 128
    ISSN: 1432-2307
    Keywords: Key words VMAT2 ; Stomach ; ECL cell ; Tumors ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The vesicular monoamine transporter 2 (VMAT2) facilitates the ATP-dependent accumulation of biogenic amine inside the secretory granules of endocrine cells and neurons and was demonstrated in the histamine-producing enterochromaffin-like (ECL) cells of the stomach. In the present investigation, VMAT2 immunohistochemistry was tested in 85 endocrine tumors, of which 60 were well differentiated gastrointestinal and pancreatic growths, 5 poorly differentiated (neuro)endocrine carcinomas (PDEC) and 1 mixed PDEC/ECL cell carcinoma of the stomach, 12 pheochromocytomas/paragangliomas, 3 adrenocortical lesions, 2 parathyroid and 2 lung neuroendocrine tumors. Extensive and intense VMAT2 immunoreactivity was observed in 16 of 16 gastric ECL cell tumors, 6 of 6 adrenal pheochromocytomas, 2 of 2 chromaffin paragangliomas and in 3 of the 4 carotid body paragangliomas investigated. Rare VMAT2-positive cells were observed in 12 of 21 intestinal enterochromaffin (EC) cell tumors, in 9 of 11 pancreatic neuroendocrine tumors, and in the mixed PDEC/ ECL cell carcinoma of the stomach (differentiated cells only). No VMAT2 immunoreactivity was observed in five gastrin, four somatostatin and three enteroglucagon/peptideYY tumors of the gastrointestinal tract, in six gastric PDECs, in three adrenocortical growths, and two parathyroid and two lung neuroendocrine tumors. These data support VMAT2 immunohistochemistry as being a useful tool for the diagnosis of gastric ECL cell tumors, separating them from all other endocrine tumors arising in the gastroduodenal area i.e., gastrin, somatostatin, EC cell and PDEC tumors, all of which proved essentially negative.
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  • 129
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    Virchows Archiv 436 (2000), S. 224-228 
    ISSN: 1432-2307
    Keywords: Key words Apoptosis ; bax ; bcl-2 ; Colon carcinoma ; CyclinD1 ; Immunohistochemistry ; p21 ; p53 ; pRb
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Tumour growth is regulated by a balance between proliferation, growth arrest and programmed cell death (apoptosis). Until recently, the majority of the studies dealing with oncogenesis has been focused on the regulation of cell proliferation. There is now growing understanding that control of growth arrest and apoptosis play key roles in the development of human cancer and in cancer treatment. Some of the more heavily studied proteins of importance for the control of growth arrest and apoptosis are p53, p21, bcl-2 and bax. Alterations in the p53 protein may lead to malignant transformation and defect therapy response, most likely as a result of defective p53-dependent apoptosis. In addition, p21 (WAF1/CIP1) is involved in cell-cycle arrest and probably in induction of p53-dependent apoptosis. Proteins belonging to the bcl-2 family are also important for normal apoptosis. Overexpression of bcl-2 protein is thought to reduce the apoptotic capacity, while bax protein seems to be necessary for induction of apoptosis. In this study, we have immunostained tissues from 93 primary colon carcinomas and have examined the expression of p53, p21 (WAF1/CIP1), bcl-2 bax, pRb and cyclin D1 for evaluation of their roles in colon-cancer progression. A highly significant association between p53 accumulation and downregulation of p21 (WAF1/CIP1) was seen. We also found a strong association between reduced/absent p21 and the development of metastases and death due to cancer disease. Cyclin D1, bcl-2 and bax protein failed to have independent prognostic impacts. Bcl-2 and bax protein levels showed an inverse relationship. The results of the present study indicate that reduced p21 protein levels play an important role in progression of colon cancer. We concluded that evaluation of p21 expression in primary colon carcinomas at the time of surgery might be a valuable tool in defining patients with a high risk of developing metastases.
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  • 130
    ISSN: 1432-2307
    Keywords: Key words Clinical course ; Immunohistochemistry ; Morphology ; Primary gastric T-cell lymphoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In contrast to primary gastric lymphomas of B-cell type, little is known about primary gastric T-cell lymphomas. We describe three cases with remarkably similar features: diffuse growth, epitheliotropism, medium too large cell size, high apoptotic rates, and a CD3+, CD4+, CD8+, CD45RO+ immunophenotype. Clonal TCRγ gene rearrangement was shown in two cases. Epstein-Barr virus infection was excluded in two cases. Taking advantage of fresh-frozen material, we analyzed two cases further, revealing CD5–, CD16+, CD56–, CD57–, CD25+, CD30+, CD103 (αEβ7)+, bcl-2 protein+, CD95+, CD95 ligand(L)–. CD95L, however, was detected in histiocytic and fibroblastoid by stander cells. The lymphomas expressed granzyme B, perforin, and the TIA-1 antigen in various combinations. All three cases had a very unfavorable clinical course characterized by local recurrence and/or dissemination to other epithelial sites, leading to death within 6–12 months after the initial diagnosis despite surgery and aggressive antineoplastic treatment. These data suggest a novel variant of peripheral T-cell lymphoma operationally characterized as primary gastric, apoptosis-rich, CD103+, EBV-, T-cell lymphoma co-expressing CD4, CD8, CD16 and cytotoxic molecules.
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  • 131
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Posttransplant lymphoproliferative disease ; Epstein-Barr virus ; Humans ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Epstein-Barr virus (EBV) infection can induce uncontrolled lymphocyte B proliferation in immunosuppressed transplant patients. Monitoring circulating EBV-infected lymphocytes can help in identifying patients at risk of posttransplant lymphoproliferative disease (PTLD). Circulating EBV genome levels were determined in 54 liver transplant pediatric recipients. Ten patients had more than 500 EBV genome/105 peripheral blood lymphocytes (PBL) and exhibited clinical manifestations of EBV infection; three developed PTLD. To treat EBV infection, the level of immunosuppression was reduced and acute rejection developed in 4 patients. Three were treated with steroid and one had to be switched from cyclosporine to tacrolimus. Treatment of acute rejection was associated with increases in circulating EBV genome. None of the patients with less than 500 EBV genome/105 PBL developed PTLD or EBV infection. Monitoring of EBV DNA is useful in the management of EBV infection and PTLD following pediatric liver transplantation. EBV infection should be treated in ways which do not expose patients to the risk of rejection.
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  • 132
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Rejection ; ICAM-1 ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Acute rejection (AR) is a frequent complication following liver transplantation (LT). ICAM-1 may be involved in its pathogenesis. High doses of glucocorticoids are the standard treatment in these patients. The aim of this study was to describe corticoid effects on ICAM-1 tissue expression in liver biopsies of patients with LT and AR. The study included liver biopsies performed before and after treatment in 12 patients with LT and proven AR. In 10 patients AR was reversible and in 2, was steroid resistant. For immunohistochemistry, an indirect immunoperoxidase technique was used. Each histology section was semiquantitatively evaluated as follows: 0: 〈 10 % staining, 1: 10–25 %, 2: 25–50 %, 3: 〉 50 %. The control group comprised nine patients with LT and normal liver biopsies. In pre-treatment liver biopsy samples, ICAM-1 was markedly expressed on sinusoidal cells (2.41 ± 0.66), and there was also expression on periportal (0.66 ± 0.65) and perivenular hepatocytes (0.83 ± 0.57). By contrast, in the liver tissue from the control group, sinusoidal ICAM-1 reactivity was significantly lower (0.88 ± 0.33; P 〈 0.05), and hepatocytes showed no reliable ICAM-1 expression. After steroid treatment the intensity of ICAM-1 decreased significantly in sinusoids (1.5 ± 0.67; P 〈 0.05) and in perivenular hepatocytes (0.25 ± 0.86; P 〈 0.05). Additionally, we also observed a decreased ICAM-1 reactivity in portal hepatocytes (0.25 ± 0.62), but these differences did not reach statistical significance. Remarkably, after treatment, hepatocytes did not show ICAM-1 reactivity in resolved AR, but in corticoid-resistant patients AR did not change or increase. In conclusion, in patients with LT and AR, ICAM-1 was expressed in hepatocytes and with more intensity in sinusoid cells. Additionally, a down-regulation of the ICAM-1 tissue expression after corticoid treatment may exist, although in corticoid-resistant AR no modulation on ICAM-1 tissue expression was observed.
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  • 133
    ISSN: 1432-2307
    Keywords: Key words Cervix ; Peripheral primitive neuroectodermal tumour ; Ewing’s tumour pathology ; Immunohistochemistry ; Cytogenetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Peripheral primitive neuro-ectodermal tumours (PNET) of the cervix are very rare. Here, we report the clinical, pathological, immunohistochemical and genetic features of a case of a PNET located in the cervix. Hysterectomy revealed a cervical tumour. On microscopic examination, a vaguely lobular arrangement of uniformly appearing neoplastic cells, with round to oval nuclei, distinct nuclear membranes and a clear, moderately glycogen-rich cytoplasm was seen. Cells stained positive for LEU 7, S 100, monoclonal NSE and particularly for MIC2. Neurogenic differentiation was also seen by electron microscopic examination. The genetic hallmark of PNET, a 22q12 rearrangement was demonstrated by fluorescence in situ hybridisation experiments, supporting the diagnosis. Awareness of the existence of primary PNET of the cervix is important to avoid confusion with other tumours of the cervix.
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  • 134
    ISSN: 1432-2307
    Keywords: Key words Nitric oxide ; Nitric oxide synthase ; Colorectal cancer ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  There is growing evidence that nitric oxide (NO) has an important role in tumor growth. However, information on the expression of NO synthase (NOS) in colorectal cancers is scanty. We therefore investigated the distribution and expression of NOS in human colorectal cancers. The expression of three types of NOS, inducible (iNOS), endothelial (eNOS) and neuronal (nNOS), was examined by immunohistochemistry in 25 cases of colorectal cancer. The expression of iNOS was also investigated at the mRNA level using the reverse transcriptase polymerase chain reaction (RT-PCR) in 6 cases. Correlations were made between iNOS expression and the histopathological findings. Immunoreactive iNOS was detected in the tumor cells in 22 cases (88%) with diffuse cytoplasmic reactions. Expression of iNOS-mRNA detected by RT-PCR in three tumor tissues was over five-fold that in normal mucosa. Intensified immunoreactivity of iNOS was associated with vascular invasion. iNOS expression did not correlate with pathological staging, tumor size, lymph node metastasis, p53 expression or tumor vessel density. Immunoreactive eNOS stained more strongly in the endothelial cells of microvessels within and around the tumor than in the areas remote from the tumor. There is enhanced expression of iNOS and eNOS in human colorectal cancers, which may correlate with tumor growth and vascular invasion.
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  • 135
    ISSN: 1432-2307
    Keywords: Key words Adhesion molecule ; Integrins ; Meningiomas ; Macrophages ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This study assessed the expression of leukocyte integrins and macrophage-associated antigens in meningiomas. Fourteen benign meningiomas, ten atypical/anaplastic meningiomas, two hemangiopericytomas and one solitary fibrous tumour (SFT) were included. Frozen sections were immunostained using antibodies directed against leukocyte integrins, CD68, CD14, CD2, CD1a, DRC1 and CD34. Their expression was evaluated semi-quantitatively. Ki67 positive cells were counted. Arachnoid membranes served as controls. Arachnoid cells expressed the β2-integrin subunit and KP1. Beta2 was detected in the tumour cells of 14 meningiomas. In nine cases, this was associated with an α-integrin subunit. There was no statistical difference in the expression of β2 between benign and atypical/anaplastic meningiomas. KP1 was constantly expressed by the tumour cells of meningiomas. It was not expressed by other meningeal tumours. CD34 was detected in the fibrous meningiomas, hemangiopericytomas and the SFT. In each tumour, macrophages were more numerous than T lymphocytes. There was no statistical difference in the density of macrophages and T lymphocytes between the benign and atypical/anaplastic meningiomas. There was no correlation between the Ki67 proliferation index and macrophage infiltration. Meningiomas, through the expression of leukocyte antigens, have a very particular phenotype. The expression of β2 integrins could play a role in the attraction of immunocompetent cells in the stroma of meningiomas.
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  • 136
    ISSN: 1432-2307
    Keywords: Key words Breast ; Adenomyoepithelioma ; Metastasis ; Thyroid ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe a patient who was admitted to our hospital with an enlarged left lobe of the thyroid gland. Since fine-needle aspiration showed atypical follicular cells, a surgical exploration followed. Owing to extensive tumor infiltration into the surrounding tissues curative surgery was not possible, and only an incisional biopsy was taken. Histological examination of this biopsy revealed a mixed tumor composed of epithelial and myoepithelial cells. A primary thyroid tumor, metastasis of a salivary gland, and a skin appendage tumor could be excluded based on clinical examination, conventional histology, and immunohistochemistry. A tumor of the left breast treated 12 years earlier had originally been classified as an intraductal/intracystic carcinoma with focal invasion, but was re-examined. Using immunohistochemistry, the breast tumor was reclassified as a malignant adenomyoepithelioma. The current tumor was apparently a metastasis from this primary breast tumor. An updated review of the literature is given, including current knowledge on histological and immunohistochemical features of adenomyoepithelioma of the breast, with special attention to the reported pathological characteristics of recurrent and malignant tumors. Based on the reported pathological characteristics of recurrent and metastatic tumors we offer a diagnostic tool for identifying potentially malignant and recurrent tumors.
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  • 137
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    Virchows Archiv 436 (2000), S. 305-311 
    ISSN: 1432-2307
    Keywords: Key words Rhabdomyosarcoma ; Soft tissue tumours ; Adults ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Rhabdomyosarcoma in adults represents a rare soft tissue neoplasm which is seen most frequently in its pleomorphic subtype in this age group. Very rarely, clear cell and spindle-cell variants have been reported. In this study we describe three cases of rhabdomyosarcoma in adult patients, characterised by prominent hyaline sclerosis and a pseudovascular growth pattern. All cases were identified in the consultation files of one of the authors and routinely processed. Immunohistochemical studies were performed on paraffin sections with the alkaline phosphatase–antialkaline phophatase method. The patients, two women and one man, were 40, 41, and 56 years old. One developed a deep-seated soft tissue mass in the left lower leg, and one, a tumour of the left upper jaw. In one patient a bone tumour in the proximal body of the sacrum without extension into soft tissues was seen. The patients were treated by wide excision, piecemeal excision and incomplete excision in one case each; additional radiotherapy was performed in all three cases, and chemotherapy in two patients. In one patient multiple pulmonary metastases were noted, which showed progression despite systemic chemotherapy. Histologically, the neoplasms were composed of round/polygonal and spindle-shaped tumour cells including typical rhabdomyoblasts. In all cases a pseudovascular pattern and prominent hyaline sclerosis of the intercellular matrix was seen. Immunohistochemically, tumour cells stained positively for desmin and muscle actin (HHF35) and also for markers of striated muscle differentiation (myogenin, MyoD1, fast myosin). In this paper an unusual morphological variant of rhabdomyosarcoma arising in adult patients is described, which should be added to the morphological spectrum of these neoplasms.
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  • 138
    ISSN: 1432-2307
    Keywords: Key words Ameloblastoma ; Transforming growth factor-beta ; Desmoplasia ; Type-IV collagen ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Desmoplastic ameloblastoma (DA) is an unusual subtype of ameloblastoma histologically characterized by the pronounced collagenized stroma. In the present study, the immunolocalization of transforming growth factor beta (TGF-β), one of the most potent local factors for modulating extracellular matrix formation, was observed in DA in order to study its participation in the stromal desmoplasia. Seven cases of DA, including a ”hybrid” lesion, were studied together with ten cases of ordinary follicular and plexiform ameloblastomas as the control. In contrast to ordinary ameloblastomas, marked immunoexpression was observed in all DAs but one. In the ”hybrid” lesion, TGF-β was not expressed in the area of follicular ameloblastoma but in that of DA. These results show that TGF-β produced by tumor cells of DA plays a part in the desmoplastic matrix formation.
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  • 139
    ISSN: 1432-2307
    Keywords: Key words Multifocal micronodular pneumocyte hyperplasia (MMPH) ; Tuberous sclerosis ; Postmenopausal woman ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report a peculiar case of multifocal micronodular pneumocyte hyperplasia (MMPH) without association of pulmonary lymphangioleiomyomatosis (LAM) in a 56-year-old postmenopausal woman with tuberous sclerosis. This case is surmised to be a forme fruste of tuberous sclerosis. Computed tomography demonstrated multiple micronodules, measuring up to 5 mm in size, present in the bilateral lung fields, but no cystic changes. A proliferation of pleomorphic type-II pneumocytes lining the thickened alveolar septa in an adenomatoid pattern, with an associated increase in alveolar macrophages, was observed without typical nuclear atypia. In fully developed lesions, the ingrowth of more proliferating type-II pneumocytes into the thickened alveolar septa and macrophages filling the alveolar lumens were characteristic findings. Proliferation of immature smooth muscle cells suggesting LAM was not observed. Positive immunohistochemical stains for cytokeratin, epithelial membrane antigen, and surfactant apoproteins A and B, and negative staining for HMB45, alpha-1 smooth muscle actin, desmin, and carcinoembryonic antigen confirmed the characteristics of alveolar lining cells in each MMPH lesion. MMPH associated with tuberous sclerosis in the postmenopausal woman appears to be similar to that described in premenopausal women. The present case is familial rather than sporadic and suggests no relationship between the development of MMPH and the underlying hormonal state.
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  • 140
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    Virchows Archiv 436 (2000), S. 602-607 
    ISSN: 1432-2307
    Keywords: Key words Thyroid ; Hashimoto thyroiditis ; Oxyphil cell ; Immunohistochemistry ; bcl-2 ; Bax ; Fas
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Immunoreactivity for bcl-2, Bax and Fas was analysed in 16 cases with Hashimoto thyroiditis. Bcl-2-expression was constantly seen in regular thyrocytes and in the mantle-zone of lymphofollicular infiltrates. However, thyrocytes in the vicinity of lymphoid infiltrates and, especially, mitochondria-rich oxyphil cells exhibited reduced staining or none at all for bcl-2. Bax was found to be weakly reactive or negative in normal thyrocytes and was not up-regulated in bcl-2-deficient epithelial cells. In contrast, expression of Fas was markedly increased both in typical thyrocytes and in oxyphil cells within areas of lymphocytic infiltration. In conclusion, focal lack of bcl-2 expression together with up-regulation of Fas is a constant feature of Hashimoto thyroiditis. The reaction pattern of oxyphil cells is identical to that of affected typical thyrocytes without proliferation of mitochondria. Loss of bcl-2 with up-regulation of Fas is therefore likely to precede oncocytic change. Whether these alterations are involved in the process of oncocytic transformation remains to be clarified, however.
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  • 141
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    Virchows Archiv 436 (2000), S. 628-633 
    ISSN: 1432-2307
    Keywords: Key words Prostate adenocarcinoma ; Endocrine cells ; Immunohistochemistry ; FSH ; Electron microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report an unusual variant of prostatic adenocarcinoma with marked endocrine differentiation (mixed endocrine-exocrine adenocarcinoma). Endocrine cells accounted for 60% of the tumour cells, were positive with silver impregnation and for chromogranin A, synaptophysin, and neuron-specific enolase, and coexpressed the exocrine antigens prostatic acid phosphatase and prostatic-specific antigen. Most of the endocrine cells were basophilic with haematoxylin-eosin and proved immunoreactive for alpha subunit of human chorionic gonadotropin and follicle-stimulating hormone. The remaining endocrine cells were represented by eosinophilic cells positive for serotonin, and by calcitonin and serotonin-immunoreactive cells not identifiable in haematoxylin-eosin-stained sections. On ultrastructural analysis, two types of endocrine cells were identified. The most frequent cell type showed abundant cytoplasmic round, electron-dense neurosecretory granules, either small (212±44 nm) or large (471±114 nm), resembling those of gonadotropic pituitary cells. The second type of endocrine cells contained irregular electron-dense granules similar to those of serotonin-storing enterochromaffin cells.
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  • 142
    ISSN: 1433-0350
    Keywords: Keywords Intractable epilepsy ; Epilepsy surgery ; Outcome ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Surgical experience with long-term follow-up is limited in childhood intractable epilepsy, compared with adult epilepsy. To assess the role of each presurgical evaluation modality and to identify prognostic factors for favorable seizure control after epilepsy surgery, 38 children with intractable epilepsy who underwent surgery were retrospectively reviewed. Among the available preoperative evaluation modalities, PET and neuropsychological testing showed the highest rates of positive results, whereas MRI was the most concordant with EEG findings. During a follow-up period of at least 12 months, 26 of the 38 patients showed favorable seizure control (Engel classifications I and II). The best seizure control was achieved in patients with a temporal resection and discrete lesion on magnetic resonance imaging. In spite of the invasive study, the less satisfactory results followed an extratemporal resection. We conclude that epilepsy surgery benefits children with intractable epilepsy and that the role of invasive study should be re-established according to the area of resection and presence of discrete lesion on MRI.
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  • 143
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    Child's nervous system 16 (2000), S. 735-741 
    ISSN: 1433-0350
    Keywords: Keywords Glioma ; Children ; Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The management and prognosis of gliomas are significantly different in children and in adults. Fortunately, the proportion of gliomas that are malignant is smaller in children than in the adult population. The different types of gliomas encountered in the pediatric population are reviewed, taking account of the most recent contributions on this subject. The importance of considering both localization and histological classification for better definition of the prognostic factors of each subgroup is emphasized. A brief review of the possible causes of gliomas is presented. Unfortunately, the information obtained by molecular and genetic study of these tumors has still not resulted in anything that can help the children suffering from gliomas in a concrete way. Surgery, with all its recent refinements, remains the best treatment for the majority of benign gliomas providing they can be removed without unacceptable sequelae. The role of chemotherapy has emerged recently for the treatment of nonresectable low-grade gliomas, such as hypothalamic- chiasmatic tumors, especially for infants, in whom the adverse effects of radiotherapy can be severe and irreversible. On the eve of the new millennium, there is renewed hope that the problem of malignant gliomas will be solved in the not-too-distant future.
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  • 144
    ISSN: 1433-0350
    Keywords: Key words Botulism ; Electrophysiology ; Blink reflex ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Electrophysiological studies of a child with presumed botulism showed that the amplitude of the serially and electrically elicited blink reflexes Rl, R2 and R2’ was reduced during recovery. These findings suggest a conduction block of the facial nerves. Other nerve conduction studies and an incremental response to repetitive stimulation demonstrated a block of the presynaptic neuromuscular transmission. Results of the biological tests were negative, but those of electrodiagnosis and clinical examination favored a diagnosis of botulism. A combination of electrically elicited blink reflexes and rapid repetitive stimulation of the peripheral nerves was found to be a sensitive method of assessing the integrity of neuromuscular junctions and the subclinical impairment of muscle nerves.
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  • 145
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    Child's nervous system 16 (2000), S. 251-255 
    ISSN: 1433-0350
    Keywords: Key words Moyamoya disease ; Brain stem glioma ; Children ; Surgical treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  An 8-year-old boy was found to have primary moyamoya disease associated with a brain stem glioma. For over 3 years the child had experienced transient ischemic attacks induced by hyperventilation. One month before referral to our hospital he had presented with progressive left facial nerve palsy. Magnetic resonance imaging showed a cystic mass in the lower pons. Angiography revealed severe bilateral stenosis of the internal carotid arteries and prominent moyamoya vessels in the basal ganglia. Partial resection of the tumor yielded a histological diagnosis of pilocytic astrocytoma. Local radiation therapy reduced the size of the tumor. Anastomosis of the superficial temporal arteries and middle cerebral arteries on both sides was then performed. After direct bypass surgery, the patient remained in a good condition for a 5-year follow-up period. Clinical investigation of the coincidence of primary moyamoya disease and brain stem glioma led the authors to conclude that these two diseases coexisted independently.
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  • 146
    ISSN: 1433-0350
    Keywords: Keywords Angiogenesis ; Glioblastoma multiforme ; Immunohistochemistry ; Tenascin-C
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Tenascin-C (TN-C) plays an important part in the growth of neoplastic tissue, leading to new vessel development. TN-C has been assessed in adult glioblastoma multiforme (GBM) and has been evaluated as anti-neoplastic therapy. No studies have focused on this tissue in paediatric GBM. Tissues were obtained from six paediatric supratentorial GBMs. Immunohistochemistry was performed using a mouse antibody directed against human TN-C, and expression in tumour vasculature was described on the basis of TN-C immunoreactivity. The expression was minimal in three, moderate in two, and intense in one specimen. TN-C was not correlated with clinical history, neurological findings, or with tumour site. Although based on a limited number of patients, this study provides additional insights into tumour growth modulation and cytogenetic profile of paediatric GBM. The detailed understanding of events responsible for GBM growth is a prerequisite for the development of therapeutic modalities leading to improved prognosis and cure.
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  • 147
    ISSN: 1433-0350
    Keywords: Keywords Cerebrovascular disease ; Children ; Surgical outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To investigate the clinical features and surgical outcome of pediatric cerebrovascular disease (CVD), we retrospectively reviewed 280 children (up to 15 years of age) who underwent neurosurgical procedures for CVD between 1979 and 1998. Open surgery (n=448), endovascular procedures (n=22), and stereotactic radiosurgery (n=14) were the main neurosurgical procedures adopted. Clinical features and surgical outcomes were described according to the etiology of the CVD and the number of years of management. The mean duration of follow-up was 34 months. The mean age was 7.1 years, and the male-to-female ratio was 1.2:1. The most frequent CVD was moyamoya disease (62%). The surgical mortality related to CVD was 0.7%. Eighty-seven percent had Karnofsky Performance Scale scores of more than 70. We demonstrate increasing detection rates and improving outcomes in recent years. The clinical course in this study shows that recovery from CVD in children is good after neurosurgical procedures.
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  • 148
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    Knee surgery, sports traumatology, arthroscopy 8 (2000), S. 120-126 
    ISSN: 1433-7347
    Keywords: Key words Anterior cruciate ¶ligament ; Reconstruction ; Growth factor ; Remodeling ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract This study was designed to examine localization of the growth factors in the autogenous patellar tendon graft used to reconstruct the anterior cruciate ligament (ACL) in the canine model. Among the various growth factors, basic fibroblast growth factor, transforming growth factor-β1, and platelet-derived growth factor were selected for analysis as potential factors that regulate graft remodeling processes. In the control patellar tendon and the ACL only basic fibroblast growth factor was positively stained. In the reconstructed graft increased levels of staining for all the three factors were observed in the early postoperative period, reaching the greatest expression 3 weeks after implantation. Thereafter immunoreactivity of these growth factors decreased and returned to the preoperative levels, which were similar to that of the control ACL 12 weeks postoperatively. This rapid reduction in the level of their localization indicates that once the extrinsic cells are infiltrated to the graft and revascularization completed, these growth factors may have less significance for subsequent remodeling.
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  • 149
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    Knee surgery, sports traumatology, arthroscopy 8 (2000), S. 61-65 
    ISSN: 1433-7347
    Keywords: Key words Collagen ; Meniscal ¶insertions ; Knee joint ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract The medial meniscus of the rabbit knee joint attaches to the tibial plateau via anterior and posterior insertions. Intact meniscal tibial insertions are essential for meniscal function. In the present study the distributions of types I, II, and X collagen in meniscal tibial insertions were investigated by indirect immunohistochemistry in a rabbit model. Four tissue zones were histologically identified in the anterior insertion site, including the ligamentous zone, uncalcified and calcified fibrocartilaginous zones and bone; the ligamentous zone was not observed in the posterior insertion site. Labeling for type I collagen was found to be strong in the ligament tissue and bone, and weak in the fibrocartilages which were also labeled for type II collagen. Tissues positive for different types of collagen overlapped and formed an irregular interface with various angles and depths, especially at the interface between the calcified fibrocartilage and bone. Positive labeling for type X collagen was identified only in the calcified fibrocartilage zone. The coexistence of types I and II collagen in the meniscal tibial insertions may indicate that this structural unit is subjected to both compressive and tensile loads. Type X collagen may play a role in maintaining the calcifying status of this tissue zone, so that its mechanical stiffness is kept between that of uncalcified fibrocartilage and hard bone. Restoration of the insertional structure including the distinct collagen distribution should be considered for a functional meniscal substitution.
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  • 150
    ISSN: 1433-0350
    Keywords: Key words Child abuse ; Shaken baby syndrome ; Brain injury ; Infants ; Children ; Neuroimaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Acute CT/MRI findings were examined in a prospective, longitudinal study of 60 children 0–6 years of age hospitalized for moderate to severe traumatic brain injury (TBI). TBI was categorized as either inflicted (n=31) or noninflicted (n=29). Glasgow Coma Scale scores and perinatal history were comparable in both groups. Acute CT/MRI studies were visually inspected by a radiologist blind to group membership. Compared with the noninflicted TBI group, the inflicted TBI group had significantly elevated rates of subdural interhemispheric and convexity hemorrhages as well as signs of pre-existing brain abnormality, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly. Intraparenchymal hemorrhage, shear injury, and skull fractures were more frequent after noninflicted TBI. Subarachnoid hemorrhage and infarct/edema occurred with comparable frequency in both groups. Characteristic acute neuroimaging findings of inflicted TBI included multiple extraaxial hemorrhages in addition to the mild atrophy, subdural hygromas, and ventriculomegaly that suggest prior brain abnormality.
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  • 151
    ISSN: 1433-0350
    Keywords: Key words Brain death ; Children ; Electroencephalogram ; Etiology ; Evoked potentials ; Radioisotopic angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The objective of this study was to determine the main clinical, neurophysiological and angiographic findings in brain death (BD) in children seen at the Instituto Nacional de Pediatría, a third-level facility in Mexico City, between 1991 and 1996. The following variables were retrospectively analyzed: sex, age, etiology, associated morbidity, duration of stay in hospital, and the results of two of three confirmatory studies (electroencephalogram, evoked potentials, radioisotopic angiography). In all, 125 patients were studied [78 male; median age 2 years (range: 18 days to 17 years)]. The most frequent etiology was infection (34%); 57% of the children developed associated morbidity. In 111 of 122 patients electrocerebral silence was observed; 100 of 107 had brain stem and somatosensory evoked potentials affording conclusive evidence of BD; and 83 of 90 patients had a positive radioisotopic angiography indicating BD. In 76 patients all three confirmatory studies were performed: for 15 there was at least one false-negative test result. Our age cohort showed a predominance of children less than 2 years old. BD etiologies in developing countries differ from those reported in developed countries.
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  • 152
    ISSN: 1433-0350
    Keywords: Keywords Syringomyelia ; Chiari I malformation ; Foramen magnum decompression ; Children ; Scoliosis ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The authors studied the role of the sole posterior fossa bony decompression in the management of symptomatic children affected by Chiari type I anomalies. The series in the pediatric literature on this subject were reviewed and compared with that presented in this article. From May 1994 to December 1998, 53 patients (3 months to 26 years) were observed. They were divided into: asymptomatic patients (27), who received no surgical treatment and were only subject to clinical observation; symptomatic patients (brain stem compression 16, syringomyelia 10, including 7 with holocord). All the symptomatic patients were treated with the same surgical approach: bony decompression of posterior fossa with removal of the posterior arch of C-1 and the outer layer of the dura without dural opening. In all 16 (100%) of the 16 patients with brain stem compression the symptoms resolved or improved; in patients with syringomyelia the symptoms were resolved or improved in 94.4% of cases. Two children required further surgery after 13 and 24 months, respectively.This series seems to demonstrate that even a simple extradural surgical approach, with a lower rate of postoperative complications and short stay in hospital, is sufficient to arrest the disease and to improve the symptomatology in a high percentage of cases (97.2%), which is comparable to that achieved with other, more aggressive, procedures.
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  • 153
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    Child's nervous system 16 (2000), S. 724-730 
    ISSN: 1433-0350
    Keywords: Keywords Epilepsy ; Children ; Invasive monitoring ; Subdural electrodes ; Surgical technique ; Infection ; Morbidity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Despite improved imaging, and electrical and magnetic external mapping, there are a large number of children with intractable epilepsy in whom a focus cannot be defined by non-invasive techniques. Invasive monitoring with depth electrodes, electrode grids and/or strips is required in up to 50% of children with a suspected focal seizure disorder. In children with suspected temporal lobe epilepsy the invasive techniques are required to identify which temporal lobe is the primary focus, to separate temporal from frontal foci, and to define the extent of involvement of the lateral temporal cortex. In children and infants with non-temporal epilepsy, invasive monitoring is required to define the epileptogenic zone and to map areas of cortical specialization. The current techniques used for surgical implantation are described here. In a correctly selected population invasive monitoring will define the epileptogenic focus or foci in 90% of children; 80% will have surgically treatable epilepsy. Infection rates are less than 1% for subdural strips and 6% for grids. In 88 cases no incidence of meningitis occurred.
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  • 154
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    Child's nervous system 16 (2000), S. 755-759 
    ISSN: 1433-0350
    Keywords: Keywords Head trauma ; Children ; CT scan ; MRI scan ; Follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  CT scanning is the current first imaging technique to be used after head injury, in those settings where a CT scan is available. The first scan is usually done without contrast enhancement. The value of CT is the demonstration of scalp, bone, extra-axial hematomas and parenchymal injury. It is rapid and easily done in the presence of the multiple monitors that many trauma patients have in place. It can be used to demonstrate the bony anatomy of the spine and is good for evaluation of abdominal and chest trauma also. MRI is more sensitive for all post-traumatic lesions other than skull fracture and subarachnoid hemorrhage, and can demonstrate parenchymal spinal cord injury. The cons are a longer scanning time, interference of the imaging by certain ICP monitors and problems with the positions of the monitoring equipment and ventilators outside the MRI magnetic field. MRI will be used increasingly to study early head injury because of its ability to measure cerebral blood flow, cerebral blood volume and the location and extent of cerebral edema. If the CT does not demonstrate pathology adequate to account for the clinical state, MRI is warranted. Follow up is best done with MRI as it is more sensitive to parenchymal change than is CT.
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  • 155
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    Child's nervous system 16 (2000), S. 129-133 
    ISSN: 1433-0350
    Keywords: Key words Arteriovenous malformation ; Brain stem ; Cerebellum ; Children ; Quadrigeminal plate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This report presents a case of arteriovenous malformation (AVM) in the region of the superior vermis and quadrigeminal plate, which was partially embolized using a endovascular technique and subsequently surgically excised. An occipital transtentorial approach was employed to excise the AVM, and the patient did well without neurological complications postoperatively. Comparing various surgical approaches, we believe the occipital transtentorial approach is the best for the AVM of this region.
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  • 156
    ISSN: 1433-0350
    Keywords: Key words Hydrocephalus ; Endoscopic III ventriculostomy ; Outcome ; MRI ; Cine-MRI ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In order to analyze the surgical outcome according to clinical characteristics and to evaluate the correlation between clinical improvement and neuroimaging changes, we retrospectively reviewed 32 children who had undergone endoscopic III ventriculostomy (ETV) from February 1994 to May 1998. There were 15 boys and 17 girls, with a mean age of 5.2 years (range: 1 month to 13 years). The etiology of the hydrocephalus was primary aqueductal stenosis in 18 patients, secondary aqueductal stenosis caused by tumors in 5, IV ventricle outlet obstruction in 5, and hydrocephalus associated with meningomyelocele in 4. The mean duration of follow-up was 19.4 months (range 1–50 months). Overall, surgical outcome was regarded as good in 21 of 29 patients. Surgical outcome was poor in patients younger than 1 year (P〈0.05). Neuroimaging 1 month after ETV showed a decrease in ventricular size in 11 of the 16 patients with good surgical outcomes. Five showed minimal changes only. In patients with good outcomes, ventricular size tended to decrease as time passed. Resolution of periventricular edema, flow void in the III ventricle on T2-weighted axial images, and cine-MR imaging were sensitive indicators of good outcome. We suggest that ETV be considered as a primary treatment option in patients older than 1 year of age with noncommunicating hydrocephalus. In addition, time factors should be taken into consideration when surgical outcome is judged. Changes in ventricular size could not predict surgical outcome completely in themselves. Therefore, a comprehensive postoperative assessment should be made with the help of T2-weighted MRI and cine-MRI.
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  • 157
    ISSN: 1438-2199
    Keywords: Keywords: Amino acids ; Nerve lesion ; Neuropathic pain ; Heme oxygenase ; Carbon monoxide ; Cell injury ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary. The influence of carbon monoxide (CO) on chronic spinal nerve lesion induced spinal cord neurodegeneration was examined using immunohistochemical expression of the constitutive isoform of its synthesising enzyme, hemeoxygenase-2 (HO-2) in a rat model. Spinal nerve lesion at L-5 and L-6 level was produced according to the Chung model of neuropathic pain and rats were allowed to survive for 8 weeks. Sham operated rats, in which the spinal nerves were exposed but not ligated, served as controls. Ligation of spinal nerves in rats resulted in an upregulation of HO-2 expression which was most pronounced in the ipsilateral gray matter of the spinal cord compared to the contralateral side. In these rats, morphological investigations showed distorted neurons, membrane disruption, synaptic damage and myelin vesiculation. Sham operated rats did not show an upregulation of HO-2 expression and the structural changes in the spinal cord were absent. These observations strongly suggest that spinal nerve lesion is associated with an increased production of CO which is somehow contributing to the neurodegenerative changes in the spinal cord, not reported earlier.
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  • 158
    ISSN: 1439-0973
    Keywords: Key Words Ritonavir ; Nelfinavir ; Children ; Antiretroviral agents ; HIV-1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background: Knowledge concerning the long-term antiretriviral and immunological efficacy of protease inhibitors in children is limited. Patients and Methods: An open-label, prospective, multicenter clinical trial was conducted over a period of 72 weeks in Switzerland. 60 HIV-1 infected children (aged 0.3–16.9 years) naive to protease inhibitors were enrolled. Ritonavir or nelfinavir and at least one new nucleoside reverse transcriptase inhibitor were introduced into the durrent treatment regimen. HIV-1 RNA levels and CD4 cell counts were monitored after introducing the protease inhibitor, and the tolerability and safety of the drugs were assessed. Results: Dictated by chronological availability, 37 children received ritonavir and 23 nelfinavir. At baseline, children given ritonavir had higher mean plasma HIV-1 RNA levels (5.03 vs 4.63 log10 copies/ml; p = 0.001) and lower mean CD4 cell counts (277 vs 555 cells/μl; p = 0.009) than children given nelfinavir. Antiretroviral treatment (ART) naive children showed higher mean plasma HIV-1 RNA levels than non-naive (5.18 vs 4.64 log10 copies/ml; p = 0.02). The decline in plasma HIV-1 RNA levels 72 weeks after treatment with ritonavir and nelfinavir was −2.17 and −1.30 log10 copies/ml, respectively (p = 0.006) and in ART-naive vs non-naive patietns −2.70 vs − 1.39 log10 copies/ml (p ≤ 0.01). 69% of ART-naive patients and 32% of non-naive patients achieved sustained plasma HIV-1 RNA levels 〈 400 copies/ml. Increases in CD4 cells were higher in ART naive compared to non-naive patients (p 〈 0.04). Conclusion: The antiretroviral and immunologic benefits of protease inhibitors are more profound in ART-naive than in non-naive children.
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  • 159
    ISSN: 1439-0973
    Keywords: Key words Tick-borne encephalitis ; Children ; Adults
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of this prospective study was to compare epidemiological data and clinical features in children and adults with tick-borne encephalitis (TBE). Patients with aseptic meningitis diagnosed at the University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia, from June to August 1997, in whom the diagnosis of TBE was ascertained by the presence of serum IgM antibodies against TBE virus, who were serologically negative for Borrelia burgdorferi sensu lato and had a negative PCR CSF result on enteroviral infection, were included in the study. Out of 213 patients with aseptic meningitis, 80 (37–56%) fulfilled inclusion criteria. There were 20 children and 60 adults. In both groups males predominated. Virtually all patients had headache and fever, and more than 50% suffered from vomiting. The majority of patients in both groups recalled a tick bite, had a biphasic course of the illness, and was found to have obviously expressed meningeal signs. In both groups the median CSF leukocyte count was somewhat lower than 100 × 106/l with a predominance of lymphocytes. Children were more often given antibiotics during the initial phase of TBE than adults (p = 0.0095). Several other statistically significant distinctions (p 〈 0.05) were found including the frequency of fatigue, malaise, vertigo, photophobia, myalgias, arthralgias, as well as elevated CSF albumin and protein concentration, elevated albumin quotient and IgG quotients; all these findings were more often present in adults. In addition a longer duration of fever, more frequent need for anti-edematous treatment and longer hospitalization were found in adults. Direct comparison of clinical and epidemiological characteristics of TBE in children and adults revealed differences in several clinical and laboratory features and corroborates the previous conclusion that TBE in childhood is a milder illness than TBE in adults.
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  • 160
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    Journal of urban health 77 (2000), S. 723-734 
    ISSN: 1468-2869
    Keywords: Child welfare ; Children ; Disclosure ; HIV ; Mothers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this investigation was to ascertain the reasons given by mothers diagnosed with AIDS (acquired immunodeficiency syndrome) for disclosing or not disclosing their HIV (human immunodeficiency virus) status to their children, a dilemma faced by most HIV-infected parents and those who counsel them. We interviewed 29 mothers residing in one of two New York City facilities that provide housing and medical treatment for adults with AIDS. The majority of these mothers do not live with their children, but all had recent face-to-face contact with them. The two reasons most frequently considered important for disclosing to children were that disclosure was the “right thing to do” and the need to make arrangements for children's future in case of maternal death or incapacity. The reason most frequently considered important for not disclosing was maternal concern about discussing death and dying with children. These findings have significant implications for counseling of HIV-positive parents.
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  • 161
    ISSN: 1615-2573
    Keywords: Kew words Congenital heart disease ; Septal defects ; Children ; Pulmonary arterial compliance ; Pulmonary hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Previous studies have documented the normal values of pulmonary arterial compliance (Cp) in animals and adult humans. In the past, variations in Cp and its measurement in children with septal defects has been unknown. In the present study, we found the Windkessel model, which uses compliance and resistance as parameters, to be a useful tool in understanding Cp in pediatric patients. Calculations of Cp were based on the pulmonary arterial diastolic pressure waveform as an exponential function of time. First, Cp was estimated by studying pressure tracings of the main pulmonary artery (MPA) obtained from both routine cardiac catheterization and pressure measured by a catheter-tip manometer, which was performed during a catheterization study of seven children with various congenital heart diseases. Second, 124 children with atrial and ventricular septal defects aged between 45 days and 12 years were studied using the data obtained from routine catheterization. Hemodynamic data were used to calculate pulmonary vascular resistance (Rp), pulmonary arterial time constant (Tp) and Cp. A strong correlation (r = 0.954) was found in the Cp value estimated by data obtained from routine catheterization and from the catheter-tip manometer study. The present study shows an estimated mean (SEM) Cp in normal children of 1.53 (0.17) ml/mmHg per m2. The estimated mean (SEM) Cp was 1.91 (0.10) and 1.70 (0.11) ml/mmHg per m2 in children with atrial septal defect (ASD) and ventricular septal defect (VSD), respectively. It was found that Cp was significantly (P = 0.04) higher in female patients with a VSD. Also, a significantly low Cp (0.95 ± 0.06 ml/mmHg per m2) was observed in patients with a VSD and pulmonary hypertension (VSDPH). In conclusion, Cp was calculated by the exponential decay portion of the MPA diastolic pressure waveform. A normal Cp value was observed in ASD and VSD patients and a significantly low Cp was observed in children with a VSDPH. Cp was higher in female VSD patients than in male VSD patients.
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  • 162
    ISSN: 1615-3146
    Keywords: Key Words Fracture ; Children ; Elastic stable intramedullary nailing (ESIN) ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Elastic stable intramedullary nailing (ESIN) is well established for stabilizing pediatric diaphyseal and special metaphyseal limb fractures. Expanding its application requires the evaluation of problems and complications to prevent uncritical use. Four pediatric surgical departments participated in a retrospective study. Between 1990 and 1998, 937 fractures were treated by ESIN. Major indications were forearm and femur fractures. Continuous documentation of treatment, postoperative course and follow-up formed the basis of evaluation. Analysis was subdivided into intraoperative problems, postoperative problems, and complications. Intraoperative problems (6.5%) were characterized by open reduction, cortical perforation by a nail tip with subsequent instability and by iatrogenic bursting of a third fragment. Postoperatively, 6.4% of patients showed soft tissue irritation due to nail ends or joint effusions. Complications (8.4%) included axial deviation 〉10° or instability of osteosynthesis in 5.3% and nerve injuries in 1.4%. Delayed healing, pseudarthrosis, osteomyelitis and synostosis were only observed in isolated cases, 5 children sustained a refracture. Severe complications are rare, problems arise from suboptimal technique and incorrect indication. Detailed knowledge of technical principles and procedural recommendations constitutes the mainstay in prevention.
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  • 163
    ISSN: 1615-2573
    Keywords: Key words Magnetic resonance angiography ; Three-dimensional ; Gadolinium ; Peripheral vascular lesion ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We applied three-dimensional (3D) magnetic resonance (MR) angiography to vascular lesions in children and evaluated the clinical usefulness of this technique. Ten patients, whose ages ranged from 1 month to 16 years, underwent 3D MR angiography for 12 vascular lesions, including lesions in seven pulmonary arteries, two thoracic aortae, a pair of renal arteries, and one iliac artery. Three-dimensional MR angiography was performed with body- or pelvic-phased array coils on a 1.5-T scanner using fast spoiled gradient echo sequence. Data were acquired with the following parameters: TE, 1.9 ms; TR, 10.1 ms; flip angle, 20–60°; 1 or 2 NEX; field of view, 24–48 × 18–40 cm; matrix, 256 or 512 × 128 or 256; slice thickness, 1.2–7.5 mm; and 12, 28, or 60 partitions. Vascular imaging was enhanced with 20% gadolinium–diethylenetriaminepentaacetic acid. The examination was performed under breath-holding in six patients and with shallow breathing in four patients. In a comparative study with other noninvasive methods, 3D MR angiography was superior in seven of nine cases to other noninvasive examinations and in two cases, all methods evaluated the lesions. Furthermore, six cases were compared with conventional angiography. In five of the six cases, both methods depicted the lesions similarly, and in one case, MR angiography was more effective. A quantitative comparison of vascular diameter in the MR image was made with that in the conventional angiographic image. The correlation between them was excellent: y = 1.145x− 2.090 (r = 0.987; P 〈 0.0001), where x is the diameter in the conventional angiographic images, y is the diameter in the MR images, and r is the correlation coefficient. In conclusion, 3D MR angiography is useful for depicting peripheral vascular lesions in children.
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  • 164
    ISSN: 1619-7089
    Keywords: Key words: Cardiomyopathy ; Doxorubicin ; Iodine-131 metaiodobenzylguanidine ; Immunohistochemistry ; Protein gene product 9.5
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Doxorubicin is one of the most useful anticancer agents, but its repeated administration can induce irreversible cardiomyopathy as a major complication. The purpose of this study was to investigate doxorubicin toxicity on cardiac sympathetic neurons using iodine-131-metaiodobenzylguanidine (MIBG) and protein gene product (PGP) 9.5 immunohistochemistry, which is a marker of cardiac innervation. Wistar rats were treated with doxorubicin (2 mg/kg, i.v.) once a week for 4 (n=5), 6 (n=6) or 8 (n=7) weeks consecutively. Left ventricular ejection fraction (LVEF), calculated by M-mode echocardiography, was used as an indicator of cardiac function. Plasma noradrenaline (NA) concentration was measured by high-performance liquid chromatography (HPLC). 131I-MIBG uptake of the left ventricular wall (24 ROIs) was measured by autoradiography. 131I-MIBG uptake pattern was compared with histopathological results, the neuronal population on PGP 9.5 immunohistochemistry and the degree of myocyte damage assessed using a visual scoring system on haematoxylin and eosin and Masson’s trichrome staining. LVEF was significantly decreased in the 8-week group (P〈0.05). The serum NA level also showed no statistical difference until 4 weeks and was significantly increased in the 8-week group (P〈0.05). MIBG uptake was decreased in the 6- and 8-week groups (P〈0.05), and was closely correlated with the reduction in the number of nerve fibres on PGP 9.5 stain. Myocyte damage was seen only in the 8-week group. Neuronal population and the 131I-MIBG uptake ratio of subepicardium to subendocardium were significantly increased (P〈0.05) in the 8-week group as compared with the control group. It may be concluded that radioiodinated MIBG is a reliable marker for the detection of cardiac adrenergic neuronal damage in doxorubicin-induced cardiomyopathy; it detects such damage earlier than do other clinical parameters and in this study showed a good correlation with the reduction in the neuronal population on PGP 9.5 stain. The subendocardial layer appeared to be more vulnerable to doxorubicin than the subepicardium.
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  • 165
    ISSN: 1619-7089
    Keywords: Key words: Thyroid cancer ; Children ; Extent of surgery ; Radioiodine treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. At most centres, the standard treatment for differentiated thyroid cancer (DTC) comprises total thyroidectomy, radioiodine treatment and thyroid-stimulating hormone (TSH) suppressive therapy. There is, however, considerable disagreement over the appropriate treatment for DTC in children. Some dispute the use of total thyroidectomy and/or question the routine application of iodine-131 therapy in children. The aim of this study was to perform a retrospective analysis of treatment results and prognostic factors for DTC in children treated at our centre. The study included 109 children with DTC (aged 6–17 years). The primary treatment comprised total thyroidectomy in 81 cases, radioiodine therapy in 85 cases and TSH suppressive therapy with l-thyroxine in all patients. Uni- and multivariate analysis of prognostic factors for disease-free survival was performed using the Cox regression method. The actuarial survival rate was 100%, and the 5- and 10-year actuarial disease-free survival rates were 80% and 61% respectively. Univariate analysis revealed that older age, total thyroidectomy and radioiodine treatment had a positive impact on disease-free survival whereas there were no statistical differences with regard to the child’s sex, histological type of cancer or lymph node status. On multivariate analysis, radical surgery was estimated to be the most significant factor (P=0.007) for disease-free survival, while less than total thyroidectomy increased the relative risk of relapse by a factor of 10. Radioiodine treatment decreased the relative risk of relapse by a factor of 5, but with borderline significance (P=0.07). Permanent postoperative complications were observed in 17% of children: in 11 laryngeal palsy occurred, in six there was hypoparathyroidism, and one suffered from both. It is concluded that total thyroidectomy and radioiodine treatment significantly improve recurrence-free survival in children and should be routinely applied even in young children as the primary treatment of DTC.
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  • 166
    ISSN: 1573-7365
    Keywords: Ethanol ; GLUT1 ; GLUT3 ; Glucose ; Cerebral Metabolism ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the normal adult brain, glucose provides 90% of the energy requirements as well as substrate for nucleic acid and lipid synthesis. In the present study, effects of ethanol on glucose transporters (GLUT) and glucose utilization were examined in rat brain. Male Sprague-Dawley rats weighing 250-300 gms were given either ethanol 3 gm/kg BW or saline IP 4 hrs prior to the animal sacrifice and removal of the cerebral cortical tissue. The cortical plasma membranes analyzed by cytochalasin B binding assay showed a decrease in GLUT number but not in GLUT affinity in the ethanol treated rats as compared to the control rats. The estimated Ro values were 70 ± 8.9 Vs 91 ± 8.9 pmoles/mg protein (p 〈 0.05 N=4) and the estimated Kd values were 0.37 ± 0.03 and 0.28 ± 0.05 μM (p: NS) in ethanol and control experiments respectively. Immunoblots of purified cerebral plasma membranes and low density microsomal fraction showed 17% and 71% decrease for GLUT1 and 54% and 21% (p〈0.05 or less; n=6) for GLUT3 respectively in ethanol treated rats than in control animals. Immunofluoresence studies also showed reduction of GLUT1 immunoreactively in choroid plexus and cortical microvessels of ethanol treated rats as compared to control rats. The effect of ethanol on regional cerebral metabolic rates for glucose (CMRGle) was studied using [6-14C] glucose and showed statistically insignificant decrease in brain glucose utilization. These data suggest that ethanol invivo decrease GLUT number and protein content in rat cerebral cortex
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  • 167
    ISSN: 1615-6692
    Keywords: Key Words Coxsackievirus B3 (CVB3) ; Myocarditis ; Inducible nitric oxide synthase (iNOS) ; Nitric oxide (NO) ; Reverse transcriptase polymerase chain reaction (RT-PCR) ; In-situ-hybridization ; Immunohistochemistry ; Schlüsselwörter Coxsackie-Virus B3 (CVB3) ; Myokarditis ; Induzierbare Stickoxidsynthase (iNOS) ; Stickoxid (NO) ; Reverse Transkriptions-Polymerasekettenreaktion (RT-PCR) ; In-situ-Hybridisierung ; Immunhistochemie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Stickoxid (NO) ist ein wichtiges bioaktives Molekül mit regulatorischen, zytotoxischen oder zytoprotektiven Eigenschaften. Bei der viralen Myokarditis vermittelt NO einerseits Wirtsabwehr gegen die virale Infektion, andererseits jedoch kardiale Dysfunktion. Stickoxid wird synthetisiert aus L-Arginin durch das Enzym Stickoxidsynthase (NOS). Die Expression der induzierbaren Stickoxidsynthase (iNOS) wird durch Zytokine reguliert, die in die komplexe Immunantwort des Myokards auf Enterovirusinfektionen involviert sind. Die vorgestellten Untersuchungen charakterisieren die Rolle von iNOS und NO in einem murinen Modell der viralen Myokarditis, induziert durch Coxsackie-Virus B3. Wir untersuchten den zeitlichen Verlauf der iNOS-Induktion in Korrelation zur Zytokin-mRNA-Expression von TNF-α, IL-1α, IFN-γ und TGF-β im Myokard von NMRI-Mäusen nach CVB3-Infektion mittels RT-PCR. Virale RNA konnte in der akuten und chronischen Phase der Erkrankung mit der seminested PCR nachgewiesen werden, was die Persistenz des viralen Genoms belegt. Wir fanden eine deutliche Expression von iNOS zu allen untersuchten Zeitpunkten (ein, zwei, drei, vier, sieben, 14, 28, 56, 98 Tage post infectionem [p. i.]). Basierend auf einer densitometrischen Auswertung waren erhöhte iNOS-Spiegel am siebten, 14. Und 28. Nach Infektion nachweisbar im Vergleich zu den Tagen 56 und 98 p. i. Die mRNA-Expression der inflammatorischen Zytokine TNF-α, IL-1α, IFN-γ war am ersten, vierten bzw. siebten Tag p. i. nachweisbar, erreichten am siebten Tag p. i. ihr Maximum und persistierte bis zum 98. Tag p. i. Ähnlich wie die iNOS-mRNA-Expressionsmuster waren die von TGF-β. Mittels In-situ-Hybridisierung und Immunhistochemie konnte iNOS in Infiltraten, Gefäßendothel- und glatten Muskelzellen, in Myozyten und im Interstitium des Myokards lokalisiert werden. Erhöhte Werte von NO, bestimmt als Gesamtnitrat/-nitritkonzentration, wurden an den Tagen 7, 14 und 28 p. i. gemessen.
    Notes: Abstract Nitric oxide (NO) is an important bioactive molecule with regulatory, cytotoxic or cytoprotective properties. In virus-induced myocarditis, NO mediates host defense mechanisms against the infection or causes cardiac dysfunctions. NO is synthesized from L-arginine by the enzyme nitric oxide synthase (NOS). The expression of the inducible form of the nitric oxide synthase (iNOS) is regulated by cytokines, involved in the complex myocardial immune response to enterovirus infections. The present study was undertaken to characterize the role of iNOS and NO in the murine model of viral myocarditis induces by coxsackievirus Be (CVB3). In response to CVB3 infection we investigated the time course of iNOS induction in correlation with cytokine mRNA expression (TNF-α, IL-1α, IFN-γ, TGF-β) in the heart of NMRI mice by RT-PCR. Positive PCR signals for viral RNA were found in the acute and chronic stage of disease by seminested PCR, indicating the persistence of viral genome. We found distinct expression of iNOS at all time points (1, 2, 3, 4, 7, 14, 28, 56, 98 days post infection [p. i.]. Higher iNOS mRNA levels were identified between days 4 until 28 p. i. in comparison to day 56 and 98 p. i. using densitometric values. The mRNA of the inflammatory cytokines TNF-α, IL-1α, IFN-γ appeared at days 1, 4, and 7 p. i., peaked at day 7 p. i. and persisted until day 98 p. i. Similar like the iNOS mRNA pattern was the expression profile of TGF-β. Using in situ hybridization and immunohistochemistry iNOS was localized in infiltrates, vascular endothelial cells, smooth muscle cells, myocytes and throughout the interstitial spaces between myocardial fibers in the heart sections of NMRI mice. Increased levels of NO were measured as total nitrate/nitrite concentration in the sera of mice from day 7 until day 28 p. i.
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  • 168
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    Herz 25 (2000), S. 724-728 
    ISSN: 1615-6692
    Keywords: Key Words: Pericarditis ; Myocarditis ; Inflammation ; Immunohistochemistry ; Schlüsselwörter: Perikarditis ; Myokarditis ; Entzündung ; Immunhistologie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Obwohl Perikarderkrankungen lange Zeit nicht im Vordergrund des Interesses der Pathologen standen, ermöglichen neue Techniken zur Entnahme von Perikardgewebe die Anwendung neuer diagnostischer Methoden der Immunhistochemie und Molekularpathologie, die sich in der Myokarditisdiagnostik bereits bewährt haben. In diesem Zusammenhang stellt sich die Frage, ob die Diagnose einer Entzündung nur auf der Grundlage von morphologischen Veränderungen gestellt werden kann. Eine endgültige Diagnose einer Perikarditis oder Myokarditis erscheint aber ohne morphologische Kriterien kaum möglich.
    Notes: Abstract In medicine, and thus in pathology, there are areas/topics of fashion and they shift from time to time. Pericardial diseases are not fashionable. Myocarditis is, and has been for a long time. Due to new ways of retrieving tissue samples from the pericardium the modern diagnostic tools such as immunohistochemistry and molecular pathology can be applied in this context as they have been in myocarditis for a long period. The diagnosis of inflammation rests on many other findings than morphological alterations and it is indeed questionable if inflammation is solely a morphological diagnosis. The methodologies of pathology can be improved and used in a better and more purposeful way even under routine conditions. It is concluded that morphology is still mandatory to make a final diagnosis of peri- and myocarditis.
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  • 169
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    Neurochemical research 25 (2000), S. 231-237 
    ISSN: 1573-6903
    Keywords: Marginal division ; neostriatum ; monkey brain ; Immunohistochemistry ; NADPH-d
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A new subdivision, the “marginal division” (MrD), was discovered at the caudal border of the striatum and surrounds the rostral edge of the globus pallidus in the rat brain in our previous studies. The neuronal somata of the MrD are mostly fusiform in shape with their long axes lining dorsoventrally. The MrD is more densely filled with substance P (SP)-, Leucine-enkephalin (L-Enk)-, dynorphin B-, neurotensin-, somatostatin- and cholecystokinin (CCK)-immunoreactive fibers and terminal-like structures than the rest of the striatum. The MrD was confirmed in the cat neostriatum as well. The present study intended to explore whether the MrD exists in the monkey neostriatum (putamen) with Nissl, histochemical and immunohistochemical methods. A band of fusiform neurons were obviously identified at the caudomedial edge of the putamen. These neurons lie outside the lateral medullary lamina and indirectly surround the rostrolateral border of the globus pallidus. The abundance of SP-, L-Enk-, neuropeptide Y-, CCK-, dopamine- and serotonin-positive fibers and terminal-like structures with a few positive fusiform neurons accumulating at the caudomedial border of the putamen obviously distinguishes this zone from the rest of neostriatum and globus pallidus. The acetylcholinesterase (AChE) positive and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) containing fusiform neurons are distinctly visualized in the same zone. The morphological figure and the location of these neurons, and the histochemical and immunohistochemical characteristics of this area coincide well with those of the MrD in the rat and cat striatum. This study thus convincingly identifies the existence of the MrD in the monkey neostriatum. It is fairly asserted that the MrD is a universal structure in the mammalian brain.
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  • 170
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    Infection 28 (2000), S. 282-286 
    ISSN: 1439-0973
    Keywords: Key Words Chronic ; Osteomyelitis ; Therapy ; Children ; Ewing's sarcoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background: Presently, most children with chronic osteomyelitis undergo surgery with the inherent risk of damage to their growth plate. We demonstrate a treatment regimen based on imaging procedures focussing on antibiotics in order to reduce the rate of surgical interventions. Patients and Methods: We retrospectively evaluated all 11 patients with clinically suspected chronic osteomyelitis who were treated at our institution from 1989 to 1995. Patients underwent open biopsy and surgical treatment only if imaging procedures showed signs indistinguishable from malignancy, or if they were highly suggestive for the presence of pus, joint infection or osteonecrosis. The patients were followed up for a minimum of 3 years. Results: All five patients treated solely with antibiotics recovered completely. Three patients were subjected to open biopsy and surgical treatment since they showed radiological signs indistinguishable from malignancy, and two patients due to pus or osteonecrosis. In follow-up, there was one relapse of chronic osteomyelitis 11 months after the first treatment course with surgery and antibiotics. One patient suffering from Ewing's sarcoma as detected by open biopsy was excluded. Conclusion: Our diagnostic procedure was useful to reduce the rate of surgery. Surgical treatment of chronic osteomyelitis is not always neccessary especially in cases of missing necrosis, joint infection and abscess as demonstrated by the complete recovery of our patients treated solely with antibiotics.
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  • 171
    ISSN: 1439-0973
    Keywords: Key words Pertussis ; Bordetella pertussis ; Hospitalization ; Complications ; Vaccine ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We prospectively followed 725 children under 2 years of age with laboratory-diagnosed Bordetella pertussis infection to investigate the hospitalization rate and complications. Diagnosis was made by culture and polymerase chain reaction (PCR) from nasopharyngeal swabs in 11,016 children who presented with ≥ 7 days of cough at 63 pediatric practices in Germany. Of these children, 33 (4.5%) were hospitalized at a mean age of 4.8 months (range, 17 days to 19.5 months). Complications occurred in 16 (48%) of the 33 patients. Pneumonia developed in two (6%) children and a convulsion was observed in one (3%). Intensive care monitoring was required for 23 (70%) children. Further complications were bradycardia (21%), apnea (12%), conjunctivitis (12%), loss of weight (12%), otitis media (6%), atelectasis (3%) and dehydration (3%). Children aged 6–24 months who had not received any dose of pertussis vaccine had a ten-fold increased risk of hospitalization compared to those who had been partially or fully immunized (p 〈 0.05). Pertussis immunization should be given at an early point in time and completely in order to prevent severe courses of pertussis and hospitalization in young children.
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  • 172
    ISSN: 1439-7609
    Keywords: Key words Rheumatoid synovitis ; Targeted biopsy ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 68-year-old woman with early rheumatoid arthritis (RA) was admitted to the hospital because of tender and swollen knee joints. We performed a targeted synovial biopsy under arthroscopy to examine the histopathological characteristics 1 month after clinical onset. The synovia showed the typical histopathology of RA. Although the inflammatory changes were predominantly limited to the surface area of the synovia, associated with neovascularization and cell infiltrates composed mainly of T cells, plasma cells, and macrophages, lesions with fibrin deposition, mesenchymoid transformation and/or immature lymphoid follicles were also observed in part, indicating that this case was in the progression phase of RA. What we regularly call "early" might be "too late" even if it is within 1 month of clinical onset.
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  • 173
    ISSN: 1468-2869
    Keywords: Asthma ; Children ; Chronic illnesses ; Diabetes ; Self-help ; Training
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Abstract A randomized field trial of a child-centered model of training for self-management of chronic illnesses was conducted of 355 Spanish-speaking school-aged children, between 6 and 15 years old, with moderate to severe asthma and epilepsy, in Buenos Aires, Argentina. The model, based on play techniques, consists of five weekly meetings of 8–10 families, with children's and parents' groups held simultaneously, coordinated by specially trained teachers and outside the hospital environment. Children are trained to assume a leading role in the management of their health; parents learn to be facilitators; and physicians provide guidance, acting as counselors. Group activities include games, drawings, stories, videos, and role-playing. Children and parents were interviewed at home before the program and 6 and 12 months after the program, and medical and school records were monitored for emergency and routine visits, hospitalizations, and school absenteeism. In asthma and epilepsy, children in the experiment showed significant improvements in knowledge, beliefs, attitudes, and behaviors compared to controls (probability of experimental gain over controls=.69 for epilepsy and .56 for asthma, with σ2= .007 and .016, respectively). Parent participants in the experiment had improved knowledge of asthma (39% before vs. 58% after) and epilepsy (22% before vs. 56% after), with a probability of gain=.62 (σ2=.0026) with respect to the control group. Similar positive outcomes were found in fears of child death (experimental 39% before vs. 4% after for asthma, 69% before vs. 30% after for epilepsy), as well as in disruption of family life and patient-physician relationship, while controls showed no change. Regarding clinical variables, for both asthma and epilepsy, children in the experimental group had significantly fewer crises than the controls after the groups (P=.036 andP=.026). Visits to physicians showed a significant decrease for those with asthma (P=.048), and emergency visits decreased for those with epilepsy (P=.046). An 18-item Children Health Locus of Control Scale (CHLCS) showed a significant increase in internality in experimental group children with asthma and epilepsy (P〈.01), while controls did not change or performed worse 12 months after the program. School absenteeism was reduced significantly for those with asthma and epilepsy (for the group with asthma, fall/winterP=.006, and springP=.029; for the group with epilepsy,P=.011). Conclusion The program was successful in improving the health, activity, and quality of life of children with asthma and epilepsy. The data suggested that an autonomous (Piagetian) model of training is a key to this success, reinforcing children's autonomous decision making.
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  • 174
    ISSN: 1573-2584
    Keywords: Bladder injury ; Bowel injury ; Children ; Pelvic trauma ; Renal injury ; Urogenital trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We analysed the inter-relationships of the cause and the type of trauma, the presence of pelvic fracture, the associated intraabdominal organ injuries,and the morbidity and mortality rates in 154 patients presenting and being treated for UGT between 1983 and 1997.The cause of injury was blunt in 77% of cases and penetrating in 13%. The most frequently injured organs were kidney followed by urethra and bladder. Bowels, liver and spleen were the most frequently associated injured organs. Moreover, bladder injuries were strongly associated with bowel injuries (p 〈 0.0001). Hemodynamically normal 49 children with minor or major kidney injuries were managed conservatively. Hemodynamically non-stable 11 patients were explored.The majority of urogenital injuries can be managed conservatively evenwhen associated with intraabdominal organ injuries. Solid genitourinary organ injuries may accompany more frequently to intraperitoneal solidorgan injury. Whereas, non-solid genitourinary organ injuries may more frequently associated with injuries of intraperitoneal hollow viscus.
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  • 175
    ISSN: 1573-2649
    Keywords: Asthma ; Children ; Health-related quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study compared the health-related quality of life (HRQL) of 236 children with mild or moderate/severe asthma with that of a large representative sample of children in the general community. The study also examined the relationship between the HRQL of children with asthma and their demographic characteristics, asthma severity and family functioning. Children with asthma had a significantly poorer HRQL than other children in the community. Amongst the children with asthma, parents reported that children living in single-parent families had poorer physical health, mental health and social functioning than children in two-parent families. There was a significant relationship between the mental health of children with asthma and family functioning but no significant relationship between their physical health and family functioning. These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. A better understanding of these relationships will facilitate the development of new interventions to help children with asthma.
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  • 176
    ISSN: 1573-2649
    Keywords: Children ; Population sample ; Quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study aimed to assess the quality of life of a population sample of schoolchildren. The Generic Children's Quality of Life Measure (GCQ) has been developed to allow comparison between chronically ill children and the general child population. The measure assesses how the child views his or her life and also how they would like it to be. Quality of life is measured as the discrepancy between the two viewpoints. This large community-based survey aimed to establish GCQ norm values for children aged 6–14 years. The children were from a sample of schools stratified by geographical location and social need: rural affluent, rural low affluence, urban affluent and urban low affluence. 720 completed questionnaires were analysed. The scores were normally distributed with a wide range. The GCQ showed an acceptable reliability with a Cronbach's α of 0.75. The quality of life score was not correlated with age (r = −0.02, p = 0.64) nor with the deprivation score of the area in which the children lived (r = −0.026, p = 0.49). There were no significant differences between the scores by gender (p = 0.22) nor by rural/urban location (p = 0.60). Normative values were established. The GCQ is suitable for using with children over a large age range (6–14 years) without the scores being confounded by the age, gender, affluence or geographical location.
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  • 177
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    Reading and writing 12 (2000), S. 191-218 
    ISSN: 1573-0905
    Keywords: Morphological awareness ; Sensitivity to word relations ; Reading ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Education
    Notes: Abstract The morpho-phonological nature of English orthography is examined in this study of the relation between morphological sensitivity and decoding ability in the latter elementary grades. Children in grades three to six were required to distinguish derivationally-related word pairs (e.g., nature-natural) from foil pairs that are related in spelling but not in morphology (e.g., ear-earth). The materials included both transparently-related (i.e., the second word incorporated the pronunciation of the first, as in person-personal) and complexly-related word pairs (i.e., the second word involved some change in pronunciation, as in atom-atomic). Across two experiments, these items were presented in either oral or written form along with various tests of reading ability, intelligence and phonological awareness. The results indicate that children's recognition of derivational relationships improved with grade-level. As anticipated, there was also a significant association between sensitivity to derivational relatedness and decoding ability which remains significant even when the word pairs were orally presented and even when phonological awareness in taken into account. Both phonological awareness and sensitivity to morphological structure emerge as important factors in decoding skill in the later elementary grades.
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  • 178
    ISSN: 1573-2584
    Keywords: Benign prostatic hyperplasia ; Immunohistochemistry ; Prostatic adenocarcinoma ; S-100 protein
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Specimens from 30 cases of benign prostatichyperplasia and 75 cases of prostatic carcinomaobtained during suprapubic prostatectomy, transurethalresection of the prostate and radical prostatectomy,were stained immunohistochemically for S-100 protein,prostatic acid phosphatase (PAP), prostatic specificantigen (PSA), neuron specific enolase (NSE) andpolyclonal keratin. S-100 protein was positive in9.3% of prostatic carcinomas and negative in allcases of prostatic hyperplasia. PAP and PSA werepositive in all cases, while NSE was positive in 16%of the carcinoma cases. Polyclonal keratin waspositive in both cell layers of the double layeredhyperplastic prostatic epithelium with a more intensestaining pattern in the outer cell layer. The authorsbelieve that the S-100 protein immunoreactivityobserved in some prostatic carcinomas, reflecting thechange in the functional status of the neoplasticcells, might be of prognostic significance. They alsoemphasize the non-myoepithelial nature of the outercell layer of the double layered prostaticepithelium.
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  • 179
    ISSN: 1573-2584
    Keywords: Immunohistochemistry ; Ki67 ; Prostate carcinoma ; Retinoic acid receptor-α
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The use of retinoids as differentiation therapy is a novel approach to prostate cancer. Retinoids act via their own nuclear receptors, RARs and RXRs, modulating gene activity, cell growth and differentiation. This study provides new data on the content and cellular distribution of RARα protein in prostate cancer specimens, in correlation to tumor grade and proliferative activity. Material and methods: A total of 84 cases of primary prostate carcinoma, divided into 3 subgroups according to tumor grade, were immunohistochemically evaluated for retinoic acid receptor-α (RARα) and Ki67 using the streptavidin/peroxidase method on formalin fixed, paraffin embedded tissues. Results: RARα positivity was detected in all cases of prostatic carcinoma, with a more profound expression in well differentiated cancers. A statistically significant correlation between RARα staining and tumor grade was found (ANOVA, p 〈 0.031). Ki67 immunoreactivity was present in 35.7% of cases, but no correlation with tumor grade was found. When RARα staining was correlated with Ki67 positivity, a statistically significant correlation was present (unpaired t-test, p 〈 0.003). Conclusions: These findings indicate that RARα expression is correlated to some extent with tumor grade and its presence is more profound in highly proliferative tumors. Further studies are needed to establish the possible clinical value of the immunohistochemical evaluation of RARα content in tumor specimens.
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  • 180
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    European archives of oto-rhino-laryngology and head & neck 257 (2000), S. 459-461 
    ISSN: 1434-4726
    Keywords: Key words Oral cyst ; Heterotopic gastrintestinal ¶epithelium ; Morphology ; Histochemistry ; Immunohistochemistry ; Clinico-pathological correlation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cystic lesions of the oral cavity are quite common. Mostly their morphology is that of simple cystic lesions lined by squamous epithelium. Rarely the epithelium may be of another type, e.g. that of gastrointestinal tract. In the English literature in English about 30 cases of oral cysts with gastrointestinal epithelium lining have been reported. This developmental lesion is very rare and is found more frequently in young males. The majority of lesions were reported to occur in the ventral surface of the anterior tongue and extend to the floor of the mouth. Heterotopic gastrointestinal epithelium has been more commonly described in the duodenum, gallbladder, jejunum, Meckel’s diverticulum, ileum, appendix, colon and rectum. We report an oral heterotopic gastrointestinal cyst in a child. A healthy 2-month-old boy had an asymptomatic swelling in the sublingual area that had been present since birth. Under general anesthesia, the patient underwent conservative excision of the cyst. Gross examination of the excised tissue showed a monolocular cystic lesion in the bottom of the oral cavity. Microscopically, the cystic lining mostly resembled intestinal mucosa; in some places, stratified squamous and columnar epithelium was also present. The pathogenesis of this lesion remains uncertain. Several theories have been postulated; the most commonly held suggests that these cysts may be derived from misplacement of embryonic rests.
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    European journal of plastic surgery 23 (2000), S. 152-153 
    ISSN: 1435-0130
    Keywords: Key words Dermatofibrosarcoma protuberans ; Cancer ; Children ; Surgery ; Skin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Dermatofibrosarcoma protuberans is an uncommon malignant mesenchymal tumor which is characterized by local aggressivity and recurrence. About 50 cases have been reported in the pediatric population. In the case presented, the lesion as a mass 5 mm in diameter, with normal overlying skin and no pain. The diagnosis was made by histology obtained on an incisional biopsy. Treatment was by wide local excision.
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    Brain tumor pathology 17 (2000), S. 153-157 
    ISSN: 1861-387X
    Keywords: Chordoid meningioma ; Castleman syndrome ; Electron microscopy ; Immunohistochemistry ; Magnetic resonance image
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Chordoid meningioma is a relatively rare variant that is often associated with peritumoral lymphoplasmacellular infiltration causing Castleman syndrome (CS). We present a 44-year-old woman with chordoid meningioma not associated with CS. The patient presented with epilepsy and right hemiparesis (Todd's palsy) on admission. The radiological findings revealed an extraaxial mass lesion in the premotor cortex. They were compatible with a preoperative diagnosis of meningioma. No physical abnormalities related to CS were detected. A left frontal craniotomy was performed. The tumor surface was gelatinous, and it was totally resected with the attached dura mater (Simpson grade I). The patient had an uneventful recovery, and her seizures subsided. The pathological findings of the specimens revealed nests and cords of spindle and epithelioid cells with abundant myxoid matrix, mimicking the features of chordoma. On the basis of radiological, immunohistochemical, and electron microscopic findings, chordoid meningioma was verified, and a review of the literature was performed.
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  • 183
    ISSN: 1590-3478
    Keywords: Key words Human immunodeficiency virus ; Central nervous system ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although the neurologic complications of HIV-1 infection during the first two years of life have been defined, the neurologic features in older children are not so well described. The present report is focused on the age-dependent neurologic presentation of HIV-1 infection. Sixty-two vertically HIV-1 infected children underwent detailed serial evaluations: neurologic assessment, neuropsychological tests, neuroimaging studies, and cerebrospinal fluid analysis. Neurologic involvement was found in 30 patients (48.3%). This population was divided into two groups, exhibiting progressive (83.3%) or nonprogressive (16.6%) neurologic signs and symptoms. In the first group of patients, progressive encephalopathy was distinguished from spastic paraparesis, possibly due to spinal cord involvement. The second group, represented by long-term survivors, requires clinical monitoring due to the possible prognostic value of acquired but presently nonprogressive signs of brain involvement. In contrast with the stereotyped features of the early form of progressive encephalopathy, the late form showed a polymorphic picture, with age-dependent neurologic manifestations. Multifocal white matter alterations and cerebral calcifications (sometimes with delayed onset and progression) were the prominent imaging findings. A correlation between cerebrospinal fluid HIV RNA levels, suggestive of viral replication within the central nervous system, and progressive neurological disease were also found.
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  • 184
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    Child & adolescent social work journal 17 (2000), S. 341-360 
    ISSN: 1573-2797
    Keywords: Community Violence ; Children ; Parents ; PTSD ; Cognitive- Behavioral Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Sociology
    Notes: Abstract Community violence is increasingly recognized as a risk factor for serious psychological problems with children particularly vulnerable to its effects. This article summarizes the existing knowledge on the effects of chronic exposure to community violence, highlights essential issues in assessing children for both exposure and resulting trauma from community violence, and provides treatment guidelines for those affected children.
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    Child & adolescent social work journal 17 (2000), S. 431-442 
    ISSN: 1573-2797
    Keywords: Groups ; Solution-Focused ; Mutual Aid ; Children ; Incarcerated
    Source: Springer Online Journal Archives 1860-2000
    Topics: Sociology
    Notes: Abstract Children of incarcerated parents are five to six times more likely to go to prison than their peers (Johnston, 1995). Yet, there is a lacuna in the literature that examines the effectiveness of interventions for children with an incarcerated family member. The purpose of the present study is to describe a solution-focused, mutual aid group intervention and to examine the effects of the group on the self-esteem of elementary-age Hispanic children of incarcerated parents when compared to a no-treatment comparison group. Implications for social work practice and research with this vulnerable population are addressed.
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    Child psychiatry & human development 31 (2000), S. 139-151 
    ISSN: 1573-3327
    Keywords: Panic Disorder ; Children ; Adolescents ; Generalized Anxiety Disorder ; Depression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Prevalence, phenomenology, comorbidity, functional impairment and familial correlates of juvenile panic disorder (PD) are described in this study. A clinical interview (Diagnostic Interview for Children and Adolescents-Revised) was administered to 220 children and adolescents consecutively referred to a Division of Child Neurology and Psychiatry. 23 subjects (10.4%), aged 7 to 18 years, fulfilled DSM-IV criteria for PD. Reported panic symptoms are described, according to gender and chronological age. High comorbidity with generalized anxiety disorder (74%) and depression (52%) was noted. Agoraphobia (56%) and other phobias (56%) were significantly more frequent than in two control groups of subjects with generalized anxiety disorder and with depression. Antecedent and/or associated separation anxiety disorder was reported in 73% of the patients. Functional impairment, assessed with a specific diagnostic instrument (Children's Global Assessment Scale) was significantly greater in PD patients than in depressed or anxious patients. 90% of patients had at least one parent with an anxiety disorder, 52% had one parent with depressive disorder, 33% had one parent with drug treated PD.
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  • 187
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    Child psychiatry & human development 31 (2000), S. 43-58 
    ISSN: 1573-3327
    Keywords: Locus of Control ; Psychopathology ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Examined the differences in the perception of control in 67 school-age children with externalizing and children with both externalizing and internalizing behavior problems. The results indicated that children with externalizing behavior and mixed behavior could be differentiated by their perception of control. Specifically, children with externalizing behavior endorsed a significantly stronger unknown locus of control than children in the mixed behavior group. Findings suggest that when behavior groups are clearly defined, neither external nor internal locus of control is the dominant style. Implications for the findings are discussed.
    Type of Medium: Electronic Resource
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  • 188
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    Springer
    Child & adolescent social work journal 17 (2000), S. 327-340 
    ISSN: 1573-2797
    Keywords: Death ; Children ; Cope
    Source: Springer Online Journal Archives 1860-2000
    Topics: Sociology
    Notes: Abstract Child welfare workers are in a unique position to help children and youth in out-of-home care who have experienced the death of a significant person. This article discusses the response of children to death from a developmental perspective and offers suggestions on how child welfare workers can use an ecological perspective to help youngsters cope with their grief.
    Type of Medium: Electronic Resource
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  • 189
    ISSN: 1861-387X
    Keywords: Blood-brain barrier ; Brain tumor ; Immunohistochemistry ; Neovasculature tight junction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To clarify whether the neovasculature of brain tumors preserves blood-brain barrier (BBB) functions, we studied the expression of a tight junction—related protein, Zo-1, using immunohistochemistry. Twenty-six astrocytic tumors were examined using an anti-Zo-1 Mab, and Zo-1 expression was compared with the expression of vasicular endothelial growth factor (VEGF), vascular endothelial growth factor receptor (VEGFR) (flt-1), and antiproliferative cell nuclear antigen (PCNA). A positive reaction for Zo-1 was seen in the endothelial cells in micro-blood vessels in all astrocytic tumors. The reactions for Zo-1 in the endothelial cells forming glomeruloid proliferations in newly formed micro-blood vessels in high-grade tumors were weaker than those in the endothelial cells of normal cerebral capillaries. Although there is a negative correlation between positive immunoreactions for BBB-related proteins and the expression of VEGF of the endothelial cells in micro-blood vessels, the proliferative activity of tumor cells, and histological grades, the present findings suggest that the endothelial cells of the neovasculature of high-grade tumors preserve partial BBB function at the cellular level. Because of the ease of immunohistochemical procedures compared with electron microscopic examination, the immunohistochemical detection of Zo-1 should provide a useful marker for tight junctions.
    Type of Medium: Electronic Resource
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  • 190
    ISSN: 1861-387X
    Keywords: Hemangioblastoma ; Supratentorial tumor ; Immunohistochemistry ; Ultrastructure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Supratentorial hemangioblastomas are rarely seen, especially in children and adolescents. We report the case of a 17-year-old male with supratentorial hemangioblastoma. Neuroimaging demonstrated a cystic lesion within the right parietal lobe. Systemic examination revealed no abnormality. The lesion was not attached to the dura and was not associated with von Hippel-Lindau disease. It was very difficult to confirm the final diagnosis of this case, in spite of extensive examination by light microscopy, immunohistochemical studies, and electron microscopy.
    Type of Medium: Electronic Resource
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  • 191
    ISSN: 1861-387X
    Keywords: Intractable epilepsy ; Cerebral malformation ; Pathology ; Hypervascularity ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The histopathological features, particularly hypervascularity, were examined in specimens resected from 21 patients, 15 with intractable epilepsy accompanying cortical dysplasia or dysembryoplastic neuroepithelial tumor (DNT), and 6 with benign brain tumors, such as ganglioglioma and low-grade glioma. Hypervascularity was found in resected specimens from 15 of the 21 patients (71.4%) and in 10 of the 12 patients (83.3%) who had double pathology. Counting of numbers of vessels by CD31 immunohistochemistry revealed that hypervascularity was prominent, especially in cases of vascular malformation or cortical dysplasia. However, almost all cases were negative for vascular endothelial growth factor (VEGF) staining, except for some cases of benign brain tumors. Moreover, all cases showed low or no proliferative potential in MIB-1 immunohistochemistry. These results suggest that the etiology of hypervascularity in the dysplastic lesions is one of a variety of cerebral malformations, as is the case with abnormal maturation and differentiation in neuroglial elements.
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  • 192
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 204-210 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 193
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 210-213 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 194
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 257-284 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 195
    Electronic Resource
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 335-338 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 196
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 346-349 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 197
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 165-179 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 198
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 180-196 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 199
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 197-204 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 200
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    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 51 (1895), S. 234-256 
    ISSN: 0021-8383
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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