Harnwegsinfektionen nach Nierentransplantation

Febrile urinary tract infections after renal transplantation (transplant pyelonephritis) are a relevant clinical problem. They cause significant morbidity and even urosepsis and are usually associated with acute graft dysfunction. Risk factors include baseline immunosuppression, anatomical and functional factors (vesicoureteric reflux into the kidney graft, bladder dysfunction), underlying diagnosis, urinary tract surgery before transplantation as well as gender (increased incidence in girls). Meticulous diagnosis and treatment are important to minimize compromise of long-term graft function. Future prospective studies are warranted to increase the knowledge of risk factors and acute and chronic graft dysfunction. This will ultimately lead to improved prophylactic and therapeutic measures and further optimization of long-term renal graft survival.     

Krankheiten nach Nierentransplantation

Kidney transplantation is the therapy of choice in children with end-stage renal disease. There are myriad problems that can arise after renal transplantation, and they are individually very variable. Recurrence of the original underlying disease is of concern in focal segmental glomerulosclerosis, in other forms of glomerulonephritis, and in primary hyperoxaluria. The progression of extrarenal manifestations such as hepatic fibrosis with the development of portal hypertension is observed in autosomal recessive polycystic kidney disease. Liver involvement in nephronophthisis is also clinically significant. Long-term side effects of steroids can be stressful and demand that the medication be tapered off. Nephrotoxic side-effects of calcineurin inhibitors can require an individually tailored drug combination strategy. EBV-associated lymphoproliferation is a consequence of exaggerated immune suppression. In many patients creeping creatinine build-up is ongoing. The most important risk factors for life expectancy are cardiovascular complications of chronic renal insufficiency and of medicamentous treatment.     

Augensymptome nach Aortenisthmusstenosenresektion

Horner??s syndrome (miosis, ptosis, enophthalmus) is caused by an irritation or damage of the stellate ganglion. After correction of coarctation of the aorta followed by a left-sided chest tube, a toddler developed Horner??s syndrome on the third day after surgery. Chest tubes causing Horner??s syndrome are rarely described in the literature. In cases of sudden appearance the position of the chest tube should be examined immediately and corrected if necessary.     

Herzversagen nach Appendektomie

We report on a 5-year-old girl who developed heart failure after an initially uneventful clinical course following a noncardiac surgical procedure. Echocardiographic examination showed severe myocardial dysfunction of both ventricles. The patient died on the 3rd postoperative day in low output failure and electromechanical dissociation. At autopsy total absence of myocardial tissue of the right ventricular free wall with severe lipomatous transformation was found. This abnormality appears clinically as an "arrhythmogenic right ventricle" in most of the cases. Therefore, severe dysrhythmia or myocardial dysfunction may have been the leading factors in the development of congestive heart failure with a deleterious outcome.     

Epstein-Barr-Virus-Infektionen nach Stammzelltransplantation

EBV associated lymphoproliferative disease (PTLD) after stem cell transplantation (SCT) is linked with an often fulminate course and a high mortality. Main risk factors are EBV primary infection after transplantation,T cell depleted graft,T cell antibodies (ATG,ALG, OKT3) and unrelated or HLA-mismatched donors.Besides some limitations, EBV viral load has proven to be an effective tool in early diagnosis and monitoring of therapy. Therapeutic options are mainly based on monoclonal anti-CD20 antibodies (Rituximab) and the adoptive T cell transfer,which proved to be effective in prophylaxis as well as in therapy.Future perspectives are standardizing of EBV viral load measurement, establishing of immunological diagnostics as well as the prophylaxis of PTLD.     

Synkopen nach Belastung

Vascular airway compression syndromes have to be differentiated from bronchial asthma. We report the case of an 11-year-old girl who had been treated for bronchial asthma since childhood and presented with recurrent syncope after exercise. A double aortic ring caused severe tracheal stenosis with reflex ventilation depression and CO2 retention documented by spiroergometry. After transsection of the right dorsal arch the symptoms resolved and flow-volume charts and gas exchange were normal.     

Krankheiten nach Lebertransplantation

Liver transplantation represents a very successful curative therapy for end-stage liver disease in children and adolescents. Despite good overall outcome there are several surgical, medical and pharmacokinetic complications, which should be considered in the interdisciplinary challenge of long-term follow-up. This paper describes typical complications following liver transplantation with respect to different postoperative time periods with the aim to aid physicians in clinics and private practice in follow-up examinations of children following liver transplantation.     

Psychologische Erstintervention nach Alkoholintoxikation

Inpatient treatment of acute alcohol intoxication in children and adolescents offers a favorable chance for a complementary psychological intervention approach with a high impact on secondary prevention. A short-term psychological intervention has been developed at the department of pediatrics of the University of Bonn and established as part of a routine procedure which is offered to every young patient after alcohol intoxication. Based on evidence from clinical psychology this article focuses on the delineation of the clinical procedure comprising fostering a trustful rapport and establishing a consensus on the goals of the therapy. Based on a functional behavioral analysis approach, the particular episode of alcohol abuse is reconstructed via exploration of situational trigger factors, cognitive-emotional information processes, behavioral reactions (excesses and deficits) and coping behavior and subsequent conditions. This allows intervention strategies particularly tailored to the individual situation to be delineated. Ambivalent tendencies towards future alcohol abuse are addressed in order to induce a basic decision concerning future risk behavior. Concrete coping plans are then developed based on behavioral and systemic family therapy.     

Katamnestische Untersuchungen nach Pertussis-Encephalose

Zusammenfassung Es wird über Nachuntersuchungen von Patienten mit Pertussis-Encephalose berichtet, die sich während der Jahre 1945–1963 in stationärer Behandlung der Universitäts-Kinderklinik Leipzig befanden. Von den insgesamt 98 Patienten kamen während des akuten Krankheitsverlaufs 44 (44,9%) ad exitum. 36 konnten im Alter von 3/4 bis 20 Jahren nachuntersucht werden. Es wurden die Anamnese erhoben und klinischneurologische, elektrencephalographische sowie psychologische Untersuchungen durchgeführt. Während bei Entlassung lediglich 7 Patienten zentralnervöse Störungen aufzuweisen schienen, waren auf Grund der Anamnese und der klinischen Untersuchung 16, der psychologischen Befunde 27 geschädigt. Lediglich 14 Hirnstrombilder waren normal; die übrigen wiesen zu etwa gleichen Teilen Herd- bzw. Allgemeinveränderungen auf. Bei 5 Patienten hatte sich eine Epilepsie entwickelt, bei lediglich 3 was ein pathologischer neurologischer Befund nachweisbar. Jeweils ein Drittel der Patienten war durch Intelligenzdefekte und sehr stark herabgesetzte Affektsteuerung, die Mehrzahl (19 von 29) durch Konzentrationsstörungen auffällig. Bei sämtlichen Untersuchungsmethoden war der Anteil pathologischer Befunde um so größer, je schwerer die akute Krankheit verlief. Auch zwischen Erkrankungsalter und den Befunden der Nachuntersuchung bestand mit Ausnahme der psychologischen Ergebnisse eine gute Korrelation, indem diese um so häufiger pathologisch waren, je früher die Kinder erkrankten. Die wenigen Kinder mit pathologischen neurologischen Befunden (3) bzw. Epilepsien (5) wiesen elektrencephalographisch und psychologisch ebenfalls meist pathologische Befunde auf. Beim Vergleich der mit den einzelnen Untersuchungsmethoden gewonnenen Ergebnisse untereinander bestand nicht immer eine gute Korrelation, indem in einigen Fällen ein pathologischer Befund in dem einen mit einem normalen des anderen Untersuchungsverfahrens einherging. Berücksichtigt man nur die Patienten, die sowohl elektrencephalographisch als auch psychologisch wie auch auf Grund der Anamnese einen völlig normalen Befund aufweisen, verbleiben lediglich 8 von 36, d. h. weniger als ein Viertel, die die Erkrankung völlig ohne Schaden überstanden. Erinnert man sich gleichzeitig der sehr hohen Letalität, stellt daher die Pertussis-Encephalose eine außerordentlich schwere Komplikation des Keuchhustens dar.     

Psychogene Schluckhemmung nach Tonsillotomie

Ohne Zusammenfassung     

Reaktivierung nach einer Herpes-simplex-Enzephalitis

Background

In case of relapse after Herpes simplex encephalitis (HSE) a clear distinction between recurrent virus infection and autoimmune disease is frequently not possible and both pathophysiological mechanisms can occur simultaneously.

Case

We report on a 4 year old boy who was admitted in stupor 10 days after HSE.

Treatment and follow-up

Treatment with aciclovir, immunoglobulins, phenobarbital und tiapridex had no effect. The child developed severe neurological deficits. After 6 months of inpatient rehabilitation his motor status returned to normal while substantial impairment of speech and attention remained.

Conclusions

Early relapse after HSE occurs within 2–4 weeks after the initial disease. Clinical presentation includes various neurological symptoms in combination with fever and impairment of consciousness. We recommend CSF testing and MRI after completion of the initial antiviral therapy.     

Masernartiges Exanthem nach Senfpackung

Ohne Zusammenfassung     

Wachstum und Entwicklung nach konventioneller onkologischer Therapie und nach Stammzelltransplantation im Kindesalter

Owing to improved survival of children with cancer and after stem cell transplantation (SCT), interest in late effects is increasing. Disturbances of growth and puberty are a particular focus of study.After conventional cancer therapy outlook for growth and pubertal development is favorable.Patients with ALL frequently develop pronounced chronic obesity unrelated to cranial irradiation. This phenomenon is not present in children with other cancer types.After stem cell transplantation disturbances of growth and puberty are particulary related to total body irradiation (TBI).Growth seems unaffected after chemoconditioning, but disturbed puberty and fertility is observed in females predominantly with high dose busulfan. We report our observations with 111 children after conventional cancer treatment and 40 patients after SCT followed up for at least 6 years.There was no significant growth retardation and no deficit in final height in patients after conventional therapy. Children with ALL/NHL frequently developed obesity. After SCT with TBI growth retardation and impaired puberty are common.Long term follow up and efficient cooperation between paediatric oncologists and endocrinologists are essential for diagnosis and management of disturbed growth and puberty in children with cancer.