Special problems of pacemaker-therapy in infants and children (author's transl)]

The special problems of pacemaker-therapy in infants and children are reported and compared with those of adults. The possibilities of application of pacemakers and the indications for temporary or permanent use are discussed. Special attention is paid to the disadvantages of presently available pacemakers for children due to electro-physiologic and hemodynamic facts. Complications of pacemaker-therapy and wishes in regard to technical improvements of pacemakers are discussed too. The possibilities of checking pacemaker patients are also mentioned. The therapeutic value of pacemaker for pediatric patients is analysed, using the results of the literature and an own experience with an infant, which is discussed in detail.     

Antibody-coaded bacteria in urine sediment of children with urinary tract infections (author's transl)]

In 40 girls and 9 women with recurrent, non-obstructive urinary tract infections, and in 5 patients with nephrolithiasis the site of infection was determined by 108 bladder washout tests. The corresponding sediments were examined for antibody-coaded bacteria using an immunofluorescence test (IFT). The IFT was positive in 18 (72%) of 25 supravesical bacteriurias. Out of 75 vesical bacteriurias 39 infantile and 7 adult (together 61%) specimens contained antibody-coaded bacteria. We think the IFT is of no diagnostic value in localizing recurrent urinary tract infections in girls. For adults such an evaluation is not yet possible due to our small number of cases.     

Artificial ventilation of preterm and term infants (author's transl)]

One of the first aims of the neonatal care unit of the Paediatric Department of the University of Innsbruck (Austria) consists in taking care of dangerously ill children of Tyrol including the neighbouring federal states and the alpine part of Italy (South Tyrol). From SUMMER 1974 to the end of October 1976 1342 preterm and term infants were treated. 142 of these children died (mortality rate 10.5%). In 94 patients, i. e. 6.9% mechanical ventilation was necessary. 39 of these children, i. e. 41.5% survived. Two indications of artifical ventilation were predominant: Hyaline membrane syndrome in 59 children (survival rate 49%) and apnoe in 22 children (survival rate 27%). Electroencephalography was performed in 39 children during the neonatal period. 34 of these children were severely ill (gestational age of 24 to 37 weeks), 5 children were born at term nevertheless moribund. 18 of the 23 dead children of this group showed severe alterations in electroencephalography. The cause of death of 10 of these children was cerebral bleeding as verified by autopsy. 8 of the 16 surviving children showed a regular psychomotoric development, 5 children of this group had a normal electroencephalogram.     

Sex-specific differences in free, inorganic sulfate excretion in 24 hours urine of healthy children (author's transl)

Free, inorganic sulfate was determined quantitatively in the 24 h urine of 65 boys and 53 girls (age 6--14 years). The determination of sulfate was carried out by the aid of the spectrophotometric method with barium chloranilate. Results: The following values were obtained for the boys and girls: Boys (ages 6--10 years) 17,66 +/- 11,70 mmol/24 h, girls (6--10 years) 10,70 +/- 10,26 mmol/24 h, boys (10--14 years) 17,40 +/- 12,32 mmol/24 h, girls (10-14 years) 7,26 +/- 8,90 mmol/24 h. No statistical age-specific differences were observed, but the sex-specific investigation revealed that the younger and older boys had a statistical higher excretion of sulfate in 24 h urine as compared to the younger and older girls.     

Disturbances of cardiac rhythm in neonates and infants (author's transl)]

The authors report on the kinds and frequency of cardiac rhythm disturbances observed in neonates and young infants at the University Children's Hospital of Innsbruck within the past 3 years. Four children who were already in utero suspected to have arrhythmia are dealt with in greater detail. The etiology and pathogenesis of rhythm disturbances are briefly outlined and the therapeutic measures summarized.     

Psychological and social aspects of overweight children (author's transl)]

If children who were originally fully capable and active according to their respective age groups, remain more than 50% overweight for a period of more than 3 years, develop a significantly lower motor, intellectual and social activity. They tend to develop an anxious auto-aggressive behavior, because it is difficult for them to transmit to others the social pressures to which they are subject. The probability of a permanent therapeutic success diminishes as the duration of the period of overweight increases. Only physically and emotionally orientated therapy is rational as 78% of our overweight children come from neurotically disturbed families. Overweight can often be due to lack of love where intensity of affection is wrongly applied.     

25-hydroxy-vitamin-D in serum of newborns and infants during continuous oral vitamin D treatment (author's transl)

Using the Haddad modified method, 25-OH-D were measured in the blood of the umbilical cord of 29 infants and in peripheral serum after 6 weeks. 16 infants were given a daily dosage of 1000 I. E., 13 infants 500 I. E. vitamin D against rickets. Further they were fed with an adapted milk containing 400 I. E. vitamin D/1. The mean cord serum values were 13 and 15 ng/ml. After treatment with 1000 I. E., 25-OH-D values around 54 ng/ml were measured after 6 weeks and under 500 I. E. daily, values of 37 ng/ml, respectively. Treatment using a dosage of 500 I. E. vitamin D combined with feeding with vitamin D fortified milk seems adequate, to prevent vitamin D depletion.     

Special features of epidural hematoma in neonates and infants (author's transl)]

Epidural hematomas in infancy, meaning up until the closing of the cranial sutures, have special clinical manifestations and courses; four cases will be demonstrated here. Following an often mild cranio-cerebral trauma a characteristical subperiosteal hematoma lacking primary consciousness disturbance and free interval can develop. The considerable loss of blood coming from the epidural hemorrhage, of mainly venous origin, leads to an often extreme anemia and shock syndrome. Due to the combination of shock and increasing brain compression a fulminant course with sudden coma, respiratory failure and irreversible circulatory collapse can terminally occur. Thus one should always think of an epidural hematoma in cases of increasing anemia, shock syndrome and an extending cranial hematoma following a brain trauma in infancy. Rapid trepanation with shock therapy and accompaning blood transfusion allows the prognosis of the epidural hemorrhage in infancy to be essentially better than in adulthood.     

Course and treatment of osteomyelitis in childhood (author's transl)]

In the years 1955-1972 132 children with osteomyelitis were treated in the Pediatric, Surgical and Orthopedic Department of the university of Kiel. There was no increase in the incidence of osteomyelitis during this period. Acute hematogenous osteomyelitis was diagnosed in 111 children, chronic hematogenous osteomyelitis in 11 children, traumatic and postoperative osteomyelitis in 10 children. Secondary chronic osteomyelitis occurred in 1 patient. Mainly staphylococci (in 90%) were the pathogenic bacteria, whereas haemophilus, pseudomonas, streptococci group A, E. coli and mixed infections occurred less frequently. In 17 of 111 patients with acute hematogenous osteomyelitis there were no roentgenological changes. Bacteriological investigations of blood and pus, and the antistaphylolysin reaction (repeated in the course of the disease) were helpful to establish the diagnosis in many cases. 107 of 111 patients with acute hematogenous osteomyelitis were cured (8 patients with defects). 4 children died in septic shock or because of complications (meningitis, pleural empyema, pneumonia). Bactericidal antibiotics in high dosage (penicillins, gentamicin) were superior to bacteriostatic antibiotics. Additional surgical treatment was necessary in 49 of 111 patients with acute hematogenous osteomyelitis. Recommendations for antibiotic therapy of osteomyelitis are given.     

Long-term out-patient treatment of children with asthma with a theophylline-ephedrine-hydroxyzine combination (author's transl)]

Drug combinations play an important role in the day-to-day management of asthmatic out-patients. The long-term use of such a combination (Marax) was assessed in 46 asthmatic children aged 1;6 to 13;8 years who were followed up for a maximum of 7 years. Using a daily dosage of up to 16 mg/kg bodyweight more than 80% of children showed definite improvement leading to prevention or significant reduction of acute attacks and clearly reduced dyspnoeic states between attacks. Patients with very severe forms appeared to be influenced less favourably. Spirometric values were obtained in some of the patients and indicated reduction of obstruction. Patients with intrinsic and extrinsic asthma responded satisfactorily. The value of a long-term prophylactic treatment is discussed. These preliminary results appear to support this form of therapy.     

Reference values of sodium, potassium, calcium, chloride and inorganic phosphate excretion in 24-hour urine of healthy children

Excretion of sodium, potassium, calcium, chloride and inorganic phosphate was determined in 24 h urine of 157 healthy children (ages 6-14 years). The diet was not controlled. The statistical age- and sexspecific investigation of the results (mval/24 h, mval/24 h/mg creatinine) showed significant differences.     

Nitrogen balances in very premature newborns in the course of parenteral nutrition (author's transl)]

Nitrogen balance studies were performed in the course of parenteral nutrition during the first 5 days of life in 2 groups of premature newborns (I. group: 7 prematures, b.w. M = 1295g; II. group: 7 prematures, b.w. M = 1447g). Glucose and fat emulsion were administered intravenously in children of the first group, in the second one L- Aminoacids (250 mg N/kg body weight/24 hrs.) were added. In comparison with the first group nitrogen retention of 77 to 170 mg/kg body weight/24 hrs. was reached, but blood urea concentration increased significantly.     

On the diaagnosis of anorexia nervosa in children and adolescents (author's transl)]

The clinical picture of anorexia nervosa is going along with typical statements, specific pathological attitudes and psychodynamic backgrounds of the families involved. This facilities the establishment of the diagnosis already during the first anamnestic interview with parents and patients. Important are: onset of illness, eating behaviour, early childhood development, parents, brothers and sisters, leisure time, mood and personality, sexuality. In most of the cases a speedy hospital admission is necessary, because at this time the onset of the disease lies back months or even years. These circumstances redner the psychotherapy of patients and their families more difficult, and the often life-threatening attitudes of the patients more entrenched.     

Results and problems in the treatment of childhood leukaemia (author's transl)]

391 children received complex chemotherapy according to uniform treatment schedules, proposed by the Hungarian Study Group for Childhood Leukaemia, which was established in 1971. Survival among the patients showed an increasing tendency: more than 50% of patients with ALL are stille alive 3 years after the beginning of treatment. One patient is in complete remission 9 3/4 years after the establishment of the diagnosis. Two types of maintenance therapy were investigated among the patients entered for this study in 1974. "Pulses" with Vincristine-Prednisolone every second month were found to be more optimal than monthly "pulses".     

The effect of primidone treatment of thyroid hormones in epileptic children and adolescents (author's transl)]

In primidon-treated patients there are significantly decreased serum concentrations of total and free thyroxin, protein bound iodine and base line serum TSH values. In primidon-treated children T3-resin test values, concentration of thyroxin-binding protein and total cholesterol are identical to those of the control group. Degree of diminution in serum concentration of protein bound iodine, total and free thyroxin and base line TSH was independant of the primidon dose per day. Probably the demonstrated alteration in the thyroid function tests studied, is mainly caused by phenobarbital, the major metabolite of primidon and not directly by unmetabolized primidon. It is suggested that the high protein-binding capacity of phenobarbital results in a competitive displacement of protein bound thyroxin comparable to that of DPH. Phenobarbital is know to be a stimulator of the drug metabolizing enzyme system in the liver. This effect may be the cause of an increased turnover of T4 which results in a decreased serum concentration of total and free T4 at last. It seems possible that there is a balance in serum concentration of thyroid hormones on a lower level. Normal euthyroid state may be presumed, if T4-secretion raises, but there is no clue for an increased pituarity response. In contrast to the normal group in primidon-treated children the base line serum TSH values are decreased. It is supposed that another effect of primidon is responsible for this fact. There may be an influence of primidon treatment on hypothalamic pituarity axis. Our findings do not indicate clearly a hypothyroid state in primidon-treated patients; further investigations should give an answer to the guestion, if side effects as tiredness, decreased impetus and constipation are not partly caused by alterations in thyroid hormone system.     

Concentrations of hemoglobin, hematocrit and serum iron in healthy infants and children aged 1 month to 16 years (author's transl)]

10,126 determinations of hemoglobin concentration, 10,055 of hematocrit and 4,420 of serum iron were performed in 7,753 infants and children aged 1 month to 16 years to give normal values for this period in a large town. Both, concentrations of hemoglobin and hematocrit decreased during the 3rd and 8th month. The first decrease in serum iron level appeared later in month 4, the time of the second fall was identical with that of hemoglobin and hematocrit. In females, a third decrease of iron levels appeared with 13 years. Between the 2nd and 8th year of life, a period of instable iron nutriture became apparent. Concentrations of hemoglobin, hematocrit as well as serum iron depend on age. 0.4% of males and females showed a deficient concentration of hemoglobin. 2.9% of males and 1.1% of females had a low, nonacceptable hemoglobin value. Iron deficiency occurred in 8.5% of males and in 8.3% of females. It is probable that the number of children with a pre-latent or latent iron deficiency is much higher.     

Normal values of LH and FSH excretion in the urine of children and juveniles by the luteonosticon and FSH-nosticon test (author's transl)

The normal values of the LH and FSH excretion in 12-h-overnight-urine-samples were measured by the commercial technique for the estimation of LH (Luteonosticon) and FSH (FSH-nosticon). These methods were used to determine the hormone excretion of these hormones in healthy individuals, 94 boys (0-18 years) and 48 girls (0-16 years). Only one urine sample was assayed for each subject. There was a highly significant correlation between the plasma LH and FSH concentrations and the urinary content of the same hormones: for FSH, r = 0.8 and for LH, r = 0.6. The plasma concentrations were measured radioimmunologically immediately before the period of urine collection. Five girls with Turner's syndrome aged 12 to 17 years showed LH values (5.0-14.5 IU/12 h) at the upper end of or slightly above the normal range and pathologically high values (22.2-43.5 IU/12 h) for FSH.