Fremdkörperaspiration

Zusammenfassung Die Fremdk?rperaspiration stellt eine h?ufige Ursache für Atemnot und respiratorische Insuffizienz bei S?uglingen und Kleinkindern zwischen 6 Monaten und 3 Jahren dar. R?ntgendichte Fremdk?rper bereiten bei Abbildung des gesamten Respirationstraktes keine diagnostischen Schwierigkeiten. Nicht r?ntgendichte Fremdk?rper erfordern ein differenzierteres Vorgehen, wobei der erste radiologische Schritt in einer konventionellen Thoraxaufnahme in In- und Exspiration bestehen sollte. Zus?tzliche Aufnahmen, Durchleuchtungsuntersuchung und gegebenenfalls die Durchführung einer computertomographischen oder szintigraphischen Untersuchung h?ngen vom Ergebnis der Thoraxaufnahme ab. H?ufigstes radiologisches Erscheinungsbild ist die einseitige exspiratorische Ventilstenose mit überbl?hung des betroffenen Lungenabschnittes. Seltener finden sich Atelektasen, rezidivierende Pneumonien an identischer Lokalisation und inspiratorische Ventilstenosen. Kombinationsbilder sind m?glich, selbst ein unauff?lliges Untersuchungsergebnis kann eine Aspiration nicht ausschlie?en.      

A new naphthoquinone isolated from the bulbs of Cipura paludosa and pharmacological activity of two main constituents

Cipura paludosa (Iridaceae) is a plant that is distributed in the north region of Brazil. Its bulbs are used in folk medicine to treat inflammation and pain. Four naphthalene derivatives have been isolated from the bulbs of this plant. Three of them have been identified as the known naphthalene derivatives, eleutherine, iso-eleutherine, and hongkonin. The structure of the fourth and new component was determined as 11-hydroxyeleutherine by extensive NMR study. In addition, the IN VIVO effect of the two major compounds, eleutherine and iso-eleutherine, was evaluated in carrageenan-induced hypernociception and inflammation in mice. Eleutherine and iso-eleutherine (1.04-34.92 μmol/kg), dosed intraperitoneally (i.p.) or orally (p.o.), decreased the carrageenan-induced paw oedema (i.p. - inhibitions of 36 ± 7 % and 58 ± 14 %, respectively; p.o. - inhibitions of 36 ± 7 % and 58 ± 14 %, respectively). Iso-eleutherine, but not eleutherine, significantly reduced (inhibitions of 39 ± 4 %) the plasma extravasation induced by intradermal (i.d.) injection of carrageenan. Likewise, eleutherine and iso-eleutherine (1.04-34.92 μmol/kg, i.p. or p.o.) were also effective in preventing the carrageenan-induced hypernociceptive response (i.p. - inhibition of 59 ± 4 % and 63 ± 1 %, respectively; p.o. - inhibitions of 36 ± 7 % and 58 ± 14 %, respectively). It was also suggested that the anti-inflammatory and anti-hypernociceptive effects of eleutherine or iso-eleutherine partly depend on the interference with the synthesis or activity of mast cell products, kinins, cytokine, chemokines, prostanoids, or sympathetic amines. Our findings show that two major compounds of C. paludosa contain pharmacologically active constituents that possess antinociceptive and anti-inflammatory activity, justifying, at least in part, its popular therapeutic use for treating conditions associated with pain.     

Headache and diplopia in an extremely obese adolescent

BACKGROUND: The prevalence of idiopathic intracranial hypertension is increased in overweight children and adolescents. CASE REPORT: In a fifteen-year old, extremely obese adolescent with a history of headache and diplopia treatment with acetazolamide resulted in relief of the neurological symptoms.     

Screening for mental disorders in cancer, cardiovascular and musculoskeletal diseases

OBJECTIVE: The early detection of patients with comorbid mental illness is of high clinical importance in chronic somatic diseases. To identify cases, screening instruments are recommended. The study compared the discriminant validity of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12) to detect mental disorders in the most frequent chronic somatic diseases. METHODS: Five hundred sixty-nine patients with musculoskeletal, cardiovascular, and cancer diseases participated in the cross-sectional, two-stage survey. First, patients were assessed with the GHQ-12 and the HADS. Second, they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Using CIDI diagnosis as a criterion, the validity of the instruments for the detection of any mental disorder as well as of depressive and anxiety disorders was analyzed with receiver-operating characteristics analyses. RESULTS: The HADS performed better in all analyses compared to the GHQ-12. Best screening results with the HADS total scale were achieved for depressive disorders with an area under the curve of 0.82, a sensitivity of 74%, a specificity of 80%, and a misclassification rate of 21% (cutoff point=18). The positive predictive value is best (44%) for the detection of any mental disorder, with a cutoff point of 17. CONCLUSIONS: The HADS total scale can be recommended as a valid screening instrument for the detection of comorbid mental disorders in patients with chronic somatic diseases. The use of the single HADS subscales has no advantage for screening performance.     

Small part ultrasound in childhood and adolescence

Small-part sonography refers to the display of small, near-surface structures using high-frequency linear array transducers. Traditional applications for small part ultrasound imaging include visualization and differential diagnostic evaluation in unclear superficial bodily structures with solid, liquid and mixed texture, as well as similar structures in nearly superficial organs such as the thyroid glands and the testes. Furthermore indications in the head and neck regions are the assessment of the outer CSF spaces in infants, the sonography of the orbit, the sonography of the walls of the large neck vessels, the visualization of superficially situated lymph nodes and neoplasms.