Neonatal hypocalcaemia associated with rotavirus diarrhoea

We observed an association between rotavirus diarrhoea and hypocalcaemia in several patients and therefore started a prospective evaluation with measurement of calcium levels in all patients with rotavirus infection during a period of 8 months. We report on 54 infants with rotavirus gastro-enteritis. Serum concentrations of sodium, potassium, and total and ionized calcium were measured on admission. If hypocalcaemia was detected, total and ionized calcium were measured every day until recovery. Calcium was supplemented as calcium gluconate which was added to milk. Out of 54 newborns with rotavirus gastro-enteritis, 20 developed hypocalcaemia. All these newborns had severe diarrhoea. Seven infants were admitted because of convulsions, but EEG and ultrasonographic examination of the brain revealed no abnormalities. Once the infants' clinical condition and the consistency and frequency of the stool had improved, calcium concentrations increased and remained within the reference range without supplementation. Conclusion Rotavirus gastro-enteritis seems to be a cause of neonatal hypocalcaemia. Received: 26 June 1997 and in revised form: 20 December 1997 / Accepted: 26 December 1997     

Therapie der frühen Stadien des Seminoms

Germinale Hodenmalignome werden ausnahmslos in fakultativ-kurativer Intention behandelt. Bei Frühstadien werden mit multimodalen Therapiekonzepten exzellente Ergebnisse erreicht, dabei weisen testikul?re Seminome Heilungsraten von nahe 100% auf. Diese sind beispielgebend für interdisziplin?re stadiengerechte onkologische Behandlungen solider Organtumoren. Solche Erfolge begründen Bemühungen, die Therapie ohne Kompromittierung erreichter Heilungsraten weiter zu reduzieren und dabei therapiebedingte Einschr?nkungen an Lebensqualit?t für die Patienten und hierfür aufzuwendende sozio?konomische Kosten so gering wie m?glich zu halten. Erforderlich sind solche Bemühungen vor dem Hintergrund steigender Inzidenzraten und alternativer Behandlungsmodalit?ten. Ihre klinische Relevanz ergibt sich aus dem hohen Anteil in Frühstadien diagnostizierter Erkrankungsf?lle. Bei identischer diagnostischer Strategie für alle testikul?ren Keimzellmalignome ist für die postoperativen Behandlungsoptionen bei frühen Stadien zwischen den radiosensiblen Seminomen und den Nicht-Seminomen zu unterscheiden. Für die Seminome werden in dieser Arbeit, orientiert am jeweiligen Tumorstadium, die perkutane Strahlentherapie nach Orchiektomie als Standardtherapie erl?utert und deren Alternativen im Stadium cS I, systemische Carboplatin-Monozytostase oder Surveillance-Strategie, bzw. im Stadium cS IIA/B, systemische Chemotherapie, vergleichend dargestellt.     

Immuntherapie maligner Non-Hodgkin-Lymphome

Zusammenfassung Auch wenn in den vergangenen Jahren z. T. eine Verbesserung der Prognose von Non-Hodgkin-Lymphomen (NHL) bereits mit veränderten konventionellen und eskalierten Chemotherapieverfahren indolenter und aggressiver Lymphome erreicht werden konnte, verläuft für einen großen Teil der Patienten die Tumorerkrankung noch immer fatal. Da eine weitere Optimierung konventioneller Modalitäten schwer möglich erschien, stellte die Etablierung immuntherapeutischer Ansätze eine attraktive Option dar. Die erfolgreiche Einführung monoklonaler Antikörper in die Behandlung maligner Lymphome hat die Immuntherapie fest etabliert. Weiterentwicklungen dieses passiven Immuntherapieansatzes sind auf dem Weg in den klinischen Alltag. Daneben sind unterschiedliche Verfahren aktiver Immunisierung (Vakzinierung) in präklinischen und frühen klinischen Entwicklungen, deren Etablierung eine weitere Bereicherung des therapeutischen Armentariums darstellen kann. Zuletzt hat — insbesondere für Hochrisikopatienten — die allogene Stammzelltransplantation in der jüngsten Vergangenheit an Attraktivität gewonnen.     

Software-Automated Implant Detection for Intraoperative 3D Imaging—First Clinical Evaluation on 214 Data Sets

Previous studies have demonstrated a frequent occurrence of screw/K-wire malpositioning during surgical fracture treatment under 2D fluoroscopy and a correspondingly high revision rate as a result of using intraoperative 3D imaging. In order to facilitate and accelerate the diagnosis of implant malpositioning in 3D data sets, this study investigates two versions of an implant detection software for mobile 3D C-arms in terms of their detection performance based on comparison with manual evaluation. The 3D data sets of patients who had received surgical fracture treatment at five anatomical regions were extracted from the research database. First, manual evaluation of the data sets was performed, and the number of implanted implants was assessed. For 25 data sets, the time required by four investigators to adjust each implant was monitored. Subsequently, the evaluation was performed using both software versions based on the following detection parameters: true-positive-rate, false-negative-rate, false-detection-rate and positive predictive value. Furthermore, the causes of false positive and false negative detected implants depending on the anatomical region were investigated. Two hundred fourteen data sets with overall 1767 implants were included. The detection parameters were significantly improved (p<.001) from version 1 to version 2 of the implant detection software. Automatic evaluation required an average of 4.1±0.4 s while manual evaluation was completed in 136.15±72.9 s (p<.001), with a statistically significant difference between experienced and inexperienced users (p=.005). In summary, version 2 of the implant detection software achieved significantly better results. The time saved by using the software could contribute to optimizing the intraoperative workflow.     

Indirect fluorescence laryngoscopy in the diagnosis of precancerous and cancerous laryngeal lesions

Indirect fluorescence endoscopy of the larynx has proven to facilitate the detection and delineation of precancerous and cancerous lesion. The different methods are easy to handle and can be performed on an outpatient basis. Early diagnosis of laryngeal cancer and its precursor lesions is simplified. The aim of the present study is to compare indirect autofluorescence laryngoscopy to 5-ALA-induced PPIX fluorescence laryngoscopy. In a prospective study, 56 patients with suspected precancerous or cancerous lesions were primarily investigated by indirect autofluorescence laryngoscopy. In a second step 5-ALA-NaCl (0.6%) was topically applied to the larynx by inhalation, and indirect fluorescence laryngoscopy repeated 2 h after application. Autofluorescence as well as 5-ALA-induced fluorescence was induced by filtered light (375–440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF System, Storz, Tuttlingen, Germany). White-light and fluorescence images were digitally recorded, immediately assessed for diagnosis and finally compared to pathohistological findings. Inconspicuous laryngeal mucosa presented a typical green fluorescence signal in autofluorescence endoscopy, which turned blue during 5-ALA-laryngoscopy. Precancerous and cancerous lesions displayed a loss of autofluorescence in autofluorescence endoscopy whereas increased protoporphyrin IX fluorescence could be observed in 5-ALA laryngoscopy. Both imaging techniques were suitable to distinguish benign from precancerous or cancerous lesions. In contrast PPIX fluorescence was easily recognized in scarred vocal folds. According to our results, both non-invasive fluorescence imaging techniques are useful in the early diagnosis of laryngeal cancer. Moreover autofluorescence can be used immediately without drug application and possible side effects. 5-ALA-induced fluorescence seems to be more suited for diagnostic examination of mucosal lesions in recurrent precancerous and cancerous lesions after surgery.     

Frühgeborenes mit massiv geblähtem Abdomen und ungewöhnlichem Ultraschallbefund

Monatsschrift Kinderheilkunde -