A new radiographic method for cardiac output and cardiac shunt determination in vivo

The present paper describes a new method for the measurement of cardiac output (CO) and cardiac shunt (CS). The CO method is based on the accurate determination of the concentration of the indicator in large vessels. For the measurement of the left to right shunting volumes, a double tracer technique is used by which radioactively labeled transferrin or erythrocytes are applied together with radioactively labelled human-serum-albumin (HSA) microspheres. The results obtained using these methods were compared with the data obtained by invasive methods. High correlation of both sets of data suggests that the proposed methods might provide an excellent extension of noninvasive procedures in the first months of a childs life.     

Attention deficit-hyperactivity disorder,comorbidities, and risk situations

ObjectiveAttention deficit/hyperactivity disorder (ADHD) is highly prevalent, and its symptoms often represent a significant public health problem; thus, the aim of this study was to verify emergency situations caused by certain comorbidities, or by exposing the patient to a higher risk of accidents.Data sourceA literature search was carried out in the PubMed database between the years 1992 and 2012, using the key words “adhd”, “urgency”, “comorbidity”, “substance disorder”, “alcohol”, “eating disorder”, “suicide”, “trauma”, “abuse”, “crime”, “internet”, “videogame”, “bullying”, and their combinations. The selection considered the most relevant articles according to the scope of the proposed topic, performed in a non-systematic way.Data synthesisSeveral situations were observed in which ADHD is the most relevant psychiatric diagnosis in relation to its urgency, such as the risk of accidents, suicide risk and addition, exposure to violence, or risk of internet abuse or sexual abuse; or when ADHD is the most prevalent comorbidity and is also correlated with emergency situations, such as in bipolar and eating disorders.ConclusionsThe results show several comorbidities and risk situations involving the diagnosis of ADHD, thus reinforcing the importance of their identification for the adequate treatment of this disorder.     

Complicated malaria tropica in an infant]

We report on a five month-old infant from Cameroon, who was admitted because of febrile gastroenteritis after living in Germany for two weeks. Since the patient was somnolent, had a parasitaemia of Plasmodium falciparum of 230,000/microliter, a haemoglobin concentration of 5.3 g/dl and a thrombocytopenia, a complicated falciparum malaria was diagnosed. Treatment was started immediately with intravenous 20 mg quinine/kg bw as a loading dose, followed by 10 mg/kg bw every 12 hours, combined with intravenous clindamycin 10 mg/kg bw bd. Red blood cells were transfused once. The parasitaemia dropped to 2000 trophozoites/microliter within 48 hours. No asexual stages were detectable from the third day of treatment on. Weekly controls for the following four weeks remained negative. The mortality rate of complicated malaria is 50% in the first year of life, which can be reduced by early treatment. We present this case to draw attention to therapeutic options in infants.     

Mainz Emergency Evaluation Score (MEES)

Der Mainz Emergency Evaluation Score (MEES) ist ein Instrument zur Evaluation der Ergebnisqualit?t von Notarzteins?tzen [1, 2, 3]. Er ist Bestandteil des DIVI-Notarzteinsatzprotokolls und wird im Folgenden beschrieben. Beim MEES werden sieben Parameter der Vitalfunktionen ausgewertet, welche in Ihrer Gesamtheit den Zustand des Notfallpatienten zuverl?ssig beschreiben (Tabelle 1). Das Bewertungskonzept des MEES beruht auf einer vierstufigen Einteilung aller sieben Vitalparameter. Der physiologische Zustand wird mit vier MEES-Punkten, ein lebensbedrohlicher Zustand mit „1*” MEES-Punkt bewertet. Geringe Abweichungen von der Norm werden mit 3 MEES-Punkten, ein erheblich abweichender Zustand mit 2 MEES-Punkten gekennzeichnet.