Alveolar capillary dysplasia. Report of a case of prolonged life without extracorporeal membrane oxygenation (ECMO) and review of the literature

We describe an unusual infant with the diagnosis of alveolar capillary dysplasia who had a relatively prolonged life without extracorporeal membrane oxygenation (ECMO). We have used this case as a springboard for a thorough review of the literature. This was a full-term female infant who presented with a picture of persistent pulmonary hypertension of the newborn. She was treated as such, with various ventilatory modes, alkalinizing agents, surfactant therapy, tolazoline, prostacyclin and nitric oxide. Because of the prolonged clinical course the possibility of alveolar capillary dysplasia was raised. The parents refused ECMO. Despite all efforts she progressively deteriorated and died at 22 days of age. Macro- and microscopic examination of the lung at autopsy were diagnostic of alveolar capillary dysplasia. A detailed review of 39 cases published in the literature with comments regarding incidence, etiology, pathophysiology, clinical picture, diagnosis and treatment is presented.     

Effects of single and repeated doses of theophylline on aspects of performance,electrophysiology and subjective assessments in healthy human subjects

The effects of both single and repeated doses of theophylline were evaluated on a battery of nine performance tests, the EEG, the EMG and on subjective assessments of mood and side-effects. The subjects were 20 healthy adults who participated in both phases of this randomized, double-blind, placebo controlled, crossover study. The single dose of 400 mg and the repeated doses of 300 mg b.d. for 4 weeks were intended to attain therapeutic serum concentrations. The Sternberg Additive Factors Method for assessing information processing revealed enhanced performance in both phases of this study, while the Horizontal Addition Test showed improved performance in the single dose phase only. The remaining seven performance tests failed to show significant differences between theophylline and placebo. Single doses of theophylline did not significantly alter mood, but marked adverse effects were encountered in the repeated dose phase, possibly related to unpleasant side-effects. Both EEG and EMG findings indicative of stimulation were associated with a single dose of theophylline, but substantial tolerance developed during 4 weeks of therapy. These findings demonstrate CNS stimulation by both single and repeated doses of theophylline with the occurrence of adverse side-effects during repeated administrations.     

Organic factors and the clinical features of late paranoid psychosis: a comparison with Alzheimer's disease and normal ageing

The diagnostic allocation and aetiological basis of paranoid psychoses with late onset is controversial. We examined the clinical features of patients with a diagnosis of paranoid psychosis and we compared their cranial computed tomography (CT) scans and electroencephalographic (EEG) recordings with findings from matched samples of patients with Alzheimer's disease and non-demented elderly controls. During a 5-year period, 81 patients (15 men and 66 women) with a diagnosis of paranoid psychosis and onset after age 50 were referred to our Institute. They represent 5.4% of the patients older than 50 admitted during the same period. More than half of these patients had first-rank symptoms. The ventricles, anterior and sylvian fissures of the paranoid group were larger than in non-demented controls but smaller than in Alzheimer's disease. The posterior dominant alpha EEG rhythm was slower than in normal ageing and faster than in Alzheimer's dementia. If paranoid patients with first-rank symptoms were distinguished from the ones without, the former had less severe brain atrophy and faster posterior dominant rhythm, although they received higher doses of neuroleptics. This could be explained by the existence of at least 2 subgroups of late paranoid psychosis: late-onset schizophrenia and organic paranoid syndrome, the former characterized by first-rank symptoms and less severe brain atrophy, the latter by more severe EEG and CT scan changes with a closer resemblance to degenerative brain disease.     

Efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting

Objectives : To determine the efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting. Methods : In this double-blind field trial, 156 children aged 4 36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days. Results : In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post-enrolment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment ( p = 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them ( p = 0.05). The weight gains at days 7 and 14 were similar in the two groups. Conclusions : These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use.     

Differenzierung der mucopolysaccharide des innenohres durch säulenchromatographische hexosamintrennung

Zusammemfassung Die sauren Hydrolysate der cochleären Abschnitte des häutigen Labyrinths von Hausschweinen und Meerschweinchen wurden säulen-chromatographisch zur Differenzierung des Glucos- und Galaktosaminanteils getrennt. In beiden Tierspecies ergab sich ein Überwiegen des Glucosamins gegenüber dem Galaktosamin. Unter Berücksichtigung histochemischer und quantitativer biochemischer Befunde lassen die Analysen den Schluß zu, daß stark saure MPS am Aufbau des häutigen Hörorgans in erheblichem Maße beteiligt sind. Neben dem Keratosulfat als Hauptkomponente sind auch Chondroitinsulfate vertreten. Die stark sauren Eigenschaften dieser Mucopolysaccharide unterstreicht die Theorie ihrer wesentlichen Rolle als Ionenaustauscher bei der Bildung der Innenohrpotentiale.

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Differentiation of mucopolysaccharide in the inner ear by separation of hexosamine with column-chromatography

Summary The glucose- and galactose-amino components were separated by columnchromatographic differentiation from the hydrolyzed cochlear sections of the membranous labyrinth of the pig and the guinea-pig. They showed in both species more glucosamine than galactosamine. Taken consideration of the histochemical and biochemical findings these analysis may be concluded that a considerable amount of the strong acid mucopolysaccharide is contributed in construction of the membranous hearing organ. In addition to keratosulphate as main components, the chrondroitinsulphate was also present. The strong acidic qualities of the mucopolysaccharide underlined the theory of their important role as ionic exchange upon the formation of the inner ear potential.

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Herrn Prof. Dr. Dr. h. c. A. Eckert-Möbius zum 80. Geburtstag gewidmet.

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Technische Mitarbeit: Frau W. Lehmann.     

Das LDH-lsoenzymmuster der menschlichen tonsillen und seine bedeutung für den energies toffwechsel

Zusammenfassung Das LDH-Isoenzymmuster von 40 menschlichen Tonsillen wurde elektrophoretiseh untersucht. Im Durchschnitt ergibt sich bei den Tonsillen eine etwa gleichstarke Beteiligung des aeroben wie anaeroben Energiestoffwechsels. Eine geschlechtliche Differenzierung war nicht zu erkennen. Mit zunehniendem Alter tritt im paratonsillaren Gewebe and im Kryptenepithel eine leichte Verschiebung zugunsten des anaeroben Stoffwechsels ein In Fallen chronisch rezidivierender Tonsillitis mit Fokalerkrankung war der aerobe Charakter des Energiestoffwechsels besonders im paratonsillaren Gewebe deutlich erhöht, bei Paratonsillitiden deutlich vermindert, ebenso im Kryptenepithel letzterer. Wesentliche Abweichungen von der Norm wurden bei einem Patienten mit einem Morbus Langdon-Down gefunden.

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The LDH-isoenzymes distribution in human tonsils and its consequence for the energy-metabolism

Summary The distribution of the LDH isoenzymes of 40 human tonsils has been investigated electrophoretically. The aerobic and anaerobic metabolism was observed without any sex predominance. With the advance of age the paratonsil tissue and the epithelial crypts showed a small displacement towards the anaerobic metabolism. In cases of chronic relapsing tonsillitis with vocal disease the aerobic character especially in the paratonsil tissue was distinctly increased, and in paratonsillitiden and their epithelial crypts were distinctly decreased. Abnormal results were obtained in one patient who suffered from Langdon-Down's disease.

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Technische MitarbeitE. Del Mestre u.W. Lehmann.