Intramural hematoma of the esophagus caused by minor head injury 6 hours previously

The diagnosis of extensive intramural hematoma of the esophagus due to a bicycle trauma was considerably delayed because symptoms did not develop until 6 h after the accident. This report underscores the importance of a barium meal and computed tomographic (CT) scan in cases of unexplained chest pain, even after minor trauma.     

Lack of correlation between changes in cyclic nucleotides and subsequent induction of tyrosine hydroxylase in rat adrenal medulla

Summary Pretreatment of rats with dexamethasone (2.5 mol/kg, a dose which blocks the release of ACTH from the pituitary gland) abolished the reserpine-mediated increase in cAMP and the increase in the cAMP/cGMP ratio in the adrenal medulla. In contrast, the reserpine-mediated induction of tyrosine hydroxylase (TH) remained unchanged. Hypophysectomy had a similar effect to dexamethasone treatment. Since changes in cAMP and changes in the cAMP/cGMP ratio are not indispensible prerequisites for the subsequent induction of TH, a causal relationship between the two phenomena seems to be excluded.     

Respiratory syncytial virus genotypes and disease severity among children in hospital

OBJECTIVES: To determine the spectrum of N and G genotypes of respiratory syncytial virus (RSV) causing respiratory tract infection and whether particular genotypes are associated with severity of infection. PATIENTS AND METHODS: Nasopharyngeal aspirates (NPAs) were obtained from 114 infants with acute respiratory tract infection due to RSV over two seasons. Viral mRNA was extracted from NPAs or cultured virus, reverse transcribed, and the cDNA amplified by the polymerase chain reaction using primers directed to parts of the N and G gene respectively. Amplicons were separately digested with four different restriction endonucleases for each gene. The fragments were separated by agarose gel, electrophoresis, and the electrophoretic patterns used to assign the various genotypes. Disease severity was assessed as very mild (upper respiratory tract signs only), mild (coryza and signs of lower respiratory tract infection), moderate (requiring nasogastric or intravenous fluids), and severe (requiring oxygen or ventilation). RESULTS: Five of the six known N genotypes were detected, but NP4 and NP2 were found most frequently. There was no association between N genotype and disease severity. Six G (SHL) genotypes were detected. Significantly (p = 0.04) more of the infants infected with the SHL2 genotype had severe or moderate disease. CONCLUSIONS: During the seasonal peaks of RSV respiratory tract infection at least 10 different RSV genotypes cocirculated. While there is no association between N genotypes and disease severity, infection with the SHL2 G genotype appears to result in moderate to severe disease.     

24-h-Blutdruckmessung nach Lebertransplantation im Kindesalter

Zusammenfassung Fragestellung: Eine arterielle Hypertonie wird nach Organtransplantationen bei Erwachsenen als Folge der Behandlung mit den hypertensiogenen Medikamenten Cyclosporin A, Tacrolimus (FK 506) oder Prednisolon h?ufig beobachtet. über das Verhalten des Blutdrucks bei Kindern nach Lebertransplantation liegen bislang kaum Untersuchungen vor. Methode: Wir haben deshalb bei 19 lebertransplantierten Kindern im Alter von 0,9–18,3 Jahren (Median: 10,9 Jahre) 24-h-Blutdruckmessungen durchgeführt. Die Lebertransplantation lag bei der Untersuchung 0,28–12,3 Jahre (Median: 3,5 Jahre) zurück. Alle Patienten erhielten Prednisolon (1,12–7,3 mg/m² und Tag), 13 erhielten zus?tzlich Cyclosporin (91–245 mg/m² und Tag) und 6 Tacrolimus (FK 506, Dosis 0,6–4,0 mg/m² und Tag) als Immunsuppressiva. Die Blutdruckmessung wurde zwischen 6 und 22 Uhr im 1/4stündigen und zwischen 22 und 6 Uhr im 1/2stündigen Rhythmus durchgeführt. Daraus wurden mittlere systolische und diastolische Blutdruckwerte für den Tag und die Nacht getrennt berechnet. Diese Werte wurden mit k?rperl?ngenbezogenen 95. Perzentilen aus p?diatrischen Normalkollektiven verglichen. Ergebnisse: Pathologisch erh?hte Werte zeigten 8 von 19 lebertransplantierten Kindern. Nur bei 3 dieser Kinder war vorher ein Hypertonus bekannt. Die mittleren systolischen und diastolischen Blutdruckwerte waren bei 4 Kindern am Tag und in der Nacht erh?ht. Bei 1 Kind waren beide Tagesmittelwerte und der n?chtliche mittlere diastolische Blutdruck erh?ht, bei 1 weiteren der mittlere systolische Blutdruck am Tag und in der Nacht. Bei 2 Kindern war jeweils ein Wert erh?ht: bei 1 der n?chtliche mittlere systolische Blutdruck, bei dem anderen der mittlere systolische Blutdruck am Tag. Ein erh?htes Serumkreatinin und/oder eine erniedrigte glomerul?re Filtrationsrate hatten 4 der 6 Kinder mit 2- bis 4fach erh?hten Blutdruckwerten. Schlu?folgerung: Eine arterielle Hypertonie ist nach Lebertransplantation im Kindesalter ein relativ h?ufiges Ereignis, jedoch ist sie seltener als nach Nierentransplantation. Sie ist mit einer Einschr?nkung der glomerul?ren Filtrationsrate assoziiert. Daher k?nnte ein Nierenschaden als Folge der erforderlichen Immunsuppression mit Cyclosporin für die Hypertonie mitverantwortlich sein.      

Effects of visual attentional load on auditory processing

Auditory evoked potentials were recorded while participants attended to visually presented digits. The difficulty of the visual task was manipulated by requiring participants to process only the current digit (0-back) or both the current and the preceding digit (1-back). Tones deviating in frequency from standard tones elicited a frontal mismatch negativity peaking around 200 ms which did not vary with visual task. However, decreasing the visual task load enhanced a right-temporal positive wave peaking around 200 ms when tones were presented slowly, and a frontocentral negative wave peaking around 450 ms when tones were presented more rapidly. The degree to which task-irrelevant sounds are processed therefore depends on the degree to which a visual task engages attentional resources.     

Results of 58872 and 58921 trials in acute myeloblastic leukemia and relative value of chemotherapy vs allogeneic bone marrow transplantation in first complete remission: the EORTC Children Leukemia Group report.

The first EORTC (European Organization of Research and Treatment of Cancer) acute myeloblastic leukemia (AML) pilot study (58872) was conducted between January 1988 and December 1991. Out of 108 patients, 78% achieved complete remission (CR), and event-free survival (EFS) and survival rates (s.e., %) at 7 years were 40 (5) and 51% (6%), respectively. It indicated that mitoxantrone could be substituted for conventional anthracyclines in the treatment of childhood AML without inducing cardiotoxicity. The aim of the next EORTC 58921 trial was to compare the efficacy and toxicity of idarubicin vs mitoxantrone in initial chemotherapy courses, further therapy consisting of allogeneic bone marrow transplantation (alloBMT) in patients with an HLA-compatible sibling donor or chemotherapy in patients without a donor. Out of 177 patients, recruited between October 1992 and December 2002, 81% reached CR. Overall 7-year EFS and survival rates were 49 (4) and 62% (4%), respectively. Out of 145 patients who received the first intensification, 39 had a sibling donor. In patients with or without a donor, the 7-year disease-free survival (DFS) rate was 63 (8) and 57% (5%) and the 7-year survival rate was 78 (7) and 65% (5%), respectively. Patients with favorable, intermediate and unfavorable cytogenetic features had a 5-year EFS rate of 57, 45 and 45% and a 5-year survival rate of 89, 67 and 53%, respectively.