Three echocardiographic methods in right ventricular function evaluation

We employed two-dimensional echocardiography for the assessment of right ventricular (RV) volumes and/or function in a series of 44 patients. The results of three different echocardiographic approaches were compared with the data obtained from single-plane RV angiography following ultrasound within a 7-day interval. Only the echocardiographic area length method with two orthogonal imaging planes employed (apical 4-chamber and subcostal projections) yielded the beneficial results. The correlations between echocardiographic and angiographic RV volume estimates were rather high (end-diastolic volume: r = 0.83, end-systolic volume: r = 0.82, stroke volume: r = 0.81) and satisfactory in ejection fraction (r = 0.75). Using the method mentioned, the differentiation of patients with an angiographic evidence of RV failure (echocardiographic ejection fraction less than 0.55) from those without it was possible with a sensitivity of 0.68 and a specificity of 0.82. Concerning the clinical impact of the presented study, we can recommend the technique in question as a screening procedure for the detection of changes in RV function exceeding 12% (95% confidence limits).     

Surgical management of major pancreatic injury in children.

INTRODUCTION: Major or complicated pancreatic trauma in children is uncommon and management strategies remain controversial. The aim of this study was to evaluate our experience with both early and delayed surgery in these pediatric cases. METHODS: We carried out a retrospective analysis of data of pediatric patients with major or complicated pancreatic injury operated on between January 1994 and December 2005 in our pediatric trauma center. RESULTS: Thirteen children (9 boys and 4 girls) with a mean age of 8.5 years (range 3 - 16 years) were operated for major or complicated pancreatic injury. The extent of injury was: grade II (major contusion without duct injury or tissue loss) in 4 children; grade III (distal transection) in 5 children and grade IV injury (proximal transection) in four patients. Pseudocyst developed in 8 children: 4 with grade II injury, 2 with grade III injury and 2 with grade IV injury (one with abdominal pseudocyst and one with an abdominal and a mediastinal pseudocyst). Early diagnosis and operation was achieved in 5 cases, while delayed diagnosis and operation occurred in 8. Three children underwent cystogastrostomy; 6 had a spleen-sparing distal pancreatectomy and 4 had resection with Roux-en-Y jejunostomy drainage. Endoscopic retrograde cholangiopancreaticography (ERCP) was the most useful diagnostic tool in assessing ductal injury. There were no deaths or long-term morbidity in our group of patients. CONCLUSIONS: Our results support the view that early operation is important in ductal pancreatic injury. We recommend transferring children with a suspected ductal injury to a tertiary center with experience in both pediatric ERCP and pancreatic surgery.     

Manifestations of ocular allergy (atopy) in childhood. Present possibilities of therapy]

Vernal catharr of the conjunctivae is frequently the initial symptom of dermorespiratory syndrome. In all nine children where ophthalmological and other manifestations of varying extent of general atopy were combined, the authors revealed a marked increase of immunoglobulin IgE 220-2230 I.U./ml (normal values up to 150 I.U./ml) and polyvalent allergy. In the treatment of vernal catharr the authors used a combination of antihistaminics and preventive immunopharmaceutical preparations administered locally (Spersallerg and Opticrom) or as general medication (Hismanal and Zaditen), supplemented by aimed hyposensitization. In acute stages of the inflammation of the eye the authors administered Triamcinolon into the upper transient conjunctival fold. In the treatment of secondary infection Garasone was most effective. A finding interesting from the immunological aspect was vernal catharr without general symptoms of atopy in a patient with hypogammaglobulinaemia IgA.     

The concept of dose intensification in the treatment of neoplastic disease

Summary This paper summarizes different theoretical and clinical approaches contributing to the concept of dose intensification. According to this concept, the amount of antineoplastic drug delivered per time predominantly determines the clinical outcome in patients with neoplastic disease. With the availability of recombinant haemopoietic growth factors haematotoxic side effects might be reduced, making this concept more feasible for clinical use. However, more prospective randomized studies, in which dose-intensity is the only treatment variable, are needed to prove that dose intensification will lead to higher survival rates.

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Zusammenfassung In der vorliegenden Arbeit werden unterschiedliche theoretische und klinische Ansätze, die zu dem Konzept der Dosisintensivierung beigetragen haben, beschrieben. Dieses Konzept beinhaltet, daß die Dosierungen von verabreichten Zytostatika pro Zeiteinheit mitbestimmend für die erfolgreiche Behandlung von Patienten mit malignen Tumorerkrankungen sind. Durch den klinischen Einsatz von rekombinanten hämatopoetischen Wachstumsfaktoren können Nebenwirkungen auf das Knochenmark verringert werden, so daß das Konzept der Dosisintensivierung klinisch besser realisierbar wird. Prospektive randomisierte Studien, bei denen nur die Dosis-Intensität verändert wird, werden vermehrt erforderlich. Es wird sich dann erweisen, ob die Dosisintensivierung zu einer Lebensverlängerung beitragen kann.

     

Early implementation of legislative children’s mental health reform: The Minnesota/Hennepin County experience

The objectives of this study were to identify the strengths and weaknesses of Minnesota’s Comprehensive Children’s Mental Health Act of 1989 and its early implementation in Hennepin County, Minn. Data were collected from official documents and key informants relative to three implementation criteria: (1) community-based and family-centered values; (2) the range, coordination, and affordability of services; and (3) process, outcome, and consumer accountability. Findings suggest that the state law is a laudable, yet seriously limited, attempt to reform the system of care for children with emotional disorders. While the law is strong in its intent regarding community-based value, range, and coordination of services as well as process accountability, implementation has been hampered by weaker intent with respect to other criteria and by a lack of a comprehensive financing plan. Despite these limitations in the state law, Hennepin County has moved to use the law as leverage to improve the local system of care. Implications for reformers in other states center on the issues of state/county relationships, scope of initial efforts, choice of organizational structure, and the interplay of financing and accountability issues.     

Doppler echocardiography in the diagnosis of pulmonary hypertension

Review of the current state of knowledge about Doppler diagnosis of pulmonary hypertension is presented. The authors compare the findings of numerous studies with their own data and analyse the causes of discrepancies and controversies that have remained to date. Doppler estimation of mean pulmonary artery pressure (PAP) using acceleration time (ACT) measurement in the right ventricular outflow tract or main pulmonary artery has been shown to correlate closely with simultaneously measured values of PAP both at rest and during exercise (r = -0.92 and -0.94, respectively). ACT values show sufficient sensitivity for the detection of pulmonary hypertension (89%), at maximum (100%) specificity. However, Doppler values not obtained simultaneously do not necessarily correlate with PAP in view of rapid physiological variations of PAP. For everyday diagnostic practice in cardiology, prediction based upon mere qualitative estimation of the type of velocity curve seems sufficient. Doppler diagnosis of pulmonary hypertension, little demanding on both technical skills and equipment, is gaining a priority status among the non-invasive methods available.