Placement of Umbilical Artery Catheters High vs. Low

Placement of umbilical artery catheters was retrospectively reviewed in 181 newborns to evaluate random placement of catheter tip in the "high" position between T₇ and T₉ in the thoracic aorta of 127 infants and in the "low" position below 4 in the abdominal aorta of 54 infants. Group differences in gestational age, asphyxia, hypotension, respiratory disease, duration of catheterization, or infusate type were not significant. Cyanosis or blanching in the low extremities occurred in 67% of the "low" group and 21% of the "high" group ( P < .001). Hematuria occurred in 39% of the "low" group and 21% of the "high" group ( P < .05). High placement appears to have fewer complications. Prompt intervention by neonatal nurse practitioners can help reverse complications that occur during umbilical artery catheterizations.     

Zur Probevertebrotomie

Zusammenfassung Wenn sich die Natur eines Krankheitsprozesses an einem Wirbelkörper durch klinische, röntgenologische und Laboruntersuchungen nicht abklären läßt, sollte die Diagnose durch eine Probevertebrotomie gesichert werden, sofern der Eingriff dem Patienten zuzumuten und von der Klärung der Diagnose therapeutische Konsequenzen zu erwarten sind. Der Wert des Probeschnittes wird durch die Beschreibung eines isolierten durch Operation geklärten Plasmocytoms des 10. Brustwirbels erhärtet.Mit 1 TextabbildungNach einem Vortrag auf der Tagung der Nordwestdeutschen Orthopäden-Vereinigung in Bonn, Mai 1963.     

Zollinger-Ellison syndrome and parathyroid adenoma. Limits of Wermer's syndrome]

The authors report the case of a patient with pancreatic and parathyroid adenomatosis and discuss whether it belongs to Wermer's syndrome. After a study of the various possible endocrine involvements, the complexity of hormonal inter-relations is studied, the prognosis and classification of multiple endocrine tumours are then discussed.     

A case of stunning of lung and bone metastases of papillary thyroid cancer after a therapeutic dose (3.7 GBq) of 131I and review of the literature: implications for sequential treatments

Thyroid stunning is usually defined as the inhibition or suppression of iodide trapping by remnant thyroid tissue or by functioning metastases following a diagnostic dose of 131I. The risk of stunning increases progressively with larger doses. Because the threshold above which this effect occurs in thyroid remnants seems to be between 37 MBq and 111 MBq of 131I, therapeutic 131I doses of 3.7 GBq may cause stunning. We describe stunning of papillary thyroid cancer lung and bone metastases after a therapeutic dose of 131I (3.7 GBq). A T1 bone metastasis and bilateral lung metastases were diagnosed by post-therapeutic dose whole-body scan. Nuclear MRI detected another lesion at T4, whose 131I fixation was not obvious. An additional 0.7 GBq were given after recombinant TSH, 37 days after the therapeutic dose; 24 h later, uptake by the lung and T1 metastases had disappeared, but trapping was again seen 6 months later on the post-therapeutic scan. This re-appearance is evidence in favour of the transitory and reversible character of stunning, and confirms its correspondence to the decreased ability of viable thyroid cells to trap iodine and not to their destruction. A better understanding of stunning would make it possible, in the event of rapidly progressing disease and in conjunction with recombinant thyroid stimulating hormone (TSH), to give several therapeutic doses of 131I in close succession without each dose hampering the effectiveness of the subsequent one.