Pediatric hyperglycemic hyperosmolar coma diabeticum: diagnostic evaluation and therapeutic concept

Hyperglycemic hyperosmolar coma diabeticum (HHS) is a rare phenomenon in pediatric patients. It causes major morbidity and significant mortality. It is characterized by the trias of hyperglycemia, hyperosmolality and absent or mild metabolic acidosis. Major complications include cerebral edema and rhabdomyolysis. Evidence based guidelines for HHS in children are lacking. Based on a literature review we discuss treatment options in pediatric HHS und suggest a therapeutic concept. Appropriate treatment consists of adequate fluid administration and a cautious lowering of the serum glucose level. Patients should be treated on an intensive care unit and monitored closely to avoid complications. Low-dose and late insulin administration seems to be favourable.     

The electroencephalographic sleep pattern in schizophrenic patients treated with clozapine or classical antipsychotic drugs

The effects of antipsychotic agents on sleep were tested by examining the nocturnal electroencephalographic recordings of 14 drug-naïve schizophrenic patients and comparing these with recordings from 12 patients treated with clozapine and 10 treated with classical neuroleptics (haloperidol: n=7; flupentixol: n=3). In both of the treated groups, sleep continuity measures and rapid eye movement (REM) density were significantly higher than in the drug-naïve group. Clozapine-treated patients showed significantly more stage two sleep, more stable non-REM sleep (stages two, three and four) and less stage one than patients treated with haloperidol or flupentixol. Clozapine had no effect on the amount of REM sleep. Although mean REM latency was almost twice as long in the clozapine compared with the other two groups, this difference was not statistically significant. The present study suggests considerable differences between the influence of typical and atypical antipsychotic agents on sleep. However, the results of this cross-sectional study should be confirmed using a longitudinal intraindividual approach.     

Urethral strictures and aortic surgery. Suprapubic rather than urethral catheters

Urethral strictures associated with the use of a urethral catheter may be more common after cardiac and aortic surgery when compared with other surgical procedures. The reasons for this are obscure. Fifty-two aortic procedures in males from 1980-1983 were reviewed with an incidence of urethral stricture of 21%. Forty anterior resections of the rectum in which a urethral catheter was used were also reviewed with an incidence of urethral stricture of only 5%. Since 1985 supra-pubic catheters have been used now in over 200 aortic procedures with no morbidity and no urethral stricture. Bacteriuria has been significantly reduced by the use of supra-pubic catheters and there would appear to be considerable advantages in the use of this technique.     

Comparison of <Superscript>18</Superscript>F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix

Purpose

The aim of the present study was to assess and compare the diagnostic performance of integrated PET/MRI and MRI alone for local tumor evaluation and whole-body tumor staging of primary cervical cancers. In addition, the corresponding impact on further patient management of the two imaging modalities was assessed.

Methods

A total of 53 consecutive patients with histopathological verification of a primary cervical cancer were prospectively enrolled for a whole-body 18F-FDG PET/MRI examination. Two experienced physicians analyzed the MRI data, in consensus, followed by a second reading session of the PET/MRI datasets. The readers were asked to perform a dedicated TNM staging in accordance with the 7th edition of the AJCC staging manual. Subsequently, the results of MRI and PET/MRI were discussed in a simulated interdisciplinary tumor board and therapeutic decisions based on both imaging modalities were recorded. Results from histopathology and cross-sectional imaging follow-up served as the reference standard.

Results

PET/MRI allowed for a correct determination of the T stage in 45/53 (85%) cases, while MRI alone enabled a correct identification of the tumor stage in 46/53 (87%) cases. In 24 of the 53 patients, lymph node metastases were present. For the detection of nodal-positive patients, sensitivity, specificity and accuracy of PET/MRI were 83%, 90% and 87%, respectively. The respective values for MRI alone were 71%, 83% and 77%. In addition, PET/MRI showed higher values for the detection of distant metastases than MRI alone (sensitivity: 87% vs. 67%, specificity: 92% vs. 90%, diagnostic accuracy: 91% vs. 83%). Among the patients with discrepant staging results in the two imaging modalities, PET/MRI enabled correct treatment recommendations for a higher number (n = 9) of patients than MRI alone (n = 3).

Conclusion

The present results demonstrate the successful application of integrated PET/MRI imaging for whole-body tumor staging of cervical cancer patients, enabling improved treatment planning when compared to MRI alone.

     

Increased alpha activity in REM sleep in de novo patients with Parkinson's disease.

We compared the sleep structure including a quantitative electroencephalographic (EEG) analysis and the frequency of periodic limb movements (PLM) in 17 patients with Parkinson's disease (PD; 10 men, seven women, mean age 65.9 years, mean Hoehn and Yahr stage 1.8) who had never been treated with dopaminergic agents (de novo), and 10 healthy controls (six men, four women, mean age 64.5 years). The REM sleep EEG of the PD patients was characterized by a sustained increase in the high-theta/alpha (7.8-10.5 Hz) frequency range during the first one-third (i.e., 11.00 p.m. to 01.40 a.m.) of the night. There was no significant difference in the sleep continuity and sleep architecture as well as in the PLM index between both groups. The analysis of the temporal dynamics of the observed changes suggests a dysregulation of the REM sleep homeostasis in the patients with PD.     

Lungenresektion aufgrund nekrotisierender Pneumonie im Kindesalter

In this paper two cases of necrotizing pneumonia, one of which required lobectomy and one, pneumonectomy, in children aged 18 months and 4 years, respectively, are presented. In the former patient the pathogens concerned were Bacillus cereus and Aspergillus fumigatus, which had led to postoperative nosocomial infections after total cavopulmonary connection. Alpha hemolytic streptococci were found in the tracheal secretion in the second patient, which had caused treatment-resistant parapneumonic empyema. Both patients eventually recovered. Complicated pneumonia requiring lung resection is rarely encountered in children in industrialized countries. Extensive pulmonary necrosis is the only indication for such surgery. The surgical operation must be carefully timed for a favourable outcome to be achieved.