Pulmonary sequelae of long-term ventilation of very low birth weight premature infants. Results of a follow-up study of 6-to-9-year-old children

Fifty six children with a birth weight of less than 1500 g and gestational age less than 34 weeks were studied at a mean age of 7.7 years. All had required mechanical ventilation, 36 suffered from hyaline membrane disease, 17 from atelectasis and three from pneumonia. Of these patients 37 developed broncho-pulmonary dysplasia (BPD). The study included skin prick test, measurement of ciliary beat frequency, chest X-ray, whole-body plethysmography and histamine challenge. Eight patients suffered from recurrent pulmonary infections up to the age of 4 years. Eleven children had a positive skin prick test. Three suffered from allergic asthma and six from hay-fever. The family history of atopy in these premature infants was no different from that of the general population. Ciliary beat frequency was normal in all cases (frequency: 11.8 +/- 1.8 Hz). In 34 patients X-rays showed minimal changes (peribronchial thickening n = 6, mild emphysema n = 28). Pulmonary function was normal except for an increase of thoracic gas volume which was correlated to grade of BPD according to Northway. There was a significant correlation between oxygen-score and radiological stage of BPD (r = 0.7). Histamine challenge showed hyperresponsiveness in 53% of the children. Eight patients showed a threshold similar of mild asthma (less than 1000 micrograms histamine per ml). The degree of airway hyperreactivity was correlated to the grade of BPD (r = 0.7; p less than 0.01) and the oxygen-score (r = -0.63; p less than 0.05). The oxygen-score may be considered a predictor of hyperresponsiveness and pulmonary outcome in later childhood.     

Antitumor effect of synthetic derivatives of lipid A in an experimental model of colon cancer in the rat

Colon carcinoma is one of the most frequent causes of cancer death in industrialized countries. The patients generally die of the metastases. In a colon cancer rat model, the authors have shown that lipopolysaccharides from Escherichia coli induced the regression of carcinomatosis and cured 20%-30% of the rats. Some synthetic derivatives of lipid A, which are less toxic than lipopolysaccharides, were injected 14 days after the tumor cells. They induced the complete regression of peritoneal carcinomatosis consisting of numerous nodules measuring 1-5 mm in 20%-30% of rats. Only compounds with three or more hydroxymyristic acid residues were effective. In vivo effects were correlated with the capacity to induce the production of interleukin 1 and tumor necrosis factor but not with the capacity to induce macrophage-mediated cytolysis. It is therefore possible to synthesize weakly toxic derivatives of lipopolysaccharides retaining their antitumoral property in vivo.     

Bronchial hyperresponsiveness to methacholine in patients with primary Sj?gren's syndrome.

The prevalence of bronchial hyperresponsiveness (BHR) to methacholine inhalation in a consecutive series of 21 patients with primary Sjögren''s syndrome was studied prospectively. Slight to severe BHR was seen in 12/20 (60%) of the patients. Ten of 12 patients with BHR (83%) had a non-productive cough, wheezing, or intermittent breathlessness. Bronchial hyperresponsiveness was more common in patients with extraglandular symptoms (10/14, 71%) than in those with only glandular symptoms (29%). Spirometrically 29% (6/21) of the patients had ''small airways'' disease'', and all those had BHR. Of 6/21 (29%) who had diffuse interstitial lung disease, two had BHR. Three of the four patients with obstructive lung function were challenged with methacholine and two of them had BHR. Only two patients with BHR had normal spirometry findings. The data showed that respiratory disease--mostly mild or moderate but even severe bronchial hyperresponsiveness--is commonly seen in patients with primary Sjögren''s syndrome.     

Associations of personality variables with smoking behavior and pulmonary function

Interindividual variability of lung function responses to smoking is unexplained. The aim of the present study is to inquire about a possible role of personality factors for an explanation of interindividual differences of lung function responses in smokers of both sexes. The results of canonical correlation analyses showed that there are no substantial correlations of personality with smoking behavior and also no significant associations of smoking behavior with pulmonary function in a healthy sample of smokers. In males only, personality factors were related to breathing frequency, but not to static and dynamic lung volumes.     

OAK knee evaluation. A new way to assess knee ligament injuries

The Orthop?dische Arbeitsgruppe Knie (OAK) documentation is based on clinical evaluation during functional knee stability testing near extension and near flexion. Increased compartmental translations and rotations, which result from structural defects because of anatomic lesions in a given knee injury, are clinically evaluated. The synopsis of the clinically detectable abnormal knee motion is graphically documented. A clinically applicable grading system of the true and reversed pivot shift phenomena completes the assessment of compartmental knee instability. Important contributing factors such as the constitutional laxity, the morphotype, and the range of motion are registered on the documentation form. The evaluation form presents four categories that represent subjective, objective, and functional criteria reflecting the overall results of repaired ligaments. This evaluation format establishes selected criteria to compare results from different centers.     

Ambulante und kurzzeitstationäre Schilddrüsen- und Nebenschilddrüsenchirurgie

Outpatient or short-stay thyroid and parathyroid surgery is still uncommon in Germany. Although a substantial number of these operations are performed with low morbidity, nearly zero mortality, and short operation time, some potentially lethal complications, especially postoperative hemorrhage, are strong arguments against liberal shortening of hospital stay. Symptomatic hematomas after thyroid and parathyroid surgery are observed in about 1-2% of cases. They frequently occur during the first 8 h after operation (40%). However, two thirds of these major complications occur later, about 20% of them more than 24 h postoperatively. Therefore, an outpatient procedure cannot be generally recommended. Short-stay (<23 h, overnight) thyroid and parathyroid surgery may be attractive, but this concept requires clear release-criteria and professional outpatient structures. Compared to general anesthesia, local and regional anesthesia did not emerge as helpful to shorten hospital stay. Also, prophylactic calcium supplementation is not recommended to enhance early hospital discharge after bilateral thyroid or parathyroid surgery.     

Distal nephron carcinoma: a rare kidney tumor

Bellini's duct carcinoma is a very rare tumor originating from the collecting tubules of the kidney. It should be part of differential diagnosis in cases with gross hematuria, failed diagnostic proof of a tumor within the collecting system and a centrally located hypovascular mass. Analysis of the cytoskeleton by means of cytokeratin patterns enables classification as a tumor of urothelial origin.     

Assessment of bone mineral content byin vivo measurement of flexural wave velocities

The determination of loss of bone mineral in an early stage of development is important. At the present time there exists no noninvasive or nonradiological methods which can be used for routine checks. An alternative method to obtain information about mineral content of bone is to measure the mechanical properties. A new method to measure the mechanical properties of long bones by means of the dispersion analysis of flexural waves is proposed. To be independent of the frequency spectrum of the impact pulse, the phase velocities were calculated from the signals of two accelerometers placed in vivo on the tibia. This method has the advantage that the velocities can be calculated for a frequency range. The results from this method were compared with the results from a well established measurement method for bone mineral content. Both methods were applied to 43 subjects selected in such a way that a broad range of bone mineral values was covered. The results imply that the proposed method can be used to test the mechanical properties of long bones.