The index manic episode in juvenile-onset bipolar disorder: the pattern of recovery.

OBJECTIVE: Recent studies of patients with juvenile bipolar disorder report low rates of recovery and high rates of chronicity. However, we lack data on the short-term outcome. This study examines the pattern of recovery from the index episode in an aggressively treated juvenile sample. METHOD: We assessed 25 subjects (< 16 years) with a diagnosis of mania, using the Diagnostic Interview for Children and Adolescents-Revised) (DICA-R), Young Mania Rating Scale (YMRS), and Children's Global Assessment Scale (CGAS) at intake and at 3 and 6 months. We studied the time taken to recover from the index episode, the level of functioning, and the factors predicting them. RESULTS: After 6 months, 24 (96%) subjects had recovered from the index manic episode. The median time to recovery was 27 days. Total episode length was significantly longer among those with previous affective episodes. CONCLUSIONS: The findings suggest that juvenile-onset mania has high rates of recovery and low rates of chronicity. These differences from the existing literature need further exploration.     

Isolated splenic hemangioma presenting with bleeding into serous body cavities

We present two children with massive bleeding into the serous body cavities accompanied by intractable consumption coagulopathy. One had a large spleen palpable at admission, the other developed progressive splenomegaly while in hospital. Neither child had any external evidence of angiomatous lesions. A splenic hemangioma was suspected clinically and on abdominal ultrasound; the diagnosis was confirmed at laparotomy. Splenectomy resulted in a prompt cure in both cases.     

LMW heparin (anti-Xa) assays for clinical monitoring and pharmacokinetic studies on the automated coagulation laboratory (ACL).

Chromogenic anti-Xa activity procedures were developed for monitoring LMW heparins on the Automated Coagulation Laboratory 300 Plus (ACL, Instrumentation Laboratory) system. For daily monitoring, a "Routine" procedure was devised which allows accurate measurements between plasma levels of 0.1 and 1.0 u/ml LMW heparin. For lower levels a "Routine-Low" method was developed which assesses activities between 0.05 and 0.4 u/ml. Due to variabilities in dODs of individual baseline plasmas, levels below 0.05 u/ml might be inaccurate when pooled normal plasma is used to establish the reference curve. While levels less than 0.05 u/ml should rarely be encountered when monitoring LMW heparins for routine clinical use, pharmacokinetic studies require accurate measurements below that level. For this reason a "Research-High" and a "Research-Low" procedure was designed. For these procedures a study subject's own baseline plasma was used to establish the reference curve. The "Research-High" measures activities between 0.4 and 2.0 u/ml, the "Research-Low" between zero and 0.4 u/ml. The procedures have excellent within-run and inter-run coefficients of variation (less than 5%) and high levels of accuracies. Even inter-instrumental reproducibilities are less than 10%. Different manufacturers' LMW heparins can be analyzed by these assays. The procedures offer full automation, great cost-effectiveness due to lower reagent volumes, rapid turn-around time and great accuracy and reproducibility.     

Isolierung von Plättchencofaktor I (Antihämophiles Globulin A,Faktor VIII) aus Rinderserum

Ohne ZusammenfassungDie Arbeit wurde teilweise mit Unterstützung der Deutschen Forschungsgemeinschaft durchgeführt.     

A de novo mutation affecting human TrkB associated with severe obesity and developmental delay

An 8-year-old male with a complex developmental syndrome and severe obesity was heterozygous for a de novo missense mutation resulting in a Y722C substitution in the neurotrophin receptor TrkB. This mutation markedly impaired receptor autophosphorylation and signaling to MAP kinase. Mutation of NTRK2, which encodes TrkB, seems to result in a unique human syndrome of hyperphagic obesity. The associated impairment in memory, learning and nociception seen in the proband reflects the crucial role of TrkB in the human nervous system.     

Zur Heparinisierung des Blutes bei der extrakorporalen Hämodialyse

Zusammenfassung An Hand der Literatur werden die bisher üblichen Verfahren zur Verhinderung der Blutgerinnung bei der extrakorporalen Hämodialyse besprochen.Auf Grund eigener Untersuchung wird die Heparingerinnungszeit in vitro als Richtlinie zur Heparinisierung empfohlen. Je länger diese ist, um so weniger Heparin wird benötigt.Zur Überwachung des Gerinnungsstatus während der Hämodialyse hat sich die Recalcifizierungszeit nachHowell in der Modifikation vonSchultze undSchwick gut bewährt. Sinkt sie unter 350 sec ab, so ist eine erneute Heparingabe erforderlich.