Avascular osteonecrosis after hyperthermia in children and adolescents with pelvic malignancies: a retrospective analysis of potential risk factors.

PURPOSE: In children with locally advanced or recurrent malignant tumours, prognosis can be improved by regional deep hyperthermia (RHT) in combination with platin-based chemotherapy. However, because of the increasing number of patients that achieve long-time remission with this therapy, it is necessary to evaluate long-term sequelae of thermochemotherapy. During the years 1993-2004 one has observed avascular osteonecrosis (AON) of the femoral head after RHT in seven children with pelvic germ cell tumours or rhabdomyosarcomas. METHODS: Although AON may develop in patients with malignancies treated with chemo- or radiotherapy alone, RHT might nevertheless contribute to the occurrence of AON. In order to determine potential risk factors for AON after RHT, this study analysed the relationship of AON to the patient's age, medical history and treatment parameters such as thermal dose equivalent and power output. RESULTS AND CONCLUSIONS: In the present study AON was associated with young age as well as intensity of hyperthermia indicated by high power levels that exceed 20 W per kg body weight and/or application of eight or more heat sessions as well as additional radiotherapy. Based on this observation, it was assumed that an optimized three dimensional thermal field modelling may be helpful to avoid hazardous temperatures in the femoral heads during RHT treatment and to reduce AON of the femoral heads.     

Outpatient microsurgical reversal of tubal sterilization by a combined approach of laparoscopy and minilaparotomy.

A prospective study of 17 cases of microsurgical reversal of tubal sterilization by a combined approach of laparoscopy and minilaparotomy was performed. Inclusion criteria included age less than 43; weight less than ideal body weight plus 20%; documentation of ovulation; 2 cm of proximal oviduct on hysterosalpingography; and a normal semen analysis or postcoital test. A comparison group of the 5 cases of sterilization reversal performed by a standard inpatient technique during the same period was analyzed. The study technique was performed on an outpatient basis in 15 of the 17 cases, 12 patients (71%) conceived 13 intrauterine pregnancies, one ectopic pregnancy occurred, and total patient costs and time until return to work were significantly less with the study versus standard technique.     

Wachstumsretardierung durch A.-iliaca-Verschluss nach Herzkatheteruntersuchung

Cardiac catheterisations in newborns and infants are being performed routinely in increasing numbers for diagnostic and therapeutic purposes. Rarely, the femoral artery or the iliac artery will be completely occluded after such a procedure, and growth retardation of the lower extremity can result. We report on a case of iliofemoral artery occlusion following cardiac catheterisation in an infant. Twelve years later, a difference of 5.5 cm in leg length was noted, as well as a difference in shoe size and intermittent claudication. Following operative reconstruction, the child’s leg pain ceased. Two years after surgery, differences in leg lengths and shoe sizes are no longer significant. Vascular complications should not be underestimated despite the juvenile potential for collateral vessels. Even in the absence of signs of ischaemia, these complications necessitate further investigation and adequate treatment in due course.     

Characteristic modifications of the breathing pattern of mice to evaluate the effects of airborne chemicals on the respiratory tract

A system was developed for exposure of unanesthetized mice to airborne chemicals and for continuous measurement of their breathing pattern prior to, during and following exposure. By measuring inspiratory and expiratory airflows (VI and VE), and integration with time to yield tidal volume (VT), we obtained characteristic modifications to the normal breathing pattern. These permitted recognition that a specific portion of the respiratory tract was affected by the selected airborne chemicals. Following recognition, we also quantitated the degree of effect using one specific measurement in each case. An effect on the upper respiratory tract, induced by the sensory irritant, 2-chlorobenzylchloride, was quantitated by measuring a decrease in respiratory frequency. An effect on the conducting airways, induced by the airway constrictor, carbamylcholine, was quantitated by a decrease in VE at the mid-point of VT. An effect at the alveolar level, induced either by the vagal nerve ending stimulant, propranolol, or by the pulmonary irritant, machining fluid G, was quantitated by an increase in the length of a pause induced at the end of expiration. The system is easy to construct and operate and can be used to rapidly evaluate the effects of airborne chemicals on the respiratory tract.     

Concentrated gram stain smears prepared with a cytospin centrifuge.

A Cytospin slide centrifuge was used to concentrate 0.05- to 0.5-ml samples of cerebrospinal and other body fluids for Gram stain. Trials with cerebrospinal fluid containing known numbers of microorganisms indicated that the Cytospin increased the sensitivity of cerebrospinal fluid Gram stains by up to 2 logs compared with unconcentrated and conventional centrifuge smears. Cytospin-concentrated smears were prospectively compared with unconcentrated Gram-stained smears and bacteriological culture results for 80 clinical body fluid specimens. Bacteria were seen in unconcentrated smears of 9 of the 16 (56%) fluids which were infected, whereas Cytospin smears of 12 of the 16 (75%) showed bacteria. Cytospin smears revealed more bacteria and demonstrated better leukocyte morphology than did unconcentrated or conventionally centrifuged samples of small volumes of infected body fluids, allowing early diagnosis of infection.     

Endoparasites in dogs and cats in Germany 1999-2002

Infections with endoparasites in dogs and cats have been determined by analysing the results of faecal examinations (Flotation, MIFC, sedimentation, Baermann, smear, ProSpecT Giardia Microplate Assay). Samples of 8438 dogs and 3167 cats from the years 1999 until 2002 have been included in the investigation. 2717 dogs (32.2%) and 771 cats (24.3%) have been infected with endoparasites. In the infected dogs the following parasites have been identified: Class Nematodea: Toxocara canis: 22.4%, Toxascaris leonina: 1.8%, Ancylostomatidae: 8.6%, Trichuris vulpis: 4.0%, Capillaria spp.: 2.3%, Crenosoma vulpis: 0.9%, Angiostrongylus vasorum: 0.3%; Class Cestodea: Taeniidae: 1.2%, Dipylidium caninum: 0.4%, Diplopylidium/Joyeuxiella: 0.1%, Mesocestoides: 0.2%, Diphyllobothrium latum: < 0.1%; Class Sporozoea: Sarcocystis spp.: 9.0%, Cystoisospora spp.: 22.3%, C. canis: 8.0%, C. ohioensis: 17.0%, Hammondia/Neospora: 1.7%; Class Zoomastigophorea: Giardia spp.: 51.6%. In the 771 infected cats the following prevalences of parasites have been found: Class Nematodea: Toxocara mystax: 26.2%, Ancylostoma tubaeforme: 0.3%, Capillaria spp.: 7.0%, Aelurostrongylus abstrusus: 2.7%; Class Cestodea: Taeniidae: 2.6%, Dipylidium caninum: 0.1%; Class Sporozoea: Sarcocystis spp.: 2.2%, Cystoisospora spp.: 21.9%, C. felis: 15.3%, C. rivolta: 7.9%, Toxoplasma/Hammondia: 4.5%; Class Zoomastigophorea: Giardia spp.: 51.6%.     

Syndrome of gingival hypertrophy, hirsutism, mental retardation and brachymetacarpia in two sisters: specific entity or variant of a described condition?

Two sisters born to consanguineous Lebanese parents had mental retardation and epilepsy, brachymetacarpalia, hirsutism, bulbous soft nose, thick floppy ears with abnormal configuration and gingival hypertrophy. One girl presented additionally with tetralogy of Fallot and the other with congenital hypothyroidism and bilateral ureteral stenosis. These manifestations resemble the syndrome of hypertrichosis-gingival fibromatosis-mental retardation and seizures of Anavi et al. [1989: Dev Med Child Neurol 31:538-542] but our two girls additionally have brachymetacarpia. The inheritance seems to be autosomal recessive. These two sisters may represent a hitherto undescribed syndrome. We discuss the findings in our patients in relation to the literature.