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Biomedical subjects

A Koch

Publications and source records attributed to A Koch.

337 records · Page 19Linked to original sources
PubMedDate not supplied

Enteral nutritional support by percutaneous endoscopic gastrostomy in children with congenital heart disease.

One of the major problems of children with severe congenital heart disease (CHD) is their poor nutritional status. Among other consequences, it influences the surgical outcome. Retrospectively we present our experience with percutaneous endoscopic gastrostomy (PEG) in 15 children with CHD. This technique allows enteral nutritional support without the disadvantages related to long-term nasogastric tube feeding. Major complications were absent, and minor complications were rare both at PEG insertion, which was performed under deep sedation, and during feeding via PEG tube. In 4 of the 8 children who were followed for at least 6 months the age-matched body weight increased more than one standard deviation. In 2 other patients it increased more than 0.5 standard deviations. In 7 children the tube was removed after 2.5 to 42 months since enteral support was no longer necessary. Apart from initial reservations the parental acceptance of PEG was good. We conclude that the PEG is a safe and reliable technique to support enteral nutrition in children with severe CHD.

Enteral Nutrition↗
PubMedDate not supplied

[Functional disorder of the hypothalamic osmoreceptor as the cause of excessive hypernatremia in a girl with absence epilepsy].

BACKGROUND: Chronic hypernatremia is a rare disorder in childhood and normally results from impairment of the water homeostasis. In some cases, chronic hypernatremia is caused by decreased intake of water based on impaired thirst perception. CASE REPORT: We report a girl with microcephaly, partial agenesis of the corpus callosum, mild midface hypoplasia and absence seizures, who presented with severe hypernatremia (serum sodium concentration 189 mmol/l). Though serum osmolality was increased up to 382 mOsm/kg, the girl showed no signs of thirst. After normalization by intravenous fluid therapy, serum osmolality and serum sodium concentration remained in the normal range with an oral water intake of at least 1500 ml/d. Polyuria was never present, the ability to concentrate urine was preserved. CONCLUSIONS: In summary, we speculate that the chronic hypernatremia in our patient is caused by a selective hypothalamic osmoreceptor dysfunction associated with mild dysplasia of the midline structures. Only very few similar cases have been documented in the literature.

Agenesis of Corpus Callosum↗
PubMedDate not supplied

[Functional tricuspid atresia in a newborn infant with cardiac rhabdomyoma].

Cardiac rhabdomyomas are benign tumours closely associated with tuberous sclerosis. We report on a neonate with a cardiac rhabdomyoma, which simulated tricuspid atresia with duct-depending pulmonary perfusion due to almost complete obliteration of right ventricular cavum. Under infusion of prostaglandin E1 the newborn stabilized and was successfully operated on the 3rd day of life. We conclude that successful tumour resection is possible in neonates with cardiac rhabdomyomas causing relevant hemodynamic obstruction.

Echocardiography↗
PubMedDate not supplied

Molecular genetic studies in medulloblastomas: evidence for tumor suppressor genes at the chromosomal regions 1q31-32 and 17p13.

BACKGROUND: Medulloblastoma represents a common primitive neuroectodermal tumor of the cerebellum, the molecular pathogenesis of which has not been identified. Previous cytogenetic observations disclosed aberrations of chromosome 1 and 17 in medulloblastomas. In the present study, we have molecularly characterized the affected chromosomal segments. PATIENTS AND METHODS: A panel of microsatellites on chromosomes 1 and 17 was used to assess allelic loss in 30 medulloblastomas and to characterize putative tumor suppressor loci. RESULTS: 36% of the medulloblastomas showed an interstitial loss of heterozygosity (LOH) on chromosome 1q. The common region of overlap was mapped between D1S1604 and D1S237 and included the locus F13B in the chromosomal region 1q31-q32.1. None of the MBs exhibited LOH of the telomeric portion of chromosome 1p which has been associated with several other human malignancies. 47% of the tumors showed LOH on chromosome 17p with a common region of overlap at 17p13.3. The lissencephaly gene 1 (LIS-1) was excluded as a candidate gene in this region. CONCLUSION: Our data strongly suggest the involvement of putative tumor suppressor genes located on the chromosome arms 1q and 17p in the molecular pathogenesis of medulloblastoma.

Adolescent↗
PubMedDate not supplied

[Endocrinologic after-care of brain tumor patients: initial retrospective analysis of HIT-study documented auxologic and endocrine parameters].

BACKGROUND: In 1987, a pilot trial (HIT 88/89) was initiated by GPOH to investigate the effectivity and toxicity of intense preradiation chemotherapy. The aim of this study was to improve the treatment of children with malignant brain tumors, but provided no standardized recording of auxological and/or endocrinological parameters. In 1993 a sub-project, "Endocrinological late effects", was started during the ongoing study to examine the late effects of treatment, and a retrospective evaluation was performed in order to standardize parameters. PATIENTS: We considered auxological and hormonal data from those patients (n = 133; 78 m, 55 f) who were alive at the time of the survey, and had completed tumor therapy. RESULTS: Analysis of the growth pattern of the children after the end of therapy indicate impaired growth. Group 1 (n = 77, CA < 10 yrs): Mean height SDS at tumor diagnosis was +0.32 (n = 77), and fell constantly after completion of therapy to -0.75 (n = 16) after 3-4.5 yrs. Group 2 (n = 56, CA > 10 yr): Height SDS-CA fell from +0.24 (n = 45) at the time of diagnosis to -0.62 (n = 14) after 3-4.5 yrs. Unfortunately, only body height and weight were recorded regularly, data on sitting height, pubertal stage and bone age were incomplete. Endocrine evaluation after end of therapy was insufficient. CONCLUSIONS: A standardization of endocrinological follow up is necessary as soon as possible, for an adequate description of the endocrinological late effects.

Adolescent↗
PubMedDate not supplied

Independent practice associations: risk contracting, financial controls and processes.

The decision to enter into risk contracting with a health plan should be carefully considered. With today's pressure to control health care costs, an IPA's financial position can change rapidly. Even small numbers of enrollees can precipitate losses of hundreds of thousands of dollars over a few months if utilization and costs are not carefully projected and monitored. Prudent contracting to limit the IPA's downside risk in a new contract's early years is the most effective tool for preserving financial stability. However, the IPA must also develop sophisticated claims processing and financial reporting systems to ensure consistent payment practices and enable management to identify problem areas rapidly. Contracts with physician providers must allow the IPA flexibility in implementing administrative withholds and in renegotiating rates with short lead times.

Capitation Fee↗
PubMedDate not supplied

[Aspergillosis of the antrum].

Aspergillus falls into the class of hyphae-forming molds and is ubiquitous. It is known as a facultatively pathogenic opportunist. It is incorporated by breathing in spores from the air and develops its pathogenicity only in predisposed subjects with a weakened systemic or local defense mechanism. While systemic mycosis involves a weakening of the defense condition by an underlying disease, immune suppressant therapy, metabolic disorder or the like, isolated antral affections usually appear in otherwise healthy subjects. Our observations in one case are presented.

Adult↗
PubMedDate not supplied

[The HIV epidemic in the German Federal Republic--infection epidemiology interpretation of numbers of AIDS cases].

Statistical analysis of AIDS case data shows that the flattening out of growth rates of AIDS in the FRG are solely due to the development of case rates in some groups of homosexual men in HIV epicentres and the absence of new infections in haemophiliacs and in patients receiving blood transfusions. Development in the epicentres is interpreted as early saturation. In the other groups that now constitute one-half of the cases reported in 1989 the increase has been steady. Existing gaps in epidemiological infection control are discussed.

Acquired Immunodeficiency Syndrome↗