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Biomedical subjects

D Adam

Publications and source records attributed to D Adam.

304 records · Page 17Linked to original sources
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[Value of pneumococcal vaccination in infants and young children].

Streptococcus pneumoniae is a common cause of meningitis, sepsis, pneumonia, acute otitis media, and sinusitis in children. Children younger than 24 months have the highest rates of invasive pneumococcal infections (Germany 1997-1999: 19.5/100,000/year). Pneumococcal infections cause in Germany 220-250 cases of meningitis, about 50,000 of pneumonia (children younger than 5 years) and more than 1 million cases of otitis media (children) annually. The case-fatality rate for invasive pneumococcal diseases is high (1997-1999 5.5%, meningitis 8.3%). 20-30% of survivors from meningitis suffer from CNS-related sequelea. In children up to 2 years vaccination with the heptavalent pneumococcal conjugate vaccine can reduce invasive pneumococcal diseases by about 80% and otitis media and recurrent otitis media by 6% and 9-16%, respectively. Due to the increased risk of pneumococcal infections in the first two years of live all children of this age group should be vaccinated. The high rate of resistance of pneumococci against macrolides in Germany, the high rate of non-licensed antibiotics in infants and the inefficacy of the 23-valent vaccine in children younger than 2 years makes the new vaccine to a necessary alternative.

Child, Preschool↗
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[5-day therapy of bacterial pharyngitis and tonsillitis with cefixime. Comparison with 10 day treatment with penicillin V. Cefixime Study Group].

160 children aged 1 to 12 years with clinical diagnosis of bacterial pharyngitis and/or tonsillitis were treated either with cefixime ready-to-use-suspension or penicillin V in an open, controlled and randomized multicenter study. Before treatment a rapid antigen detection test was accomplished and throat swabs were taken. After randomization, the children were either treated for 5 days with 8 mg cefixime/kg bodyweight ready-to-use suspension once daily or with 20,000 I.U. penicillin V/kg bodyweight t.i.d. also administered as suspension. The data of 151 children could be evaluated for clinically efficacy. In the cefixime-group 86.7% of the children were cured and 9.3% significantly improved. After initial improvement, in one child (1.3%) a relapse occurred and in the two remaining children (2.7%) therapy failed. 90.8% of the patients treated with penicillin V were cured, 6.6% improved and in one child each a relapse was registered resp. therapy failed. Complete microbiological data were available in 137 patients. In the cefixime-group in 82.6% of the patients the pathogens were eradicated. The elimination rate in the penicillin-group was 88.2%. At the follow-up 3-4 weeks after end of treatment 6 relapses were seen in the cefixime-group, and 8 in the patients treated with penicillin. Both regimes were safe. Mild to moderate adverse events at least possibly related to the study medication were seen in only 4 children treated with cefixime and in 5 treated with penicillin. A 5 day treatment of bacterial pharyngitis and tonsillitis with cefixime was as effective as a ten day treatment with penicillin V.

Cefixime↗
PubMedDate not supplied

[Effectiveness and tolerance of cefixime in comparison with penicillin V in bacterial pharyngitis and tonsillitis in children. Cefixime Study Group].

154 children aged 2 to 12 years with clinical diagnosis of bacterial pharyngitis and/or tonsillitis and--in most of the patients--a positive enzyme immunoassay for group A beta-hemolytic streptococci before therapy were enrolled in this open controlled randomized and multicenter trial. The children received either 8 mg/kg bodyweight cefixime once daily or 20,000 I.E. pencillin V/kg bodyweight t.i.d. Clinical evaluation and microbiological tests were carried out before treatment and 1-5 days after end of the treatment. 3-4 weeks after end of the treatment the rate of relapses was evaluated. The data of 149 children could be evaluated for clinical efficacy. In the cefixime group 93.3% of the children were cured and 6.7% improved compared to 89.2% and 10.8%, respectively, in the penicillin V group. Complete microbiological data were obtained from 136 patients. The eradication rate was 82.7% in the cefixime group and 77% in the group of patients treated with penicillin V. At follow up relapses were seen in 7 of the cefixime treated patients and in 6 of those receiving penicillin V. Mild side effects were reported by 4 patients in the cefixime group and by 3 children treated with penicillin V (1 drop out each). These results show that cefixime once daily is at least as effective as penicillin V t.i.d. in pharyngitis and tonsillitis in children. Both compounds are well tolerated.

Anti-Bacterial Agents↗
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Use of quinolones in pediatric patients.

Animal experiments have shown that quinolones can cause irreversible damage to cartilage in strained joints of young animals. Since a similar effect in humans cannot be excluded, the new quinolones are contraindicated in children and pregnant women. Nalidixic acid was the first quinolone developed and was often used in pediatric patients for the treatment of urinary tract infections. This compound is also known to cause damage to juvenile cartilage in animal studies but is still licensed for pediatric use. In three different retrospective studies of children treated with nalidixic acid, no case of quinolone-associated arthropathy could be detected by careful X-ray examinations or comparisons with control patients. This disparity most probably can be explained by interspecies differences: human cartilage may be insensitive or only slightly sensitive to the arthropathic effects of quinolones. Careful prospective evaluations of the efficacy and safety of new quinolones in childhood infections are both medically indicated and ethically justified.

4-Quinolones↗
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Transferable amikacin resistance in gram-negative bacterial isolates.

Seven amikacin-resistant strains of Enterobacteriaceae isolated in Slovakia and Germany were included in this study. The strains were also resistant in vitro to high levels of gentamicin, tobramycin, netilmicin and isepamicin. Phosphocellulose paper binding assays indicated that resistance to aminoglycosides was due to synthesis of aminoglycoside acetyltransferase AAC(6')-I a mechanism until now only identified in staphylococci and streptococci. This mechanism of aminoglycoside resistance has also been found in two isolates of Klebsiella pneumoniae from Germany. The substrate profile suggested that in addition to AAC(6')-I and APH(2"), several strains also produced AAC(3)-II. Aminoglycoside resistance was found to be transferable to Escherichia coli 3110 rifr in all isolates, and R plasmids of 36-45 MD were detected in donor and transconjugant strains. All isolated plasmids from transconjugants encoded resistance to aminoglycosides by genes encoding the enzymes AAC(6')-I and APH(2").

Acetyltransferases↗
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Traumatic intracerebral hematoma. A report of 50 cases.

The study presents an analysis of demographic, clinical and paraclinical characteristics of 50 cases as well as the surgical treatment results of 50 cases with traumatic intracerebral hematoma (TIH) out of 70 admitted. The men showed the greatest incidence, the male/female ratio was 5:1. Age mean was 55.3 yrs. Hematomas were caused in one third of the cases by traffic collisions, followed by severe cranial traumata associated or not with other traumatic lesions and/or preceding diseases. The most frequent location was anterior in the frontal (30%) and temporal lobes (26%). Diagnosis was confirmed by arteriography and tomography. Specific paraclinical aspects of TIH were discussed together with those of the primary intracerebral hematoma (PIH). All patients were operated on under general anesthesia. A minimum craniectomy was carried out aimed at the lesion. Surgery was planned after a full neurological examination. Postoperative mortality was increased (42%) due to the severity of trauma (88%) in patients with a Glasgow coma scale assessment under 8, to age (50% of the patients were over 50 yrs), to hematoma size (84-100% in patients with a diameter of the hematoma between 50 and 100 cu cm, and over 100 cu cm, respectively) and to the location (66% in the frontal hematomas compared to 33% in temporal ones).

Adolescent↗
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Head injuries with temporal lobe compression.

The present study is based on the evolution of 219 cases of temporal compressive craniocerebral trauma admitted to the neurotraumatology department between 1985 and 1990. Correlations are made between the accident-operation time interval and the results obtained. Special emphasis is laid on the paraclinical methods used to make an accurate and complete diagnosis, of which computerized tomography is the most reliable for head injuries. The most frequent compressive lesions found in this series were the indirect cerebral lacerations. Their approach was done by a trephine opening aimed at the anterior 1/3 of the temporal lobe, in its basal part. The prognosis depends on the state of consciousness (patients in deep coma had small chances for survival) and on the time interval between accident and surgery, a rapid and adequately equipped transport of the patient being also of utmost importance.

Adolescent↗
PubMedDate not supplied

Lumbosacral tumors with a retroperitoneal development.

Neoplasms are relatively rare in the lumbosacral region. The present study presents two cases with tumors in the lumbosacral region, a chordoma and a tumor with multinucleated giant cells which further showed a presacral development. Some common aspects of the clinical and radiologic symptomatology were evidenced as well as the specific characteristics of each separate tumor in our cases. The diagnosis was possible due to the modern radiologic equipment.

Adult↗
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Management of the neurosurgical emergencies in pregnancy.

This study presents the files of nine pregnant women with severe neurosurgical diseases (traumatic, vascular, and tumoral) who were treated in the Neurosurgical Clinic, from 1982 to 1988. Conclusions were drawn after a survey according to the optimal therapy applied, to the mother or fetus priority, to the age of patients and to the severity of the neurological impairment. The early intervention of a team including the neurosurgeon, obstetrician and the specialist in the intensive care unit saves one life or both. A delay condemns both.

Accidental Falls↗
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Transient brachial diplegia (crossed paralysis): etiopathogeny and differential diagnosis.

The present paper presents three short clinical observations of patients with cerebral trauma and concussion also showing transient motor deficits of upper limbs but no sensory disorders. The etiopathogenesis of motor brachial deficits is also discussed. The conclusion is that the sudden anterior flexion of the head determines an instantaneous hit of the pyramidal bulbar decussation (the upper part) to the odontoid apophysis or to the anterior margin of the occipital foramen. Recovery depends on the severity of trauma. This clinical entity is very rare. There are other pathologic causes which can trigger a transient brachial diplegia, thus, requiring a differential diagnosis.

Accidental Falls↗
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Subacute subdural hematoma.

The subacute subdural hematoma (SASDH) is an entity which is still to be analyzed because the attention of the clinicians was directed towards the acute subdural hematoma (ASDH) and to the chronic subdural hematoma (CSDH). A series of 69 patients with SASDH was studied outlining the particularities of the affection. A trauma caused the hematoma but it was a milder one. The associated cerebral lesions were generally produced by concussion (34%) and cerebral dilacerations represented only 8.4%. Clinical symptoms were obvious between the third and the fourteenth day after trauma due to the cerebral compression. The consciousness was moderately impaired. The patients with GCS < 8 represented 18.9%. The neurological picture stated with time allowed a programmed paraclinical investigation: a. radiography of the skull revealed cranial fractures in 10.1%; b. carotid arteriography showed a lentiform aspect of the avascular space; c. CT presented variable densities (isodensity--3%, hypodensity--14.5%, and hyperdensity--27.5%) depending on the length of the interval between trauma and admission. The operation evacuated the liquid blood collection through a widened burr hole. Death during operation was 17.4% and 79.8% survived.

Adult↗
PubMedDate not supplied

Identification of p55 tumor necrosis factor receptor-associated proteins that couple to signaling pathways not initiated by the death domain.

The 55 kDa receptor for tumor necrosis factor (TNF-R55) has become a paradigm for membrane receptors that are devoid of intrinsic enzymatic activity. The initiation of intracellular signaling events observed in TNF-stimulated cells appears to depend on protein intermediates that interact with specific cytoplasmic domains of TNF-R55. By use of TNF-R55 deletion mutants, we have defined a novel domain of TNF-R55 (NSD) distinct from the death domain which is specifically required for activation of neutral sphingomyelinase (N-SMase). In addition, using the yeast interaction trap system, we have identified one protein (FAN) that binds to the NSD and mediates activation of N-SMase as well as seventeen other potential interaction partners of TNF-R55. These candidate interactors include the adaptor protein Grb2-linking TNF-R55 to the Ras pathway-as well as the enzyme phosphoglycerate mutase, suggesting a role of TNF-R55 in glycolysis/ energy metabolism of cells.

Animals↗