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G Heimann

Publications and source records attributed to G Heimann.

100 records · Page 6Linked to original sources
PubMedDate not supplied

[Kinetics and clinical use of the combined D-xylose and NBT-PABA test].

The oral D-xylose- and NBT-PABA-test are frequently applied as screening methods for malassimilation syndromes. After oral load time-related serum concentrations are used as reference values. In this study both substances were given simultaneously as isotonic solutions after a fasting period of 6 hours. A standard meal was offered 20 minutes later. Blood samples were taken prior to and 60, 90 and 120 minutes after administration of the test-substances. 43 pediatric patients were studied. 11 patients with cystic fibrosis, 10 patients with underlying intestinal disease such as coeliac disease and cows milk intolerance and 22 patients with other than gastrointestinal diseases were compared. In children with coeliac disease and cows milk intolerance 1-hour PABA concentrations were in the range of the control group whereas 1-hour D-xylose concentrations were lower than 15 mg/dl. In patients with cystic fibrosis the maximum concentrations of D-xylose were within the limits of normal values while 1-hour PABA concentrations were lower than 0.15 mg/dl in cases of relevant exocrine pancreatic insufficiency. The results of this study show that the combined D-xylose and NBT-PABA-test has proved its practical value in cases of suspected malassimilation and its discriminatory property between patients with relevant pancreatic insufficiency and patients with diminished intestinal absorptive capacity due to coeliac disease or cow's milk intolerance.

4-Aminobenzoic Acid↗
PubMedDate not supplied

[Disseminated neuroblastoma with intracerebral metastasis in a newborn infant].

We report on a newborn with disseminated neuroblastoma, intracerebral metastasis, localized in the right choroid plexus could be visualized by sonography and computed tomography. Despite low dose chemotherapy with adriamycin and cyclophosphamide skin and plexus metastasis showed marked progression. Therefore multiagent chemotherapy (NBL-82-Study) was initiated and further investigations revealed complete regression of the intra- and extracranial metastases and the leftsided adrenal tumor as well. Two years after the end of therapy, the patient is in good condition without signs of relapse. This case report underlines the importance of cranial sonography or computed tomography in disseminated neuroblastoma of young infants in order to detect or exclude intracranial metastases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Manifestation of intolerance to cow's milk protein in mucoviscidosis with the symptom triad of hypoproteinemia, edema and anemia].

The symptom complex--hypoproteinemia, edema and anemia--occurs in approximately 5 percent of CF-patients during the first 6 months of life. Since milk is the only nutritional source in this age group, a hypocaloric nutrition respectively marginaly low protein intake may contribute to these symptoms in case of an exocrine pancreatic insufficiency. Even if breast milk and soy bean formulas can advance the disease it must be mentioned that relapses of the symptom triad had never occurred under pancreatic enzyme supplementation independently of the source of milk being fed. A cow's milk protein intolerance and coincidental exocrine pancreatic insufficiency lead to the symptom complex in an infant in spite of an adequate caloric and protein intake. This case revealed again that sweat electrolyte tests are unreliable during the acute period of disease, sweat tests were positive when the presenting symptoms were resolved. The case demonstrates that repeated sweat chloride tests are mandatory during an asymptomatic phase of disease besides the exclusion of a renal or cardiac origin of the symptom complex. An early postnatal diagnosis of CF and immediate initiation of pancreatic enzyme and fat soluble vitamin supplementation could prevent such courses of disease.

Anemia↗
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Diagnosis and stage-related treatment of disseminated intravascular coagulation in meningococcal infections.

Disseminated intravascular coagulation (DIC) is a frequent complication of meningococcal sepsis in children. Despite the availability of potent antibiotics, mortality in meningococcal disease remains high (about 10%), rising to 40% in patients presenting in severe shock and consecutive DIC. As the clinical course and the severity of manifestations of systemic meningococcal infections varies there is a need for early diagnosis of the infection and of the stage of coagulopathy in order to reduce the high mortality rate. Few and rapidly available parameters are needed to classify the wide spectrum of clinical and laboratory findings in patients with DIC. The parameters include partial thromboplastin time, prothrombin time, plasma levels of fibrinogen, antithrombin III (AT III), fibrin monomers and D-dimer concentration, fibrin degradation products and the thrombocyte count. Monitoring the course of hemostasis findings in 28 pediatric patients (age between 3 months and 8 years, mean 3.1 years) with systemic meningococcal infections we observed a change of coagulation parameters already in the first stages of the infection: A prolongation of partial thromboplastin time mean 69.1 sec (range 22-150 sec, normal 30-45 sec), a decrease of prothrombin time to 45.7% (range 13-71%, normal 70-100%) and of AT III to an average level of 70% (normal 85-125%) was found 1 to 4 (-6) hours after admission. The following deterioration of prothrombin time and partial thromboplastin time turned out to be statistically significant (p < 0.05, signed rank test). The monitoring of hemostasis parameters mentioned above made it to possible define the stage of coagulopathy and thus to start a stage related therapy. Treatment consisted of shock control by liquid substitution, compensation of metabolic acidosis, correction of clotting disorders (AT III and heparin in case of pre-DIC; AT III and fresh frozen plasma in case of advanced DIC), antibiotic treatment (beta-lactam antibiotics e.g. cefotaxime or ceftriaxone), and--when necessary--catecholamine infusions. An early assessment of the coagulation disorders in meningococcal disease can be based on few coagulation parameters. Thus an appropriate treatment can be arranged in order to prevent a fatal outcome of meningococcal sepsis and to protect against the development of a Water-house-Friderichsen-syndrome.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Intestinal infection, the most frequent cause of invagination in childhood: results of a 10-year clinical study].

BACKGROUND: Intussusception is the most common cause of an acute abdomen in early childhood. 90% of all intussusceptions were thought to be idiopathic, because no lead points could be evaluated. PATIENTS: In our study we examined 148 children (93 boys and 55 girls) between 2. month and 18. years of age with 155 intussusceptions. METHOD: Besides epidemiological features and patients history we determined systematically all symptoms which occurred since the beginning of sickness. We performed ultrasound examinations before and after hydrostatic reduction with each child in order to find pathologic lead points. Microbiologic stool examination could be carried out at 99 specimen. RESULTS: 41 of 155 children with intussusception (26.5%) showed a pathologic finding next to the intussusception, with 29 children (18.7%) suffering from mesenteric lymphadenitis. 60.6% of examined stool specimen were abnormal. The most common germs were adenovirus, yersinia and staphylococcus aureus. Abdominal pain was the main symptom and was found in 72.6% of all children. 21% suffered from the classic trias abdominal pain, vomiting and rectal bleeding. 21.9% had diarrhea and 18% fever and signs of inflammation as unspecific symptoms. CONCLUSIONS: In our study we found mesenteric lymphadenitis as the most common lead point in intussusception. In conclusion with 60.6% pathologic germs in the examined stool specimen we assume gastrointestinal infection as the main cause of intussusception in childhood.

Abdomen, Acute↗
PubMedDate not supplied

[Antacids for postoperative prevention of stress ulcer in infants: a dose finding study].

UNLABELLED: In the prophylaxis of stress ulcers with antacids in young infants there are no recommendations of dosages that consider the physiologic maturation of gastric acid secretion. During the first six month of life the amount of gastric acid secretion in relation to body weight and body surface area increases exponentially. Therefore adult dosages of antacids cannot be transferred to infants. METHODS: In a cross over study 12 infants aged between 4 and 174 days, who had been undergoing a cardiosurgical intervention with the heart lung machine, were treated during 48 hours with 2 different antacid regimens over a period of 24 hours each, monitoring the gastric pH continuously. The used antacid consisted of an aluminium-magnesium complex (Al(OH)3, 90 mg/ml and Mg(OH)2, 60 mg/ml): Regimen A: 6 x 0.5 ml per kg body weight. Regimen B: 0.25 ml per kg body weight at a gastric pH less than 3, with the pH read every 30 minutes. RESULTS: Compared to 28 applications under regimen B, 72 single doses were given under regimen A, 58 of them at a gastric pH of higher than 3. Thus, the mean administered dose was significant lower under regimen B (2.2 ml) than under regimen A (12.0 ml). Consequently, the mean level of gastric pH was higher under regimen A (median: 5.96 +/- 1.31 versus 4.94 +/- 1.16). pH-values lower than 3 were more often measured under regimen B, whereas the phases at this pH-level were longer under regimen A. CONCLUSION: The usual body weight related dosage of antacids seems to be to high for early infancy. In the face of the discrepancy of the administered antacid quantity comparing regimen A with regimen B, it seems to be reasonable for the studied age group to reduce the single antacid dose to 0.25 ml/kg body weight while adhering to a high application frequency of 6 times a day.

Antacids↗
PubMedDate not supplied

[SCE rate and lymphocyte differentiation in children with acute lymphoblastic leukemia and SCE rates of leukemia patients in long-term remission].

Sister chromatid exchanges (SCE) and lymphocyte subsets of children with acute lymphoblastic leukemia (ALL) were investigated in children with ALL during chemotherapy and at least 5 years after chemotherapy. The treatment of the new admitted patients followed protocol ALL-BFM-90. Children with ALL at the time of diagnosis showed statistically significant higher SCE frequencies (4.9 +/- 0.77) than healthy controls (3.6 +/- 0.93; p = 0.002). The in vivo effects of cyclophosphamide (CP) resulted in a dramatic increase of the SCE frequency (20.5 +/- 3.76). This increased SCE level of lymphocytes might reflect an instability of DNA or a deficiency of DNA repair capacity. However, immediately one week after the administration of CP, the SCE rate decreased. This decline of SCE frequency correlates with a severe reduction of the absolute numbers of T lymphocytes. The observed reduction of SCE frequency may be due to a depletion of T lymphocytes, or a repair of DNA. The patients in long term remission ( > 5 years) have had the therapy according BFM-83 (9 pat.) and modified 'Pinkel-regime' (2 pat.). No difference was found between the SCE-rate of the patients in remission and of the age-dependent control group. These results might correlate with the low risk for future development of relaps or second malignancy.

Adolescent↗
PubMedDate not supplied

[Therapy of choroid plexus carcinoma in childhood. Case report and review of the literature].

Carcinomas of the plexus choroideus (PCC) represent the rare malignant variety of plexus choroideus papillomas and take a particularly unfavourable course. Tumors of the plexus choroideus account for about 2-4% of all primary brain tumors in children and 0.5% of those in adults. The PCC is more frequent in children than in adults; the authors found reports on 72 cases of PCC in children and on 16 cases in adults. In most cases the PCC is located in the lateral ventricles. The symptoms caused by PCC are non specific and appear as those of increased intracranial pressure (on the basis of hydrocephalus hypersecretorius and/or occlusivus). As the nature of the tumor cannot be identified by means of medical imaging, the diagnosis is usually set up histologically. Prognosis is poor for patients treated only by surgery, which in most cases has been performed as subtotal resection of the tumor. So the necessity for an oncological strategy combining surgery and 'adjuvant' therapy arises. The authors report the application of such a strategy in the case of a three-year-old boy with a PCC of the left lateral ventricle. After nearly four years of remission, the boy died of meningeosis carcinomatosa. This course underlines the malignancy of this tumor; even after years the poor prognosis can still be diminished by the spread of meningeal metastases. In a survey of the case reports published in literature the patients' data, their therapy and the outcome are demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma↗
PubMedDate not supplied

Pit-1 and pituitary function.

Several patients with pituitary dwarfism and a variable degree of hypothyroidism have been shown to have mutations in their Pit-1 gene. Pit-1 activates transcription of the growth hormone and prolactin genes and is necessary for the control of the beta-TSH gene transcription. The various mutations have different effects on the DNA binding and transactivating properties of Pit-1. Multiple pituitary hormone deficiency due to Pit-1 mutations is inherited either dominantly or recessively depending on the DNA binding properties of the mutant protein. The comparison of pheno- and genotype in patients with multiple pituitary hormone deficiency provides some insight into the function of the Pit-1 protein.

Animals↗