[Treatment of digitalis poisoning with a specific digitalis antidote].
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Antibodies↗
Biomedical subjects
G Jorch
Publications and source records attributed to G Jorch.
[Coincidence of virus encephalitis and measles-mumps vaccination].
A 15-month-old girl developed meningoencephalitis 7 days after measles/mumps vaccination, and died 3 days later. No measles or mumps virus was found in brain tissue, but echovirus type 5 could be cultered postmortally on a cervical lymph node.
Diagnosis, Differential↗
Direction of flow with PDA.
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Blood Flow Velocity↗
[Determination of the factors Gm(1,2,4,5,21) and Inv(1) in human secretions: saliva, sweat, nasal secretion and semen (author's transl)].
If there is enough stain material available Gm and InV factors can be proved to be present in semen. Contamination by nasal or vaginal secretions should be taken into account. Sweat, however, does not interfere with the determination. In saliva, InV but no Gm properties were demonstrable. Stamp glue reacts unspecifically with InV antiserum and could therefore be a source of error. The conclusive value of Gm and InV findings as evidence in court was derived from the phenotype frequencies obtained in blood samples of 400 unrelated persons.
Antibody Formation↗
Significance of respiratory syncytial virus (RSV) infection in the 1st year of life.
BACKGROUND: In this study we investigated the frequency, symptoms and predisposing factors of respiratory syncytial virus (RSV) infection during the 1st year of life in infants with obstructive airway disease in comparison with infants without airway disease. PATIENTS: We enrolled 216 infants in their 1st year of life, who were hospitalized because of obstructive airway disease. As an age- and sex-balanced control group, we examined 133 infants hospitalized for other reasons than airway disease. METHOD: A deep pharyngeal swab was taken from all infants and immediately examined for the presence of RSV antigen by using an enzyme immunoassay (Directigen). Patient data were surveyed by a questionnaire. RESULTS: The frequency of RSV infections among infants with obstructive airway disease (34.3%; n = 74) differed significantly from the control group (15%; n = 20; p < 0.01). The frequency of RSV-infected infants with obstructive airway disease decreased with age ranging from 39.1% in trimenon I to 29.0% in trimenon IV. This trend was not observed in the control group. With respect to clinical symptoms and risk factors, there were no differences between RSV-infected versus noninfected infants. CONCLUSION: RSV is an important agent causing lower obstructive airway disease (34.3% of all patients). There are no specific symptoms that can be used for diagnosing RSV infection. In order to prevent other patients on the ward from contracting nosocomial RSV infection and in the light of therapeutic options, one should test newly admitted patients presenting with symptoms of an obstructive airway disease for RSV antigen. On a ward with high-risk patients, we would recommend the use of an RSV test for all new patients.
Age Factors↗
Infant's physiological response to short heat stress during sauna bath.
Thermoregulatory response to Finnish sauna bath was investigated in 47 infants (age 3 - 14 month). Before taking a short sauna bath lasting 3 min, the infants stayed in a swimming pool for 15 min. Under these conditions sauna bathing did not increase the rectal temperature. Unexpectedly rectal temperature even decreased by 0.2 degrees C (p < 0.05) probably due to redistribution of cold peripheral blood into the core of the body. Mean systolic and diastolic arterial blood pressure and mean heart rate remained unchanged after sauna bathing. The blood pressure amplitude decreased significantly after the swimming period from 47 mm Hg to 38 mm Hg (p < 0.05) and rose again after sauna bathing to 42 mm Hg. All infants tolerated short heat exposure in the sauna without side effects. The circulatory adjustment was efficient. Even young infants were able to cope with the acute circulatory changes imposed by heat stress. Adequate thermoregulatory and cardiovascular adaptive responses to sauna bathing could be shown for the first time in infants between 3 and 14 months of age.
Age Factors↗
[Risk factors of retinopathy of prematurity in infants 32 to 36 weeks gestational age].
INTRODUCTION: In our study we determined possible risk factors for retinopathy of prematurity (ROP) in infants 32 to 36 completed weeks of gestational age based on a regional German neonatal database. We examined especially whether or not oxygen therapy over more than 3 days is related to a higher risk of ROP. MATERIALS: We identified 7172 ophthalmologically examined infants, 32 to 36 completed weeks gestational age, born from 1990 to 1996. ROP was diagnosed in 195 (2.7 %). We examined the following variables as risk factors for ROP in infants receiving oxygen for less than 4 days: gestational age, sex, blood pH of 7.0 or less, body temperature of 36 degrees C or less, phototherapy, blood pO2 of 35 mm Hg or less, small-for-gestational age, sepsis, ventilation after birth, and blood transfusion. RESULTS: Sex, blood pH of 7.0 or less, blood pO2 of 35 mm Hg or less, sepsis, phototherapy, and small-for-gestational age were not associated with a significant risk of ROP. A gestational age of 32 weeks compared to a gestational age of 36 weeks was associated with an increased risk of ROP (odds ratio, 2.95; 95 % confidence interval, 2.18 to 4.01). Ventilation after birth (adjusted OR, 2.29; 95 % CI, 1.70 to 3.15) and blood transfusion (adjusted OR, 5.28; 95 % CI, 3.80 to 7.23) increased the risk of ROP regardless of gestational age. Oxygen therapy for more than 3 days was not associated with an increased risk of ROP (OR, 1.06; 95 % CI, 0.67 to 1.70). CONCLUSION: In neonates delivered between 32 and 36 weeks of gestation, the duration of oxygen supplementation should not necessitate an ophthalmological examination. A vigorous restriction of blood transfusions could reduce the incidence of ROP.
Cross-Sectional Studies↗
[Sudden death of twins: botulism because of contamination by pap vegetables].
Botulism is caused by the blockage of the neural transmission in the cholinergic synapses by botulinum neurotoxin (BoNT) which is produced by Clostridium botulinum or other Clostridia. The classic form of botulism occurs after the ingestion of food contaminated by BoNT. The course of the infection can be asymptomatic, mild with subtle paralysis ("failure to thrive") oder severe with generalized paralysis ("floppy infant"). Infected infants can also die sudden and unexpectedly. These deaths often are attributed to Sudden Infant Death Syndrome (SIDS), unless a thorough postmortem examination reveals Botulism. The rate of fatal Botulism falsely attributed to SIDS is not known, because it is difficult in most cases to show the causal relationship between contamination, disease and death. We report the sudden and unexpected simultaneous death of twins of 22 months which could be attributed to Botulism. Contamination of food, colonization of the gut by Clostridia and infection with specific pathomorphological changes could be proven. The initial suspicion of infanticide could be excluded. lt could be shown, that Botulism is a potential cause of simultaneous unexpected deaths in twins.
Botulinum Toxins↗
[Surfactant therapy in severe neonatal respiratory failure--multicenter study--I. Surfactant therapy in 264 premature infants of < 34 weeks with IRDS with special reference to "non-responders"].
As a part of a west german multicenter study (16 hospitals) 264 preterm neonates < 34 gestational weeks were treated with bovine surfactant (Alveofact, 50-200 mg/kgBW). Entry criterion was need of mechanical ventilation and FiO2 of > 0.5. Compared with a previous prophylactic study with the same surfactant product these patients were slightly more mature (median: 29 gestational weeks, 1260 g) but had a higher oxygen demand at the time of treatment (median FiO2: 0.82). Survival rate (28. d) was 82%. At this time 38% showed spontaneous respiration without, 16% with additional oxygen. The incidence of pulmonary interstitial emphysema was 22%, of pneumothorax 13%, and of PDA 33%. Severe intracranial hemorrhage (grade III or IV according to Papile) had 25%, ROP (any grade) 27%. Nonresponder showed a higher initial FiO2 of 0.94. With regard to umbilical artery pH, mode of delivery, birth weight, and maturity) they were similar to the responders. We did not find a parameter, by which we could predict the response to surfactant.
Female↗
[Pediatric characteristics of adult respiratory distress syndrome: a meta-analysis].
A meta-analysis of the literature is carried out in order to present the current knowledge of ARDS in childhood (0-15 years). This might be helpful for planning controlled studies on new therapeutic measures (e.g. surfactant replacement, antioxidants, extracorporeal gas exchange). By means of Medline all available publications were taken into account referring to minimal criteria defined before. There were 4 studies (50 patients) and 48 individual case-reports (48 patients). Most often ARDS was caused by infection (21 resp. 30%), aspiration (12 resp. 23%) and trauma (10 resp. 23%). Therapeutically high respiration pressures and toxic oxygen tensions were applied generally (average maximum PEEP: 14.7 resp. 15.8 cm H2O; average maximum PIP: 59.6 resp. 61.9 cm H2O; FiO2 > 0.5 for an average of 10.1 resp. 10.4 days). The most frequent complications were barotrauma (43.8 resp. 78%), infection (60.4%) and multiorgan failure (66.7%). Mortality rate was 31.3 resp. 52%. So also in childhood almost every second case is fatal. Especially multiorgan failure as well as high levels of FiO2 and PEEP indicate bad prognosis at an early stage. Therefore it is necessary and justified to perform clinical trials on therapeutic agents successfully tested in animal studies before.
Adolescent↗
[Pethidine analgesia and cerebrovascular circulation in very small premature infants].
Aim of the study was the assessment of possible side effects of analgesia with pethidine on the intracerebral circulation of very immature preterm infants. For this purpose the blood flow velocity in the internal carotid artery, basilar cerebral artery and the anterior cerebral artery was measured by pulsed Dopplersonography before and 5-10 min after i.v. injection of 1.0 mg/kg pethioine on 10 preterm infants with a gestational age of 24-30 weeks. Furthermore values for the parameter mean arterial blood pressure, heart frequency and tcpCO2 were obtained. None of the measured parameters showed a significant difference with the i.v. bolus injection of pethidine. As even very immature preterm infants do feel pain and can show potential dangerous physiological pain reactions and as this study proves the tolerance of the drug, analgesia with morphine derivates is recommended.
Blood Flow Velocity↗
[Necrotizing enterocolitis--analysis of a case cohort].
During a period of 25 months 11 newborns treated at the children's university hospital of Münster (0.8%) underwent laparotomy for necrotizing enterocolitis (NEC). The cases appeared sporadically without forming "clusters" typical of infectious etiology. 10 of 11 cases were premature infants (median birth weight 1280 g) stressing the predisposing role of immaturity. Ischemic events occurred in all patients prior to the onset of symptoms. The introduction of surfactant-therapy during the study period did not influence the incidence apparently. Ultrasonography was superior to radiology with regard to detection of extraluminal gas. We differentiated two types of clinical courses (3 acute and 8 protracted). In 5 cases we noticed a relapse of clinical symptoms after uptake of oral feeding. 3 newborns died with septic shock. The median hospitalisation time was 88.5 days in the 8 survivors. Enterostomy was replaced by definite anastomosis after 67.5 days (median). Median daily weight gain was 16.6 g. Late complications like permanent stenoses of short bowel syndrome were not observed. Early surgical intervention according to the general rules of abdominal surgery seems important even in very low birth weight infants.
Birth Weight↗
[Continuous Doppler sonography: a new method in the monitoring of the cerebral circulation in very small premature infants].
Disorders of cerebral circulation, which are a major risk factor of intracerebral haemorrhage in the preterm baby, can be recognized by Doppler sonography. The development and clinical application of a small miniature Doppler transducer (13 x 9 x 20 mm) is presented which can be fixed onto the infant's fontanel. It is suitable for continuous measurements with a low energy output of only 13 mW.
Cerebral Hemorrhage↗
[Cerebrovascular circulation in premature infants in relation to theophylline therapy].
The impact of 6 mg/kg resp. 1.5 mg/kg i.v. administered Euphyllin (containing ca. 80% theophylline and ca. 20% ethylenediamine) on intracerebral circulation was investigated in 20 (gestational age 25-37 weeks) resp. 10 preterms (26-33 weeks). For that purpose blood flow velocity was measured in three intracerebral vessels (Internal carotid artery, internal jugular vein, and anterior cerebral artery) by transfontanellar pulsed Doppler ultrasonography before, 2 min after and 6 min after the drug was given. Vmax (mean peak velocity) decreased by 25% in the internal carotid artery, by 26% in the internal jugular vein, and by 17% in the anterior cerebral artery. With 1.5 mg/kg a decrease could only be evaluated in the internal carotid artery (by 10%). The reduction of cerebral blood flow induced by theophylline is due to both the simultaneous decrease of pCO2 (by 3 mmHg in our study) and a direct vasoconstrictive effect of the drug on the cerebral resistance vessels. Effects of theophylline on systemic circulation are not responsible for its influence on cerebral circulation. Regarding the physiological variability and ischemic threshold of the human brain the impact of theophylline on neonatal cerebral circulation must be estimated as a tolerable risk.
Blood Flow Velocity↗
[Disorder of the blood-brain barrier caused by mannitol poisoning in an infant with encephalotoxicosis].
The clinical course of a mannitol intoxication in a 5-month-old infant is reported. Mannitol measurements were performed by gas-chromatographic-mass-spectrometric analysis. The role of the osmolal gap as a simple diagnostic tool in mannitol intoxication was underlined by comparison to serum mannitol levels. Mannitol elimination was analysed by measuring mannitol levels in urine, ultrafiltrate, and peritoneal dialysis outflow. The highest concentrations were found in urine (approx. 300% serum values) and the lowest in peritoneal dialysis outflow (approx. 50% serum levels). "Total body Mannitol" was calculated each day from body weight, hydration, and serum mannitol levels and opposed to the amount eliminated via urine, ultrafiltration, and peritoneal dialysis. The results were only compatible with a volume of distribution of approx. 5.3 1, representing total body water at a lean body weight of 7 kg. It could thus be demonstrated that the sudden fall of serum mannitol levels from 19.6 mg/ml to 5.5 mg/ml without dialysis treatment in an anuric patient was due to a leak of mannitol into the intracellular compartment.
Acute Kidney Injury↗
[Traumatic macroglossia--a rare indication for tracheotomy].
Hemorrhage into the tongue caused by a trauma is able to produce dangerous hematomas. During an hypertensive crisis a 17 year old patient suffered from an ictus with a bite on his tongue. A macroglossia developed with shortness of breath, so that only a tracheotomy could grand a sufficient ventilation. The macroglossia decreased within 6 days, the nasal breathing was no longer prevented, so the tracheostoma could be closed. An operative intervention is necessary, if conservative therapy is without success referred to diminuation of the tongue.
Adolescent↗
[Surfactant therapy in severe neonatal respiratory failure--multicenter study--II. Surfactant therapy in 10 newborn infants with meconium aspiration syndrome].
As a part of a west german multicenter study (424 patients, 16 hospitals) 10 term neonates ventilated because of severe meconium aspiration syndrome were treated with 1-4 doses of 50 mg/kg/BW of a bovine surfactant (Alveofact). Before treatment respiratory distress was severe (median FiO2: 1.0, median MAD 9.9 mmHg, median OI: 20). Acute improvement ("responders") was shown in 4 patients. All patients survived. Time of mechanical ventilation was 6-26 d. High frequency ventilation was applied in two nonresponders, ECMO in one.
Female↗
[Surfactant therapy in severe neonatal respiratory failure--multicenter study--III. Surfactant therapy in 41 premature infants < 34 weeks with suspected congenital infection (case-control analysis)].
As a part of a multicenter study (424 patients, 16 hospitals) 41 ventilated very low birth weight infants (24-33 gestational weeks, 640-1560 g), who were suspected to have connatal pneumonia, were treated with a bovine surfactant (Alveofact, 50-200 mg/kgBW). Using a case control design they were compared with 41 patients having IRDS. There were no differences between the collectives with regard to the acute response to surfactant, the clinical course, and the outcome at the 28. d of life. Accidental treatment with natural surfactant in very immature neonates suffering from severe respiratory distress due to connatal pneumonia resp. connatal pneumonia accompanying IRDS seems not to harm these patients.
Escherichia coli Infections↗