Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-month-old toddler with a normal cardiac history who presented with purulent pericarditis due to group A streptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a Staphylococcus aureus aortitis in the dilated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.

Adolescent↗

PubMedDate not supplied

Bilateral diaphragmatic paralysis after cardiac surgery: ventilatory assistance by nasal mask continuous positive airway pressure.

The case of an 8-month-old boy with bilateral diaphragmatic paralysis after surgical reoperation for congenital heart disease is presented. In order to avoid repeated intubation and long-term mechanical ventilation or tracheotomy, we used nasal mask continuous positive airway pressure (CPAP) as an alternative method for assisted ventilation. Within 24 hours the boy accepted the nasal mask and symptoms such as dyspnea and sweating disappeared. Respiratory movements became regular and oxygen saturation increased. Nasal mask CPAP may serve as an alternative treatment of bilateral diaphragmatic paralysis in infants, thereby avoiding tracheotomy or long-term mechanical ventilation.

Diaphragm↗

PubMedDate not supplied

[Atypical form of long-QT syndrome--a case report].

An unusual case of familial Long QT syndrome is reported. After a longstanding symptom free interval this eight year old girl experienced multiple episodes of malignant ventricular arrhythmias including ventricular tachycardias of the torsades-de-pointes type and ventricular flutter. The treatment with beta- and alpha-blocking agents, phenytoin, calcium antagonists, clonidine and magnesium in increasing doses and varying combinations was unsuccessful. A left sided cardiac sympathectomy failed also to control the life threatening ventricular arrhythmias and to decrease the relative high mean heart rate. Finally a consecutive right cardiac sympathetic denervation in combination with an experimental class I antiarrhythmic agent led to a subjective and objective improvement in the patient's condition which allowed discharge from hospital. Despite a symptom free interval of four months and nearly normalized Holter ECG results the longterm prognosis remains unclear. This unusual case discloses interesting features, because 1) it supports the theory of an intracardiac cellular anomaly rather than the imbalance hypothesis, 2. chronic beta-blocker treatment possibly resulted in an up-regulation of beta-adrenergic receptors which made beta-blocking agents ineffective despite high doses, and 3. an consecutive right sided cardiac sympathectomy resulting in bilateral cardiac sympathetic denervation had to be done-an intervention which is seldom performed in the Long QT syndrome.

Anti-Arrhythmia Agents↗

PubMedDate not supplied

[Pacemaker therapy in children].

Between 1975 and June 1987 55 children underwent first permanent pacemaker (PM) implantation. The patients' age at time of implantation ranged between 1 month and 17 1/2 years (mean 5 5/12 years). In all cases - except a 17 years old girl who received a transvenous endocardial lead - only epicardial screw-in electrodes were used. Only VVI-PM have been implanted. In 84% the indication for implantation was post-surgical brady-arrhythmia, in 16% it was an inborn or acquired disturbance of the conducting system. With our patients we have a survey of 2603 months of PM implantation. During this period 14 children underwent totally 20 revisions, in 50% the electrode was the cause of failure. The interval between two revisions calculated as a quotient from months of PM implantation and number of revisions has increased significantly during the last years and amounts now to 130 months. The relative low incidence of revisions is in our opinion mostly related to the nearly exclusive use of epicardial leads.

Adolescent↗

PubMedDate not supplied

Induction of T helper cell type 1 response and elimination of HBeAg during treatment with IL-12 in a patient with therapy-refractory chronic hepatitis B.

This study reports the increase of immunoregulatory T helper cell type 1 response and elimination of HBV-DNA during IL-12 therapy in a patient with chronic hepatitis B virus infection who had not responded to three previous interferon-alpha therapies and one treatment with Famciclovir over a period of 6 years. The patient received IL-12 at a dose of 0.5 microgram/kg bodyweight weekly. Peripheral blood mononuclear cells were isolated before and during IL-12 application and incubated for 7 days with specific type 1 (purified protein derivative) and type 2 (tetanus-toxoid) TH cell antigens as well as with a macrophage/monocyte activating antigen (Bacille Calmette-Guérin). In the supernatants cytokines were determined by a double-sandwich ELISA. After 8 weeks HBV-DNA became negative and HBeAg seroconversion to anti-HBeAg occurred. Immunologically the loss of viremia was accompanied by a strong increase of the purified protein derivative-induced production of the type 1 cytokine interferon-gamma (1219 pg/mL before, 13,138 pg/mL after IL-12 therapy). Furthermore, Bacille Calmette-Guérin-induced secretion of the macrophage/monocyte-associated cytokines IL-1, tumor necrosis factor-alpha and granulocyte-macrophage colony-stimulating factor was higher at the end of therapy. This case indicates that IL-12 enhances type 1 T helper cell activity which may be a predisposition for elimination of HBeAg and successful treatment of hepatitis B.

Adjuvants, Immunologic↗

PubMedDate not supplied

Single fibre action potential recording from the nerve to the musculus obliquus externus abdominis following pin-prick in humans. III.(IV).

1. With 2 pairs of wire electrodes single afferent and efferent action potentials were recorded from the whole nerve to the musculus obliquus externus abdominis in humans. 2. The peak group conduction velocity of Golgi tendon organ afferents was with about 55 m/sec at 36 degrees C intermediate to the velocities of the primary and secondary muscle spindle afferents and intermediate to the velocities of the alpha 1 and alpha 2-motoneurons. 3. Following pin-prick of the skin on top of the musculus obliquus externus abdominis, the activity of the secondary spindle afferents in the nerve to the musculus obliquus externus reduced and the activity of the primary spindle afferents disappeared. These afferent changes are interpreted as the result of the defense contraction of the muscle underlying the skin. 4. The results are discussed with respect to withdrawal reflexes measured electromyographically. A motoric reinnervation of the urinary bladder in spinal cord lesions by a nerve anastomosis is also discussed.

Abdominal Muscles↗

PubMedDate not supplied

A critical view concerning metabolism and physiological function of histamine in the gastric mucosa.

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Amine Oxidase (Copper-Containing)↗