Biomedical subjects
Publications and source records attributed to H M Grubbauer.
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A report is presented of two cases of recurrent meningitis (mainly pneumococcal meningitis with different serotypes). The different possible causes of recurrent meningitis are discussed. The key to diagnosis in recurrent meningitis caused by forgotten traumatic fracture of the ethmoid bone is X-ray investigation including tomography of this region. The prognosis is poor in infancy, but improves with increasing age of the child and is dependent on early diagnosis of the underlying causative process.
A five-month-old infant with Reye's syndrome developed disseminated intravascular coagulation, which was successfully controlled by heparin. A fatal outcome could not, however, be averted. The pathogenetic role of disseminated intravascular coagulation in Reye's syndrome is discussed.
Life-threatening, glycoside-induced cardiac rhythm disturbances are often seen following accidental digitalis intoxication in small children. Modern therapeutic management should take into consideration the pharmacokinetics as well as the mechanisms responsible for cardiac and extracardiac symptoms. Discussed are the possibilities of eliminating and inactivating the ingested glycosides, the indications and contraindications for administration of electrolytes, as well as the use of anti-arrhythmic drugs and pacing for cardiac arrhythmias. Special consideration should be given to close observation and instrumental monitoring; ideally these should be carried out in an intensive care unit. Unnecessary loss of time in the management of such cases should be avoided through proper organization of diagnostic and therapeutic activities.
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A case of myocardial infarction in a newborn, most probably consecutive to air embolism, is described. The acute episode occurred immediately after the removal of a venous umbilical catheter. The infant survived, without clinical evidence of cardiac impairment 14 months later. However, he developed signs of a spastic cerebral palsy.
A case of a twelve year old boy with idiopathic juvenile osteoporosis is reported. The disease is characterized by onset in the prebubertal or pubertal age. The initial complaint is deep pain of the extremities, followed by a decrease in growth and multiple fractures of the spine and lower extremities. Radiologically a severe generalized osteoporosis is shown. Diagnosis depends on the results of clinical and x-ray examination, bone histology studies and the ruling out other forms of osteoporosis, those due to other disease of bones, renal diseases and metabolic or endocrine disturbances. Spontaneous remissions usually follows 2-4 years of disease. A specific treatment is not known.
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43 children suffering from borreliosis, meningitis and septicemia were treated with ceftriaxone. A six year old boy with acute jaundice due to ceftriaxone induced cholelithiasis encouraged us to reevaluate the frequency of ceftriaxone induced cholelithiasis and its' sequelae in children in a prospective study. Out of 43 children (age 6.3 years, 4 months to 16 years, male: female 25:18), 20 children (46.5%) showed sonographical evidence for ceftriaxone induced cholelithiasis after a treatment of at least 10 days. Two of them even had signs of intrahepatic cholestasis, 3 kids suffered from severe abdominal pain, non of them showed serologic abnormalities. Another 5 children (11.6%) had sludge in the gallbladder without evidence for cholelithiasis. In all patients the "pseudocholelithiasis" spontaneously resolved within at most 2 months. We suggest a sonographical examination of the gallbladder at the end of the ceftriaxone treatment in order to detect cholelithiasis, which might call for further monitoring and maybe dietary treatment.
We present the case of an eleven months old infant, who suffered from herpes simplex type I encephalitis. Cerebral ultrasound examination showed on 5th day of disease signs of focal echodensity. At that time CT showed a focal meningeal enhancement and CSF findings were normal. Suspicions changes were also obtained by MR-Imaging and EEG on the same day. Herpes simplex virus was identified in the CSF with Polymerase chain reaction days later. There are no typical clinical signs for herpes encephalitis, CT, NMR, EEG findings as well as antigen and antibody-tests do naturally take their time. Cerebral sonography in infants offers to be the best bed-side method for early suspicion of herpes encephalitis, which may support diagnostic workup and can help to start a specific therapy (Acyclovir) as soon as possible.
CAVH was carried out in 10 olig/anuric children with diuretic resistant hypervolemia. In addition, three children had hypercalcemia and one child hypernatremia. All but one needed artificial ventilation for pulmonary edema and positive inotropic cardiac support. Mean duration of CAVH for correction of fluid- and electrolyte imbalance was 51.5 hours (range 20-144 hours). The mean fluid removal of 1715 +/- 1479 (SD) ml decreased mean body weight from 21.4 +/- 18.9 (SD) kg to 19.2 +/- 17.0 (SD) kg. The electrolyte disorders were corrected within 18-24 hours. After correction of fluid overload and electrolyte imbalance 7 children could be extubated and cardiac support could be stopped. Two children died because of multiple organ system failure. CAVH was well tolerated by all children, no hemofiltration related complications occurred. CAVH is an effective and safe extracorporal renal replacement therapy system to correct fluid- and electrolyte imbalances in critically ill children. It can be installed easily and quickly, can be performed in every pediatric intensive care unit and is well tolerated even by small children.
Primary central alveolar hypoventilation (CAHV) is a rare disorder described in newborns, children, and adults. We report a 2 9/12 year old child with CAHV of unknown etiology. The evaluation of her ventilatory control system showed abnormalities awake and in the different sleep states. Hypoventilation was found to be more severe during non-REM sleep than during REM sleep and awake state. She had central apnea, an irregular respiratory rhythm in the non-REM sleep too, and diminished ventilatory response to inhaled 5%-6% CO2 in both REM and non-REM sleep. Her ventilation decreased when she was breathing 50% and 100% oxygen. During breathing 15% oxygen she did not arouse in spite a transcutaneous pO2 of 10 mmHg. She was first treated with mechanical ventilation during sleep and has now received bilateral simultaneous phrenic pacemaker support during quiet sleep for about one year. With the phrenic pacemaker she has normal minute volume and transcutaneous blood gases during sleep. During a respiratory infection she needed again mechanical ventilation via her tracheostoma 24 hours a day for one week. This case of a CAHV demonstrates a dysfunction of the central and partially also of the peripheral chemoreceptors. The abnormalities of the ventilation were demonstrable not only in the non-REM sleep but also in the REM sleep and awake state.
The case is described of a 6 months old infant who developed purulent pericarditis during the course of pneumonia. Pericarditis probably developed in this condition by contiguous spread from the pleura. Diagnosis of impending cardiac tamponade was masked by the occurrence of massive unilateral empyema. The management of this condition is discussed by open surgical drainage. Real-time two-dimensional echocardiography is useful for diagnosis and surveillance in this disease.