The clinical findings and sonographic observations in four patients with AFBN in childhood are described. AFBN in childhood is an acute interstitial nephritis presenting with septicaemia. The patients show a rapid deterioration of condition, weight loss, flank pain and often leucocyturia without detection of bacteria. The diagnosis is confirmed by renal sonography, showing typical focal alterations. Sonographic follow-up is important to prove the diagnosis. Even without detection of bacteria intravenous broad-spectrum antibiotic therapy is required. The antibiotic should be active against gram-negative organisms and Staphylococci. Medication should be given for 2-3 weeks. After adequate treatment the clinical condition will improve within a few days whereas sonographic alterations return to normal after 2-4 weeks. In childhood, a bacterial infection of other organs preceding AFBN is more common than anomalies of the urinary tract as predisposing factors. Therefore in most cases a hemotogenous infection must be presumed and its focus discovered and eliminated by appropriate antibiotics since otherwise AFBN may recur.

Acute Disease↗

PubMed1987

Pregnancy after bone marrow transplantation for severe aplastic anemia.

Two women suffering from severe aplastic anemia were treated by bone marrow transplantation (BMT). They became pregnant 17 and 40 months after the procedure. During the first 20 weeks of pregnancy, one of them continued to receive cyclosporin A (CSA) to prevent graft-versus-host disease. Her CSA serum levels during these first 4 months ranged from 35 to 280 ng/ml. The course of pregnancy was uneventful and a healthy boy was delivered at term by Cesarean section. The other patient was shown to have rejected the transplanted marrow 4 months after BMT; autologous regeneration had occurred. During the last 2 months of her pregnancy, the hemoglobin and platelet numbers decreased again. Nevertheless, a healthy girl was delivered at term. Three months after delivery this patient's hematologic parameters are almost back to normal.

Anemia, Aplastic↗

PubMed1987

[Microabscesses of the spleen in patients with acute leukemia].

Eight patients with acute myelogenous leukemia in complete remission after induction chemotherapy developed septic fever. Fever was unresponsive to broad-spectrum antibiotic therapy. Ultrasonography showed multiple 0.5-2 cm in diameter, anechoic densities and some 1-3 cm "target" appearances in spleen and liver. Computed tomography demonstrated multiple, round, 0.5-2 cm areas of diminished attenuation in spleen and liver, which did not enhance like the surrounding parenchyma. These microabscesses increased in size and number without equivalent antifungal therapy and decreased or disappeared after specific treatment. Candida-infection was confirmed by histologically from liver specimens in four patients, fungal organisms were seen microscopically an liver-biopsy in one patient and at autopsy one patient was found to have candida disseminated to the spleen, liver, kidneys, lung and CNS.

Abscess↗

PubMed1987

[Differential diagnosis of dextrocardia in childhood].

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Angiocardiography↗

PubMed1987

[Induction of brain tumors with methylnitrosourea. Comparative study of 2 strains of rats].

For clarifying the question with respect to the different incidence in various animal strains of the formation of cerebral tumours 10 BD II and Wistar rats were given methyl-nitrosourea (a weekly amount of 5 mg per kg of life-weight over a period of 35 weeks). After an average of 398 and 367 days half the number of animals in each group showed cerebral tumours. These primarily seem to be isomorphous gliomas which then show an increase in malignity.

Animals↗

PubMed1987

Evaluation of pleural and pericardial effusions by magnetic resonance imaging.

MR examinations of 36 patients with pleural and/or pericardial effusions were retrospectively evaluated. The purpose of this study was to determine of MR imaging is capable of differentiating between pleural and pericardial effusions of different compositions using standard electrocardiogram (ECG)-gated and non-gated spin echo pulse sequences. Additional data was obtained from experimental pleural effusions in 10 dogs. The results of this study indicate that old hemorrhages into the pleural or pericardial space can be differentiated from other pleural or pericardial effusions. However, further differentiation between transudates, exudates and sanguinous effusions is not possible on MR images acquired with standard spin echo pulse sequences. Respiratory and cardiac motion are responsible for signal loss, particularly on first echo images. This was documented in experiments in dogs with induced effusions of known composition; "negative" T2 values consistent with fluid motion during imaging sequences were observed in 80% of cases. However, postmortem studies of the dogs with experimental effusions showed differences between effusions with low protein concentrations and higher protein concentrations. We conclude from our study that characterization of pleural and pericardial effusions on standard ECG-gated and non-gated MR examinations is limited to the positive identification of hemorrhage. Motion of the fluid due to cardiac and respiratory activity causes artifactual and unpredictable changes in intensity values negating the more subtle differences in intensity associated with increasing protein content.

Animals↗

PubMed1987

Functional defect of zinc transport in patients with Crohn's disease.

In the present study, we investigated the question whether the zinc deficiency in Crohn's disease is, at least partly, related to defective zinc entry at the jejunal brush border membrane. Brush border membrane vesicles (BBMV) were prepared from surgically resected pieces of morphologically intact human jejunum by a Mg++ precipitation method. We studied zinc, D-glucose, sodium and D-mannitol uptake into BBMV in 27 patients: 1) 20 patients with Crohn's disease 2) 7 controls. In 8/20 patients with Crohn's disease we found a significant decrease in zinc uptake (-25% +/- 5%, p less than 0.05) into BBMV. This impairment of zinc uptake in 40% of our patients with Crohn's disease was not associated with changes in the transport rates for D-glucose, sodium or D-mannitol. In addition no differences in enzyme marker concentrations or electron microscopic appearance were found.

Biological Transport↗

PubMed1987

[Value of nuclear magnetic resonance tomography in the staging of tumors of the urinary bladder].

The accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) in the staging of bladder tumors was evaluated in 46 patients. In the T-staging MRI was superior to CT. With MRI 38 out of the 46 tumors were correctly staged into the four groups T0, T1-T3a, T3b and T4. With CT this classification was only possible in 28 cases. The main advantages of MRI were the capability for multiplanar imaging, which improved evaluation of the bladder base and the bladder dome, as well as a better differentiation between tumor recurrency and fibrosis. In the evaluation of adenopathy MRI and CT proved to be equal and demonstrated a sensitivity of 50%.

Carcinoma, Transitional Cell↗

PubMed1987

[Mycoplasma pneumonia in children].

Roentgenographic findings of bilateral interstitial involvement without segmental consolidation and with regional lymphadenitis, when occurs after infancy, are always suggestive of pneumonia caused by Mycoplasma pneumoniae, as this is one of the most frequent typis of pneumonia in children. M. pneumoniae can be presumed from the discrepancy between the extensive roentgenographic findings and the generally good condition of the patient. Before therapy is decided upon it is important to know what the etiology is.

Child↗

PubMed1987

[Use of drugs by students].

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Adult↗

PubMed1986

[Vegetative hyperthermia: a thermoregulation disorder or a variant from the norm?].

A diagnosis of low-grade idiopathic fever was made in 85 women and 15 men, examined for subfebrile temperature of unknown origin, after organic disease had been excluded. Compared with 100 healthy control subjects these patients had inadequate movement-dependent temperature elevations with a usually pronounced discrepancy between the rectal temperature, predominantly more than 38 degrees C, and a normal or only slightly raised axillary temperature recorded after bodily movement. Other characteristics were that the elevated temperature was uninfluenced by antipyretic drugs. Almost all patients initially complained about general lassitude as well as frequently about atypical functional complaints and psychological symptoms. These observations indicate that low-grade fever is a functional syndrome due to a harmless faulty regulation of body temperature. In addition to a special constitutional reactivity, psychological factors and possibly previous febrile infections are likely to be involved as precipitating causes.

Adolescent↗