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J Meller

Publications and source records attributed to J Meller.

114 records · Page 7Linked to original sources
PubMedDate not supplied

[Case report: neonatal hypertension].

BACKGROUND: Neonatal arterial hypertension is rare with an incidence between 0.2 - 3 %. Clinical presentation varies widely and is in some cases dramatic. PATIENT: A 4-day old full-term neonate was admitted to the intensive care unit with severe congestive heart failure and metabolic acidosis. Mechanical ventilation was initiated and dobutamine administered because of poor systolic function. Continuous monitoring of blood pressure revealed severe arterial hypertension (30 to 40 mm Hg above the 95th percentile). Ultrasonography showed an echogenic left kidney with normal perfusion. Laboratory examinations revealed a raised peripheral renin activity, thrombocytopenia, slightly raised d-dimers, a microhematuria and mild proteinuria. After resolution of hypertension under therapy with an ACE-inhibitor, a MAG3 renal scan showed complete absence of renal function on the left side. Renal artery stenosis was excluded by venous transcardial angiography. Under therapy with Captopril, the patient was discharged and followed up for 8 months. He is developing normally with normal serum creatinine (0.4 mg/dl), but low renal function (17 %) of the left side as assessed by DMSA-scan and compensatory right kidney hypertrophy are observed. DISCUSSION: Diagnosis and treatment of neonatal hypertension are discussed with respect to the proposed case. After exclusion of other causes we conclude that a perinatal microangiopathic event may have lead to the renal lesions with malignant renovascular hypertension.

Age Factors↗
PubMedDate not supplied

[Differentiated thyroid gland carcinoma in children and adolescents].

Differentiated thyroid cancer is a rare disease in childhood and adolescence. Most frequently, thyroid cancer in children belongs to the papillary variant, whereas a follicular histological pattern is much less frequently encountered. Dedifferentiated (anaplastic) cancers are very rare at this age. Especially indolent cervical lymph node enlargement is suspicious for a thyroid cancer, even more when occurring together with a solitary, rapidly growing, and indurated thyroid nodule. Every nodule in the thyroid of children and adolescents, if not unequivocally cystic, is suspicious of a malignancy. In contrast to adults, multifocal tumor manifestations are frequently found in children and adolescents which often have spread beyond the capsule of the thyroid at the time of diagnosis. Regional lymph nodes are involved in up to 90%, and distant metastases are present in up to 20% of the cases. Despite these much more advanced stages as usually found in adults, the prognosis of children is better than at advanced age, since these tumors are highly differentiated, and, even in the case of distant metastases, a curative approach is still possible. The therapy (surgery/radioiodine) and the follow-up follows the same principles as those which have been established for older patients.

Adenocarcinoma, Follicular↗