This report describes a 12-year-old girl who developed vaccine-type pneumococcal septicemia (type 4, Danish nomenclature) 2 years after splenectomy for recurrent idiopathic thrombocytopenia despite vaccination with the 23-valent vaccine 4 weeks before surgery and antibiotic prophylaxis with penicillin V. The disease presented as high fever with shivering and vomiting followed by disseminated petechiae and a deteriorated general condition. Initial laboratory studies showed severe sepsis with leucocytopenia and thrombocytopenia, a markedly elevated CRP, and disseminated intravascular coagulation. Despite antibiotic treatment, which was initiated with clindamycin, cefotaxime and trimethoprim/sulfamethoxazole and was switched to cefotaxime and penicillin after the result of the blood culture had been obtained, the patient had to be ventilated, and hemofiltration became necessary because of acute renal insufficiency. Furthermore, she required amputation of all her toes because of severe necrosis. No type-specific pneumococcal antibody titers were detected during and after infection. It remains unclear whether the susceptibility to Streptococcus pneumoniae was due to primary failure of antibody production or a decline in antibody levels after vaccination. Patients and/or their relatives should be informed that neither vaccination nor continuous antibiotic prophylaxis can guarantee full protection against infection with S. pneumoniae in patients after splenectomy.

Bacterial Vaccines↗

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Experimental evaluation of dynamic MRI for quantification of liver perfusion.

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Animals↗

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[Disseminated intravascular coagulation caused by prenatal hemorrhage into a congenital mesoblastic nephroma. Case report].

We report the case of a premature female newborn of the 35th gestational week with a congenital mesoblastic nephroma. The tumor was prenatally diagnosed in the 32nd week of gestation. By close sonographic controls, rapid enlargement was verified towards the end of the 35th week of gestation. This was probably caused by hemorrhage into the tumor. Anemia and postnatal disseminated intravascular coagulation followed. Cesarean section was done, because the anemia was suspected by Doppler sonographic evaluation. Disseminated intravascular coagulation could not be sufficiently controlled by conservative means but only by surgical removal of the tumor. The tumor turned out to be a congenital mesoblastic nephroma by histologic evaluation. Despite postoperative anuria and catecholamine dependency, our patient eventually showed a very favourable outcome. Diagnosis, clinical behavior and therapy of this tumor with a generally good prognosis are described and discussed.

Blood Coagulation Tests↗

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[Experiences with capnometry in pediatric intensive care].

We investigated the correlation between arterial and end-tidal pCO2 in 17 children during intensive care. The indications for using capnometry were noninvasive monitoring of ventilation after cardiac surgery or during complicated course of illness or for control of intended hyperventilation. We found a good correlation between arterial and end-tidal pCO2 in the overall patient population (r = 0.82), but the relationship varied widely from patient to patient. There was only a weak correlation (r = 0.44) in pCO2 over 45 mm Hg. Hyperventilation could be identified in 64.2%, whereas hypoventilation was correctly indicated in only 23%.

Carbon Dioxide↗

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[Toxic shock syndrome due to osteomyelitis].

An 11 3/4 year old girl contracted Toxic-Shock-Syndrome following osteomyelitis. The symptoms comprised a severe fall in blood-pressure with centralisation, petechiae and haematoma particularly in the lower extremities, hyperaemia of the oral mucosa and of the throat with profuse and unstaunchable bleeding in this area within in a short period of time. In order to stabilise the blood-pressure the patient had be given approx. 15 l colloidal solution (350 ml/kg) intravenously, mainly frozen-plasma. The risk of aggravation of a pulmonary failure along the lines of ARDS particularly due to the backward flow of the interstitial deposited fluid was avoided by the use of continuous veno-venous haemofiltration (CVVH).

Child↗

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[Pericardial tamponade as a complication of the use of peripheral percutaneous silastic catheters].

We report on two cases of cardiac tamponade by pericardial infusion in premature infants. In both infants an infusion was given via a Silastic central venous catheter. Because of the cardiac tamponade resuscitation and pericardiocentesis had to be performed. Both infants survived this serious complication of a central venous catheter.

Cardiac Tamponade↗

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[Ductus aneurysm as a rare cause of inspiratory stridor in the newborn infant].

A paralysis of the left vocal cord was seen by laryngoscopy in a 3-days-old boy with inspiratory stridor. A ductus aneurysm was established by angiocardiography, which was believed to be the cause of the vocal cord paralysis. Within 8 days after the angiocardiography the aneurysm became smaller and the stridor disappeared. Twelfth months later the control-angiocardiography showed the total obliteration of the ductal aneurysm.

Aneurysm↗

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[Clinical relevance of the tracheal bronchus].

We report about 6 infants with serious respiratory disease who revealed a tracheal bronchus on bronchoscopic or bronchographic examination. In two of these children this finding seemed to be the main problem; it could be cured by surgical or conservative therapy. The course of the further 4 children's disease was determined by additional serious malformations (Oesophageal atresia, congenital heart disease, anomalies of the pulmonary arteries). In these cases, the tracheal bronchus did not influence the clinical course significantly.

Abnormalities, Multiple↗

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[Diagnosis of bilateral renal vein thrombosis in infancy by pulsed Doppler sonography of the renal vessels].

In a premature infant bilateral renal venous thrombosis and associated thrombosis of the inferior vena cava were diagnosed at the age of 6 weeks, using a 2-dimensional ultrasound sector scanner with integrated pulsed doppler ultrasound of the renal vessels. In contrast to 30 healthy children, who showed continuous forward flow in the renal arteries throughout systole and diastole, diastolic flow was decreased or even retrograde in renal venous thrombosis (RVT) according to the severity of thrombosis. Doppler recordings in renal veins normally showed continuous retrograde flow patterns, whereas in RVT venous flow was decreased or absent. Pulsed doppler ultrasound is a useful and noninvasive method for recording renal flow patterns, especially in renovascular disease.

Humans↗