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Biomedical subjects

K Harms

Publications and source records attributed to K Harms.

At least 55 records · Page 3Linked to original sources
PubMed1993

Neutrophil elastase and acute pulmonary damage in neonates with severe respiratory distress syndrome.

This study evaluated possible acute effects of neutrophil elastase on neonatal pulmonary morbidity. The activity of free elastase and alpha 1-proteinase inhibitor as well as concentrations of elastase-alpha 1-proteinase inhibitor in tracheal aspirate fluid of neonates with severe respiratory distress syndrome (fraction of inspired oxygen > 0.6, mechanical ventilation) were analyzed between 6 and 36 hours after surfactant replacement therapy. One hundred forty neonates were included in this prospective study. Characteristics, disease severity, and ventilatory requirements were nearly identical in both groups. All patients were treated with natural porcine surfactant (Curosurf) at an age of 2 to 15 hours. In 42 neonates (30%) considerable activities of free elastase were detected (805 micrograms/L; 100 to 1850 [median, 25th to 75th percentile]); in 98 neonates (70%) who had protective levels of alpha 1-proteinase inhibitor, no elastase activity was detected. The average concentrations of elastase-alpha 1-proteinase inhibitor were significantly increased in patients with free elastase activity when compared with those of the nonelastase group. In logistic regression analyses, 28-day outcome data showed a pronounced increase in risk of pulmonary interstitial emphysema for patients with free elastase activity in tracheal aspirate fluid. The incidence of other pulmonary and nonpulmonary complications was very similar in both groups. It is concluded that elastolytic damage and barotrauma may both contribute to acute pulmonary injury in the early stages of respiratory distress syndrome.

Female↗
PubMed1992

Factors influencing morbidity and mortality in infants with severe respiratory distress syndrome treated with single or multiple doses of a natural porcine surfactant.

In an international multicenter trial infants with clinical and radiological signs of severe RDS (age 2-15 h, birthweight 700-2,000 g, mechanical ventilation, FiO2 greater than or equal to 0.6, no complicating disease) were randomized to receive either a single dose (n = 176) or up to three subsequent doses (n = 167) of a natural porcine surfactant (Curosurf). Using a logistic regression model, the effects of therapy, birthweight, sex, hospital and other clinical factors on survival and various outcome parameters were evaluated. Mortality (13 vs. 21%, p less than 0.05) and the incidence of pneumothorax (9 vs. 18%, p less than 0.01) were significantly lower in the multiple-dose group. Low birthweight, hospital allocation, low Apgar score and initial disease severity were associated with an increased mortality. Low birthweight, hypothermia (admission temperature less than 36 degrees C) and acidosis (pH less than 7.25) prior to surfactant treatment could be identified as risk factors for the development of intracranial hemorrhage.

Biological Products↗
PubMed1992

[Percutaneous Silastic catheters in newborn and premature infants. A report of experiences with 497 catheters in 5 years].

BACKGROUND AND METHODS: Central catheters are an important prerequisite for adequate parenteral nutrition in preterm infants. However, a variety of complications have been shown to be associated with central lines: septicemica, thrombotic complications, mechanical complications. In this retrospective analysis we summarize our recent experience with central silastic catheters. RESULTS: Within a five-year-period (1986-1990). 497 silastic-catheters were inserted in 366 high risk neonates (mean birthweight 1360 g; 1060-1740 g, 25.-75. percentile) treated at the NICU, Department of Pediatrics, University of Göttingen. 451 catheters which were placed in a central position, were removed after an average duration of 11 days (mean; 8-18 days, 25.-75. percentile). During the observation period, 62.8 percent of the catheters were purposely removed. Making use of the Kaplan-Meier-curve, we calculated how long the catheter could stay without complications; 50% of all catheters could be expected to be in place for 25 days. The incidence of septicemia was 1.9%, bacterial contamination of the catheters was evident in 22% of all central lines. The most predominant microorganisms responsible for catheter-contamination were coagulase-negative staphylococci. In addition, catheters were removed because of signs of phlebitis or suspected thrombotic complications (11.1%), and mechanical complications (dislocation, occlusion; 11.7%). Due to malposition of the central catheter two preterm infants developed pericardial effusions. There was no correlation between the site where the catheter was inserted and these complications. CONCLUSION: Central silastic catheters wherever clinically indicated are a valuable adjunct in the parenteral nutrition on high risk neonates.

Catheterization, Central Venous↗
PubMed1992

[Candida infections in premature infants weighing less than 1,500 g. Mucocutaneous colonization and incidence of systemic infections].

BACKGROUND: An increasing incidence of systemic candidiasis has been reported in low birth weight infants requiring intensive care. We have retrospectively analyzed mucocutaneous Candida-colonization and infection rate in 422 preterm infants with a birthweight < 1,500 g. METHODS: All infants were treated at the NICU, University of Göttingen, from 1/1985-5/1991. 359 neonates (85%) were on mechanical ventilation, no prophylactic antimycotic regimen was applied. Mucocutaneous swabs and cultures from various anatomic sites were regularly obtained from all infants. RESULTS: 37/422 preterm infants (8.8%) had mucocutaneous colonization with candida, none of our patients developed systemic candidiasis. In 7 mechanically ventilated patients (1.9%) Candida albicans or Candida tropicalis was repeatedly detected in the bronchial secretions; 1 patient who had invasive Candida-pneumonia was effectively treated with 5-Fluocytosin and Fluconazol. 4/352 (1.1%) central silastic catheters were colonized with Candida albicans; none of these patients required specific treatment. CONCLUSION: The low rate of mucocutaneous Candida-colonization and invasive infection found in our patients may be explained--at least in part--by epidemiological and obstetrical factor as well as by the procedures of the neonatal management.

Candidiasis, Chronic Mucocutaneous↗
PubMed1992

Randomized European multicenter trial of surfactant replacement therapy for severe neonatal respiratory distress syndrome: single versus multiple doses of Curosurf.

There is now convincing evidence that the severity of neonatal respiratory distress syndrome can be reduced by surfactant replacement therapy; however, the optimal therapeutic regimen has not been defined. This randomized European multicenter trial was designed to determine whether the beneficial effects of a single large dose of Curosurf (200 mg/kg) in babies with severe respiratory distress syndrome (arterial to alveolar oxygen tension ratio approximately 0.10) could be enhanced by using multiple doses of surfactant. Preterm neonates (birth weight 700 to 2000 g) with severe respiratory distress syndrome requiring artificial ventilation with fraction of inspired oxygen greater than or equal to 0.6 were randomized into two groups at an age of 2 to 15 hours. Both groups received the usual dose of Curosurf (200 mg/kg) immediately after randomization. In neonates randomized to receive multiple-dose treatment, two additional doses of Curosurf (100 mg/kg each) were instilled into the airways (12 and 24 hours after the initial dose) provided that the patients still needed artificial ventilation with fraction of inspired oxygen greater than 0.21. In both groups (single dose: n = 176, multiple doses: n = 167) there was a rapid improvement in oxygenation as reflected by a threefold increase in arterial to alveolar oxygen tension ratio within 5 minutes after surfactant instillation (P less than .001), and peak inspiratory pressure and mean airway pressure could be reduced significantly during the first 6 hours after surfactant treatment. In addition, ventilatory requirement (peak inspiratory pressure, ventilatory efficiency index) was reduced in the multiple-dose group 2 to 4 days after randomization (P less than .05 to .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Biological Products↗
PubMed1990

Early versus late surfactant replacement therapy in severe respiratory distress syndrome.

26 preterm infants with severe respiratory distress syndrome (RDS) have been treated at different ages with a single dose of natural porcine surfactant (Curosurf, 200 mg/kg). Criteria for treatment included clinical and radiological signs of severe RDS (grade III-IV), requirement of artificial ventilation and an FiO2 greater than or equal to 0.6. Nineteen neonates have been subjected to early treatment (2-15 h of age, mean birth weight SD: 1201 +/- 387 g) and 7 patients to late treatment (greater than 15 h to 48 h of age, birth weight SD 1624 +/- 649 g). Average FiO2 before treatment was 0.88 in early-treated patients and 0.8 in late-treated patients, age at treatment was 4.6 h and 36 h, respectively (median). Both early- and late-treated infants exhibited an improvement in oxygenation (more than twofold increase of the PaO2/FiO2 ratio) within 5 minutes after initiation of therapy. Average duration of intermittent pressure ventilation was 15 days in the early treatment group and 19 days in the late treatment group. Total exposition to greater than 21% oxygen was 21 days in early-treated and 48 days in late-treated infants. Pneumothorax occurred in none of the patients. All early treated infants survived without signs of severe bronchopulmonary dysplasia (BPD greater than 21% O2, greater than 90 days plus radiological changes). However, two out of seven late-treated infants developed severe BPD; one patient died as a consequence of cardiopulmonary deterioration. Two patients in the early treatment group died of nonpulmonary complications. We conclude that surfactant replacement therapy should probably be initiated as soon as possible after manifestation of severe RDS.

Birth Weight↗
PubMed1990

[Surfactant substitution in severe respiratory distress syndrome in premature infants weighing less than 1,000 g].

19 preterm infants with severe respiratory distress syndrome (RDS) were treated with a single dose of natural porcine surfactant (Curosurf, 200 mg/kg). 9 patients had a birth weight of less than 1000 g (845 +/- 112 g, mean +/- SD and the mean gestational age was 27.2 +/- 2.1 weeks). The other 10 had a birth weight of greater than 1000 g (1521 +/- 218 g and a mean gestational age 31 +/- 2.8 weeks). Age at treatment was 3 h in infants less than 1000 g and 4 h in patients greater than 1000 g. Both groups of infants showed a rapid improvement in oxygenation and gas exchange within minutes after surfactant replacement. Exposition to greater than 60% and greater than 40% oxygen was identical in both groups. However, time in greater than 21% oxygen was significantly longer in infants less than 1000 g (median 30 days, 8.5 days in patients greater than 1000 g, p less than 0.01). The duration of mechanical ventilation was 33 days, in patients greater than 1000 g and 5 days; p less than 0.01. None of the infants developed a pneumothorax, but 6 out of 9 patients less than 1000 g developed mild bronchopulmonary dysplasia. 2 infants less than 1000 g died at day 5 and day 11 from cardio-circulatory arrest following ligation of a patent ductus arteriosus, and nosocomial septicaemia, respectively. Prolonged mechanical ventilation and exposure to oxygen in patients less than 1000 g cannot be attributed to surfactant deficiency alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1989

[Conservative treatment of non-resorptive hydrocephalus in premature infants].

Following perinatal asphyxia and intracranial hemorrhage frequently progressive ventricular dilatation develops in preterm infants. Most common is communicating hydrocephalus due to obliterative arachnoiditis. Ventricular dilatation is reported to affect normal brain development and early therapy is recommended. Cerebrospinal fluid shunting is still accompanied by multiple complications, esp. in preterm infants with a birth-weight below 1,500 g. Seven preterm infants, born between the 27th and 34th gestational week with a birthweight of 910-1,940 g were medically treated for their progressive communicating hydrocephalus. The therapy consisted of intermittant lumbar punctures, medication of acetazolamide and furosemide as well as electrolyte and base replacement. Therapy was started at the 14th-31st postnatal day and lasted from 46 to 149 days. In all children the ventricular dilatation diminished. A steady state of cerebrospinal fluid production and absorption was regained in four children. Due to reoccurrence of ventricular dilatation shunting was performed in three others at the age of more than 3 months and with a weight of 3,620-5,170 g. Thus, medical therapy of hydrocephalus provides time for development of preterm infants, delay of shunting procedures and normalisation of cerebrospinal fluid dynamics.

Acetazolamide↗
PubMed1988

[Treatment of severe respiratory distress syndrome in the premature infant with natural surfactant].

14 preterm infants with severe respiratory distress syndrome (birthweight 1170 +/- 369 g, mean +/- 1SD) have been treated with a single dose of natural porcine surfactant (Curosurf, 200 mg/kg); follow up and outcome data were compared with matched controls (1200 +/- 288 g, n = 20). Treated infants showed improved oxygenation and gas exchange within minutes after surfactant application. Duration of intermittent positive pressure ventilation was significantly reduced in treated patients when compared to controls (surfactant treated: 16 d (mean value), controls 27 d, p less than 0.05). Similarly, total exposition in greater than 40% oxygen was 5.5 h in treated infants versus 79 h in controls (p less than 0.001). Pneumothorax occurred in 7 of the 20 control infants (35%), but in none of the treated patients (p less than 0.05). However, haemodynamically significant patent ductus arteriosus (PDA) occurred more often in the surfactant group (50% versus 30%, not significant). The incidence of PDA requiring treatment was the same in both groups. Occurrence of intracranial haemorrhage, bronchopulmonary dysplasia and retinopathy of prematurity was identical in both groups. Mortality was 25% in controls and 7% in treated babies. This study confirms the efficacy of surfactant treatment in neonates with severe respiratory distress syndrome.

Birth Weight↗
PubMed1987

The increased echogenicity of the pancreas in infants and children: the white pancreas.

An increased echogenicity of the pancreas ("white pancreas") was sonographically found in 25 children with various pancreatic and systemic diseases. Fifteen patients with cystic fibrosis had a small white pancreas. Five patients with haemosiderosis, two with pancreatitis and one with Shwachman-syndrome presented with a normal-sized or slightly enlarged pancreas. Fatty infiltration and calcifications of the pancreas can also increase its echogenicity.

Acute Disease↗
PubMed1986

[A cross-over study on the effectiveness of ofloxacin and ciprofloxacin administered orally].

Efficacy of Oral Ofloxacin and Ciprofloxacin. Cross-over Study. The efficacy of the 4-quinolones ciprofloxacin (CPX) and ofloxacin (OFX) was studied in a cross-over study. Twenty out-patients with cystic fibrosis and chronic colonization of the respiratory tract with Pseudomonas aeruginosa were treated for ten days with OFX, then another ten days with CPX, and vice versa. Drug concentrations in serum and sputum were assayed. The patients' clinical and laboratory parameters were monitored. The side-effects that appeared did not require interrupting treatment. The serum and sputum concentrations were found to be above the minimal inhibitory concentration. Although P. aeruginosa was not eliminated by the therapy, two-thirds of the patients showed improvement during the infection that could be observed clinically and in laboratory measurements. Oral treatment with OFX and CPX is efficacious.

Administration, Oral↗
PubMed1985

A video analysis of the non-verbal behaviour of depressed patients before and after treatment.

Using videotaped interviews of depressive in-patients, which were recorded on day 0 and day 21 of antidepressive pharmacotherapy, the behavioural structure of the syndromal main aspects, retardation and agitation, was analysed. This analysis was done on the basis of non-verbal behaviour only. A factor analysis was carried out on the observational data. Three independent factors, constituting together the clinical picture of endogenous depression, could be defined: one factor of retardation and two different factors of agitation. The importance of such non-verbal analyses for a more differentiated diagnostic evaluation, on the one hand, and to provide more insight into the diagnostic process as such, on the other, is pointed out. Additionally it was found that syndromal complexity decreases in a characteristic manner along with clinical improvement.

Adult↗
PubMed1982

Extrinsic allergic alveolitis combined with celiac disease in childhood.

A 13-year-old boy suffering from celiac disease (CD) developed shortness of breath at exercise and episodes of malaise, fever and acute dyspnea following contact with pigeons. Lung function testing and chest X-ray suggested interstitial lung disease. Serum precipitins and a combined systemic and pulmonary reaction 4 h after challenge with an extract of pigeon droppings confirmed bird-fancier's lung. This case exhibits two points of interest. Extrinsic allergic alveolitis was found in childhood in combination with CD and it may be considered that both these diseases are based on one common immunologic disorder; HLA-typing of the boy's family showed that he carried HLA-DR 3 in a double dose and was therefore homozygous for HLA-DR 3. This is of some interest because extrinsic allergic alveolitis and CD are both associated with HLA-DR 3.

Adolescent↗
PubMed1979

Video-analytic study of manual kinesics and its lateralization in the course of treatment of depressive syndromes.

Video-taped interviews of 47, predominantly endogenous depressive in-patients, recorded on days 0 and 21 of pharmacotherapy were analysed with respect to frequency, duration and side-preference of defined hand movements. The data were related to clinical improvement or deterioration as assessed by judgement of the syndromal aspects: retardation and agitation. 1. Above all, improvement is marked by a decrease of Continuous body-focused movements (C) and an increase of Object-focused movements (O) of the speech primacy type (OS)-deterioration by an increase of C and decrease of OS. 2. The degree of retardation corresponds to O, the degree of agitation, above all to C. 3. O show no side-preference with a higher degree of retardation or agitation respectively, but a marked right perference with a lower degree of retardation or agitation, Discrete body touching (D) shows a left preference only, with a higher degree of retardation. A comparison of sidedness of O between interviews 1 and 2 shows no lateralization trend, either in the improvement or the deterioration group. In contrast, D changed from left weightiness to symmetry, coinciding with improvement but not with deterioration, With reference to the latter findings we discuss the possibility of a particular mode of cerebral lateralization predisposing to endogenous depression.

Amitriptyline↗
PubMed1977

[Management of second stage of labour: observations, reflections, advices (author's transl)].

All vaginal deliveries of the Department of Obstetrics and Gynecology of the University Basel (N = 4081) during the year 74/73 and of the University Tübingen (N = 3249) 75/74 were analysed using an IBM-system 370/135 Only alive singletons beyond the 28th week of gestation were analysed. Clinical management was quite different in the two departments; the incidence of vaginal operations (Basal 11.2%, Tübingen 12.6%), however, as well as the distribution of pH-values and Apgar-scores after 1 min were quite similar. Basel: Acidotic risk (i.e. pHUA less than 7.200) 13.5%, severe acidotic risk (i.e. pHUA less than 7.100) 1.55%, low Apgar-scores (1--3) 0.7%. Tübingen: :12.3%, 2.11%, 1.6%. 3.5% of all parturients (Basel) had duration of second stage of labour with active maternal pressure support lasting more than 30 min. In two highly selected samples differing only with regard to the occurrence of cord-entanglements at birth (N1 = 1755, N2 = 1098) the association (rank correlation method according to Kendall) between the parameters of the fetal acid-base balance and the duration of second stage of labour as well as duration of the period with "active bearing down" was studied. Without cord encirclements pH in the umbilical artery fall --0.087 and in the umbilical vein --0.115 units and with cord complications the values amounted to --0.062 (UA) and --0.120 (UV) respectively pro 60 min duration of second stage with "bearing down efforts". Analogous computations for pCO2, pO2 and HbO2 are presented. Apgar-scores in these samples showed a very loose connection with the time variables. From these data the conclusion is drawn that the indication to perform vaginal operations for termination of delivery should not primarily be governed by the factor time but rather by the whole obstetrical situation i.e. the possible fetal risk of the intervention. This holds only if maternal welfare is established and fetal well being is monitored continuously.

Acidosis↗