Biomedical subjects
Publications and source records attributed to L Hohenauer.
Pediatric patients are often affected by malformation and genetic illness. Among 316 consecutive cases of genetic counseling chromosomal disorders amounted to one third of the problems and 10% of the cases were neural tube defects. Drugs in pregnancy and intrauterine infections contributed to another 10%. Genetic counseling represents a small but important part of a comprehensive medical care.
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During a period of 31 months ending February 1982 all bacterial pathogenes recovered from patients of our Newborn intensive care unit were registered. A total of 834 were isolated, 42% were cultured from the surface of the patient, 50% were cultured from secretions, tubes or catheters and 8% were isolations from blood, liquor or urine, thus proving septic infection. Staphylococcus albus, E. coli and Pseudomonas aeruginosa were most often found. The pattern of other pathogenes was very variable. High frequency of isolations of one specific germ was always followed by a remarkable infectious morbidity caused by this agent. Nosocomial infections were recognized easily by this program. Hospital hygiene could be altered appropriately according to the bacteria isolated. Antibiotic strategy was adapted to the antibiotic in vitro sensibility of the prevalent bacteria. Aminoglycosides and above all gentamycin were most effective.
Two prospective studies compare the dietary treatment of acute diarrhoea (gastroenteritis in infancy with either partially adapted formula or with special formula (HN 25) with a low lactose content (1.8%), or virtually free of lactose (0.05%), including only infants with acute diarrhoea, a loss in weight not exceeding 8%, and without parenteral fluid intake. There is no difference in the duration of hospitalization. However, the time until normalization of the stools was significantly shorter when lactose-reduced formula or formula virtually free of lactose was fed (4.4 resp. 3.1 vs. 5.1 days). There were 9 relapses in the control group fed partially adapted formula, and none in the trial group fed special formula. The present results show that in mild and moderate diarrhoea a dietary treatment with lactose-reduced formula should be preferred to a treatment with infant formula.
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47 cases of Pneumothorax (P) were encountered among 3679 consecutive patients of the neonatology unit of the Landes Kinderkrankenhaus Linz (= 1.3%). Of these 47 cases 38 occurred in artificially ventilated patients this amounts to 11.7% of all 325 ventilated newborn babies during the study period. Only 9 Pneumothoraces (= 0.24%) occurred spontaneously. Pneumothoraces in non ventilated patients were confined to the first few hours of life while the risk of pneumothorax is equally spread over the ventilation period in babies on respirators. Pneumothoraces which occurred in ventilated babies showed always tension signs while only 2 of the 9 spontaneously occurring pneumothoraces showed increased tensions. Transillumination of thorax was extremely helpful as bedside test for diagnosis.
The Oro-mandibular-limb-hypogenesis-syndrome is a combination of rare malformations. The etiology is unknown. Early reconstruction of the mouth and orthopedical care are described. The psychological management of the parents and the early contact between mother and child are important.
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Basis knowledge of genetics is necessary for the pediatrician, but he also must be experienced in talking with grieving parents. Grief reactions should be facilitated and by this help to the parents the best basis for future genetic counselling is established. The clinical diagnosis is a prerequisite for genetic counselling. Parents seeking help must be prepared to find their own decision. If the counsellor makes typical mistakes he provokes more disappointment than relief. If he succeeds his help can preserve or encourage future lives.
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Raw milk expressed from the infant's own mother is the ideal initial nutrient, even for premature babies with a birth weight of below 1500 g. When these babies start to grow very rapidly from about the third week of life on, this milk is probably nutritionally inadequate. For babies with birth weights above 1500 g raw milk provided by the natural mother is the ideal nutrient at all times. This is a report of a simple and inexpensive system which enables us to collect breast milk and to test the bacterial count of each sample of milk. This milk is given to the babies without any heat treatment if the bacterial count is 10(3) per ml or less. Milk displaying bacterial counts of 10(4) to 10(5) per ml is boiled. Milk with higher bacterial counts is thrown away. Intensive counselling of the mothers as regards personal hygiene, with particular emphasis on breast hygiene and pumping technique improves the quality of the milk. In fact, 43% of the milk samples delivered to us have bacterial counts of below 10(4) per ml.
In a newborn boy with hydrocephalus the computed tomography (CT) demonstrates hypoplastic hemispheres of the cerebellum, the inferior part of the vermis is lacking and the enlarged cisterna magna is directly communicating with the fourth ventricle. The ventricles 1--3 are markedly enlarged. Only the additional studies after the application of Metrizamide intrathecally could demonstrate the direct communication of the spinal CSF system with the fourth ventricle, determining the diagnosis: Dandy-Walker-Variant. The computed tomography-cisternography (CTC) is an important additional investigation with only minimal risks to the patient.
The classication of a newborn baby according to gestational and intrauterine growth is important for correct diagnosis of fetal disease or impending dangerous situations. Besides the known gestational age the valid intrauterine growth curve is a prerequisite for this classification. New intrauterine growth curves derived from newborns in the four German speaking countries are presented and their general use is encouraged.
By good perinatal care the perinatal mortality rate can be brought down to 10 promille. A great number of high risk newborns will survive. The developmental prognosis of these at risk babies has strikingly improved. Among these babies the rate of neuromotor defects has been reduced by about 50%. Babies with birth weights of less than 1501 g will develop spastic diplegia in less than 5% and more than 80% of the babies with birth weights of less than 1001 g and the babies after artificial ventilation will develop normally.