Biomedical subjects
Publications and source records attributed to M Schiller.
Nonidentical twins with ectopic ureteroceles, and duplication of the urinary collecting system in two more members of the same family are described. This incidence may indicate that inborn anomalies of the urinary tract may have a genetic background.
Acquired eventration of the diaphragm is caused by injury to the phrenic nerve with resultant paralysis and elevation of the entire diaphragm. In this reported case, damage to the phrenic nerve was caused by an intercostal drain. This has not been previously reported.
Clinical signs of central vein thrombosis as a complication of internal jugular vein cannulation are rarely seen. Two infants who developed thrombosis of the superior vena cava and one adult who developed thrombosis of the left brachiocephalic vein are presented.
Seventy insomniac patients, previously unresponsive to conventional hypnotic dosage, were treated for seven nights with temazepam in 20 mg soft gelatin capsules (Euhypnos Forte). The patients adjusted the dose to suit themselves up to a maximum of 60 mg. Nineteen patients found that one 20 mg capsule suited them best in spite of previous lack of response to two 10 mg capsules, and were thus excluded from the final analysis. Out of the remaining fifty-one patients, thirty-five were best suited by 40 mg and sixteen by 60 mg of temazepam. Sleep was rated Very Good or Good by forty patients (78.4%) and significant hangover occurred in only four (7.8%), all of whom were on 40 mg. Adverse reactions were insignificant. Some observations by one author (CALM) on the significance of the results in the management of insomnia in general practice are included.
A technique for percutaneous catheterization of the internal jugular vein in infants and children was used since January 1975 in 206 patients ranging in age from a few hours to 12 years old. The series included 31 premature infants weighing less than 2,500 grams and 107 babies weighing less than 4,000 grams. Five attempts at cannulation failed. Each catheterization procedure required an average of 1.8 needle insertions before the vein was entered. In 129 patients, the first attempt was successful. Sixteen complications related to the procedure occurred early in our experience, seven of which were life threatening. One death was directly ascribed to the actual insertion of the catheter and mediastinal extravasation of infusion material. Most of the early complications probably could have been injected through the catheter immediately after cannulation, in addition to aspirating the blood and lowering the infusion bottle. The 22 late complications were related to infection; one infant died because of catheter sepsis. To minimize septic complications, an arbitrary limit of seven days was set, after which the catheter was replaced. Cannulation of the internal jugular vein in infants and children should be regarded as a serious surgical procedure to be performed by a trained team and only when properly indicated.
Acute appendicitis with perforation in a premature baby, weighing 1 050 g, is described. Initially the infant did well after surgery, but succumbed to sepsis, as a result of hyperalimentation, eleven days later. This is the smallest infant suffering from appendicitis reported in the English literature.
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Serious disturbances in respiration and venous return developed in 2 infants in whom infusion into a central vein was controlled by a peristalic pump. The effects were the result of extravasation which led to build-up of pressure in the medistinum.
11 beta-Hydroxydehydroepiandrosterone has been isolated from the urine of a 14-yr-old girl with a virilizing adrenal adenoma. Its excretion was estimated to be 0.4 mg/24 h by gas chromatography and the compound was further identified by mass spectrometry. When [7-3H]dehydroepiandrosterone was incubated with mitochondria prepared from the adenoma, approximately 10% was converted to 11 beta-hydroxydehydroepiandrosterone. The identity of the radioactive 11 beta-hydroxydehydroepiandrosterone was verified by reversed isotopic dilution, its conversion to 11 beta-hydroxyandrostenedione, and its mobility in several chromatographic systems. This is the first demonstration of an 11 beta-hydroxylase from a human source having an affinity for dehydroepiandrosterone.
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Analysis of fifty-two instances of intussusception proved the importance of barium enema examinations as a diagnostic and therapeutic modality. Hypertrophy of the lymphatic tissue in the terminal ileum reactive to common diseases of infancy and childhood is of utmost importance in the etiology of "idiopathic intussusception."
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