[Successful treatment of a brain abscess with antibiotics and drainage puncture in an 11-year-old boy with a complex cyanotic heart defect]

A Blalock-Taussig-anastomosis was performed at the age of 2 years in a boy with transposition of the great arteries, ventricular septal defect, and pulmonary atresia. Nine years later he developed a transient aphasia. Cranial computed tomography (CT-scan) revealed a structure compatible with brain abscess. The boy was conscious and no neurological deficit was found. Initial therapy consisted of Ampicillin, Tobramycin, and Metronidazole, 12 days later an acute hemiplegia developed. 30 ml of pus were aspirated from the brain abscess, and the boy's condition dramatically improved. Streptococcus milleri was found bacteriologically and antibiotic therapy was continued over six weeks. Serial CT-scans during and after therapy demonstrated disappearance of the brain abscess. The presented case shows that after a shunt procedure in cyanotic heart disease right-to-left-shunting and therefore chronic oxygen desaturation and polycythemia are still present as facilitating factors for focal encephalomalacia, cerebritis, and brain abscess. In case of short duration of neurological symptoms and a size of abscess less than 4 cm in diameter antibiotic therapy without total excision may eliminate the infection.

[Cavernous hemangioma and disseminated intravascular coagulation (Kasabach-Merritt syndrome) in a newborn infant with a large ventricular septal defect]

In a 3170 g newborn with a large cavernous hemangioma at the left thigh, heart failure was evident. Echo- and angiographically a large perimembranous ventricular septal defect was found. An important a-v shunt within the hemangioma could be excluded by hemodynamic investigation and selective arteriographic examination of the vascular tumor. Thrombocytopenia present from the first day of life was only temporarily overcome by corticosteroid therapy but nevertheless consumption coagulopathy (Kasabach-Merritt-Syndrome) developed and additional therapy with heparin was necessary in order to normalize the coagulation factors. However, no regression in size of the tumor occurred over the first 8 weeks of life and a total exstirpation of the hemangioma was performed. Postoperatively no further cortison or heparin therapy was necessary. Despite vigorous medical treatment the congestive heart failure persisted. After surgical closure of the ventricular septal defect at the age of three months the infant thrived and could be discharged without pathological symptoms.

The relationship between anaerobic performance and muscle metabolic capacity and fibre distribution

Relationships between functional anaerobic indicators and the character of cellular muscle energy metabolism were studied. Twelve untrained male students were tested by a specific anaerobic test on the treadmill. The mean values of the anaerobic test were as follows: blood lactate 10.69 mmol . 1(-1), running speed 16.08 km . h-1 and duration 92.67 s. The average distribution of muscle fibres (m. vastus lateralis) was: type I 52.2%, type II A 29.0% and type II B 18.8%. The mean enzyme activity values were: triosephosphate dehydrogenase (TPDH) 4.67 mu kat . g-1 w.w., lactate dehydrogenase (LDH) 5.76 mu kat . g-1 w.w, citrate synthase (CS) 0.21 mu kat . g-1 w.w. and hydroxyacyl-CoA dehydrogenase (HAD) 0.12 mu kat . g-1 w.w. Significant negative correlations were found between delta LA and CS (r = 0.64) and % of fibre type II B and CS (r = 0.78) and positive correlations between % of fibre type I and CS and/or HAD (r = 0.60 and r = 0.62, respectively).

Lung function in children and adolescents with idiopathic interstitial pulmonary fibrosis

Lung function of 65 patients who had idiopathic interstitial pulmonary fibrosis (IIPF) that had been treated with prednisone was evaluated by tests of ventilatory function, lung mechanics, and gas exchange at rest and during exercise. Ages on initial investigation ranged from 5 to 20 years. In 35 of 65 patients the studies were repeated an average of four times over a period of 1 to 9 years. Results of the first testing were as follows: vital capacity (VC)-significantly reduced in all patients; inspiratory capacity (IC)-significantly reduced in all patients; total lung capacity (TLC)-reduced in 91%; functional residual capacity (FRC)-reduced in 31%; residual volume (RV)-reduced in 6%; elastic recoil of the lungs (Pstl)-significantly increased in 97% at 100% TLC, significantly increased in 52% at 90% TLC, reduced in 68% at 60% TLC; 7) static compliance (Cst)-reduced in 83%; 8) dynamic compliance (Cdyn)-reduced in 88%; 9) specific airway conductance at FRC level (Gaw/TGVex)-significantly increased in 50%; 10) maximum expiratory flow rates at 60% TLC (Vmax 60% TLC, in TLC/s)-significantly reduced in 33%; 11) upstream airway conductance (Gus 60% TLC, in TLC/s/cm H2O)-reduced in 32%; 12) diffusing capacity of the lungs for carbon monoxide (DLco) related to body-surface area-abnormal in 58% (when corrected for lung size, i.e., DLco/TLC, abnormal in only 8%); 13) PaO2 at rest and after 6 minutes submaximal exercise-reduced in 25% and 63%, respectively. Changes in lung function that occurred with growth were assessed in terms of percentages of predicted values. Results showed that the VC and IC remained significantly reduced. An actual reduction of TLC, FRC, RV, breathing frequency, DLCO, and Pstl at 100% and 90% TLC was observed. Increases were seen in Pstl at 60% TLC, Gaw/TGVex, Vmax, and Cst. Indices of lung elasticity suggested that regions of fibrosis and emphysema had become present. Smaller patients were also noted to have stiffer lungs.

The retailing of health care

A number of striking parallels between recent developments in health care marketing and changes in the retailing industry exist. The authors have compared retailing paradigms to the area on health care marketing so strategists in hospitals and other health care institutions can gain insight from these parallels. Many of the same economic, demographic, technological and lifestyle forces may be at work in both the health care and retail markets. While the services or products offered in health care are radically different from those of conventional retail markets, the manner in which the products and services are positioned, priced or distributed is surprisingly similar.

Corpus cardiacum stimulated trehalose efflux from cockroach (Periplaneta americana) fat body: control by calcium

Cockroach fat body incubated in a simple physiological saline solution releases trehalose to the surrounding medium. The output of trehalose occurs in the absence of ambient Ca2+ and decreases slowly with time. In two separate experiments, 0.1 mM CaCl2 added to the saline increased the output of trehalose on average by 70% but higher concentrations of Ca2+ did not further increase the efflux of trehalose. Stimulation of trehalose efflux by corpus cardiacum extract is absolutely dependent on extracellular Ca2+, no increase occurring beyond the basal level in the absence of the ion. The activity of corpus cardiacum extract increases as the concentration of CaCl2 is increased to 0.5 mM. This concentration of Ca2+ in the saline permits the extract to increase trehalose efflux by as much as 60% above the basal level. Corpus cardiacum extract, as well as the hypertrehalocaemic agents cyclic AMP and theophylline, increase significantly the influx of Ca2+ into fat body in vitro. The basal efflux of trehalose from fat body and that stimulated by corpus cardiacum extract is not dependent on extracellular Mg2+.

Phase 1 tolerability and antiamoebic activity studies with 1-methylsulphonyl-3-(1-methyl-5-nitro-2-imidazolyl)-2-imidazolidinone (Go.10213): a new antiprotozoal agent

Go.10213, a new nitroimidazole, was studied in 12 male volunteers for tolerability and in 20 patients with intestinal amoebiasis for antiamoebic activity. Go.10213 was well-tolerated by volunteers up to a dose of 400 mg X 3. Patients also tolerated well the dose of 100-150 mg X 3 for 7 days. In two patients, there were mild and transient side-effects like headache, dizziness, fatigue, etc. No neurological side-effects were observed. There were no significant changes in blood pressure, pulse rate and ECG. The organ function tests did not show any adverse effects of Go.10213 on bone-marrow, kidney, liver, etc. Go.10213, at a dose of 150 mg X 3, showed potent antiamoebic activity in 10 patients with intestinal amoebiasis, as judged by the clinical relief, the eradication of the trophozoites and cysts of Entamoeba histolytica from stools and the healing of colonic ulcers. Go.10213, a novel nitroimidazole, may prove to be the most potent and safe agent against the protozoal infections, e.g. amoebiasis, giardiasis and trichomoniasis.

Drug surveillance programme in psychiatry - adverse durg reactions

In a clinically monitored surveillance of adverse drug reactions in a sample of 186 indoor patients in a general hospital over an average hospital stay of about two weeks, the following points were noteworthy. 32.8% of the patients reported side-effects and of these 79.3% were of mild to moderate intensity.Side-effects could be easily managed by specific antidotes and reassurance and permitted continuation of the same medication.There was no association between side-effects and socio-demography or clinical characteristics of the patient. Side-effects fitted in with the pharmacological profiles of the drugs used. In only 7.3% of cases was major treatment change made after the occurrence of the side effect. Improvement was independent of side-effects and no unusual or toxic reactions were seen.

Temporary depression of lactase activity by thyroxine in suckling rats

The present study was performed in order to clarify controversies concerning the effect of thyroxine on lactase activity in young mammals. Lactase activity was determined in suckling rats with two reference systems (protein and DNA) after one and three thyroxine injections (0.2 mg/100 g body weight). In comparison with control animals lactase activity was decreased after thyroxine administration. The thyroxine effect was dosage-dependent: three injections caused a more profound and prolonged depression of lactase activity. In both thyroxine-treated groups lactase activity returned to age-specific normal levels before the low lactase activity of adult rats was attained. The transient thyroxine-induced changes of lactase activity were similar to the reference parameters protein and DNA.

Upstream and total airway conductance in children and adolescents

Static lung volumes, pressure-volume curves, airway conductance (Gaw) and maximum expiratory flow-volume curves were obtained in a group of healthy children and adolescents (age 6 to 17 years, body height 115 to 180 cm). Relating lung recoil pressure to maximum expiratory flow at the same lung volume level allowed the calculation of the conductance of the upstream segment (Gus). Gaw increased with increased body height and lung volume, so that specific Gaw did not change during growth. Gus also increased with body height, except at lower lung volume, but when corrected for simultaneous changes in lung volume it decreased. These physiological results suggest that the central airways grow proportionately to the changes in lung volume, whereas the growth of the peripheral airways is proportionately less marked. It is however not possible to draw definite conclusions on the isotropical or anisotropical growth of different parts of the lungs from these physiological observations.

Plasma levels of trimethoprim and sulfonamide after administration of trimethoprim-sulfamethoxazole and trimethoprim-sulfamoxole

In a cross-over study with ten healthy volunteers, the plasma levels of trimethoprim (TMP) and sulfonamides were compared using orally given trimethoprim-sulfamethoxazole (TMP-SMX: Septra) and trimethoprim-sulfamoxole (TMP-SMO: Supristol) in recommended doses. The dosage schedule for TMP-SMX was 2 tablets every 12 h for nine doses, and for TMP-SMO it was 2 tablets as in the first dose, followed by 1 tablet every 12 h for eight more doses. Serial plasma levels of TMP and sulfonamides after the first dose of each of the two products showed no significant differences. However, after the ninth dose of each product, the paired t test revealed significantly higher levels of TMP and sulfonamides after TMP-SMX as compared with TMP-SMO.

Measurement of antipyretic activity of ibuprofen and paracetamol in children

The antipyretic activity of ibuprofen (Brufen) and paracetamol (Crocin) was compared in 22 children with pyrexia who received either ibuprofen or paracetamol in syrup form. Both axillary and rectal temperatures were recorded prior to drug administration and 1/2, 1, 2, 3, 4, 5, 6, 8, and 12 hours after dosing. Analysis of the results in terms of rate of temperature decrease and degree and duration of decrease in temperature indicated that both drugs produced significant reduction in temperature and in the rate of temperature decrease. The maximum effect of the two drugs was similar. However, ibuprofen was more effective than paracetamol at 6 and 8 hours after administration, and its duration of action was longer. The associated antipyretic and antiinflammatory features of ibuprofen could provide an advantage in the control of exudative forms of upper respiratory tract infections.

Comparative effects of imipramine and dothiepin on salivary rate in normal volunteers

1 Imipramine induced significant reduction in salivary rate compared to placebo in a cross-over, double-blind study of twelve normal volunteers. In contrast, there was no significant difference between the reduction in salivary rate induced by dothiepin and placebo. 2 Comparison of salivary rates showed no significant difference between the drugs in the initial and cross-over treatment periods. However, pooled observations from the initial and cross-over treatment periods indicated that imipramine produced a significantly greater reduction in salivary rate than dothiepin. 3 The results suggest that dothiepin would cause far less dryness of mouth compared to imipramine. This feature might ensure greater therapeutic compliance.

Phenylalanine depletion for the management of phenylketonuria: use of enzyme reactors with immobilized enzymes

Multitubular enzyme reactors with immobilized phenylalanine ammonia lyase were tested in vitro and in vivo for depletion of phenylalanine in circulating blood. Sustained reduction of phenylalanine was achieved in less than 30 minutes. A 50% decrease of phenylalanine was obtained with a 2-hour application of enzyme reactors and was maintained for more than 2 days. Similar enzyme reactors have therapeutic potential for temporary management of phenylketonuric patients when their circulating phenylalanine becomes exceedingly high because of infection, fever, or pregnancy.

[Significance of contemporary methods of lung function testing for the detection of airway obstruction in children and adolescents (author's transl)]

In the article we outlined the basic principles of some recent methods of lung function testing, suitable for the assessment of airway obstruction in children and adolescents. There is also a brief description of various methods, normal values expressed in a form of regression equations, significance of different methods for the assessment of airway obstruction in patients with respiratory diseases and in children from a region with increased levels of air pollution. Among the various functional indices we found the most sensitive for the assessment of airway obstruction maximum expiratory flow rates measured at lower lung volume levels. Airway conductance appeared as the most sensitive method for the evaluation of bronchodilation following inhalation of some drugs. The measurements of airway conductance in a body plethysmography during normal quiet breathing and of maximum expiratory flow rates from flow-volume curves represent the basic methods for the detection of airway obstruction, i.e. in the larger central airways, and in the peripheral airways respectively.

Phase 1 tolerability and searching dose studies with 4-isothiocyanato-4'-nitrodiphenylamine (C.9333-Go/CGP 4540), a new anthelmintic

1 Phase 1 and 2 studies were carried out in thirteen volunteers and thirty patients with hookworm anaemia with a new anthelmintic, 4-isothiocyanato-4'-nitrodiphenylamine (C.9333-Go/CGP 4540). Single and multiple doses were administered by mouth under careful supervision by the staff of the clinical pharmacology unit. 2 4-Isothiocyanato-4'-nitrodiphenylamine (C.9333-Go/CGP 4540) was well tolerated in volunteers up to a single dose of 1750 mg and in patients up to 3000 mg in divided doses. Side effects were rare, transient and mild. One patient had moderate giddiness for 24 h after the compound. The laboratory investigations did not show any adverse effects on organ functions. Transient non-specific changes in the T-wave were occasionally observed in the e.c.g. 3 Multiple doses (125 mg, 250 mg or 1000 mg X 3) of the compound were highly effective in eradicating hookworm infection, as judged by almost 100% reduction in faecal egg counts and significant recovery of parasites from 24 h stool samples. The compound also showed activity against A. lumbricoides, T. trichiura and E. vermicularis. The compound appears to be promising and more studies, in a field situation, are desirable.

Pulmonary elasticity in children and adolescents

Static (Cst(L)), dynamic (Cdyn(L)), and "specific lung compliance (CL/TLC, CL/FRC) and the elastic recoil pressure of the lungs (Pst/(L)) were measured in 131 healthy children and the adolescents (age 6 to 17 years) from simultaneous recordings of esophageal pressure and lung volume. Esophageal elastance and vertical esophageal pressure gradients were also studied. Pst(L), measured at different lung volumes (fractional) from the expiratory quasi-static pressure-volume (PV) curves of the lungs, increased significantly with increasing body height, age, and body surface. Cst(L), determined from the midportion of PV curves, and Cdyn(L) measured during normal breathing at frequencies around 20/min also increased significantly with somatic growth. "Specific" Cst(L) decreased with increasing body height, age, and body surface. "Specific" Cdyn(L), esophageal elastance, and the vertical esophageal pressure gradient were independent of body height, age, and body surface, Cdyn(L) was less than Cst(L) mainly in smaller and younger children, and was not considered a valid index of pulmonary elasticity. Values of Pst(L), "specific" Cst(L), and the change of slope of the midportion of PV curves in children and adolescents suggested developmental changes of pulmonary elasticity in man over the age range studied.