Mid-Term Outcome after Extracorporeal Life Support in Postcardiotomy Cardiogenic Shock: Recovery and Quality of Life

Background: Extracorporeal life support (ECLS) therapy for refractory postcardiotomy cardiogenic shock (rPCS) is associated with high early mortality rates. This study aimed to identify negative predictors of mid-term survival and to assess health-related quality of life (HRQoL) and recovery of the survivors. Methods: Between 2017 and 2020, 142 consecutive patients received ECLS therapy following cardiac surgery. The median age was 66.0 [57.0-73.0] years, 67.6% were male and the median EuroSCORE II was 10.5% [4.2-21.3]. In 48 patients, HRQoL was examined using the 36-Item Short Form Survey (SF-36) and the modified Rankin-Scale (mRS) at a median follow-up time of 2.2 [1.9-3.2] years. Results: Estimated survival rates at 3, 12, 24 and 36 months were 47%, 46%, 43% and 43% (SE: 4%). Multivariable Cox Proportional Hazard regression analysis revealed preoperative EuroSCORE II (p = 0.013), impaired renal function (p = 0.010), cardiopulmonary bypass duration (p = 0.015) and pre-ECLS lactate levels (p = 0.004) as independent predictors of mid-term mortality. At the time of follow-up, 83.3% of the survivors were free of moderate to severe disability (mRS < 3). SF-36 analysis showed a physical component summary of 45.5 ± 10.2 and a mental component summary of 50.6 ± 12.5. Conclusions: Considering the disease to be treated, ECLS for rPCS is associated with acceptable mid-term survival, health-related quality of life and functional status. Preoperative EuroSCORE II, impaired renal function, cardiopulmonary bypass duration and lactate levels prior to ECLS implantation were identified as negative predictors and should be included in the decision-making process.

Respiratory infections in children: when is brodimoprim indicated?

Respiratory infections are the most common infection in children. They differ remarkably according to age, bacteria and viruses. Therefore a careful history of outbreak, age, former infections, involvement of surroundings, symptoms, etc are essential. The present study included 50 children, aged between 0.3 and 12 yrs, all treated ambulatorily. 21 received brodimoprim (B) and 29 erythromycin (E). Indications were: tonsillitis, bronchitis, otitis media, sinusitis and scarlet fever. Dosages were: B was given 10 mg/kg body weight (b.w.) initially followed by 5 mg/kg b.w., once-a-day. The duration of treatment varied between 4 and 14 days (mean 8.3 days). E was given 30.50 mg/kg b.w. 3 times per day; duration 4 to 14 days (mean 8.6 days). Overall results were: in group B:12 cures, 5 improvements, 3 failures; 1 not assessable. In group E: 20 cures, 8 improvements, 1 failure. Side effects: in group B: vomiting (1), skin reaction (2), discontinuation (2); in group E: skin reaction (1), diarrhea (5), diarrhea+vomiting (1); discontinuation (2). The differences in efficacy and tolerability in the two groups are not statistically significant. The improved compliance with a single versus t.i.d. dosages has to be taken into account.

Halobetasol propionate cream by day and halobetasol propionate ointment at night for the treatment of pediatric patients with chronic, localized plaque psoriasis and atopic dermatitis

In a multicenter, 14-day pediatric study in 81 evaluable patients with severe, localized corticosteroid-susceptible dermatoses, the combined treatment with halobetasol propionate cream once during the day and halobetasol propionate ointment once at night produced a very satisfactory therapeutic effect. The success rates, as indicated by ratings of "healed" and "marked improvement," were 100% and 90.9% in patients with atopic dermatitis and psoriasis vulgaris, respectively. Healing was reported in 86.8% and 72.7% of patients treated for atopic dermatitis and psoriasis, respectively. Both the cream and ointment preparations were well tolerated. Adverse effects at the site of application were reported in only 3 of 81 patients. Mild skin atrophy was observed in one patient. No systemic adverse effects were observed.

Prevalence of coeliac disease in diabetic children and adolescents. A multicentre study

Screening for coeliac disease (CD) with serum antigliadin antibodies (AGA) was performed in 1032 diabetic children and adolescents. In 8 children CD had been diagnosed before study entry. Of the remaining 1024 children, 33 had an elevated AGA titre in the first serum sample. On follow-up an elevated AGA titre was confirmed in only 17 of 31 patients. Nine of the repeatedly positive patients underwent jejunal biopsy, and CD was diagnosed in two asymptomatic patients; both were positive for IgG- and IgA-AGA. Among 10 AGA-positive patients in whom biopsies could not be performed, only 1 showed IgA-AGA and thus carried a high risk for CD. From our results we estimate a prevalence of CD in Swiss and German diabetic children between 1.1% and 1.3%. False-positive AGA titres occurred significantly more often in patients with diabetes duration of less than 1 year. AGA testing reached a specificity of 99% if performed at least 1 year after the onset of diabetes. Children suffering from both diabetes and CD showed a diabetes manifestation at a significantly younger age than non-coeliac patients, whereas CD tended to be diagnosed at a remarkably late age.

Comparison of human and porcine insulin therapies in children with newly diagnosed diabetes mellitus

A multicenter, longitudinal study of children below the age of 16 years with newly diagnosed Type 1 (insulin-dependent) diabetes treated either with porcine monocomponent insulin (n = 26) or semisynthetic human monocomponent insulin (n = 26) was performed during the first 24 months after onset of diabetes. The two groups were carefully matched for age, duration of disease symptoms, initial metabolic values, islet cell antibodies and HLA-DR antigens. During the 24-month observation period there was no significant difference between the two groups in respect to the clinical course, insulin dosage, HbA1 and residual B-cell activity. No child in either group had a real remission without necessitating insulin therapy. The prevalence of insulin antibodies increased slowly and was 62% in the group treated by human insulin and 52% in the porcine insulin-treated group after 24 months. The titres were generally low and there was no statistical difference between the two groups in respect to insulin antibody formation.

HLA-DR 3 is associated with a more slowly progressive form of type 1 (insulin-dependent) diabetes

The presence of HLA-DR 3 was analysed in 745 patients with Type 1 (insulin-dependent) diabetes with age at diagnosis between 1-19 years. HLA-DR 3 and/or 4 was found in 678/745 (91%) of the patients. Presence of DR2 with neither DR 3 nor 4 was demonstrated in 15 patients. Patients with HLA-DR 3 without DR 4 presented with Type 1 diabetes more evenly over the year; they also presented without incidence peaks at 7 years or 10-11 years, as seen especially in DR 3/4 patients. The DR 3 patients more often had mild disease with less ketonuria at diagnosis, less often ketoacidotic symptoms and more often a subsequent partial remission. The apparently more severe disease among diabetic girls may, at least to some extent, be explained by their higher prevalence of HLA-DR 4. The differences found were similar in North America and Europe. The results suggest that Type 1 diabetes is a genetically heterogeneous disease and that HLA-typing may be a useful marker of this heterogeneity.

A study to ascertain whether hydrocortisone 17-butyrate (Locoid) 0.1% cream has any effect on the hypothalamic-pituitary-adrenal axis in children with skin diseases

A study was conducted in eight children requiring topical corticosteroid treatment for dermatological disorders. The trial was carried out with hydrocortisone 17-butyrate (Locoid) 0.1% cream. The children were treated twice daily with Locoid cream applied to areas involving at least 20% of the body surface for a period of 2 to 3 weeks. Statistical analysis did not reveal any significant changes in plasma cortisol levels after treatment compared to pre-treatment baseline levels. No side-effects were reported.

[Dysostotic changes and the prognosis of Perthes' disease after operation (author's transl)]

Goff and Mau for the first time demonstrated dysostotic changes in children with Perthes' disease. Their effect on the course of the disease has not so far been determined. It was examined on 41 patients following varus-osteotomy. Follow-up after 2--6 years showed late radiologic results, measured against the total quotient (Heyman and Herndon) depended essentially on this dysostotic component. The worst results are seen in children with high-grade skeletal retardation. Final results are further influenced by age, stage of the disease at the time of surgery and pre-operative status. Age plays a part in that results are better the younger the child. There are obvious parallels between results of radiologic and histologic examination at the time of operation and the weightbearing capacity. Dysostotic changes prolong the course of Perthers's disease and cause long-term lack of firmness of the femoral head. The influence of these facts on the still controversial indication for surgery is discussed. Our findings suggest that protection against weightbearing should be prolonged after operation according to the dysostotic changes.

Sinusitis in paediatrics

The authors discuss the problem of the diagnosis of sinusitis in children from the viewpoint of the practising paediatrician, on the basis of 106 children and adolescents aged between 6 and 17 years, and suffering from sinusitis. Maxillary sinusitis (56.5%) and a combination of maxillary and ethmoidal sinusitis (24.5%) were commonest, and pan-sinusitis occurred in about 10% of cases. The commonest complaints in the history were cough, headache, pyrexia and rhinitis. The commonest clinical findings were pharyngitis, retropharyngeal drip, tenderness to pressure over the sinus points, otitis media, a deterioration in the general condition, enlarged tender angular lymph nodes, bronchitis and rhinitis. The result of treatment of sinusitis in childhood with the antibiotic used here, doxycycline, are assessed. A successful result was obtained in 94.3% of cases; cure in 77 patients (72.6%) and marked improvement in 23 (21.7%). There were six failures (5.7%). In the majority of children - 72 cases (68%), the duration of treatment was 15-21 days. It was 10-14 days in 18 children (17%) and more than 3 weeks in 16 children (15%). Rapid subjective improvement was seen in 65 cases (61.3%), and rapid objective improvement in 80 (75.5%). The tolerance of doxycycline was very good in nearly all patients. Mild symptoms of gastrointestinal intolerance were seen in two cases.

Bacterial flora of the healthy skin in children

The normal bacterial flora of the skin of 100 healthy children was studied in a paediatric practice with regard to the germ spectrum and the resistance constellation, by means of abrasion skin samples taken from the upper part of the back. Staphylococcus albus was by far the most predominant bacteria, followed by Sarcina bacteria and Corynebacteria. The high degree of pervasion of this physiological cutaneous flora with antibiotic-resistant strains increases the suspicion that in the case of florid bacterial skin infections in children, subsequent to traumatic or inflammatory changes of the integument, the antibiotic resistance of the normal resident flora can be transferred to the pathogenic flora. In view of the endemic resistance of pathogenic and saprobic strains of bacteria against practically all antibiotics at present used in paediatric practice, it is to be urgently recommended that instead of antibiotics topical braod-spectrum antimicrobial agents (antiseptics), e.g. clioquinol, triclosan, etc., should preferably be used.

[Cytodiagnosis of the synovial fluid]

In a survey in a general part the differential-diagnostic approach in the establishment of cytological findings of the arthrocentesis for the judgment of the normal and pathologically changed synovial fluid are described. Especially the differential-diagnostic possibilities by constellations of the findings from determination of the total number of leucocytes, the differential cell picture and the determination of the individual signs characteristic for a disease are demonstrated. A special part deals with the assessment of the cytologic findings of the arthrocentesis for the diagnosis, the local and general judgment of the activity and the judgment of the therapeutic success of medicamentous and operative measures in rheumatoid arthritis with the help of the cytology of the puncture of a joint.

Insulin antibodies in 104 children with diabetes mellitus

Binding capacity for porcine, bovine, and human insulin was estimated in 104 diabetic children using homologous systems of iodinated and noniodinated insulin. All patient sera bound porcine and bovine insulin whilst 11.5% did not bind human insulin. There was no clear correlation between duration of insulin treatment and binding capacity. However, some patients with only short duration of treatment had high capacity for porcine insulin. The binding capacity for human insulin was low in most patients. High insulin requirement was on average combined with high binding for bovine insulin. Cases of diabetes, which are difficult to control, treated with individual mixtures of porcine and bovine insulin, often showed high binding for porcine and also for human insuline. The value of estimations of insulin-binding capacity in diabetic children is debatable. However, the high incidence of antibodies seems to justify the use of low immunogenic (monocomponent) insulin preparations.

[Differentiation of cytoplasmatic, mitochondrial and lysosomal enzymes by fractional extraction of rat liver]

Enzymes of extramitochondrial, mitochondrial and lysosomal origin were differentiated by the method of fractional tissue extraction from rat liver. It could be confirmed that soluble enzymes of the extramitochondrial (cytoplasmatic) compartment (glycerine aldehydphosphate-dehydrogenase, argininosuccinate lyase) and soluble enzymes of the mitochondrial matrix can be differentiated easily according to their different intracellular localisation. Additionally, our results emphasize that soluble enzymes of both compartements and marker-enzymes of the lysosomal cell space which are known to be structurally-bound, can be differentiated too. However, the method failed to establish significant differences between enzymes located in the submitochondrial compartment (adenylatekinase, monaminooxidase and succinic-dehydrogenase) and lysosomal enzymes (cathepsin-D and N-acetyl-D-glucosaminidase).

Vibramycin in paediatrics. An evaluation of the onset of action and efficacy

The effectiveness of and tolerance to doxycycline (Vibramycin, Pfizer) was investigated in a group of 188 children and the radpidity of both subjective and objective improvement was assessed in a second group of 58 children. Doxycycline was found to be very effective. It was possible to analyse the results of treatment in 245 out of the total of 246 patients. Cure was obtained in 168 patients (68.6%) and marked improvement was seen in 59 (24.1%). The overall success rate was thus 92.7%. 18 patients (7.3%) failed to respond; these either had a history of relapsing infections or were infected with resistant organisms. Doxycycline also proved to be rapid in its effect. Rapid subjective improvement was seen in 48 out of 58 patients (84.2%) and rapid objective improvement in 41 patients (70.7%). Tolerance to doxycycline was very good. Treatment had to be interrupted in only one out of 246 patients; there were initial gastrointestinal symptoms in 4 patients. Doxycycline showed itself to be a very suitable antibiotic for use in day-to-day paediatric practice.