Fulminant liver failure in a young child following repeated acetaminophen overdosing

Acetaminophen (paracetamol), a widely used analgetic drug, is well tolerated at therapeutic doses, but may cause severe hepatotoxicity when ingested in large overdose. Self-poisoning is still very popular in adults and accidental ingestion of one single overdose occurs occasionally in children. In contrast, lethal intoxication in children after repeated administration of therapeutic doses is a very rare event. This case report describes an iatrogenic acetaminophen overdosing in a 5-year-old child receiving 8.5 g acetaminophen in 48 h. Fulminant liver failure developed within 60 h. Autopsy findings included panlobular liver cell necrosis. Acetaminophen serum levels were rather low compared to cases with ingestion of one single overdose. Postmortem diagnosis of chronic acetaminophen intoxication as cause of death should include the clinical history as well as, if available, the calculated drug serum half-life.

[Holt-Oram syndrome in combination with reciprocal translocation, lung hypoplasia and cardiomyopathy]

A now two years old girl had developed respiratory insufficiency shortly after birth requiring prolonged artificial ventilation. A hypo- and dysplasia of the right lung was identified as the underlying cause. Further diagnostic evaluation revealed a malformation of bones, i.e. shortness of the humerus, aplasia of the radius, shortness of the ulna and a congenital anlage of four metacarpal bones in fixed malposition. In addition, an atrial septal defect of the sinus venous type with left-to-right shunting was present. This, in combination with the sceletal abnormalities pointed to the diagnosis of Holt-Oram syndrome. In her first year of life the patient also developed a hypertrophic non-obstructive cardiomyopathy. Cytogenetic analysis of her family revealed a reciporke translocation between chromosome 1 and 11 (t -1, -11 (1p13, 11q13)) in the patient herself, her father and the father and a sister of her father. However, this finding as well as the hypertrophic cardiomyopathy has to be regarded as being independent from Holt-Oram syndrome.

Intracranial hemangiopericytoma in a child

Hemangiopericytoma in the central nervous system is a rare tumor occurring predominantly in supratentorial sites. Classification may be confusing because the tumor may mimic the histological pattern of other vascular neoplasms. The particular feature of hemangiopericytoma are pericytes of blood vessels; they distinguish it as a separate and distinct tumor. The case of a 3 3/4-year-old child with a 3 3/4-year course is reported with a tumor in the middle fossa, the diencephalon, and the brainstem. The cystic tumor was resected twice. The child is presently alive with neurological deficit. The clinical, radiographic and histological findings are presented. The role of aggressive surgical treatment is emphasized.

Periodic cessation of respiratory effort during sleep in adult rats

Using a noninvasive technique which measures respiration as a function of chest and abdominal movement, it was found that adults rats have periodic cessations of respiratory effort during the daytime. In a preliminary study, male Fischer-344 rats had respiratory pauses of 2.4-2.6 seconds duration, which tended to be more frequent in older (22-month) compared to young adult (3-month) rats. Respiratory rate was lower and respiratory volume greater in the 22-month-old animals. In a more detailed study of 3-month-old male Sprague-Dawley rats, respiratory pauses were divided into two types: those preceded by a large inspiration ("sighs") and those which were not. The latter, which appear to be most analogous to human apneas of clinical interest, occurred in all animals studied, with a frequency of 13 to 26 events during six hour recordings. These pauses varied in duration from 2.0 to 6.1 seconds and were most frequent and longest in REM sleep.

Effects of flurazepam on sleep, arousal threshold, and the perception of being asleep

This study examined the effects of flurazepam on arousal threshold and on quality of sleep during nights in which arousal threshold studies were performed. Ten patients with subjective insomnia received 30 mg flurazepam or placebo on nights in which arousal thresholds in response to electronic tones or a recording of the subjects' names were determined. Arousal thresholds differed across waking and sleep stages, but there was less difference in response to the subjects' names than to electronic tones. Flurazepam raised arousal thresholds to both stimuli, but did not selectively influence response in any individual sleep stage. Flurazepam did not alter subjects' estimates of elapsed time or duration of sleep between tests.

Inguinal nephroblastoma

A case of an extrarenal nephroblastoma is reported which was located in the inguinal region. In the surrounding fat tissue normal ectopic glomerular and tubular structures and two more nephroblastomas were found. Therefore and because of negative clinical investigations in regarding of a renal malignant tumour the inguinal mass was thought to be the primary tumour and not a metastasis. This conclusion is important for the diagnosis and therapy.