[Fatal flecainide intoxication in a 17-year-old girl]

A 17-year-old girl was found vomiting and somnolent at home and was taken to a hospital. The girl initially presented with ventricular tachycardia with broad QRS complexes which was very difficult to control. During the course a subsequent cardiogenic shock developed and despite exhaustion of all therapeutic options the fatal outcome could not be averted. The medicolegal autopsy revealed no evidence of any form of violence but the signs of medical treatment. Furthermore, no pathology of internal organs was detected. The toxicological analyses revealed a lethal intoxication with flecainide as the cause of death. The investigations of the police indicated that the girl took flecainide in suicidal intention.

[MALT Lymphoma of the Conjunctiva in a 13-year old Child--5-Year Relapse-free Follow-up Following Antibiotic Treatment]

MEDICAL HISTORY

In February 2007, a 13-year old boy presented with a livid tumour in the lower conjunctival fornix of the left eye. OPHTHALMOLOGICAL FINDINGS: The tumor was salmon-coloured, bulging and elastic and filled the whole lower conjunctival fornix of the left eye. There was no other pathological finding in the left eye. Uncorrected visual acuity was 20/20. Intraocular pressure was 12 mmHg. The eye was fully motile.

TREATMENT

Incisional biopsy was performed in February 2007. The tumor was histologically an extranodal MALT lymphoma. DNA testing for Chlamydophila trachomatis and Chlamydophila pneumonia was negative. Systemic treatment was started with doxycycline (200 mg daily). After six weeks, the tumour was slightly smaller. Azithromycin 500 mg once a week was added. 18 months after initiation of the treatment, the tumour had completely regressed. A second sample taking in the former tumor area showed tumor-free conjunctiva and subconjunctival tissue. As a precaution, the combined antibiotic therapy was continued for 10 months and the patient was followed for five more years. The lymphoma did not relapse in the conjunctiva and orbit or in the whole body.

CONCLUSION

We showed that extranodal MALT lymphomas of the conjunctiva can be successfully treated with antibiotics alone. At the start of therapy, the child was 13 years old. To our knowledge, this patient is the first child in Germany and one of the first in the world with ocular adnexal lymphoma who could be successfully treated with combined antibiotic therapy and who could be followed up for 5 years without relapse. Thus, we could avoid radiotherapy or chemotherapy in childhood and eliminate the risk of a therapy-induced secondary malignancy.

Superovulation and embryo recovery from peripubertal Holstein heifers

The use of peripubertal donors in embryo transfer (ET) programs presents significant opportunity to accelerate genetic gain in domestic livestock by reducing the generation interval. These studies were designed to evaluate feasibility of superovulation and embryo recovery in peripubertal heifers (starting at 7.8 months of age), and to determine whether subsequent reproductive and lactational performance of donor heifers were impaired. Study 1 utilized 10 pairs of contemporary full-sibling heifers in which one heifer in each pair was assigned to receive a superovulation regimen and her full-sibling contemporary received placebo. Treated heifers were artificially inseminated at estrus and embryos were flushed transcervically 4-6 days later. Based on recovery of oocytes and/or embryos, 9 of 10 heifers responded to the hormonal regimen and 12 total embryos were recovered. Seven embryos (58%) were transferred into recipients resulting in five pregnancies. Control and treated heifers remained in the herd and were bred at a natural estrus by AI at 15 months of age. Lactation records, i.e., 305 days mature equivalent (305 d ME) were obtained, and all animals were evaluated for udder conformation traits between 32 and 38 months of age. Reproductive traits (age at first calving and days to conception) and lactational traits of heifers subjected to embryo transfer and their non-treated full-siblings did not differ (P > 0.05). Study 2 was conducted to establish the commercial feasibility of hormonally programming peripubertal heifers ranging in age from 7.8 to 9.9; 10 to 11.9; 12 to 13.9 and >/= 14 months. In total, 3982 embryos were recovered from 520 heifers, with 2419 (60.7%) of those categorized as viable (transferable). The number of ova/embryos obtained per flush (5.6 +/- 1.0) and the number of transferable embryos (2.8 +/- 0.5) was reduced (P < 0.05) in heifers of age 7.8-9.9 months compared to all other age groups. There was no difference (P > 0.05) in the number of ova/embryos recovered (7.8 +/- 0.3), or the number of transferable embryos (4.8 +/- 0.2), among heifers that were >/=10 months of age. The number of unfertilized ova did not differ by age, however, more degenerate embryos tended to be recovered from heifers <10 months of age compared to heifers >/=14 months of age. These data indicate that transferable embryos can be safely recovered from heifers beginning at 10 months of age without compromising subsequent reproductive or lactational performance of the donor.

Smith-Lemli-Opitz syndrome with a classical phenotype, oesophageal achalasia and borderline plasma sterol concentrations

The diagnostic biochemical hallmarks of Smith-Lemli-Opitz syndrome (SLOS) are elevated concentrations of the cholesterol precursors 7- and 8-dehydrocholesterol (7- and 8-DHC). We describe a patient with classical SLOS phenotype and oesophageal achalasia, which has not been reported in SLOS patients before. Plasma 7-DHC and 8-DHC were only marginally elevated. The diagnosis was confirmed by sterol analysis in cultured skin fibroblasts and mutation analysis.

Resting energy expenditure in obese children aged 4 to 15 years: measured versus predicted data

AIM

To measure the relationship of resting energy expenditure (REE) and body composition, and to compare REE data calculated from anthropometric parameters using published equations with measurements obtained by indirect calorimetry (IC) in a population of obese paediatric patients.

METHODS

The study included 82 healthy obese paediatric subjects (49 boys, 33 girls; body mass index 29.6 +/- 5.0 kg/m , age 1 1.4 +/- 2.6 y, weight 72.4 +/- 20.9 kg, height 155 +/- 14 cm). REE was measured by IC, body composition was determined by dual energy X-ray absorptiometry (DXA). Bootstrap analysis was performed to validate the step-down linear regression analysis results.

RESULTS

Lean body mass (LBM) and weight were identified as the most significant determinants of REE. LBM was the best single predictor (r = 0.78; p < 0.001) for REE. Regression equations are given in the text. Prediction of REE on the basis of published anthropometric formulas was strongly dependent from the equation used. Some equations tend to underestimate REE in the population studied with a considerable systematic error.

CONCLUSION

In the present paper we show that (1) the published equations to predict REE in obese subjects yield scattered data and some are even biased by a systematic error, and that (2) the inclusion of DXA-derived LBM improves accuracy and precision of predicted REE in boys and girls aged from 4 to 10 y and in boys from 11 to 15 y.

Linearity and accuracy errors in bone densitometry

This investigation was undertaken to quantify accuracy errors and identify possible linearity errors in dual energy X-ray absorptiometry (DXA) of bone, based on studies of commercially available bone densitometers for planar densitometry. The following was found in a combination of in vitro phantom studies and in vivo investigations of human volunteers: (1) Pronounced differences between the instruments when measuring vertebral size and contours of the projected bone regions. (2) Falsely low bone mineral content (BMC in terms of g) in cases of low nominal bone mass, due to the fact that edge regions were omitted by the calculation software of some devices. (3) An increase in the projected bone area secondary to an increase in nominal bone mass with some instruments. (4) Clinically and statistically significant errors of accuracy of BMC and to a lesser extent bone mineral density (BMD). (5) Substantial linearity errors with some osteodensitometers for BMC, a phenomenon that reduces the usefulness of this parameter. It is concluded that DXA devices are affected by a combination of accuracy errors and linearity errors, some more than others, and that linearity errors influence their ability to monitor change in BMC and to a lesser extent in BMD, making system intercomparison difficult.

Recent developments in DXA. Quality of new DXA/MXA-devices for densitometry and morphometry

The introduction of new devices demands the assessment of their capabilities in established terms. The accuracy, reproducibility and spatial resolution of in vitro (phantom) osteodensitometric and morphometric measurements of QDR 2000 Plus and EXPERT are presented. Design details of these DXA/MXA-devices are listed and discussed in combination with the data acquired in the test measurements and calculations. The image quality will improve with further software developments. The long-term reproducibility and in vivo reliability remains to be evaluated.