Potential of electric discharge plasma methods in abatement of volatile organic compounds originating from the food industry

Increased volatile organic compounds emissions and commensurate tightening of applicable legislation mean that the development and application of effective, cost-efficient abatement methods are areas of growing concern. This paper reviews the last two decades' publications on organic vapour emissions from food processing, their sources, impacts and treatment methods. An overview of the latest developments in conventional air treatment methods is presented, followed by the main focus of the paper, non-thermal plasma technology. The results of the review suggest that non-thermal plasma technology, in its pulsed corona discharge configuration, is an emerging treatment method with potential for low-cost, effective abatement of a wide spectrum of organic air pollutants. It is found that the combination of plasma treatment with catalysis is a development trend that demonstrates considerable potential. The as yet relatively small number of plasma treatment applications is considered to be due to the novelty of pulsed electric discharge techniques and a lack of reliable pulse generators and reactors. Other issues acting as barriers to widespread adoption of the technique include the possible formation of stable oxidation by-products, residual ozone and nitrogen oxides, and sensitivity towards air humidity.

Pulsed corona discharge: the role of ozone and hydroxyl radical in aqueous pollutants oxidation

Ozone and hydroxyl radical are the most active oxidizing species in water treated with gas-phase pulsed corona discharge (PCD). The ratio of the species dependent on the gas phase composition and treated water contact surface was the objective for the experimental research undertaken for aqueous phenol (fast reaction) and oxalic acid (slow reaction) solutions. The experiments were carried out in the reactor, where aqueous solutions showered between electrodes were treated with 100-ns pulses of 20 kV voltage and 400 A current amplitude. The role of ozone increased with increasing oxygen concentration and the oxidation reaction rate. The PCD treatment showed energy efficiency surpassing that of conventional ozonation.

Unilateral cerebellar hypoplasia and mesencephalic malformation in a Hanoverian foal

Neurological cases, especially in foals, are rare in the daily practical work. The most common causes are traumata and infectious diseases of the central nervous system (CNS). This case report provides further insights into the wide spectrum of possible neuropathological lesions by detailing a complex malformation with unilateral neurological signs that occurred later post natum. Thus, clinicians should also be aware of malformations in case of respective neurological patients. A Hanoverian foal was presented with progressive ataxia. General and blood examination revealed no further alterations. By neurologic examination, a unilateral hypermetria was diagnosed and a cysternography of the head was performed. A cerebellar malformation was assumed and the foal was euthanized due to poor prognosis. At necropsy, a unilateral absence of a cerebellar hemisphere and vermis accompanied by contralateral malformation of the mesencephalon was diagnosed. The missing areas of the right cerebellar hemisphere were replaced by a cystic formation. The left part of the mesencephalic lamina quadrigemina was reduced in size and the corpus callosum was hypoplastic. Additional microscopical findings were most obvious near the cyst formation and included angiofibrosis in remaining cerebellar and mesencephalic parenchyma and leptomeninges, heterotopia of cerebellar neurons, sclerosis in cerebellar cortex, focal proliferation of meningeal cells and mild mononuclear perivascular infiltrates. Occassional irregular neuronal arrangement in the mesencephalon was also present. Infectious agents such as Borna disease virus, rabies virus, and equine herpesvirus were not detected. Therefore, the complex malformation in this foal might have been caused by a destructive, possibly ischemic event, or could represent a sequel of a primary retrocerebellar cyst with accompanying compression of adjacent parenchyma.

Unilateral cerebellar hypoplasia and mesencephalic malformation in a Hanoverian foal

Neurological cases, especially in foals, are rare in the daily practical work. The most common causes are traumata and infectious diseases of the central nervous system (CNS). This case report provides further insights into the wide spectrum of possible neuropathological lesions by detailing a complex malformation with unilateral neurological signs that occurred later post natum. Thus, clinicians should also be aware of malformations in case of respective neurological patients. A Hanoverian foal was presented with progressive ataxia. General and blood examination revealed no further alterations. By neurologic examination, a unilateral hypermetria was diagnosed and a cysternography of the head was performed. A cerebellar malformation was assumed and the foal was euthanized due to poor prognosis. At necropsy, a unilateral absence of a cerebellar hemisphere and vermis accompanied by contralateral malformation of the mesencephalon was diagnosed. The missing areas of the right cerebellar hemisphere were replaced by a cystic formation. The left part of the mesencephalic lamina quadrigemina was reduced in size and the corpus callosum was hypoplastic. Additional microscopical findings were most obvious near the cyst formation and included angiofibrosis in remaining cerebellar and mesencephalic parenchyma and leptomeninges, heterotopia of cerebellar neurons, sclerosis in cerebellar cortex, focal proliferation of meningeal cells and mild mononuclear perivascular infiltrates. Occassional irregular neuronal arrangement in the mesencephalon was also present. Infectious agents such as Borna disease virus, rabies virus, and equine herpesvirus were not detected. Therefore, the complex malformation in this foal might have been caused by a destructive, possibly ischemic event, or could represent a sequel of a primary retrocerebellar cyst with accompanying compression of adjacent parenchyma.

Aqueous photocatalytic oxidation of sulfamethizole

Aqueous photocatalytic oxidation (PCO) of a non-biodegradable sulphonamide antibiotic sulfamethizole was studied. The impacts of photocatalyst dose, initial pH, and substrate concentration in the range from 1 to 100 mg L(-1) were examined with a number of organic and inorganic by-products determined, suggesting the initial break-up of the SMZ molecule at the sulphonamide bond. The experiments were carried out under artificial near-UV and visible light, and solar radiation using Degussa P25 and less efficient visible light-sensitive C-doped titanium dioxide as photocatalysts.

Selective photocatalytic oxidation of steroid estrogens in water treatment: urea as co-pollutant

The objective of the present research concerns the competitive photocatalytic oxidation (PCO) and adsorption of steroid estrogens (SEs) on titanium dioxide in presence of urea. The results showed the indifference of SEs towards the presence of urea in concentrations characteristic for the domestic sewage. The selective PCO of SEs appeared to be feasible in alkaline media, in which the PCO exhibited the highest efficiency. Ethanol used for hydrophobic SEs dissolution in water appeared to be interfering with the PCO.

Decreased white-matter density in a left-sided fronto-temporal network in children with developmental language disorder: evidence for anatomical anomalies in a motor-language network

The neurophysiological and neuroanatomical foundations of developmental language disorder (DLD) are still a matter of dispute. A main argument is that children with DLD show atypical anatomical asymmetries of speech-relevant brain areas, which possibly affect efficient language processing. In contrast to previous anatomical studies in DLD children, this study employed voxel based morphometry (VBM) in order to search for brain anomalies outside the classical language areas. Children with DLD (n=21) and healthy children (n=21) matched for age, sex, hand preference, and education were studied using high-resolution MRI scans. Using a new variant of the voxel-based morphometry technique (augmented VBM), the brains of children with DLD and control children were compared with respect to white matter (WM) and grey matter (GM) differences. In addition, simple hand motor tests were used to uncover possible motor impairments in DLD children. We found decreased WM volumes in a left-hemispheric network comprising the motor cortex, the dorsal premotor cortex, the ventral premotor cortex, and the planum polare on the superior temporal gyrus. In addition, DLD children exhibited motor impairments in most of the applied motor tests. These results provide strong evidence that children with DLD have anomalous anatomy in a left-sided network comprising motor and language areas. Thus, this study supports the suggestion that motor and language functions are equally impaired because the underlying anatomical underpinnings are regionally identical.

Photocatalytic oxidation of VX-simulation substance

Experimental studies of photocatalytic oxidation (PCO) of VX-gas simulation substance cysteamine-S-phosphate sodium salt (NaHPO3S-CH2-CH2-NH2, CPSS) at various initial concentrations and pH were undertaken. PCO ultimately resulted in complete mineralisation of CPSS. The PCO byproducts of CPSS include acetate, oxalate and trace amounts of formate ions. The formation rates of acetate and phosphate were equal to the rate of degradation of CPSS, which indicates easy breakage of P-S, C-S and C-N bonds. Sulphate was formed more slowly due to stepwise oxidation of reduced sulphur. Amino group, generally transformed to ammonia, was partially oxidised to nitrite and nitrate in alkaline media. The fastest mineralisation in terms of both TOC degradation and phosphate formation was observed in neutral media. Under neutral media conditions, the PCO rate increased linearly with the CPSS concentration increase. The maximum efficiency by TOC degradation was observed as large as 77 mg per Wh of incident UV flux with quantum efficiency 3.8%.

[Efficiency of a postoperative treatment after rotator cuff repair with a continuous passive motion device (CPM)]

AIM

The main objective of this study was to prove that a postoperative combined continuous passive motion (CPM) and physiotherapy treatment protocol (CPM group) can achieve 90 degrees active abduction in the shoulder joint earlier than physiotherapy alone (PT group). The indication was a complete tear of the rotator cuff.

METHOD

The study was conducted under in-patient and out-patient conditions. 55 patients were included in this study. The prospective, randomized multicenter study design complies with DIN EN 540. The primary endpoint was the time span until 90 degrees active abduction was achieved by the patients.

RESULTS

Patients in the CPM group reached the primary endpoint on average 12 days earlier than the control group. This difference was statistically significant (p = 0.0292). Analyzing the secondary endpoints, e. g., pain and disablement, the results in the CPM group showed again advantages of the combined treatment protocol (CPM + physiotherapy).

CONCLUSION

The postoperative treatment of a total tear of the rotator cuff with a combined continuous passive motion and physiotherapy protocol provided a significantly earlier range of motion in the shoulder joint than physiotherapy alone. There was no report of CPM-related adverse effects.

The influence of ferrous/ferric ions on the efficiency of photocatalytic oxidation of pollutants in groundwater

The complex influence of ferrous/ferric ions on the efficiency of aqueous photocatalytic oxidation (PCO) of 2-ethoxyethanol (2-EE), methyl tert-butyl ether (MTBE) and humic substances (HS) was established. A drastic efficiency increase at lower concentration of ferrous/ferric ions was observed to change to a sharp decrease at higher concentrations for 2-EE and MTBE, whereas for HS only an inhibitive effect of Fe2+/3+ on the PCO efficiency was noticed. The authors proposed an explanation for the observed phenomena based on the different sensitivities of pollutants towards radical-oxidation reactions and the competitive adsorption of metallic ions and pollutants on the TiO2 surface.

Gas-phase photocatalytic oxidation of motor fuel oxygenated additives

Methyl tert-butyl ether (MTBE) and tert-butyl alcohol (TBA) were oxidized in the gas phase by photocatalytic oxidation (PCO). Transient PCO was carried out at room temperature on TiO2 (Degussa P25), 0.2% Pt-TiO2, and 2% Pt-TiO2 catalysts. Surface-adsorbed reaction by-products were characterized by temperature-programmed desorption (TPD) and oxidation (TPO). Continuous flow PCO was also carried out at 373 K on TiO2. Acetone, H2O, and CO2 were the gas-phase products for PCO of TBA and MTBE, and formic acid was adsorbed on the TiO2 surface. Temperature-programmed desorption of TBA and MTBE formed 2-methyl-1-propene, water (TBA), and methanol (MTBE). During continuous-flow PCO, acetone desorbed in molar amounts equal to the amount of decomposed TBA and MTBE. The Pt/TiO2 catalysts had higher rates of complete oxidation during PCO and TPO. Injection of water during transient PCO increased the rates of oxidation of adsorbed TBA, formic acid, and acetone. Photocatalytic oxidation of TBA proceeded faster in humid air than dry air, but MTBE oxidation was less sensitive to humidity. The TiO2 catalyst was stable for MTBE, TBA, and acetone PCO at 373 K. The PCO at low conversions followed the Langmuir-Hinshelwood model.

Photocatalytical oxidation of de-icing agents in aqueous solutions and aqueous extract of jet fuel

Improper handling of jet fuel at abandoned military bases has resulted in heavy pollution of the soil and groundwater. Experimental research of photocatalytical oxidation (PCO) of jet fuel aqueous extract and aqueous solutions of de-icing agents was undertaken. The influence of different parameters - pH, concentration of substances to be oxidised, presence of inorganic admixtures, effect of OH. radical generators--on the PCO of solutions of de-icing agents and jet fuel aqueous extract was determined. The role of OH. radicals was found to be less important in determining the PCO rate. The PCO of organic pollutants was also investigated using a catalyst immobilised onto the surface of buoyant hollow glass microspheres. Attached titanium dioxide (TiO2) showed lower photocatalytical activity than when suspended in slurry, although it allows waters to be treated in simple shallow ponds without intensive stirring. The biodegradability of aqueous solutions of de-icing agents and jet fuel aqueous extract increased as PCO proceeded.

Corpus callosum size in children with developmental language disorder

Using high-resolution in-vivo magnetic resonance morphometry of the midsagittal area of the corpus callosum (CC) and four callosal subareas in 21 children with developmental language disorder (DLD) of the phonologic-syntactic type we found no significant anatomical differences in comparison to an age- and gender-matched normal control group. There was also no significant between-group difference when the approximately 7% smaller forebrain volume among children with DLD was accounted for by relating CC measures to forebrain volume. Only a tendency towards a larger anterior and middle CC in relation to forebrain volume was found in DLD children. In our DLD children we found the same relationship between CC midsagittal size and forebrain volume as recently reported for normal adults, namely, that the CC area increases to the two-third power of forebrain volume.

Identification of mutations in the MSX2 homeobox gene in families affected with foramina parietalia permagna

Foramina parietalia permagna (FPP) is an autosomal dominant condition characterized by cranial defects of the parietal bones. It can be present as an isolated feature, but it is also one of the characteristics of a contiguous gene syndrome associated with deletions on chromosome 11p11-p12. One of the proteins known to be involved in skull development is the MSX2 homeobox protein. Previously, MSX2 has been shown to be mutated in patients suffering from Boston type craniosynostosis. We have now analyzed the MSX2 gene in five families affected with FPP. An intragenic microsatellite marker did not reveal any recombination and a cumulated LOD score of +3.2 at theta = 0 was obtained. Sequence analysis further showed that in four out of five families an MSX2 mutation was responsible for the skull defect. Moreover, it appears that FPP is caused by haplo-insufficiency of the MSX2 gene. This implies that Boston type craniosynostosis and FPP are allelic variants of the same gene, with FPP caused by loss of MSX2 function and craniosynostosis Boston type due to gain of MSX2 function.

[Catamnestic results and questions in neurologic rehabilitation--in relation to encephalomyelitis disseminata (multiple sclerosis)]

Owing to the changes in the laws governing the health care system, medical rehabilitation for patients treated as in-patients is becoming increasingly a subject of discussion, especially for chronic illnesses. Using multiple sclerosis (encephalomyelitis disseminata) as an example, a special database is used to examine the courses, contents, improvements or deteriorations seen in in-patient rehabilitation as experienced by 901 patients who were in rehabilitation clinic in the years 1995-1998. This period was selected to allow the ascertainment of possible effects of far-reaching changes in the law taking effect from autumn 1996 onward. The EDSS (Expanded Disability Status Scale) was applied, and patients financed by statutory health insurances were compared with those financed by pension insurance funds for length of stay, outcome and therapeutic content. In the case of 256 patients being financed by pension funds it was possible to use the classification of therapeutic services as a basic tool and the connection with degree of disability was recognizable: different degrees of severity of the illness led to different treatment programmes. Health insurance patients were always more severely ill than those financed by pension insurance. Interestingly, the legal changes had no effect on the treatment outcomes of the patients. The data retrieved confirm the efficacy of the rehabilitation programmes.

The relation between forebrain volume and midsagittal size of the corpus callosum in children

Applying in vivo magnetic resonance (MR) morphometry in healthy adults we have recently discovered that the relationship between forebrain volume (FBV) and the midsagittal size of the corpus callosum (CC) follows a geometrical rule according to which larger brains have a relatively smaller midsagittal CC. This allometric relation was taken as support for the hypotheses of Ringo and co-workers suggesting that brain size may be an important factor influencing interhemispheric connectivity and lateralization. In this paper we examined whether the aforementioned relation between FBV and CC size also holds for healthy children between 3 and 14 years of age. We confirmed this relationship as previously found for adults. Thus, the geometrical rule and the implications associated with it apply for a wide age range. In addition we found significant correlations with age for posterior and mid-parts of the CC even when FBV was controlled for, suggesting an anterior to posterior maturation gradient of CC development.

Child age and planum temporale asymmetry

Investigations using in vivo magnetic resonance (MR) morphometry have shown that left-right asymmetry of the planum temporale (PT) is a structural correlate of hemispheric functional asymmetries in adult humans (e.g., handedness, language representation). Postmortem studies of brains of fetuses and newborns have demonstrated that PT asymmetry becomes visible as early as in the last gestational trimester. The same studies could not clarify when the full (adult) degree of PT asymmetry is reached during brain development and whether this process may be influenced by functional specialization during childhood. We examined 61 neuropsychiatrically normal right-handed children aged 3 to 14 years (mean age +/-SD, 8.4 +/- 2. 7 years; cross-sectional study). MR morphometry showed no change in PT or planum parietale asymmetry with increasing age or brain volume. An unexpected gender difference of unknown significance emerged, with girls displaying a stronger leftward PT asymmetry, independently of age. For the age range studied, the results suggest that functional differentiation follows a structural asymmetry that is already "preset."

CT and MRI of congenital sinonasal ossifying fibroma

We report a 9-year-old boy with a sinonasal ossifying fibroma, probably congenital, with atypical findings on CT and MRI. CT revealed a soft-tissue density mass in the sphenoethmoidal sinuses, nasal cavity and right maxillary sinus with a few foci of calcification and with remodelling and destruction of the adjacent facial bones. MRI showed high signal on T2- and intermediate signal on T1-weighted images. A thin, partly enhancing outer shell and some nonenhancing septa were visible on contrast-enhanced images. MRI also showed the tumour to extend into the anterior cranial fossa. Subtotal removal was performed. We compare our findings with reports in the literature and discuss the differences from fibrous dysplasia.

Focal grey matter heterotopias in monozygotic twins with developmental language disorder

We describe 9-year-old monozygotic male twins with a developmental language disorder of the phonologic-syntactic type and learning difficulties. High-resolution MRI revealed bilateral parieto-temporal grey matter heterotopias in both twins, on the left more than on the right, and more pronounced in the more affected twin. This suggests a causal relationship between the heterotopias and the neuropsychological findings in this twin pair.

CONCLUSION

Neuronal migration defects and ensuing focal heterotopias may be causally related to developmental language disorders.

Normal intrasylvian anatomical asymmetry in children with developmental language disorder

Symmetry of posterior intrasylvian cortices (e.g., planum temporale, planum parietale) has been suggested to represent a risk factor for developmental disorders of language and reading. Using high-resolution magnetic resonance morphometry, we studied 21 right-handed children with developmental language disorder of the phonologic-syntactic type, and found normal left-right asymmetry of the planum temporale and planum parietale when compared with 21 matched controls. The planum temporale was bilaterally smaller in the affected children, a finding accounted for by their approximately 7% smaller forebrain size. Our data do not support a role of gross visible unilateral or bilateral abnormalities of posterior intrasylvian ontogenesis in this disorder.

Motor performance and handedness in children with developmental language disorder

Developmental language disorder (DLD) is diagnosed when there is a failure of normal language development in a child with normal nonverbal intelligence. The discussion about additional or causal deficits is controversial. In this study a computer-based motor performance series with a tapping, aiming and pegboard movement task and an additional paper-pencil handedness test were applied to a group of children with DLD of the phonologic-syntactic subtype and with normal nonverbal intelligence to describe the additional motor problems. Furthermore we examined whether our DLD children showed a different handedness. Tapping and pegboard with both hands were significantly impaired in our DLD children. Overall our DLD children did not show a different handedness than the control group.

Typical pattern of the Kaufman-Assessment Battery in children with developmental language disorder

In this study we used the Kaufman-Assessment Battery for children (K-ABC), which assumes a dichotomy of sequential versus simultaneous processing of intelligence, in order to describe the typical pattern of processing in 25 children with normal nonverbal intelligence and developmental language disorder (DLD) of the phonologic-syntactic subtype, a mixed receptive-expressive DLD with grammatical and phonologic deficits. The results of the K-ABC showed a significant deficit in auditory sequential processing, whereas simultaneous processing was normally performed.

Localisation of a gene for Papillon-Lefèvre syndrome to chromosome 11q14-q21 by homozygosity mapping

Papillon-Lefèvre syndrome is an autosomal recessively inherited palmoplantar keratoderma of unknown aetiology associated with severe periodontitis leading to premature loss of dentition. Three consanguineous families, two of Turkish and one of German origin, and three multiplex families, one of Ethiopian and two of German origin, with 11 affected and 6 unaffected siblings in all were studied. A targeted genome search was initially attempted to several candidate gene regions but failed to demonstrate linkage. Therefore a genome-wide linkage scan using a combination of homozygosity mapping and traditional linkage analysis was undertaken. Linkage was obtained with marker D11S937 with a maximum two-point lod score of Zmax = 6.1 at recombination fraction theta = 0.00 on chromosome 11q14-q21 near the metalloproteinase gene cluster. Multipoint likelihood calculations gave a maximum lod score of 7.35 between D11S901 and D11S1358. A 9.2-cM region homozygous by descent in the affected members of the three consanguineous families lies between markers D11S1989 and D11S4176 harbouring the as yet unknown Papillon-Lefèvre syndrome gene. Haplotype analyses in all the families studied support this localisation. This study has identified a further locus harbouring a gene for palmoplantar keratoderma and one possibly involved in periodontitis.

Gait analysis by measuring ground reaction forces in children: changes to an adaptive gait pattern between the ages of one and five years

The aim of this study was to look at the maturational profile of gait parameters by measuring ground reaction forces during independent walking in children. Fifty-four normal children aged 1 to 5 years were examined. The children walked with eight force transducers under each sole. Gait velocity and step length increased with age, whereas step frequency remained relatively constant. Phases of double ground contact expressed as percentages of the total gait cycle decreased significantly from age 1 to 5 with the steepest decrease occurring in the first year of independent walking. No asymmetry between left and right could be detected for any of these parameters. The pattern of ground reaction forces with a significant heel strike and obvious enrollment process resembling that in adults was achieved between the age of 2 and 3 years. Measuring ground reaction forces is a fast and easily manageable method of analysing gait pattern in children and is also a promising tool for detection of gait abnormalities in children with neurological disease.

Goldenhar, Möbius and hypoglossia-hypodactyly anomalies in a patient: syndrome or association?

The Möbius, Goldenhar and hypoglossia-hypodactyly anomalies are usually sporadic conditions with a recurrence risk of about 2%. The combination of Goldenhar and one or the two others is rare, whereas the concomitant occurrence of Möbius and hypoglossia-hypodactyly, and/or Poland, and/or Klippel-Feil anomaly is well known. Pathogenetically, vascular disruptions around the 4th embryonic week have been hypothesized. In vivo and pathological studies as well as animal models support this theory for all the above-mentioned combinations. Whether a preceding blastogenetic alteration is an influencing factor or a disorganization mutation, remains unclear. We describe a 3-year-old girl with bilateral anotia, epidermoid on the right eye, 6th and 7th nerve palsy, hypoglossia, left hypodactyly, and ventricular septal defect.

CONCLUSION

We wish to emphasize the aetiological relevance of vascular disruptions in this previously unreported combination of Möbius, Goldenhar and hypoglossia-hypodactyly anomalies. The concurrence of anomalies in this patient represents an association and not a pleiotropic syndrome.

Papillon-Lefèvre syndrome--successful treatment with a combination of retinoid and concurrent systematic periodontal therapy: case reports

Papillon-Lefevre syndrome is a rare autosomal-recessive congenital differentiation disorder; the external signs are hyperkeratosis of the palms and soles. Intraorally, the most salient manifestations are dystrophic periodontal problems that affect both the primary and permanent dentitions and frequently lead to premature tooth loss. Two children were treated with acitretin 0.5 mg/kg of body weight per day from November 1992 to November 1993, and another child since October 1993. Concurrently, the children received professional oral hygiene care (scaling, root planing, and curettage). The combination of retinoid therapy and periodontal treatment improved the dermatologic and periodontal conditions.

Monozygotic twins concordant for Rubinstein-Taybi syndrome: changing phenotype during infancy

We describe monozygotic twin sisters concordant for Rubinstein-Taybi syndrome diagnosed at the age of 10 weeks. The typical features of Rubinstein-Taybi syndrome in early infancy increasingly developed towards the total "Gestalt" at the age of 2 years and 10 months.

Gorlin-Chaudhry-Moss or Saethre-Chotzen syndrome?

We report a 2-year-old girl with craniosynostosis, an ossification defect of the cranial vault, midface hypoplasia, low frontal hairline, anti-mongoloid slant of the palpebral fissures, ptosis of the lateral upper lids and high-arched narrow palate. There are additional findings fitting the Gorlin-Chaudhry-Moss syndrome, such as hypoplasia of the labia majora, hypoplasia of the distal phalanges of fingers and toes and conductive hearing loss, but hypertrichosis and dental anomalies are missing, which were described in the four females previously reported with the probably autosomal recessive Gorlin-Chaudhry-Moss syndrome. Since the autosomal dominant Saethre-Chotzen syndrome may show similar cranio-facial features, short fingers with non-obligatory cutaneous syndactyly, and ossification defects of the cranial vault, the Saethre-Chotzen syndrome should also be considered in our patient.

Osteosarcoma in a 16-year-old boy with Baller-Gerold syndrome

We report a 16-year-old growth deficient boy with craniosynostosis, radial hypoplasia and hypoplastic thumbs. These findings are consistent with the autosomal recessively inherited Baller-Gerold syndrome (BGS) which furthermore shows a great variability of concomitant occasional anomalies. At the age of 16 years our patient suffered from an osteosarcoma of the left distal femur. The occurrence of malignancies has not yet been reported in the hitherto described 22 patients with BGS.

Acrofacial dysostosis of unknown type: nosology of the acrofacial dysostoses

We describe a stillborn girl with an unclassified form of mandibulofacial dysostosis, a postaxial defect of the right, and a preaxial defect of the left hand. The Nager syndrome is characterized by preaxial limb defects, whereas the Genée-Wiedemann syndrome (= Miller syndrome) by postaxial limb defects. We briefly review the established acrofacial dysostoses (AFD) and discuss the position of our case in the current classification.

Oto-palato-digital syndrome type II in two unrelated boys

We report on two boys with oto-palato-digital syndrome type II, characterized by growth retardation, bowed long bones, missing or hypoplastic fibulae, sclerosis of the skull base and wavy, irregular clavicles and ribs. The facial appearance is distinctive due to prominent forehead, widely spaced eyes, antimongologid slant of palpebral fissures, flattened nasal bridge and retrogenia. The mother of one patient showed a mild manifestation of oto-palato-digital syndrome type II. Only about 20 cases of this rare X-linked disorder have been reported so far. The similarities and dissimilarities to oto-palato-digital syndrome type I are discussed.

Ceftriaxone alone or in Combination with Teicoplanin in the Management of Febrile Episodes in Neutropenic Children and Adolescents with Cancer on an Outpatient Base

STUDY OBJECTIVE

This study prospectively investigated the outpatient once daily therapy with ceftriaxone alone or if necessary in combination with teicoplanin, in the treatment of infections in children and adolescents with chemotherapy-induced neutropenia or aplastic anemia.

PATIENTS

42 patients 1-22 years of age suffering from solid tumors, hematological and oncological diseases, with clinical signs of infection, increased serum CRP (> 1 mg/dl) and/or fever above 38.5 degrees C and neutropenia (WBC count and/or ANC < 1 x 10(9)/l) were included in this outpatient based study. One important exclusion criterion was poor clinical condition with symptoms of septic shock.

METHODS

After bacterial, fungal and viral cultures had been obtained, single agent broad spectrum cephalosporin treatment was initiated with ceftriaxone applied once daily in a dose of 80 mg/kg body weight as short infusion over 30 min. Daily examinations included WBC, CRP, physical inspection and reassessment. In case of persistence or increase of fever and CRP, either outpatient management was carried on with teicoplanin added or patients were hospitalized and switched to combination antibiotic regimen.

RESULTS

There were 64 febrile episodes in 42 patients. Single agent once daily broad spectrum cephalosporin was adequate in 43/64 (67%) of infectious episodes in neutropenic patients. For persisting or increased fever or CRP elevation, 9 patients were treated with ceftriaxone and teicoplanin successfully. Thus hospitalized was avoided in 52/64 (81%) of infectious episodes.

[Effect of bradykinin on systemic and pulmonary hemodynamics in the human]

In our studies we investigated the vasodepressor effects of bradykinin in vivo in normotensive and hypertensive subjects. Bradykinin was injected intravenously and intraarterially (40-6050 pM/kg) respectively was infused intraarterially (40-6050 pM/kg/min). The investigations were performed in 21 normotensives and 15 hypertensives. Bradykinin injections were performed after the following pharmacological interventions: salt restriction (10 mmol Na/d), salt loading (300 mmol Na/d), captopril (50 mg), ramipril (5 mg), lisinopril (20 mg), ketotifen (2 x 1 mg), indomethacin (2 x 50 mg), and propranolol (80 mg). The results show that bradykinin lowers blood pressure dose related by marked reduction in peripheral vascular resistance. The blood pressure reduction was strongly correlated with the increase in kinin concentration. This effect of bradykinin appears to be independent of changes in sodium metabolism, of beta adrenoceptors, of histamine-1 receptors, and of prostaglandins. ACE-inhibitors potentiate the blood pressure lowering effect of bradykinin about 20- to 50-fold. In case of an intraarterial injection of bradykinin in only 2-5% o the intravenously used dose of bradykinin are needed to produce an identical fall in blood pressure. From this experiments a pulmonary clearance rate of bradykinin over 95% can be calculated. In the pulmonary arteries bradykinin has no effect on the vascular resistance. In patients suffering from primary or renovascular hypertension the blood pressure response to bradykinin was enhanced. The bradykinin potentiating effect of the ACE-inhibitors was not altered in the hypertensives. In patients suffering from bradykinin hypertension or primary hyperaldosteronism bradykinin developed the same blood pressure lowering effect as in the normotensives.