Early prediction of outcome with aEEG in preterm infants with large intraventricular hemorrhages.

BACKGROUND: The electrocortical background contains prognostic information in full-term asphyxiated newborn infants already during the first postnatal hours. In preterm infants with intra-ventricular hemorrhages (IVH) the background activity in EEG and amplitude-integrated EEG (aEEG) is depressed during the first days of life, and the extent of the depression correlates with the degree of IVH. However, it has not been previously evaluated whether very early aEEG can predict later outcome also in pre-term infants. OBJECTIVE: To investigate if early prediction of outcome is possible from aEEG in preterm infants with large IVH. METHODS: aEEG recordings from the first postnatal week were investigated in 64 preterm infants with IVH grade III - IV. For every 24-hour period the aEEG background pattern was classified, and the maximum and minimum numbers of bursts/h, respectively,were counted. Outcome was divided into three categories: died (n = 36), survived (n = 28) with "poor" outcome, i.e., severe cerebral palsy and not able to walk and/or mental retardation (n = 8), and survived with "fair" outcome, i.e., healthy or mild cerebral palsy (n = 19). One surviving child was lost in the follow-up. RESULTS: There were significant differences in maximum bursts/h (MaxB) at 0-24 hours (p = 0.033), 24-48 hours (p = 0.011), 48-72 hours (p=0.049) and 72-96 hours (p=0.032), respectively, between the infants who died and the surviving infants. At 24-48 hours the median (range) MaxB in the surviving infants with "fair" outcome was 156 (103-179) versus 102 (73-156) in the surviving infants with "poor" outcome (p = 0.002). With the assumption that MaxB < 130 was predictive of death or survival with "poor" outcome, 68 % and 78% of infants were correctly predicted at 0-24 hours and 24-48 hours, respectively. CONCLUSIONS: This study shows that outcome may be predicted with aEEG already during the first days of life in preterm infants with large IVH. The findings should be confirmed in prospective studies since they may have clinical implications if specific medical interventions become available.

Abandonment of mandatory jail for impaired drivers in Norway and Sweden.

In 1988 and 1990, respectively, Norway and Sweden adopted legal reforms including abandonment of mandatory jail sentences for persons driving with BACs above specific limits. Interrupted time-series analysis finds that in both countries traffic deaths diminished simultaneously with the reforms, consistent with the understanding that Scandinavian success in reducing impaired driving does not depend upon mandatory jail.

[Comparative urine protein analysis using SDS electrophoresis and isoelectric focusing]. / Vergleichende Urinproteinanalyse mittels SDS-Elektrophorese und Isoelektrofokussierung.

Urinary specimens of 156 patients were examined simultaneously by SDS electrophoresis and isoelectric focusing (IEF). Simultaneous separated protein test mixtures may help to a rapid orientation on the isoelectric points and molecular weights of the urinary proteins. The SDS electrophoresis as well as the IEF make possible a safe proteinuria typing, whereby both methods have specific advantages.

[Associated glomerulonephritis in immunocytoma]. / Assoziierte Glomerulonephritis beim Immunozytom.

It is reported on a 43-year-old patient in whom a mesangio-proliferative glomerulonephritis with nephrotic syndrome was diagnosed 7 months before manifestation of an immunocytoma. Under the treatment of the tumourous disease with chemotherapy and radiation a complete remission of the glomerulonephritis developed. The patient died of a generalized herpes zoster after 2 years 10 months. At the postmortem examination no pathological changes on the kidneys could be proved. After a survey of cases with tumour-associated glomerulonephirits published up to now possible pathogenetic mechanisms and clinical data of the glomerulonephritis as paraneoplastic syndrome are discussed.

[Acute cerebrovascular disease at the internal medicine hospital]. / Die akute zerebrovaskuläre Erkrankung im internen Krankenhaus.

On the basis of the medical reports of 255 patients with an acute cerebral insult the clinical symptoms, the courses of the illness as well as the diagnostic procedure were discussed. 76 of 255 patients (29.8%) are taken ill before they reach their 65th year, which stresses the sociomedical importance of acute cerebrovascular syndromes. With patients under 65 years the clinical syndrome corresponds to the following stages of the cerebrovascular insufficiency: stage IIa-14.5%, stage IIb-43.4%, stage III and IV-36.8%. A brain embolism is found in 5.3% of the cases. If there is an acute cerebrovascular insufficiency the ultrasonic Doppler detection as a noninvasive procedure should be the beginning of the paraclinical diagnosis. Should the ultrasonic Doppler detection give an indication of extracranial stenosis or obstruction of the A. carotis, then an angiographic diagnosis ought to be started in order to make possible a surgical treatment of the A. carotis.

[Effect of ultraviolet irradiation on renal osteopathy in patients in the chronic hemodialysis program]. / Einfluss der ultravioletten Bestrahlung auf die renale Osteopathie bei Patienten im chronischen Hämodialyseprogramm.

Under influence of the ultraviolet radiation the formerly lowered 25-hydroxycholecalciferol (25-OH-CC) level increases in persons with healthy kidneys. Such investigations were not yet carried out in patients undergoing dialysis. Since the insufficiency of active vitamin-D-metabolites plays an essential role in the development of the renal osteopathy, since 1978 in 13 patients undergoing dialysis a regular ultraviolet radiation has been performed, in order to stimulate the cutaneous vitamin-D-production. The time of observation was 31.7 +/- 14.3 months. Deionized water served for the production of dialysate. The calcium content was about 3.5 +/- 3.8 mval/l. The patients had very rarely bone and joint complaints. Severe clinical complications of renal osteopathy developed only in one female patient in the 3rd year of dialysis with a fracture of the neck of the femur as well as in a 2nd patient after transplantation of a kidney with permanently progressing demineralization and spondylitis. Controls of the courses showed only in 18.2% a progressing loss of the peripheral mineral content of the bones. The alkaline phosphatase was not increased, the alkaline bone phosphatase appeared with low and not provable activities. A suppression of the secondary hyperparathyroidism could not be proved. Parathormone was increased with 2.30 +/- 1.90 micrograms/l. The 25-OH-CC-levels were normal or slightly increased with 39.1 +/- 12.4 micrograms/l, whereas they were essentially lower in a comparative group without ultraviolet radiation. Therefore in connection with the very low rate of complications of the renal osteopathy with normalized 25-OH-CC-levels new therapeutic possibilities were the result in patients undergoing dialysis after ultraviolet radiation. The increasing importance consists also in the fact that 90% of the human vitamin-D-need are supplied via skin and it was proved by animal experiments that also after bilateral nephrectomy the formation of the active vitamin-D-metabolite 1,25-dihydroxycholecalciferol is possible by photosynthesis.