A survey of medicine use in children and adolescents in Austria.

Aims of this survey were to evaluate prescription patterns for children and adolescents in primary and hospital care settings in Austria and to identify the medicines used most frequently in this population. Prescription data were assessed for the year 2014: for primary care, reimbursement data were obtained from Austrian health insurances; for hospital care, information on medicines dispensed to pediatric wards from hospital pharmacies. Frequencies of medicine use were analyzed by Anatomical Therapeutic Chemical classification system, age groups, and care setting. In primary care, anti-infectives (25%) and medicines for the respiratory system (14%) and for the nervous system (13%); in hospitals, anti-infectives (23%) and medicines for the nervous system (13%) and alimentary tract (12%) were prescribed most frequently. Amoxicillin/beta-lactamase inhibitor, ibuprofen, and paracetamol were the most frequent substances in both primary and hospital care settings. Based on the top 80% prescribed substances, a hit list of 150 pediatric medicines was defined for Austria. CONCLUSION: This is the first representative and comprehensive survey of medicine use in children and adolescents in Austria, allowing comparison of prescription patterns to other European countries and assessing temporal trends in the future. Moreover, it serves as basis for planned measures to improve rational use of pediatric medicines. What is Known: • Large knowledge gaps exist for medicine use in children and adolescents concerning appropriate dosing, efficacy, and safety aspects. • Off-label medicine use is common in the treatment of children and adolescents. What is New: • We present a comprehensive survey of current prescription patterns for children and adolescents in Austria and define a hit list of pediatric medicines, as basis for developing an evidence-based information platform for health care professionals. • Anti-infectives, medicines for respiratory tract system, and pain medication are most frequently prescribed.

Lenalidomide and dexamethasone for acute light chain-induced renal failure: a phase II study.

We prospectively evaluated the activity and tolerance of lenalidomide-dexamethasone in 35 patients with acute light chain-induced renal failure. The lenalidomide dose was adapted to the estimated glomerular filtration rate and dexamethasone was given at high dose in cycle one and at low dose thereafter. Four patients died within the first two cycles, and five discontinued therapy leaving 26 patients for the per-protocol analysis. Responses were observed in 24/35 (68.6%) patients of the intent-to-treat population. Complete response was noted in seven patients (20%), very good partial response in three patients (8.6%), partial response in 14 patients (40%), and minimal response in one patient (2.9%). Renal response was observed in 16 (45.7%) patients: five (14.2%) achieved complete, four (11.4%) partial and seven (20%) minor renal responses. Five of 13 patients who were dialysis dependent at baseline became dialysis independent. The median time to myeloma and to renal response was 28 days for both parameters, while the median time to best myeloma and best renal response was 92 and 157 days, respectively. The median estimated glomerular filtration rate increased significantly in patients with partial response or better from 17.1 mL/min at baseline to 39.1 mL/min at best response (P=0.001). The median progression-free and overall survival was 5.5 and 21.8 months, respectively, in the intent-to-treat population and 12.1 and 31.4 months, respectively, in the per-protocol group. Infections, cardiotoxicity, anemia and thrombocytopenia were the most frequent toxicities. In conclusion, the lenalidomide-dexamethasone regimen achieved rapid and substantial myeloma and renal responses. The trial was registered under EUDRACT number 2008-006497-15.

Bendamustine-bortezomib-dexamethasone is an active and well-tolerated regimen in patients with relapsed or refractory multiple myeloma.

Bendamustine with bortezomib and dexamethasone was evaluated in 79 patients with relapsed/refractory multiple myeloma. Median age was 64 years, and patients had a median of 2 prior treatment lines (range, 1 to 6 lines). Bendamustine 70 mg/m(2) days 1 and 4; bortezomib 1.3 mg/m(2) intravenously days 1, 4, 8, and 11; and dexamethasone 20 mg days 1, 4, 8, and 11 once every 28 days was given for up to 8 cycles. Primary end point was overall response rate (ORR). Secondary end points were progression-free survival (PFS), overall survival, time to response, and toxicity. ORR was 60.8%, and when minor responses were included, 75.9%. Median time to response was 31 days. ORR rate was similar in patients previously exposed to bortezomib, lenalidomide, and bortezomib plus lenalidomide. PFS was 9.7 and OS was 25.6 months. Multivariate analysis showed high lactate dehydrogenase, ≥3 prior treatment lines, and low platelet counts correlating with short survival. Grade 3/4 thrombocytopenia was noted in 38%, and grade 3/4/5 infections were noted in 23%. Grade ≤2 polyneuropathy increased from 19% at baseline to 52% at cycle 8 and grade 4, from 0% to 7%. Bendamustine-bortezomib-dexamethasone is active and well tolerated in patients with relapsed/refractory myeloma. This trial was registered in the EudraCT database as No. 2008-006421-13.

Assignment of unknown persons to their geographical origin by determination of stable isotopes in hair samples.

Analysing the isotope ratio of light elements in human tissue of an unknown person helps to reconstruct the life history with regard to geographical origin and/or typical food supply. In this study the isotope ratios of the bio-elements in hair samples of 111 persons from 13 different countries all over the world were measured with the aim of provenance determination. The results indicated that individuals from Costa Rica and Brazil can be differentiated from typical European individuals by delta(13)C, Australians by delta(34)S and delta(2)H in hair samples. The combination and evaluation of the data by multivariate statistical analysis considerably improved origin assignment. Investigation of hair samples from a number of individuals from one particular region (southern Germany) yielded remarkable variation of isotopic values indicating different nutritional habits. The possibilities and limitations of this method in its current state are demonstrated and discussed.

Celiac dissection after blunt abdominal trauma complicated by acute hepatic failure: case report and review of literature.

Injuries of the abdominal visceral vessels are uncommon but devastating entities resulting in extremely high rates of mortality. The most common cause of abdominal vascular injuries is penetrating trauma, accounting for 90% to 95% of these injuries. In contrast, blunt trauma accounts for 5% to 10% of all abdominal vascular lesions. Although traumatic injury to the celiac artery is among the rarest of all vascular injuries, mortality can be as high as 75%. We report a 66-year-old patient who sustained multiple injuries in a motor vehicle crash. The initial whole-body computed tomography (CT) scan revealed a combination of severe brain injury and bilateral thoracic lesions. On day 6 after the accident, the patient's clinical situation deteriorated rapidly. At this time, the abdominal arterial CT scan showed a dissection of the celiac artery. Therapeutic anticoagulation was not feasible because of the intracranial hemorrhage. Also the patient's clinical situation worsened so rapidly that interventional therapy, including surgical and endovascular treatment, could not be performed. Finally, the patient died of fulminant hepatic failure, therefore not surviving a potentially treatable injury. The diagnosis of celiac artery dissection in this patient was significantly delayed because the initial trauma CT protocol did not include an arterial phase of the abdominal vessels.

Origin assignment of unidentified corpses by use of stable isotope ratios of light (bio-) and heavy (geo-) elements--a case report.

An unknown male body was found near an expressway in Germany. As different criminalistic and forensic methods (e.g. tooth status, fingerprint or DNA-analysis) could not help to identify the person, multielement stable isotope investigations were applied. The combined analysis of stable isotope ratios of light (H, C, N) and heavy elements (Pb, Sr) on the man's body tissues supported to assign him to Romania. The case report demonstrates an application of multielement-isotope analysis in the forensic fields and its potential.

Is the histomorphological concept of the female pelvic floor and its changes due to age and vaginal delivery correct?

AIMS: To compare the histomorphology of pelvic floor specimens of 94 female cadavers, ten male cadavers, and 24 female symptomatic patients who underwent pelvic floor surgery, and to evaluate the association of age, parity, and sex to myogenic and/or neurogenic changes to the levator ani muscle (LAM). METHODS: The pelvic floor was biopsied at the pubococcygeus, the iliococcygeus and the coccygeus muscle. After staining, signs for myogenic/neurogenic changes to the muscle were evaluated (fibrosis, variation in fiber diameter, centralization of nuclei, small angulated fibers, and type grouping). To identify the intact neuromuscular junction stainings with NCAM (neuronal cell adhesion molecule) and acetylcholinesterase (ACE) were used. RESULTS: A significant influence of age and parity on the histomorphological criteria of myogenic cell-damage was shown in this study. Although these criteria were found even in young nulliparous women, there was a significant increase in older or parous women with at least one vaginal delivery. We failed to demonstrate significant changes between the nulliparous LAM, the male LAM, and the LAM from women with prolapse and incontinence. None of the specimen showed any obvious evidence of neuropathy. CONCLUSIONS: We have evaluated histological criteria adapted from the examination of limb muscles in the LAM of nulliparous young women. "Myogenic changes" seem to be a normal finding in the LAM. The increase of these changes with aging and parity points to mechanical stress to the LAM as the most plausible causative factor. We propose that further studies using histomorphological techniques of the pelvic floor muscle in nulliparous and parous women should clarify the potential role of our histological findings.

T2 quantitation of human articular cartilage in a clinical setting at 1.5 T: implementation and testing of four multiecho pulse sequence designs for validity.

RATIONALE AND OBJECTIVES: Evaluation of the T2 relaxation time of articular cartilage holds great potential for quantitative assessment of internal changes of the cartilage matrix. The purpose of the present study was to assess the validity of multiecho-based cartilage T2 quantitation in a clinical MRI setting at 1.5 T. METHODS: Four multisection multiecho sequence variants dedicated for quantitative T2 mapping of human articular cartilage were implemented on a 1.5 T whole-body imager and tested for accuracy in CuSO4-agarose gel phantoms and human patellar cartilage. Sequence design was varied to minimize errors in T2 quantitation due to stimulated echoes. RESULTS: As compared with single spin-echo experiments, the apparent T2 values calculated from the multiecho sequence variants showed mean deviations ranging from +26% to -32% (phantoms) and from +42% to -18% (cartilage). The patellar cartilage T2 covered a range from about 25 milliseconds to 55 milliseconds, with longer T2 values observed in the more superficial layers. In cartilage, best results were obtained from the sequence design using improved section profiles and a spoiler gradient scheme for suppression of stimulated echoes. CONCLUSIONS: Our results revealed a clear dependence of apparent T2 relaxation times on the pulse sequence design, emphasizing that the "true" T2 is hard to find. In addition, the effect on the apparent T2 values resulting from the specific modification of any sequence variant varied according to the respective tissue's properties. Therefore, the acquisition technique in conjunction with the specific tissue on which T2 mapping is performed need to be reported in detail and should kept consistent to allow large-scale comparisons and monitoring of treatment strategies, e.g., in osteoarthritis.