High cadmium and mercury concentrations in the tissues of the orange-back flying squid, Sthenoteuthis pteropus, from the tropical Eastern Atlantic.

The orange-back flying squid, Sthenoteuthis pteropus, plays an important role in the eastern tropical Atlantic Ocean (ETA) pelagic food web, as both predator and prey. Specimens of S. pteropus were caught off the Cape Verde Islands and concentrations of Ag, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, V, and Zn were measured in the digestive gland. Among the analysed elements, Cd showed the highest average concentration with values among the highest ever recorded in cephalopods. In addition to the digestive gland, Hg concentrations were also analysed in the buccal mass and mantle tissue. Among the three tissues, buccal mass showed the highest Hg concentrations. In females, Hg concentrations in the buccal mass were positively correlated with stable isotope ratios (δ13C and δ15N) and mantle length, showing both bioaccumulation with age and bioamplification along the trophic levels. High Cd and Hg concentrations in the digestive gland and muscle respectively would lead to elevated exposure of squid-eating top predators such as yellowfin tuna, swordfish or dolphinfish, which are commercially harvested for human consumption. This study provides a deeper understanding of the trace element contamination in an abundant and ecologically important, but poorly studied pelagic squid in the ETA.

[Pharmacodynamic and pharmacokinetic characteristics of pain therapy in neonates: Austrian interdisciplinary recommendations on pediatric perioperative pain management]. / Pharmakodynamische und pharmakokinetische Besonderheiten der Schmerztherapie bei Neugeborenen : Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern.

The false assumption that neonates are less sensitive to pain than adults led to a long delay in the introduction of a reasonable pain therapy for children. Even if the basic principles of the development, transmission and perception of pain in premature infants and neonates are not completely understood, the results of studies have clearly shown that pain can be perceived from 22 weeks of gestation onwards. This knowledge results in the necessity to also administer an adequate pain therapy to premature and newly born infants. However, for the use of pharmaceuticals in neonates and infants the pharmacodynamic and pharmacokinetic characteristics must also be considered. The immaturity of the organs liver and kidneys limits the metabolism and also excretion processes. The different physical proportions also modify the dosing of pharmaceuticals. Children in the first year of life differ substantially from adults in physiology, pharmacodynamics and pharmacokinetics. The care of neonates and infants requires specialist knowledge which is described in this article.

[Austrian interdisciplinary recommendations on pediatric perioperative pain management: background, aims, methods and key messages]. / Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern : Hintergrund, Ziel, Methodik und Kernaussagen.

These recommendations were originally commissioned by the"Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin" (ÖGARI, Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine). Against this background, Austrian experts from the disciplines anesthesiology, pain management, pediatrics and the "Berufsverband Kinderkrankenpflege" (Professional Association of Pediatric Nursing) have with legal support developed evidence-based and consensus recommendations for the clinical practice. The recommendations include key messages which cover the most important recommendations for the individual topics. The complete recommendations on pediatric perioperative pain management consist of seven separate articles which each deal with special sub-topics with comments on and explanations of the key messages. The target groups of the recommendations are all medical personnel of the individual disciplines involved in the treatment of perioperative and posttraumatic pain for neonates, infants and children up to 18 years old.

Trophic ecology drives trace element concentrations in the Antarctic octopod community.

Despite the Antarctic Ocean being considered a pristine environment, elevated trace element concentrations have been reported in many marine organisms. The Antarctic Ocean is particularly vulnerable to climate change, which can also affect the bioaccumulation of trace element concentrations in biota. While Antarctic octopods are key components of the regional food webs as prey for a variety of predators (e.g., seals, fish, and seabirds), their contamination state by trace elements remains largely unknown. This study investigated the trace element concentrations in relation to the trophic ecology in Antarctic octopods. Stable isotope values (δ13C and δ15N) and trace element concentrations (Ag, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, V, and Zn) were measured in eight different species (Adelieledone polymorpha, Pareledone aequipapillae, P. albimaculata, P. aurata, P. charcoti, P. cornuta, P. felix, and P. turqueti) sampled near Elephant Island, close to the Antarctic Peninsula. Stable isotopes of δ15N varied among species, with significant differences between A. polymorpha and P. aurata suggesting potential niche segregation. Trace element concentrations also differed among species and with sampling depth, which likely reflects their trophic ecology. The data presented in this study provides the first insight into the trace element concentrations for these endemic octopods in this vulnerable habitat and their stable isotope values.

Trace element concentrations, including Cd and Hg, in long-finned pilot whales (Globicephala melas edwardii) mass stranded on the New Zealand coast.

The Southern Hemisphere long-finned pilot whale (Globicephala melas edwardii) is a top predator in the New Zealand pelagic food web, feeding predominantly on arrow squids. This study quantified trace element concentrations (Al, As, Cd, Co, Cr, Cu, Fe, Hg, Ni, Mn, Pb, Se, V, Zn) in four tissues (blubber, kidney, liver, muscle) from 21 individuals from stranding sites in New Zealand. Maximum Cd and Hg concentrations were measured in liver and kidney, respectively. Selenium had a positive correlation with Cd and Hg, suggesting the involvement of Se in Cd and Hg detoxification. Arrow squids from the whales' stomach contents were DNA barcoded and identified as Nototodarus sloanii. Trace element concentrations were measured in squid samples from the whale stomach contents. The significant correlation for Hg between the squid tissue and the whale tissue suggests that arrow squids play a major role in trace element uptake by G. m. edwardii.

Trace element analysis reveals bioaccumulation in the squid Gonatus fabricii from polar regions of the Atlantic Ocean.

The boreoatlantic gonate squid (Gonatus fabricii) represents important prey for top predators-such as marine mammals, seabirds and fish-and is also an efficient predator of crustaceans and fish. Gonatus fabricii is the most abundant cephalopod in the northern Atlantic and Arctic Ocean but the trace element accumulation of this ecologically important species is unknown. In this study, trace element concentrations (Ag, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, and Zn) were analysed from the mantle muscle and the digestive gland tissue of juveniles, adult females, and adult males that were captured south of Disko Island off West-Greenland. To assess the feeding habitat and trophic position of this species, stable isotopes of carbon (δ13C) and nitrogen (δ15N) were measured in their muscle tissue. Mercury concentrations were positively correlated with size (mantle length) and trophic position. The Hg/Se ratio was assessed because Se has been suggested to play a protective role against Hg toxicity and showed a molar surplus of Se relative to Hg. Cadmium concentrations in the digestive gland were negatively correlated with size and trophic position (δ15N), which suggested a dietary shift from Cd-rich crustaceans towards Cd-poor fish during ontogeny. This study provides trace element concentration data for G. fabricii from Greenlandic waters, which represents baseline data for a northern cephalopod species. Within West-Greenland waters, G. fabricii appears to be an important vector for the transfer of Cd in the Arctic pelagic food web.

Influence of sexual dimorphism on stable isotopes and trace element concentrations in the greater hooked squid Moroteuthopsis ingens from New Zealand waters.

The Chatham Rise, one of the highest offshore-primary production regions in New Zealand waters, hosts a great abundance and diversity of deep-sea cephalopods including the greater hooked squid, Moroteuthopsis ingens. Stable isotope ratios of carbon (δ13C) and nitrogen (δ15N) and trace element concentrations (Ag, As, Cd, Co, Cr, Cu, Fe, Hg, Ni, Pb, Se, V, and Zn) were assessed in female and male specimens of different size classes (89-563 mm mantle length). Values of δ13C and δ15N were overall higher in females and δ13C was further influenced by size and sex. Both muscular mantle (the largest fraction of the total body mass) and digestive gland (the known main storage organ for Ag, Cd, Cu and Zn in many cephalopods) tissues were analysed. Higher levels of Cd were observed in males than in females. A positive effect was found between size and Hg concentrations, which could be related to the ontogenetic descent of larger specimens into deeper waters, where they are exposed to higher Hg concentrations, and/or dietary shifts toward Hg-enriched prey with increasing size. This study provides trace element data for this abundant and ecologically important species, and further reveals higher trace element concentrations (especially Hg) in M. ingens from the Chatham Rise, compared to specimens from the sub-Antarctic zone.

Regional assessment of trace element concentrations in arrow squids (Nototodarus gouldi, N. sloanii) from New Zealand waters: Bioaccessibility and impact on food web and human consumers.

The New Zealand arrow squids, Nototodarus gouldi and N. sloanii, play an important role in the marine food web, and are both economically important fishery species. This study compares trace element concentrations (As, Cd, Co, Cr, Cu, Fe, Hg, Ni, Mn, Pb, U, and Zn) in these animals from different fishing locations within New Zealand's Exclusive Economic Zone (Auckland Islands, Chatham Rise, Dunedin, Golden Bay, Taranaki, and West Coast of the South Island). Muscular mantle (the tissue usually consumed by humans) and digestive gland tissue (the primary organ for trace element accumulation) concentrations were compared among regions, revealing size, species, and sampling location effects. Overall, N. gouldi had higher concentrations of As and Zn. The Taranaki region had the highest concentrations for Cd, Co, Cu, and Zn in both tissues analysed. To assess the bioaccessibility of these trace elements to humans, an in-vitro digestion simulation experiment was conducted, revealing bioavailable concentrations overall below the maximum levels presently considered tolerable for human consumption. However, the in-vitro digestion had no observable effect upon Cd concentrations in arrow squid mantle tissue (implying that the measured concentrations are bioaccessible to humans), and revealed that Cd had the highest potential impact on marine food webs and human health. Digestive gland concentrations in particular indicate that arrow squids can be considered important vectors for trace element transfer to top predators (mean concentration for Cd: 123 ± 148 µg g-1 dw), with region-specific differences.

Factor V Leiden and prothrombin gene G 20210 A variant in children with ischemic stroke.

OBJECTIVE: To investigate if the factor V Leiden mutation (F-V-LM) and/or the prothrombin gene G 20210 A variant (P-G20210A-V) are risk factors for acute stroke in Austrian children. PATIENTS: 33 children with acute ischemic stroke documented by computer tomography and/or magnetic resonance imaging of the brain were enrolled in an open multicenter survey. RESULTS: 6/33 children had F-V-LM (5 heterozygous, 1 homozygous). This represents 18% (95% CI: 6.7-39.9%) of our pediatric stroke population and thus exceeds the expected prevalence in the Austrian population of 4,6% (Fischer's exact test, p = 0.01). F-V-LM was not found in 11 children with neonatal stroke but in 6/22 children with stroke after the neonatal period. 5/6 children with F-V-LM had an underlying disorder that is a risk factor for stroke in children. The P-G20210A-V was detected in 1/26 (3.85%; 95% CI: 0.1-21.4%) patients. Comparison of the prevalence of P-G20210A-V in our study with that in the general population of Austria of 1% revealed no statistical significance (Fischer's exact test, p = 0.38). CONCLUSION: Our data suggest that the F-V-LM is a risk factor for acute stroke in Austrian children beyond the neonatal period. The P-G20210A-V apparently does not represent a risk factor for stroke in Austrian children.

Psychogenic relapses in childhood epilepsy in puberty and adolescence.

Epileptic patients who, after years of being free from symptoms, have relapses during puberty or adolescence (some-times coinciding with a reduction in therapy) pose special therapeutic and diagnostic problems. Because of pubertal lability, the cause of a relapse might seem to be "organic", especially if the EEG also shows a "deterioration", yet psychogenic factors must not be disregarded. On the basis of typical case studies, a characteristic constellation is presented. The achievement of a "well-behaved" child at first dramatically improves and this correlates with the success of antiepileptic therapy. Then individuation and further development cannot adequately take place because the family unit is not functioning properly. At a critical stage of development, the excessive expectations of the parents lead to too much stress on the child, thus destroying the balance within the family system, which has hitherto been maintained only with difficulty. Attempts to improve the situation by changing the medication (increasing the dose or switching to another drug) fail. If, however, it is realized that the symptoms are of psychogenic origin, adequate therapeutic interventions (e.g. adequate schooling or professional training as well as psychotherapy) promise good results.

Determination of glucitollysine for the quantitation of non-enzymatic glucosylation by ion exchange chromatography and reverse phase liquid chromatography.

A specific and sensitive method for the quantitative determination of the stable, reduced glucose-lysine adduct, glucitollysine (GL), in plasma protein samples is described. The method uses standard amino acid ion exchange chromatography followed by reverse phase high performance liquid chromatography after derivatisation of GL to a fluorescent product. Moreover, GL was characterised and identified in plasma samples by means of mass spectroscopy. GL measured in plasma samples of eleven type I diabetics and two healthy controls showed a significant linear correlation to concomitantly determined haemoglobin AI and glucosylated plasma proteins, but did not correlate with plasma glucose levels. This method allows the estimation of non-enzymatic glucosylation in biological samples with a high degree of specificity and sensitivity down to the low nanogram range.

Quantitative EEG in young diabetics.

The aim of this study was to investigate the influence of metabolic control on quantitative electroencephalographic (EEG) abnormalities in young diabetic patients. We compared quantitative EEGs of 44 insulin-dependent diabetic patients with age-matched controls. Furthermore, differences in EEG variables of diabetic patients and controls were correlated with the age of onset and duration of diabetes, hemoglobin A1c concentrations, and episodes with severe hypoglycemia. We found a correlation between high values of hemoglobin A1c and decreased relative power of the alpha band. Patients with previous ketoacidotic episodes had increased relative power of the delta/theta band and decreased relative power of the alpha band. Patients with hemoglobin A1c values less than 8.5% exhibited slowing of background activity compared with normal controls. We conclude that metabolic control influences the EEG and that improvement of glucose metabolism is an important factor in avoiding EEG abnormalities in young diabetic patients.

Carbamazepine and benzodiazepines in combination--a possibility to improve the efficacy of treatment of patients with 'intractable' infantile spasms?

Therapeutical efforts in epilepsies with infantile spasms (IS) often show unsatisfying results, especially if neurological impairments are found. In a clearly negatively selected group of 24 children with IS and 10 patients with symptomatic myoclonic-astatic epilepsies--pretreated without success with ACTH and/or benzodiazepines (BDZ) alone or combined with other anticonvulsants--we tried a two-drug therapy of BDZ with carbamazepine (CBZ). Dosage of both drugs was within the usual range. In a follow-up period of 1-5 years, 8 of the IS patients and 4 of those with myoclonic-astatic seizures became seizure-free; furthermore, 6 children showed a marked reduction in their seizure frequency: 3 more than 80%, 3 more than 50%. Besides the fact that the patients did not develop a so-called escape-phenomenon--as often seen in therapy with benzodiazepines--they also showed fewer and less intensive side-effects. Without optioning for antiepileptic polytherapy in general, we conclude that in cases of "intractable" IS the combination of BDZ with CBZ might be more successful than the single drug. To confirm these preliminary findings further controlled studies have to be carried out.

Topographical EEG analysis of rolandic spikes.

We performed topographic EEG investigation with instant voltage mapping in 57 patients with a Rolandic spike focus including 35 patients with benign Rolandic epilepsy. A pronounced maximal negativity of "Rolandic" spikes could be demonstrated over central or mid-temporal electrodes, with a spread to parietal or upper frontal areas with a dipole formation (centrotemporal negativity, frontal positivity) and involvement of midline. There was a moderate correlation between spike amplitude or duration with spread to adjacent areas. No other focal abnormalities such as focal slowing could be revealed by visual or FFT EEG analysis. During light sleep spike activity was pronounced and often associated with generalized spike wave activity. Thus, a functional disturbance rather than a structural lesion can be assumed.

Recent evaluation of prognostic risk factors in esophageal atresia--a multicenter review of 223 cases.

In this study, 223 cases of esophageal atresia (Type IIIb: 85.7%; Type II: 5.8%; Type IIIc: 4.0%; Type IIIa: 2.2%; Type IV: 2.2%) from 6 pediatric surgery centers of Austria, were retrospectively examined for the following parameters and their influence on the prognosis: Birth weight (2494.7 +/- 702.0 g), gestation week (range 27-42 weeks; mean 37.3 +/- 3.1 weeks), sex (male: n = 128; female: n = 95), long-gap atresia (> or = 2 cm: n = 33), Tracheomalacia (n = 16), associated malformations (n = 122; cardiac 27.4%, renal 17.9%, skeletal 17.0%, anal: 10.3%, intestinal 9.9%, mediastinal 7.6%, chromosomal 2.2%), preoperative aspiration (n = 92), pneumonia (n = 96), anastomotic insufficiency (n = 45), empyema (n = 5), mediastinitis (n = 8), sepsis (n = 32), other medical complications (n = 122, in 80 infants), other surgical complications (n = 57). The mortality rate was 41.3% overall, from 1975 to 1991; however, it was 25% from 1987 to 1991 and 0% in 1991. A statistically significant correlation was found between prognosis and the following factors: Cardiac malformations (p = 0.0001), medical complications except aspiration and pneumonia (p = 0.0001), empyema (p = 0.0081), mediastinitis (p = 0.0214), and sepsis (p = 0.0295). These 5 significant factors were given different points and a prognostic score was calculated by the addition of these points. This score was predictive for survival in 90.6% of cases and for mortality in 94% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Benign Rolandic epilepsy in children. Topographic EEG analysis]. / Benigne Rolandische Epilepsie im Kindesalter. Topographische EEG-Analyse.

Topographic EEG investigation with instant voltage mapping showed maximal negativity of "Rolandic" spikes over central or midtemporal electrodes with spread to parietal or upper frontal areas with a dipol formation (centro-temporal negativity, frontal positivity). Spike amplitude or duration was not correlated with spread to adjacent areas. No other focal abnormalities, such as focal slowing, occurred. Spike activity was pronounced during light sleep and was often associated with generalized spike wave activity, which is more likely to be a sign of functional disturbance rather than the sequelae of brain damage. A review of literature shows that this pattern is helpful in the differentiation from focal abnormalities due to brain lesions.

[Neuroimmunologic parameters in therapy refractory epilepsy in children]. / Neuroimmunologische Parameter bei therapieresistenter Epilepsie im Kindesalter.

In a prospective study comprising 48 children (21 boys, 27 girls, age 12 months to 15 years) the hypothesis was tested whether an alteration in the light chain immunoglobulins kappa (kappa) and lambda (lambda) is an expression of autoimmune mechanisms and could be used as a diagnostic parameter. Immunoglobulins were analysed by kinetic nephelometry. The patients were grouped according to clinical and laboratory parameters. A high kappa/lambda ratio caused by high concentration of the kappa chain was found in children with therapy-resistant epilepsy. 60% showed a high kappa/lambda ratio, no distinct association was ascertainable in 26% cases and in 14% of the cases false positive results were obtained. In seizure-free children immunological markers were specific in 72% of cases, whilst 24% could not be characterized and 4% showed false positive results. The kappa/lambda ratio, therefore, is a good diagnostic aid in the treatment of therapy-resistant epilepsies.

[Can muscle relaxation prevent the development of pneumothorax in artificially ventilated newborn infants?]. / Kann Muskelrelaxation das Entstehen eines Pneumothorax bei beatmeten Neugeborenen verhindern?

A retrospective study was conducted on 37 ventilated newborn infants to find out whether muscle paralysis by pancuronium had prevented pneumothorax (pt) in those severely ill newborn infants. In the group of 21 newborns who developed pt, 17 (81%) had been paralyzed with pancuronium. In the group of 16 newborns without pt, 10 (61%) had received pancuronium (chi 2 = 1,568, ns). Thus, muscular paralysis had not prevented pt. Since the newborns in both groups were equally severely ill (mean compliance of the respiratory system 0.48 +/- 0.17 ml/cm H20 in the group with pt, 0.38 +/- 0.12 in the group without pt), we assume that pancuronium was unable to prevent pt in ventilated premature and full-term newborn infants. We therefore caution against the use of pancuronium as a paralytic drug known to have deleterious side effects.

[Computerized tomography in epilepsy in children]. / Computertomographie bei Epilepsien im Kindesalter.

We present a retrospective study of 160 children attending our epilepsy out-patient department. Computed tomography (CT) was performed on 123 (77%) patients, namely all children with the exception of those with febrile seizures, typical absence seizures, and benign Rolandic epilepsy. Incidence of CT abnormalities and their correlation with clinical features were evaluated. The CT scan was normal in 84 and abnormal in 39 patients. Although in general, the detection of abnormality on CT will not alter the management of the child, in a small percentage (2%) of our cases a lesion treatable by surgery was discovered. The indications for CT are summarized.

[Psychosocial dwarfism--a rare form of growth disorder]. / Psychosozialer Minderwuchs--eine seltene Form der Wachstumsstörung.

Psychosocial dwarfism is a syndrome caused by emotional deprivation (maternal deprivation), characterized by symptoms of delayed motor and intellectual development, abnormal eating and drinking habits, enuresis and encopresis, aggressiveness and a pathological family structure. Diagnosis of psychosocial dwarfism is easy if the case history is carefully elicited and the growth hormone level is determined within the first few days following change in environment (e.g. hospitalization). Difficulty in reaching the correct diagnosis or misdiagnosis can occur if the symptomatology is not studied in its entirety. Diagnosis at the earliest possible stage is very important for the further development of the child, since behavioural disturbances and growth retardation are reversible with environmental change. This is demonstrated by the presentation of the case history of a 6 year-old boy--the third case reported in the German literature.