Health-related quality of life in paediatric patients with congenital heart defects: association with the type of heart defect and the surgical technique.

The aim of the study was to investigate the impact of a number of surgical interventions for a various congenital cardiac defects (CHDs) on self-reported HRQoL. METHODS: Patients who had received corrective surgery of several congenital heart defects (surgical VSD closure, Fallot, TGA after atrial or arterial switch or Fontan-type circulation for univentricular AV-connection) were interviewed in the office of their home peadiatric cardiologist. HRQoL in children along 7 dimensions was assessed using a standardised questionnaire (PEDQoL); information on the medical case history of each respondent was also collected. STATISTICS: HRQoL was assessed in the questionnaire by asking about the frequency (never, rarely, often, always) of specific negative experiences; more frequent experiences indicate a lower quality of life. Frequency expressions were transformed into numerical values (25, 50, 75, 100%), and mean values for HRQoL were calculated for each patient and for each domain. Differences in HRQoL among patients with different types of interventions were analysed using the Mann-Whitney Test or the Kruskal-Wallis Test as appropriate; p values <0.05 were considered to indicate significant differences, while p values <0.1 were considered to indicate notable trends. RESULTS: Patients: 169 patients (60% male, 40% female) were part of the study. The mean age was 11.6 years; 50 patients had surgical VSD closure, 52 surgeries for Tetralogy of Fallot (22 transannular patch, 18 no transannular patch, 12 inaccurate description), 40 had complete transposition of the great arteries (28 atrial switch, 12 arterial switch), 22 had a Fontan-type procedure for univentricular AV-connection. HRQoL differed little among patients with different CHDs for the items "relation to friends," "interactions in the affected families", and "own body image". For other items, notable differences emerged: patients with univentricular hearts rated their physical capacity worse and showed a tendency towards negative ratings in other domains. On the other hand, patients after Fallot or TGA correction tended to rate their HRQoL in several domains as relatively high. Focusing on the mode of surgery for Fallot repair, respectively, TGA correction the only significant difference was found for "physical capacity" in TGA (atrial vs. arterial repair). Mustard patients tended to rate most items worse. Physical capacity was rated worst by patients with a Fontan circulation. Repeated surgery led to lower ratings for all domains except "physical capacity" and "body image". CONCLUSIONS: Different surgical techniques for CHD do not affect children's and adolescents' self-reported HRQoL to the extent that one would expect. This observation is in line with observations in groups of children with different chronic diseases. Specialised psychosocial support is necessary in order to maintain this positive self-evaluation and to ensure patients are able to lead autonomous personal and professional lives.

Positive or negative fructose breath test results do not predict response to fructose restricted diet in children with recurrent abdominal pain: results from a prospective randomized trial.

OBJECTIVES: To perform a prospective, blinded, randomized interventional trial in patients with recurrent abdominal pain. The primary endpoint was to determine the abdominal pain intensity after 2 weeks of fructose restricted diet. Secondary endpoints were changes of pain frequency and a secondary symptom score (SSS). METHODS: 103 individuals with recurrent abdominal pain for more than 3 months were randomized. 51 patients were allocated to group A (diet) and 52 to group B (no diet). 2 weeks later the patients underwent hydrogen breath test and were assigned to the test positive or negative group to identify patients with fructose malabsorption. RESULTS: 2 weeks after intervention the pain score decreased significantly from a median 5.5 in group A to 4 and did not change significantly in group B (5.3 to 5). In group A both patients with positive and negative breath tests had a significant lower pain score (-2 and -1.75, respectively). Frequency of abdominal pain decreased in both groups but without significant difference, SSS improved only in group A from median 6 to 3.5. Positive breath test was no predicting factor, neither was abdominal pain during the test. CONCLUSIONS: Fructose restricted diet in children and adolescents with recurrent abdominal pain may be of benefit to improve both abdominal pain symptoms and other secondary symptoms. Since a negative breath test result does not exclude a positive response to fructose restriction, the hydrogen breath test does not seem to be the appropriate diagnostic mean to predict the response to the diet.

Role of surgical staging and adjuvant treatment in uterine serous carcinoma.

PURPOSE OF INVESTIGATION: This study evaluates the association of clinical and pathologic characteristics of patients with uterine serous carcinoma (USC) with disease recurrence. MATERIALS AND METHODS: Surgically-staged patients with USC at a single institution were identified and clinical and pathologic variables were compared. RESULTS: Of the 51 patients included in this analysis, 75% percent received adjuvant chemotherapy, 51% received radiation therapy, and 47% received both. After a median follow-up of 33 months, 42% of patients had disease recurrence. On multivariable analysis, positive pelvic lymph nodes were associated with a shorter interval between surgery and recurrence: 13.6 months progression-free survival (PFS) with positive vs 17.2 months with negative lymph nodes (p = 0.05). Patients with early-stage disease who did not receive any adjuvant treatments had a significantly greater risk of disease recurrence (44.4% vs 7.70%, p = 0.043). CONCLUSION: In this population of surgically-staged patients with USC, pelvic lymph node metastases were predictive of a shorter PFS.

[Current shortcomings in the treatment of cryptorchidism - analysis performed by a paediatrician]. / Aktuelle Defizite in der Therapie des Maldeszensus testis - Analyse eines Pädiaters.

Cryptorchidism is the most common disorder in paediatric surgery in the Western world and a major risk factor for subfertility and malignancy. In 2009, German national guidelines were changed to recommend that treatment for undescended testes should be completed by the age of 1 instead of 2. However, the share of boys undergoing orchidopexy for cryptorchidism within the first year of life has only marginally increased in response to the guideline of the Association of the Scientific Medical Societies in Germany (AWMF). The number of orchidopexies performed in children below the age of 1 is too low both in Germany as well as internationally. The majority of primary care physicians treating children do not seem to be aware of this discrepancy between guideline recommendations and average actual age at orchidopexy. Moreover, a considerable number of cryptorchidism cases seem to be due to secondary ascent of the testis - an underappreciated condition that usually occurs at school age. Consequently, the timing of orchidopexy in primary undescended testes must be optimised. Therefore, education of parents and primary care physicians regarding the necessity of early orchidopexy and frequent testicular examinations even beyond infancy is mandatory to improve the prognosis of cryptorchidism regarding subfertility and malignancy. Further studies are needed to clarify the reasons for the large number of late orchidopexies.

[Experimental studies on the effect of long-term oestrogens on contrast excretion during intravenous urography (author's transl)]. / Tierexperimentelle Studie zur Wirkung der Ostrogen-Langzeitapplikation auf die Kontrastmittelausscheidung im intravenösen Urogramm.

The possible connection between long continued oestrogen intake and dilatation of the upper urinary tract was examined urographically in nine female rabbits. The degree of dilatation was judged on eleven parameters. The results of the study indicate that oestrogens without simultaneous mechanical influence on the urinary tract does not lead to dilatation of the pelvis or ureter. The results are illustrated graphically and are compared with the findings in the literature.

Squamous cell carcinoma in chronic ulcerative lesions: a case report and literature review.

A case report and literature review are presented involving a fatal case of squamous cell carcinoma of the lower extremity. The unique aspects of this patient include the young age at presentation (35 years old), and the association with both a burn scar (Marjolin's) ulcer and a draining osteomyelitis fistulus tract. Epidemiologic data for Marjolin's ulcers as well as squamous cell carcinoma associated with draining sinus tracts of osteomyelitis are reviewed, in addition to the recommended management of such patients. The case presented is a reminder of the need to maintain a high index of suspicion for malignant transformation within ulcerative lesions.

[Influence of anthraquinones on the formation of urinary calculi in experimental animals (author's transl)]. / Einfluss von Anthrachinonderivaten auf die tierexperimentelle Harnsteinbildung

The growth-inhibiting influence of hydroxy-anthraquinone derivatives of root of rubia in various calcium offerings was investigated using a foreign-body bladder calculus model in rabbits. Following oral doses of glycoside-bound and free aglycemics a pronounced calcium-complex binding effect and a significant reduction in the growth rate of the calculi was observed. Use of anthraquinone glycosides to prevent recurrence of calcium-containing urinary stones is recommended.

Intraobserver and interobserver reproducibility for radial, circumferential and longitudinal strain echocardiography.

OBJECTIVES: Strain echocardiography (StE) promises to be a new tool for quantitative assessment of cardiac function. Analysis of intra- and interobserver reliability is an important aspect in the process of developing these novel techniques from theory to the implementation into daily routine diagnostics.The purpose of the study was to estimate reliability of the segmental StE. METHODS: Left ventricular strain analysis for radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was performed in 21 healthy volunteers. RS and CS values were obtained in the parasternal short axis at the level of the papillary muscles. LS values were determined in the apical 2-, 3- and 4-chamber views. Cine-loops were recorded and quantitative analyses were conducted on an off-line workstation. RESULTS: Intraobserver reproducibility was highest using LS in the 4-chamber view (9 ± 13.6 % mean deviation, rho = 0.624, p = 0.003), followed by CS (13.3 ± 8.3 %, rho = 0.406, p = 0.068) and lowest in RS (26.3 ± 30.1 %, rho = 0.391, p = 0.080). Interobserver analyses of LS derived from 3-chamber view showed lowest deviation (11.9 ± 9.5 %, rho = 0.513, p = 0.017), followed by CS (15.2 ± 12.0 %, 0.263, p = 0.249) and the least consistent measurements in RS (35.9 ± 46.3 %, rho 0.382, p = 0.088). CONCLUSION: This study shows that the clinical utility of StE depends on the regional differences of LV wall motion and image quality. LS-values showed promising intra- and interobserver reproducibility values. For quantitative follow-up studies LS should be preferred.

S100A12 and hBD2 correlate with the composition of the fecal microflora in ELBW infants and expansion of E. coli is associated with NEC.

OBJECTIVE: To describe the development of the gut microbiota in extremely low birth weight (ELBW) infants with and without necrotizing enterocolitis (NEC) between April 2008 and December 2009, fecal microflora was prospectively analyzed in fecal samples of all ELBW infants using real-time PCR assays. In addition, fecal inflammatory were measured. RESULTS: Fecal microflora established early in ELBW infants and microbiota composition remained stable over the first 28 days of life except for the prevalence of C. difficile which decreased with decreasing antibiotic use. Infants who subsequently developed NEC had an increase of total bacterial count (9.8-fold) 24 h prior to clinical symptoms mainly due to the expansion of E. coli species (21.6-fold), whereas microbiota composition did not differ from healthy ELBW infants five days before onset of NEC. Importantly, S100A12 and hBD2 positively correlated with the total and E. coli bacterial CFU/g feces (r (2) 0.4 and 0.64, resp.). CONCLUSIONS: In summary, we found evidence for a disturbed homeostasis between the intestinal microbiome and host immunity in ELBW infants with NEC. Moreover, S100A12 and hBD2 correlate with the fecal microbiota thus linking the intestinal innate immune response to the bacterial colonization thus possibly providing a diagnostic tool in the future.

[Registration of intraoperative 3D ultrasound with preoperative MRI data for computer-assisted orthopaedic surgery]. / Registrierung von intraoperativem 3D-Ultraschall mit präoperativen MRT-Daten für die computergestützte orthopädische Chirurgie.

AIM: The trend towards minimally invasive surgery leads to an increasing demand for methods enhancing in situ spatial orientation. Hence, navigation systems are being more and more used for many operations. At the beginning of a navigated surgery the coordinate systems of the patient need to be registered with the navigation system. Our registration method is based on intraoperative freehand ultrasound imaging and overcomes some problems related to landmark-based registration, such as invasiveness, inaccuracy and the time-consumption of the process. After a successful registration, the operation can be conducted safely with the aid of the navigation system which provides enhanced spatial orientation on high-quality preoperative image data (e.g., MRI, CT). Soft tissue is depicted especially well in MRI data. Since imaging of soft tissue close to the joints is of high diagnostic importance, MRI scans are often part of the preoperative routine. These data can also be utilised by a navigation system. In this article we present our first results on the registration of 3D ultrasound and MRI data of the knee. METHODS: 3D ultrasound and T (1)/T (2)-weighted MRI data were acquired from the distal femur and the proximal tibia. The ultrasound volume data were pre-processed to enhance the contrast of bone and surrounding tissue. A dataset combined from T (1)- and T (2)-weighted MRI images was also created. Points of the bone surface corresponding optimally to the bone surface demonstrated in the ultrasound images were extracted from the MRI volume data. For the surface extraction of the femur the T (1)-weighted image data were used, and for the tibia the combined MRI dataset was used. Based on the extracted bone surface, MRI and ultrasound volume data were registered with a surface-volume registration algorithm. RESULTS: Registrations of ultrasound data of both the femur and the tibia were successful. Bone and cartilage was depicted well in the ultrasound data and visual inspection showed the accurate overlay of bone structures in MRI and ultrasound volumes. CONCLUSION: We have demonstrated the feasibility of registering bone structures based on 3D-ultrasound and MRI data. Our method allows for minimally invasive routine surgery of orthopaedic diseases which so far had to be operated conventionally because other methods for navigated surgery are too expensive, inaccurate or time-consuming.

[Filling therapy with special reference to experimental studies on model-cast inlays]. / Zur Füllungstherapie unter Berücksichtigung experimenteller Untersuchungen am Modellgussinlay

By way of introduction, the authors report the results from clinical and radiographic examination of teeth with inlays restorations. In view of further corroboration of the clinical results with modelcast inlays, the authors measured the marginal adaptation of inlays made of Goplat 203 and Sena 65, respectively. The difference in the average marginal adaptation between Goplat 203 and Sena 65 is insignificant, amounting to 3.6 mum in favour of the gold alloy, which permits to recommend Sena as a casting alloy for posterior teeth.

[Effect of nutrition on composition of calculi in the animal experiment. III. Cation exchangers, anthraquinones, diphosphates, methylene blue]. / Einfluss der Nahrung auf die Zusammensetzung von Fremdkörpersteinen im Tierexperiment. III. Kationenaustauscher, Anthrachinone, Diphosphate, Methylenblau.

Medicamenty and compounds used in the metaphylaxis of urinary calculi were tested on an animal model for objectifying the effect. Kation changers, anthrachinones, diphosphates, and methylene blue were used.

Interleukin-8 in urine: a new diagnostic parameter for intra-amniotic infection after premature rupture of the membranes.

Interleukin-8 (IL-8), a 72 amino acid peptide secreted by cells of the immune system and of the amnion, chorion and decidua, was measured in women in late pregnancy. IL-8 was detected in the urine of 91 of 104 women with premature rupture of the fetal membranes, with values exceeding 1000 ng/L in cases of severe intra-amniotic infection. Women with urinary tract infections were excluded. The routine measurement of IL-8 in urine, together with C-reactive protein in serum, thus provides a low risk and technically simple approach to the assessment of intra-amniotic infection.