Combination therapy of omega-3 fatty acids and acipimox for children with hypertriglyceridemia and acute lymphoblastic leukemia.

BACKGROUND: Lipemic alterations are commonly seen in pediatric patients with acute lymphoblastic leukemia (ALL) treated with corticosteroids and L-asparaginase. OBJECTIVE: In these children, hypertriglyceridemia rarely causes symptoms and mostly responds well to a low-fat diet. Only few patients demand further therapy, which is not clearly approved in the literature to date. Therefore, it may be important to compile generally accepted standard procedures for lipid-lowering therapy in the pediatric ALL population. METHODS: We performed a study on 119 newly diagnosed pediatric patients with ALL, all treated according to the ALL-BFM 2000 protocol at our institution between the years 2000 and 2009, to evaluate the incidence of hypertriglyceridemia and the efficacy of a combination therapy with omega-3 fatty acids and acipimox in hypertriglyceridemic patients who did not respond to diet. RESULTS: We observed hypertriglyceridemia in 34.5% of patients in this collective. In the majority, normalization of triglycerides was successfully managed by administration of a low-fat diet. However, 7.6% of patients (related to total study population) with hypertriglyceridemia did not show diminished lipid levels during diet and/or presented with symptoms such as abdominal pain, dyspnea, or anginal chest pain. In these cases, we performed a lipid-lowering combination therapy with omega-3 fatty acids and acipimox. We observed a prompt decline of serum triglycerides to normal values and an improvement of symptoms within days after onset of this therapy without occurrence of any side effects. CONCLUSION: In summary, the combination treatment with omega-3 fatty acids and acipimox could represent an alternative to other reported lipid-lowering therapies without severe adverse reactions.

[Terminology in the context of anesthesia for preterm and term newborns and infants]. / Terminologie bei der Anästhesie von frühgeborenen und reifen Neugeborenen.

An acceptable, standardized and mandatory terminology is important for the planning and implementation of anesthetic procedures on term and preterm newborns and infants. Contradictory use of perinatal terminology poses a problem in current medical practice. This article provides an overview of conventional definitions and technical terms. It also puts forward terminological principles for a model of risk stratification of anesthesia in the newborn period and infancy.

Correlation between cardiac tissue Doppler and peripheral vascular Doppler in the anemic fetus - an additional method to determine the transfusion threshold?

PURPOSE: To examine the relationship between cardiac tissue Doppler and peripheral vascular Doppler measurements in fetal anemia. MATERIALS AND METHODS: We analyzed high frame rate cardiac Tissue Doppler Imaging (TDI) data files of 26 anemic fetuses. The peak systolic tissue velocity (PSV), peak systolic displacement (PD), and peak systolic strain (PS) were determined in the mid-segment of the ventricular walls (ROI 1 right ventricle (RV), ROI 2 left ventricle (LV)) and in the basal segment of the ventricular walls (ROI 3 tricuspid annulus, ROI 4 mitral annulus). TDI parameters were correlated with established fetal vascular Doppler parameters (peak systolic blood flow velocity (Vmax) in the middle cerebral artery (MCA), pulsatility index (PI) in the MCA, in the umbilical artery (UA), and in the venous duct (DV)). RESULTS: The PSV in the LV correlated significantly negatively with the PI in the MCA. Both the PSV and PD in the LV correlated significantly negatively with the PI in the UA. The PS in the RV correlated significantly negatively with the PI in the UA. The left ventricular PSV and PD correlated significantly positively with the PI in the DV. The Vmax in the MCA did not correlate with any systolic myocardial TDI parameter. CONCLUSION: In fetal anemia, peak systolic myocardial TDI parameters correlate with vascular Doppler parameters, confirming that TDI is a promising method to evaluate myocardial function in the anemic fetus. This suggests combining both techniques to quantify fetal myocardial function in anemia even more accurately, possibly allowing for the determination of the indication for intrauterine transfusion.

[Odontogenic tumors in childhood - case report and review of literature]. / Odontogene Tumoren im Kindesalter - Fallbeschreibung und Literaturübersicht.

BACKGROUND: Odontogenic tumors are a heterogenic group of neoplasias of the oral cavity, whose biological behaviour reaches from true hamartomas to highly malignant tumors. PATIENT: We describe the case of a 4 year old caucasian girl presenting with eruption disturbance of a primary tooth and corresponding maxillary tumor. After surgical removal of the mass, histological examination classified the tumor as ameloblastic fibroodontoma. This very rare neoplasm is of odontogenic origin. DISCUSSION: Following our case report, the variety of odontogenic tumors regarding tumor biology, clinical symptoms and therapeutic options in childhood are discussed. CONCLUSION: In case of complaints or clinical symptoms paediatricians should take the possibility of such neoplasias into consideration.

Scanning electron microscopy study including maceration techniques of an absorbable alloplastic implant designed for the reconstruction of ventral abdominal wall defects.

The interposition of synthetic material represents the most generally acknowledged method for achieving a tension-free surgical repair of major abdominal wall defects. As permanent materials are frequently associated with severe complications (rejection, peritonitis, enterocutaneous fistula, erosive invasion into the intestine), a newly designed absorbable prosthetic (polydioxanone, PDS) has been developed. The ellipsoid implant is composed of a knitted envelope and a filling of loosely arranged filaments. Interpositioning of the implant into an artificial circular abdominal wall defect was carried out on 30 Wistar rats. Explantation was performed 21 days post implantationem (p.i.), 42 days p.i. and 180 days p.i. The aim of the study was to evaluate the use of scanning electron microscopy (SEM) combined with maceration techniques (2 N NaOH for 1, 3 and 5 days) for a spatial assessment of the interactions between the implanted material and the ingrowing tissue components. Application of 2 N NaOH caused the complete dissolution of the PDS-material and a concomitant gradual disappearance of cellular and amorphous tissue components, thereby unmasking the remaining collageneous network. SEM of non-macerated specimens demonstrated that 21 days p.i. the entire implant has been filled with connective tissue components. Additionally, the ventral and dorsal surfaces of the implant were covered by a collageneous layer (neo-fascia). 21 days p.i. the PDS-filaments had developed minor clefts, which increased in number and depth 42 days p.i., and were transformed into small remnants 180 days p.i. Alkali treatment revealed the three-dimensional arrangement of collagen fibers, which ensheathed the PDS-filaments and formed interconnecting networks between them. At the ventral portion of the implant the fibrous network was more elaborate and densely distributed. 180 days p.i. the implant has been transformed into a membranous structure (neo-membrane) composed of the ventral and dorsal neofascia, remnants of PDS-filaments and a continuous connective tissue layer containing wave-like collagenous structures. Whereas 21 and 42 days p.i. no herniation was observed, 130 days p.i. the implant began to bulge out of the ventral abdominal wall. It is therefore concluded that inspite of the advantages of absorbable materials, longer resorption times may be required to allow a sufficient consolidation of the ingrowing connective tissue to resist the tensile forces of the abdominal muscle coat. SEM combined with 2N NaOH maceration proved to be a usefull tool in addition to conventional histological techniques for a three-dimensional assessment of fibrous connective tissue components ingrowing into alloplastic implants.

Relaxin deficiency in the placenta as possible cause of cervical dystocia. A case report.

In a case of cervical dystocia which had to be delivered by caesarean section, the placenta was examined for relaxin content. The placenta was processed by acidic acetone extraction and separation of the raw extract on a carboxymethylcellulose column. The activity of relaxin was estimated by means of heterologous porcine radioimmunoassay. The elution profile of the placenta extract showed significant differences to that of the placenta in normal deliveries i.e. there was no evidence of typical protein peaks with relaxin activity. It is suggested that there is possibly a causal relationship between the lack of placental relaxin and the pathological behaviour of the cervix during delivery.

Studies on the involvement of lysosomes in estrogen action, III. The dehydrogenation of estradiol to estrone by porcine endometrial lysosomes.

Endometrial cells from prepuberal pigs contain an estradiol 17 beta-dehydrogenase. By differential centrifugation of homogenate fractions and isopycnic separation of the particles sedimenting in the 600 leads to 38000 x g range, accompanied by marker enzyme and electron microscopic analyses, the enzyme appears to be exclusively associated with a subpopulation of lysosomes. It displays a high affinity for estradiol with a Km = 5 x 10(-7) mol/l. Dehydrogenation of estradiol to estrone is favorably driven by NAD, poorly by NADP. The reverse reaction with estrone as substrate and either NADH or NADPH or NADPH + regenerating system as cosubstrate does not proceed beyond the detection level, but trace amounts of 6 alpha/7 alpha-hydroxyestrone are observed at pH 6.5 with the latter two cosubstrates.

Studies on the involvement of lysosomes in estrogen action, II. Seasonal variation in the sedimentation patterns of endometrial lysosomes from prepuberal pigs.

The lysosomal population in endometrial cells of prepuberal pigs varies with the seasons. In summertime, lysosomes equilibrate in sucrose density gradients over a broad, domeshaped area from p = 1.21 g/cm3 to p = 1.15 g/cm3. The winter pattern is characterized by a major sharp peak of aggregated lysosomes at p = 1.20 g/cm3, visible as a "snowflurry"-like band. The two extremes are linked by transition patterns in spring and fall. The possible correlation of this phenomenon to the seasonal fluctuations in the level of soluble cytoplasmic estrogen receptor is discussed.