[Regionalisation of preterm births in county districts? Yes we can!]. / Regionalisierung bei Frühgeburtsbestrebungen im ländlichen Raum? Yes we can!

BACKGROUND: In preterm labour prenatal transfer of the pregnant woman to perinatal centres or subspecialty hospitals is thought to improve outcome of very low birth weight infants (VLBW). Can preterm labour diagnosed early enough? MATERIAL: Records of the neonatal referral centre at the Ulm University Hospital (1974-2003) and of the regional neonatal working group (1986-2003). RESULTS: The rate of inborn VLBW infants increased from 40 to 95-100%. CONCLUSION: It was possible to diagnose preterm labour early enough for prenatal transfer. DISCUSSION: On the strength of past experience it may be assumed that the obstetrician's or institution's willingness to transfer mothers before delivery was the critical factor of the nearly complete regionalization.

Severe intracranial hemorrhage in a newborn infant with transplacental transfer of an acquired factor VII:C inhibitor.

We describe a woman in whom inhibitors to factor VIII:C developed in her first pregnancy. The neonate had a factor VIII:C level of 1% and an inhibitor titer of 5.2 Bethesda units. After an uneventful vaginal delivery, the boy had an intracranial hemorrhage at 5 days of age. To our knowledge, this is the first report of a bleeding complication in a newborn infant with transplacental transfer of an acquired factor VIII:C inhibitor.

Colour Doppler imaging of intracranial vasculopathy in severe infantile sialidosis.

Neonatal ascites is usually attributed to prenatal infections, lysosomal storage disease and anomalies of the genitourinary tract, gastrointestinal tract or cardiovascular system. We report one case of neonatal ascites associated with infantile sialidosis. Cerebral sonography showed stripe-like intracerebral echogenicities in the region of the basal ganglia. Colour Doppler imaging demonstrated blood flow within the echogenicities confirming the suspected diagnosis of intracranial vasculopathy.

Diagnosis of neonatal aortic thrombosis by colour coded Doppler sonography.

We report on a neonate with complete aortic thrombosis following umbilical artery catheterization. Diagnosis was established by colour coded Doppler sonography which showed absent flow in the region distal to the thrombosis. After thrombolytic therapy with recombinant tissue plasminogen recanalization of the descending aorta could be shown by Colour Doppler imaging (CDI).

[Presystolic increasing maximal flow velocity in the intracranial vessels in 3 children with heart failure]. / Präsystolisch ansteigende maximale Flussgeschwindigkeit in den intrakranialen Gefässen bei drei Kindern mit Herzversagen.

The doppler-sonographic examination of flow velocities in intracerebral arteries is of central importance in the diagnostic evaluation of potential neurologic complications in intensive care patients. Furthermore pulsed Doppler-sonography can assess the hemodynamic consequences of several congenital heart defects (e.g. the ductus arteriosus Botalli). Characteristics of the normal flow profile in the intracranial arteries are the systolic and diastolic forward flow caused by the "Windkessel" function of the aorta. Well known pathologic flow profiles (systolically and diastolically increased flow velocities, diastolically decreased flow velocities and diastolic retrograde flow) occur in neurologic and cardiovascular diseases. We have investigated three children after cardiac surgery, who showed a presystolic increase in the flow velocities, which is clearly different from the flow profiles mentioned above. In our opinion, this abnormal flow pattern is due to a decreased ventricular output in combination with an elevated central venous pressure in these patients.

[Toxic shock syndrome due to osteomyelitis]. / Toxic-Schock-Syndrom (TSS) infolge Osteomyelitis.

An 11 3/4 year old girl contracted Toxic-Shock-Syndrome following osteomyelitis. The symptoms comprised a severe fall in blood-pressure with centralisation, petechiae and haematoma particularly in the lower extremities, hyperaemia of the oral mucosa and of the throat with profuse and unstaunchable bleeding in this area within in a short period of time. In order to stabilise the blood-pressure the patient had be given approx. 15 l colloidal solution (350 ml/kg) intravenously, mainly frozen-plasma. The risk of aggravation of a pulmonary failure along the lines of ARDS particularly due to the backward flow of the interstitial deposited fluid was avoided by the use of continuous veno-venous haemofiltration (CVVH).

[Experiences with capnometry in pediatric intensive care]. / Erfahrungen mit der Kapnometrie in der pädiatrischen Intensivtherapie.

We investigated the correlation between arterial and end-tidal pCO2 in 17 children during intensive care. The indications for using capnometry were noninvasive monitoring of ventilation after cardiac surgery or during complicated course of illness or for control of intended hyperventilation. We found a good correlation between arterial and end-tidal pCO2 in the overall patient population (r = 0.82), but the relationship varied widely from patient to patient. There was only a weak correlation (r = 0.44) in pCO2 over 45 mm Hg. Hyperventilation could be identified in 64.2%, whereas hypoventilation was correctly indicated in only 23%.

[Life-threatening perinatal hemorrhage of a sacral teratoma]. / Lebensbedrohliche perinatale Blutung eines Steissbeinteratoms.

Great sacral teratomas are rare congenital tumors. The frequency in liveborns is about 1:40,000. Well known complications of sacral teratomas are malignant degeneration, infection and, in case of intraabdominal expansion, compression of the urogenital tract. We report a case of unusual fulminant perinatal bleeding out of a great sacral teratoma ruptured during birth.

Outpatient arteriography: its safety and cost effectiveness.

An 11-year experience with 2,029 outpatient arteriograms in a 500-bed community hospital with active vascular and cardiovascular services is reported. During this period 3,864 inpatient arteriograms were also obtained. The major complication rate has been lower for the outpatient procedures than for the inpatient procedures, and no malpractice claims have been made as a result of outpatient arteriography. There were considerable cost savings with the outpatient arteriography. Since conventional arteriography can be done safely and economically on an outpatient basis, and provides images of superior quality, it is considered highly competitive with digital subtraction angiography.

[Buprenorphine as a postoperative analgesic following halothane anesthesia. Hemodynamic and respiratory effects]. / Buprenorphin als postoperatives Analgetikum nach Halothan-Narkosen. Hämodynamische und respiratorische Effekte.

In 10 healthy patients, buprenorphine was given as the postoperative analgesic (dosage: peripheral venous injection of 5 microgram/kg BW) after traumatological interventions in the lower extremities, which had been performed under barbiturate-induced halothane anaesthesia. The haemodynamic investigations revealed that buprenorphine has only a minor effect on the high pressure system. In the area of the pulmonary circulation, there was a significant increase in mean pulmonary artery pressure from 15.9 mm Hg to 17.8 mm Hg (+12%), as well as an increase in pulmonary vascular resistance by 16.5%. These changes were most marked 30 to 60 min after the administration of buprenorphine. When 2-3 1 O2/min were administered, none of the patients had PaO2 values of less than 100 mm Hg. 60 min after the injection, the PaCO2 value increased from 33.7 mm Hg to a maximum of 43.9 mm Hg. In 3 patients, PaCO2 increased to more than 45 mm Hg. All patients with greater increases of PaCO2 also evidenced greater increases in the pulmonary vascular resistance. Altogether the haemodynamic changes after buprenorphine administration following halothane anesthesia were not very distinct. In individual cases, however, there were greater increases in PaCO2. The cause of this could involve the additive effects of premedication and anaesthesia medication, and possibly the pain level as well. Both the increase in pulmonary artery pressure and the increase in total pulmonary vascular resistance in these patients were due to hypercapnia (von Euler-Liljestrand mechanism).