Predictive values of component-specific IgE for the outcome of peanut and hazelnut food challenges in children.

BACKGROUND: Oral challenges are the gold standard in food allergy diagnostic, but time-consuming. Aim of the study was to investigate the role of peanut- and hazelnut-component-specific IgE in the diagnostics of peanut and hazelnut allergy and to identify cutoff levels to make some challenges superfluous. METHODS: In a prospective and multicenter study, children with suspected peanut or hazelnut allergy underwent oral challenges. Specific IgE to peanut, hazelnut, and their components (Ara h 1, Ara h 2, Ara h 3, and Ara h 8, Cor a 1, Cor a 8, Cor a 9, and Cor a 14) were determined by ImmunoCAP-FEIA. RESULTS: A total of 210 children were challenged orally with peanut and 143 with hazelnut. 43% of the patients had a positive peanut and 31% a positive hazelnut challenge. With an area under the curve of 0.92 and 0.89, respectively, Ara h 2 and Cor a 14-specific IgE discriminated between allergic and tolerant children better than peanut- or hazelnut-specific IgE. For the first time, probability curves for peanut and hazelnut components have been calculated. A 90% probability for a positive peanut or hazelnut challenge was estimated for Ara h 2-specific IgE at 14.4 kU/l and for Cor a 14-specific IgE at 47.8 kU/l. A 95% probability could only be estimated for Ara h 2 at 42.2 kU/l. CONCLUSIONS: Ara h 2- and Cor a 14-specific IgE are useful to estimate the probability for a positive challenge outcome in the diagnostic work-up of peanut or hazelnut allergy making some food challenges superfluous.

Fate of patients with extracorporeal lung assist as a bridge to lung transplantation versus patients without--a single-center experience.

OBJECTIVES: Mechanical lung assist (MLA; extracorporeal membrane oxygenation (ECMO) or extracorporeal lung assist (ECLA)) is increasingly used as a temporary bridge to lung transplantation (LTx). This study was designed to evaluate the impact of preoperative MLA on the operative outcome, including longer-term survival, in comparison to patients undergoing LTx without preoperative MLA. METHODS: A total of 143 patients underwent LTx at our institution from 2002 to 2011. Forty-three percent (n=62) of patients presented with idiopathic pulmonary fibrosis and 71% (n=102) presented with severely elevated pulmonary artery pressure. RESULTS: Thirteen patients (9.1%) required pre-LTx MLA support (age 44 ±13 years, double LTx 73.3%, female gender 53%) whereas 130 patients did not (age 52 ±11 years, double LTx 41.5%, female gender 36.9%). In one patient, MLA was successfully weaned and the patient underwent subsequent LTx. All patients in the MLA group were intraoperatively supported with continuous ECMO. One patient had to be supported with MLA after LTx for a period of 8 days. The short-term and mid-term postoperative survival of the MLA patient group was not significantly different from the non-MLA group (LogRank p=0.28). The 30-day, 90-day and 1-year survivals were 95%, 90% and 71%, respectively, in the patients without MLA compared to 85%, 77% and 68% in the MLA group. CONCLUSIONS: MLA has no impact on long-term survival rate in LTx patients, but has an influence in postoperative survival. MLA support is a valuable tool to bridge unstable patients to LTx.

[Neonatal ultrasonographic cerebral findings: association with risk factor for cerebral palsy]. / Stellenwert der postnatalen Neurosonographie für die frühzeitige Erfassung und ursächliche Klärung der Zerebralparese.

BACKGROUND: Is it possible to identify patients with cerebral palsy (CP) with postnatal ultrasound scan? Which risk factors are associated with an increased risk of CP?. PATIENTS AND METHODS: The data of 37 children with CP, who were sonographically investigated during the first 24 hours of life were analyzed retrospectively. The data of 21 preterm infants with gestational age /= 33 wk and in 5/8 of the mature babies. The mature babies had prenatal brain atrophy or hypoxic-ischaemic cerebral lesions. Cytomegaly and encephalitis were detected in two babies. Immature babies >/= 33 wk showed prenatal porencephaly or encephalomalacia after asphyxia. Premature babies

[Effects of oral administration of bifidobacteria on intestinal microflora in premature and newborn infants]. / Wirkungen oral verabreichter Bifidobakterien auf die intestinale Mikroflora von Früh- und Neugeborenen.

In a prospective, randomised study the effects of orally administered bifidobacteria on the intestinal microflora were investigated in 100 preterm and term neonates under intensive care conditions during the first 21 days of life. The 50 infants (group with bifidobacteria) received lyophilized bifidobacteria (Töpfer Bifidus) via nasogastral tube with an initial dosage of 3 times daily 1.25 x 10(8) bifidobacteria on day 2 of life and a daily dosage of 6 times 1.25 x 10(8) bifidobacteria on day 3 until day 21 of life. The other 50 infants (control group) did not receive bifidobacteria. The preterm and term neonates were fed either with pasteurized mother's milk or milk from healthy female donors (n = 79) or with an infant formula (Alfaré, n = 13) or initially with Alfaré and thereafter with mother's milk (n = 8). The intestinal microflora of preterm and term neonates under intensive care conditions could be influenced by the oral administration of bifidobacteria. The administration of bifidobacteria resulted in the group of inoculated infants in a significantly earlier colonization of bifidobacteria (8.1 +/- 3.9 days of life) than in the control group (11.3 +/- 4.7 days of life). On day 7 a bifidobacterial dominance (> 90% of the intestinal microflora) could be found in 26% of infants with inoculation of bifidobacteria and only in 2% of the control group (p < 0.001). These significant differences could be shown until day 21 of life. A difference in septicemia frequency between the two groups could not be demonstrated. At the beginning of the infection a bifidobacterial dominance was found in only one of 23 cases of septicemia.

Forming clinical impressions during the first five minutes of the counseling interview.

The influence of earlier formed clinical impressions of the client on later judgments within a counseling session were examined. It was predicted that redundancy in judgments of counselors' clinical impressions of the client after 5 min. and after 30 min. of an interview would be greater for counselor-trainees who are (a) more self-confident about their judgments and (b) lower in cognitive complexity, than other counselor-trainees. A stimulus tape in which a male counselor conducted an initial 30-min. interview with a depressed female client was shown to 80 counselor-trainees. At the 5- and 30-min. marks, the tape was stopped, and the counselor-trainees indicated their clinical impressions of the client. These impressions included written thoughts and ratings of clinical characteristics of the client. Analyses showed that both their self-confidence and cognitive complexity were not associated with differences in redundant judgments.

[Ultrasound and clinical studies of periventricular leukomalacia in high risk newborn infants. II. Perinatal risk factors]. / Sonographische und klinische Untersuchungen zur periventrikulären Leukomalazie bei Risikoneugeborenen. II. Perinatale Risikofaktoren.

The incidence of periventricular leukomalacia (PVL) in risk neonates was evaluated among 300 risk neonates in a prospective ultrasound study at the Pediatric Clinic of the Medical Faculty, University of Rostock. Perinatal risk factors for the development of PVL and gestational age were taken into consideration. Maternal infections during pregnancy were found to be a risk factor for development of PVL. A severe hyaline membrane disease was more frequently diagnosed in highly immature preterm neonates with postnatal PVL. The percentage of highly immature preterm neonates with postnatal PVL and severe hyaline membrane disease was higher in vaginal-born risk neonates. A correlation between 1-minute Apgar scores < or = 3 and postnatal PVL was found in more mature preterm neonates.

[Ultrasound and clinical studies of periventricular leukomalacia in high risk newborn infants. I. Neuro-ultrasound results]. / Sonographische und klinische Untersuchungen zur periventrikulären Leukomalazie bei Risikoneugeborenen. I. Neurosonographische Untersuchungsergebnisse.

The incidence of periventricular leukomalacia (PVL) in risk neonates was evaluated in a prospective ultrasound study at the Pediatric Hospital of the Medical Faculty, University of Rostock. The study was carried out in 300 registered risk neonates. These risk neonates were divided into 3 groups: < or = 31 gestational week (n = 70), 32-36 gestational week (n = 154), > or = 37 gestational week (n = 76). A prenatal PVL was diagnosed in 41 neonates, a postnatal PVL was found in 56 neonates after the 5th day of life. In 77% of all risk neonates with PVL, the diagnosis was made on the first day of life. After the first day of life, PVL was presented mainly in highly immature neonates. A correlation of PVL to gestational age could only be found in neonates with postnatal PVL. Subarachnoid space enlargement was found to be significantly more frequent in risk neonates with prenatal PVL than in risk infants with postnatal PVL. Residual ultrasound findings of PVL were significantly more frequent in male than in female risk neonates.

15N-tracer studies in formula-fed preterm infants: the role of glycine supply in protein turnover.

In preterm infants, protein-turnover rates obtained by [15N]glycine as a tracer are known to be overestimated. This may reflect the insufficient supply of dietary glycine. In this randomized study, the influence of a glycine-rich diet on whole body protein turnover rates in eight male preterm infants (29-32 weeks, 1,200-2,540 g birthweight) using the 15N-tracer technique on days 21 and 28 of life was investigated to evaluate the necessity of supplementing preterm infant formulas with proteins rich in glycine. Before and during the study, the infants were alternately fed with a commercial available preterm infant formula (I, 2% protein, 40 mg glycine/dl) and a variety of this formulation with glycine-rich proteins (II, 2% protein, 130 mg glycine/dl). The protein-turnover rates were computed after 15N-single-pulse labeling with the help of the three-compartment model (TCM) and the urinary ammonia end-product method (AEPM). The tracer used was [15N]glycine (dosage: 2 mg 15N/kg). For the determination of 15N-excess-excretion kinetics, fractionated urine specimens were collected over a 36-h period. The protein-turnover rate calculated by TCM was 8.8 +/- 1.6 g/kg/day (formula I) and 7.7 +/- 2.0 g/kg/day (formula II); using AEPM, the rate was 8.7 +/- 2.5 g/kg/day and 7.5 +/- 1.5 g/kg/day, respectively. We conclude that the presaturation of the precursor pool by an adequate glycine intake minimizes drawbacks that may arise when using [15N]-glycine as a tracer in preterm infants, and a protein concentration of 2%, as in formula I, and consequently, a 170% glycine content when compared with the same human milk volume, meets the glycine requirement.

Effects of preinterview suggestion on counselor memory, clinical impression, and confidence in judgments.

This study examined the effects of schematic preinterview suggestion on counselors' (a) recognition memory of the information presented by the client; (b) clinical impression rating of the client; and (c) confidence in rating clinical impression. Fifty-two Master's-level counselor-trainees were assigned randomly to two conditions of preinterview suggestion about the status of the client (i.e., depression and no depression). After subjects had received appropriate preinterview information (i.e., depression or no-depression content) and had viewed a videotaped counseling interview, information was gathered from them. The results indicated that the preinterview suggestion (a) did not affect counselor-trainees' clinical impression rating of the client; (b) did not affect confidence of rating; and (c) yielded a weak, but significant, confirmatory memory. Implications for the interview setting are discussed.

[Perinatal and neonatal mortality and morbidity in newborn infants up to 1,000 g]. / Perinatale und neonatale Mortalität und Morbidität bei Neugeborenen bis 1000 g.

World-wide intensive efforts have been made for more than 20 years to reduce the rate of preterm delivery, but so far without remarkable success. Preterm delivery accounts for 6-9% of all deliveries and very-low-birth-weight infants (< or = 1000 g) total up to about 60% of perinatal mortality. This study reports on a retrospective analysis of fetal outcome with 33 very-low-birth-weight-infants (< or = 1000 g) delivered at the Women's Hospital (University of Rostock) during the time from 1986 to 1992. The rate of early mortality was at 45.2%, survival rate was at 33% (n = 11). Caesarean section with preservation of fetal membranes proved to offer better results of fetal outcome than spontaneous delivery. Comparing the fetal outcome of all patients concerned, it became obvious that newborns whose mothers enjoyed intensive prenatal care had better chances than those newborns whose mothers came to hospital not before onset of preterm labour. From our experiences we conclude that intensive antenatal care with very early assessment of all possible risk factors for preterm labour is the prerequisite to reduce the rate of preterm delivery.

Development of an instrument to assess clinicians' recognition memory using a videotaped stimulus interview.

This study represents the development of an instrument to assess clinicians' memory using a videotaped counseling interview. The instrument, called the Recognition Checklist (RC), consists of 60 items of information based on the content presented by the client on the stimulus tape. Initial findings indicated that this instrument has promising reliability and validity and warrants further development and application to the study of clinicians' memory of the interview process and interviewing skill training.

Response to sodium benzoate treatment in non-ketotic hyperglycinaemia.

Therapy with benzoic acid in a case of classic neonatal non-ketotic hyperglycinaemia (NKH) was successful in stopping seizures but not in promoting mental development. Serum glycine levels were normalizable even by administering low doses of 53 mg sodium benzoate/kg body mass (BM) per day. Despite giving a higher dosage (240 mg/kg BM per day) normalization of glycine concentration in cerebrospinal fluid (CSF) was not achieved. However, seizures ceased. Restriction of protein intake (< or = 2 g/kg BM per day) seemed to be profitable. CSF glycine concentrations below 100 mumol/L may be sufficient to prevent seizures in older infants who have adapted to neuronal glycine exposure. No toxicity of sodium benzoate treatment was detected when administering doses of up to 470 mg/kg BM per day but side effects such as itching and hyperactivity were obvious.

Whole-body protein parameters in premature infants: a comparison of different 15N tracer substances and different methods.

[15N]glycine, [15N]leucine, and [15N]yeast protein thermitase hydrolysate (YPTH) as tracers for investigating the protein turnover rates in premature infants were studied in nine human milk-fed neonates (born after 32 to 34 wk of gestation) by paired comparison of the tracers. The 15N enrichment of total urinary nitrogen and ammonia after administration of a single oral dose of 15N was measured by emission spectrometry. Flux rates were calculated using a three-compartment model and the ammonia end product method. The mean whole-body protein synthesis rates, as determined by the three-compartment model derived from the three 15N tracers, differed significantly (p less than 0.01) among [15N]glycine (15.9 g/kg/d), [15N] leucine (9.1 g/kg/d), and 15N-YPTH (5.9 g/kg/d). When the corresponding rates were determined from the excretion of label in ammonia, the results showed the opposite tendency; the lowest apparent synthesis rates were found after [15N]glycine (7.5 g/kg/d), followed by [15N]leucine (14.4 g/kg/d), and the highest figure resulted after [15N] YPTH (16.7 g/kg/d). The results of this comparison substantiate the assumption that there are methodologic errors in connection with the use of different tracers and models for the calculation of whole-body protein parameters in preterm infants, with respect to the main requirement for tracer kinetic studies; the tracer nitrogen must be representative of total amino acid nitrogen. Seen in this light, mixtures of completely labeled amino acids such as YPTH may represent the most reliable tracer substance.(ABSTRACT TRUNCATED AT 250 WORDS)

Client cognitive responses to counselor paradoxical and nonparadoxical directives.

Client cognitive responses to counselor paradoxical and nonparadoxical directives were examined. It was predicted (a) that clients who received paradoxical symptom prescriptions would display a greater negativity toward the counselor and counseling than those who received nonparadoxical directives; and (b) that clients who received no rationale for the paradoxical directives would display a greater negativity than those who received a rationale. Thirty clients who had reported performance anxiety received one 45-minute counseling interview. Ten clients received paradoxical directives with a rationale, 10 received paradoxical directives with no rationale, and 10 received nonparadoxical directives. Results showed no significant differences in either client in-session negativity or out-of-session implementation of directives between the paradoxical and nonparadoxical conditions and between the rationale and no rationale paradoxical conditions. Possible implications of the findings are discussed.

The effects of cognitive complexity and arousal on client perception of counselor nonverbal behavior.

This analogue study examined the interaction between cognitive complexity and arousal in client discrimination of counselor positive and negative nonverbal behavior. Thirty university students, divided into low, medium, and high arousal conditions, viewed a videotaped counseling interview in which the counselor nonverbal behaviors were varied systematically and then rated counselor perceived expertness. The results showed that subjects discriminated counselor positive and negative nonverbal behaviors in the early portion of a 30-minute interview, but this tendency deteriorated quickly as the interview progressed. Also, there was a significant interaction between subject cognitive complexity and arousal level. Implications of the findings are discussed.

[The effect of food supplements on the bioavailability of breast milk for premature infants--fecal fat and carbohydrate excretion]. / Der Einfluss von Nahrungssupplementen auf die Bioverfügbarkeit der Frauenmilch für Frühgeborene. Die faecale Fett und Kohlenhydratexkretion.

Faecal excretion of fat and carbohydrates was studied in 14 preterm infants fed on raw mother's milk (group I) or banked fortified human milk (group II) at days 7, 14, 21 and 28 of postnatal life: group I: n = 5; 31.0 +/- 2.0 weeks; 1954 +/- 441 g; group II: n = 9; 32.0 +/- 1.0 weeks; 1806 +/- 176 g. Mixtures of amino acids, peptides, minerals, dextrine and maltose were designed for fortifying banked human milk. There were no significant differences between faecal excretion of fat and carbohydrates in both feeding groups. The investigated human milk fortifier helps to realize the protein-energy ratio needed in preterm infants with well tolerable volumes of feeding and without stressing their limited digestive capacity.