[Significance of Thoracic Surgery for Treatment of Pleural Empyema in Childhood and Adolescence]. / Stellenwert der Thoraxchirurgie im Gesamtkonzept der Behandlung von Pleuraempyemen bei Kindern.

BACKGROUND: There still is controversy about surgical treatment of pleural empyema in children. PATIENTS AND METHODS: Retrospective analysis of treatment strategy, focussing on indication for surgery and outcome of children treated in 2 centres for pleural complications due to primary pneumonia from January 1(st) 2008 to December 31(st) 2012. RESULTS were compared to studies published within the last 10 years. RESULTS: 1 451 children with pneumonia were treated during the 5 year period. 187 (average age 6.1 years, sex: 86/101 f/m) developed a pleural effusion. THERAPY: pleural punction in 22 children, chest tube in 78 and operation in 37 children. In 9 cases microorganisms were identified. 34 children were operated for empyema stage II, only 3 for stage III. 3 children were operated due to septicaemia not responding to antibiotics. Time from admission to operation (including referring hospital):14.5 days. Time from operation to discharge: 12,5 days. All children but one were operated by thoracoscopy. COMPLICATIONS: 1 bronchopleural fistula, 1 delayed healing of the wound. All children survived and fully recovered mean (observation period 28 months postoperatively). SUMMARY: In experienced hands thoracic surgery yields excellent results for children suffering from pleural empyema stage II and III. Recent randomised prospective trials comparing fibrinolysis with VATS do not convince regarding the treatment protocols of their surgical arms. Fibrinolysis is nevertheless a valuable treatment in early stage II empyema, especially if thoracic surgical experience is not available. However, the further advanced the empyema presents, the sooner surgical experience should be gathered.

Septic shock in children in an urban area in Western Germany--outcome, risk factors for mortality and infection epidemiology.

BACKGROUND: Only sparse data exist about children with septic shock in Europe. The present study aimed to evaluate demographics, treatment, outcome and risk factors for mortality in Western Germany. PATIENTS: Children with septic shock aged 2 months to 17 years. METHODS: In a multi-center retrospective study of 20 children's hospitals data were obtained and analyzed by chart review. Risk factors for mortality were identified and assessed by multivariate regression analysis. RESULTS: Overall mortality in 83 cases with septic shock was 25% (21 patients). Significant risk factors were high PRISM III score, low pH, low arterial systolic blood pressure, presence of disseminated intravascular coagulation and extent of multi-organ failure, but not lactate (p=0.05) and base excess (p=0.065). Mortality in hospitals which treated 10 or more patients (category 1) was 17% and increased to 22% in hospitals which treated 3-6 patients (category 2). In hospitals with only 1 or 2 patients (category 3) mortality rate was 61% (p<0.01 when compared to category 1 or 2). A stepwise increase was also seen in the severely sick patients according to PRISM III (>19): category 1: 23%, category 2: 40%, category 3: 62.5% (p<0.05 for comparison of category 1 and 3). Multivariate analysis of significant risk factors revealed low number of treated patients as the only individual risk factor for mortality. CONCLUSION: Mortality from pediatric septic shock in an urban area in Western Germany is high. Disease severity and treatment in a department with few cases were associated with increased mortality.

Organ donor with unclear primary brain tumor, a contraindication for transplantation? Case report of a one year old child.

UNLABELLED: BACKGROUND AND CASE REPORT: The use of organs from donors with central nervous systems (CNS) malignancies is controversial discussed. We present a 1 year old boy, who was admitted for torticollis. A computer tomography detected a large tumor in the posterior cranial fossa. The tumor was resected, but postoperatively a malignant brain swelling occurred, being resistant to standard treatment. After brain death was established and permission was given, organ donation was performed. All grafts showed good initial functions and no complications. METHODS: We investigated the evidence for transplantation of organs from donors with central nervous malignancies. RESULTS: The Australia and New Zealand Combined Dialysis and Transplant Registry, the United Network for Organ Sharing and Hornik et al., reported three transmissions of a glioblastoma multiforme in 958 recipients, who received grafts from donors with CNS tumors. In contrast the Israel Penn International Tumor Registry suggests that transmission is more common: 62 organs were transplanted, 14 cases showed transmission. All cases of medulloblastoma, showing transmission were associated with ventriculoperitoneal shunt. In summary, 1 020 organs of CNS tumors were transplanted, 17 cases were identified with tumors transmission from CNS malignancy. CONCLUSION: Organ donors where brain death is established suffering from brain tumors should not be generally regarded as contraindications for an organ transplant. Organs from patients with risk factors (e. g. ventriculoperitoneal shunt) should be excluded from the donor pool as transmission is more likely. The risk of donor transmitted malignancies should be weight against the urgency to receive a transplant graft.

Spatial S-R compatibility: positional instruction vs. compatibility instruction.

Subjects had to perform both in a classical spatial compatibility experiment where they were instructed to press a right or left button to a right or left stimulus ('positional instruction'), and in a variant, where they had to give a spatially compatible or incompatible response depending on the color of the stimulus ('compatibility instruction'). The result shows the normal advantage of compatible over incompatible responses for the experiment with positional instruction whereas the spatial compatibility effect completely disappeared for the experiment with compatibility instruction. This supports a translation hypothesis and speaks against an automatic activation hypothesis of spatial stimulus-response compatibility.

Spatial S-R compatibility with orthogonal stimulus-response relationship.

Spatial stimulus-response (S-R) compatibility with unimanual two-finger choice reactions was investigated under conditions in which the spatial orientation of response keys was either parallel to or perpendicular to the orientation of the stimuli. Subjects responded to green or red lights in the left or right visual field (irrelevant stimulus location). The response keys were oriented horizontally on the left or right side of the body midline parallel to the stimuli, and were pressed with the palms facing down (Condition A), or were oriented orthogonally to the stimuli in the midsaggital plane, either horizontally and pressed with palms facing down (B) or facing up (C), or vertically and pressed with palms facing the body (D). The results for Condition A demonstrate the usual spatial S-R compatibility effect between field of stimulation and spatial position of responding finger. For Conditions B and D, a strong reaction time advantage still obtained for those stimulus-finger pairings that are compatible under Condition A. Condition C revealed an RT advantage for the opposite pairings. This shift of the compatibility effect from Condition B to Condition C indicates that the left/right distinction of fingers does not follow a simple, fixed spatio-anatomical mapping rule. The results are discussed within the framework of a hierarchical model of spatial S-R compatibility, with spatial coding and spatio-anatomical mapping as factors.

Shift of functional cerebral asymmetry during the menstrual cycle.

This study investigated whether for females, who are said to be less strongly lateralized for cognitive functions than men, hemispheric superiority might depend on the phase of the menstrual cycle. The results show that while asymmetry in lexical decisions did not change throughout the menstrual cycle, asymmetry in face perception decreased linearly from a large right hemisphere superiority during menstruation to a small left hemisphere superiority during the premenstrual phase. This is seen as being relevant not only for the discussion of sex differences in cerebral asymmetry but also for the concept of cerebral organization in general.

S-R compatibility effect or cerebral laterality effect? Comments on a controversy.

This article investigates the role played by misleading terminology in the origins of a recent controversy about the nature of stimulus-response compatibility effects.