[Differences in antibiotic prescribing between general practitioners and pediatricians in Hesse, Germany]. / Unterschiede im Verschreibungsverhalten von Antibiotika bei Allgemein- und Kinderärzten in Hessen.

BACKGROUND: A careful consideration of antibiotic prescription is necessary due to emerging antibiotic resistance. Differences in prescription rates between physician groups have only rarely been examined. We compared the prescription of antibiotics for systemic use in children between pediatricians and general practitioners (GPs). METHOD: Data source was the statutory health insurance sample AOK Hesse/KV Hesse. Overall, 47,033 insured children in 2006 between 2 and 17 years of age were included in the analysis. Odds ratios (OR) and 95% confidence intervals (CI) for an antibiotic prescription were calculated by logistic regression adjusted for confounders, comparing pediatricians with GPs. Diagnosis-specific models were constructed. RESULTS: GPs and pediatricians prescribed 79.3% of all antibiotics in 2006 (40.6% and 38.7%, respectively). Significantly decreased ORs for an antibiotic prescription were observed for pediatricians, with OR (95% CI) of 0.46 (0.43-0.49), 0.40 (0.30-0.54) and 0.40 (0.30-0.53) for respiratory tract infections, urinary tract infections and nonsuppurative otitis media, respectively. No significant associations were observed assessing scarlet fever, pneumonia and suppurative otitis media, respectively. CONCLUSION: In this retrospective analysis, pediatricians were associated with a lower antibiotic prescription rate regarding diagnoses where antibiotic therapy is not clearly indicated. However, in diagnoses where antibiotic therapy is clearly indicated, no differences in prescription rates between pediatricians and GPs were observed. Further studies are warranted to gain insight into different treatment strategies between different groups of medical practitioners.

MRI and MRS studies on the time course of rat brain lesions and the effect of drug treatment: volume quantification and characterization of tissue heterogeneity by parameter selection.

Magnetic resonance imaging has been used to follow the time course of lesions induced in the rat brain as an animal model for characterization of the volume of the lesion. The dispersion in spin-spin relaxation has been used to characterize the nature of the brain lesion. Parameter selective estimation of T2, quantitative determination of the lesion size and volume selective in vivo proton spectroscopy have been employed for the purpose. The work has been carried out on rats which were subject to lesioning by ibotenic acid as a model for excitotoxicity and also on rats which received doses of ibotenic acid and subsequent doses of the NMDA antagonist drug MK 801 (dizocilpine). The time course of the progress of the lesions in untreated animals and the effect of neuroprotection by MK 801 was continuously monitored in all test animals. Further, a relatively new inhalation anesthetic agent, isoflurane, has been employed. A more logical and semiquantitative T2 bandwidth demarkation useful in distinguishing different degrees of lesioning from the onset and up to the 'edema' stage through penumbra (mild lesion), medium degree lesion and severe lesion has been proposed.

[Early ultrasonic diagnosis of thoracopagus]. / Frühe Ultraschalldiagnose des Thorakopagus.

Two cases of early ultrasonic diagnosis of conjoined twins (thoracopagi) in the 13th and 21th week of pregnancy, respectively, are reported. Heart and liver were fused in both and the upper gastrointestinal tract in one of the pairs. Once an ophalocele was seen. The most important ultrasonic criteria were close and fixed position of the twins to each other, ventral fusion of the thoracal and abdominal contours and detection of joint organs. Since hearts and livers were not paired, there was no chance of any successful therapy and on the parent's request, both pregnancies were terminated.

Haemorrhagic shock-encephalopathy syndrome: plasmapheresis as a therapeutic approach.

We present the case of a 4.5-week-old boy with acute encephalopathy, shock, intestinal bleeding and disseminated intravascular coagulation. The clinical course and typical laboratory parameters were compatible with a diagnosis of haemorrhagic shock-encephalopathy syndrome (HSE). Immediate shock treatment, repeated haemodialysis and plasmapheresis did not prevent a fatal outcome 4 days after the onset of clinical symptoms.

Haemodynamic and antiarrhythmic protective effects of intracoronary perfusion during percutaneous transluminal coronary angioplasty.

In 17 anaesthetized open-chest pigs, experiments were performed to determine if a myocardial protective effect can be obtained by intracoronary perfusion through the dilatation catheter during balloon inflation for percutaneous transluminal coronary angioplasty. Placement of the catheter such that the balloon lay in the middle third of the left anterior descending coronary artery caused a significant deterioration in haemodynamic status prior to balloon inflation, and on 5 occasions led to the development of ventricular fibrillation (VF). Balloon inflation without perfusion for periods of up to 5 min produced further haemodynamic deterioration, and culminated in VF in 4/14 cases. Simultaneous perfusion during balloon inflation (proximal perfusion pressure 900-1200 mmHg), with flow rates of 14.5 ml min-1 for arterial whole blood and 21 +/- 7 ml min-1 for blood diluted with 0.90% NaCl (haematocrit approx. 25%), not only prevented the haemodynamic deterioration but resulted in an improvement compared with values obtained with the catheter in position prior to balloon inflation. In no case did VF occur during 5 min of balloon inflation plus perfusion. The use of diluted blood as the perfusate was not associated with intracatheter thrombus formation, which was sometimes seen as a complication of whole blood perfusion.