[Intoxications in Children and Adolescents in Germany]. / Deutschlandweites Vergiftungsspektrum im Kindes- und Jugendalter.

BACKGROUND: In Germany, intoxications cause the bulk of emergencies in children, to be prevented or attenuated by preventive measures. Therefore, knowledge about intoxications is essential for pediatricians. The present work provides general and epidemiologic data about intoxications and most frequent categories and single toxicants. METHODS: Data of intoxications in children and adolescents from 6 German poison centers (2012-2016 and 2002-2016) were retrospectively analyzed. Categorical data are given as mean±standard deviation, most frequent toxicants as a score. RESULTS: Calls, especially from non-professionals, increased since 2002. Two third of intoxications occurred in small and pre-school children, more frequently in boys (50%) than girls (44%), in adolescents girls predominated (>60%).<14 years intoxications occur mainly at home, day care or school (>95%), in adolescents suicide attempts and abuse come to the fore (13%). 90% of the cases are asymptomatic or mild, with increasing symptoms at higher ages (adolescents 13% vs. small children 1%). Intoxications with drugs are predominantly in adolescents, surfactant containing cleaning agents and cosmetics, sanitary cleaner, tobacco, glow lights and solute descaler in children. DISCUSSION AND CONCLUSIONS: Increasing incoming calls from professionals and non-professionals point out the importance of the poison centers. Although intoxications in children and adolescents mainly proceed without or mild symptoms, the relevance of preventive measures especially for children<7 should not be underestimated.

Escitalopram causes fewer seizures in human overdose than citalopram.

CONTEXT: Seizures are a recognized complication of acute overdose with the racemic (1:1 ratio of R- and S-enantiomers) selective serotonin reuptake inhibitor antidepressant citalopram. OBJECTIVE: We tested the hypothesis that escitalopram (the therapeutically active S-enantiomer of citalopram) causes fewer seizures in overdose than citalopram at comparable doses of the S-enantiomer. METHODS: Multicenter retrospective review of cases with citalopram and escitalopram overdose reported to German, Austrian, and Swiss Poisons Centers between 1997 and 2006. RESULTS: 316 citalopram and 63 escitalopram cases were analyzed. Somnolence, nausea, vomiting, tachycardia, QT prolongation, and tremor occurred with similar frequency in both groups. There was a striking difference in the frequency of single and multiple seizures: 43 cases (13.5%) in the citalopram group and 1 case (1.6%) with a single seizure in the escitalopram group (p=0.0065). DISCUSSION AND CONCLUSIONS: At comparable ingested doses of the S-enantiomer, the symptom profile for citalopram and escitalopram intoxications is similar except for seizures that occur more frequently in citalopram than in escitalopram poisoning.

An update on interventional lung assist devices and their role in acute respiratory distress syndrome.

In recent years, pumpless arteriovenous systems for extracorporeal gas exchange have become a new therapeutic option for the treatment of patients suffering from acute respiratory failure. Experiences with the pumpless extracorporeal membrane lung in animal experiments and in patients with adult respiratory distress syndrome published in the current literature are reviewed. In addition this article presents a case of varicella pneumonia with persistent hypoxemia and hypercapnia under mechanical ventilation that showed a significant improvement with treatment with a pumpless extracorporeal lung assist using an arteriovenous shunt for eight days. The patient made a complete recovery. This is the first report of a patient with a life-threatening varicella pneumonia successfully treated with pumpless extracorporeal lung assist device. This review provides an update on interventional lung assist devices and a critical discussion of their advantages and limitations.

Anticoagulation with low-molecular-weight heparin (dalteparin) in plasmapheresis therapy: initial experience.

BACKGROUND: In contrast to other extracorporeal treatments no established regime exists for anticoagulation with low-molecular-weight heparin (LMWH) in plasmapheresis therapy. A study was conducted to investigate whether LMWH (dalteparin-Na) is suitable as an effective anticoagulant in plasmapheresis therapy. STUDY DESIGN AND METHODS: Eleven patients with autoimmune neurological diseases and the necessity for a plasmapheresis therapy were enrolled. A capillary membrane filter was used. A total of 2000 mL of human plasma was isovolumetrically exchanged per plasmapheresis cycle. The anticoagulation was accomplished with a single bolus of LMWH (dalteparin) of 80 to 90 IU per kg of body weight. The system was visually monitored. Anti-factor (F)Xa activity, thrombin-antithrombin III complex (TAT), and prothrombin fragment 1+2 (F 1+2) were determined at regular intervals. Samples were taken from the collected plasma pool to determine the loss of LMWH during the plasmapheresis procedure. RESULTS: All plasmapheresis cycles with LMWH were successful without complications. Approximately 40 percent of the initially administered LMWH bolus was lost by the large porous filter during the plasmapheresis. The anti-FXa values were determined to be 0.5 IU per mL during the entire plasmapheresis. TAT values were elevated (TAT median, 14.3 microg/L). F 1+2 values measured before the filter cartridge remained within the normal range for the entire plasmapheresis cycle (<1.2 nmol/L) and were increasingly elevated after the filter. CONCLUSION: Our initial experiences with LMWH for anticoagulation in plasmapheresis indicate that a body weight adjusted dose of LMWH (dalteparin) is suitable for anticoagulation in plasmapheresis therapy. No complications were observed. The data are encouraging. Further investigations will show if and how the present anticoagulation regime could be further optimized.

Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus.

BACKGROUND: There is only limited data on improvements of critical medical care is resulting in a better outcome of comatose survivors of cardiopulmonary resuscitation (CPR) with generalized myoclonus. There is also a paucity of data on the temporal dynamics of electroenephalographic (EEG) abnormalities in these patients. METHODS: Serial EEG examinations were done in 50 comatose survivors of CPR with generalized myoclonus seen over an 8 years period. RESULTS: Generalized myoclonus occurred within 24 hours after CPR. It was associated with burst-suppression EEG (n = 42), continuous generalized epileptiform discharges (n = 5), alpha-coma-EEG (n = 52), and low amplitude (10 microV <) recording (n = 1). Except in 3 patients, these EEG-patterns were followed by another of these always nonreactive patterns within one day, mainly alpha-coma-EEG (n = 10) and continuous generalized epileptiform discharges (n = 9). Serial recordings disclosed a variety of EEG-sequences composed of these EEG-patterns, finally leading to isoelectric or flat recordings. Forty-five patients died within 2 weeks, 5 patients survived and remained in a permanent vegetative state. CONCLUSION: Generalized myoclonus in comatose survivors of CPR still implies a poor outcome despite advances in critical care medicine. Anticonvulsive drugs are usually ineffective. All postanoxic EEG-patterns are transient and followed by a variety of EEG sequences composed of different EEG patterns, each of which is recognized as an unfavourable sign. Different EEG-patterns in anoxic encephalopathy may reflect different forms of neocortical dysfunction, which occur at different stages of a dynamic process finally leading to severe neuronal loss.

Low-resolution detergent tracing in protein crystals using xenon or krypton to enhance X-ray contrast.

Xenon and krypton show different solubilities in polar versus apolar solvents. Therefore, these noble gases should accumulate in apolar regions of protein crystals. Specifically, they should accumulate in lipid and detergent solvent regions within crystals of membrane proteins, which can be used as a basis for contrast-variation experiments to distinguish such apolar solvent regions from the aqueous phase by a low-resolution X-ray diffraction experiment. This possibility was explored with the OmpF porin, one of the general diffusion pores of the Escherichia coli outer membrane. Trigonal crystals were exposed to elevated pressures of the two noble gases (up to 10(7) Pa) for several minutes and subsequently flash-cooled to liquid-nitrogen temperatures. Both rare gases bind to a number of 'specific' sites, which can be classified as 'typical' noble-gas binding sites. Compared with a representative water-soluble protein, they are however much more abundant in OmpF. In addition, a very large number of weakly populated sites are observed which accumulate in the region of the 'detergent belt' for crystals exposed to xenon. After application of a Fourier-filtering protocol, low-resolution images of the detergent belt can be obtained. The resulting maps are similar to maps obtained from low-resolution neutron diffraction experiments on contrast-matched crystals.