A novel measurement system for assessing the nose in patients with cleft lip and palate (CLP).

Objective: The presented study shows a new and innovative method to determine nasal asymmetries in a simple way in patients with cleft lip and palate (CLP) in order to plan corrective surgery. Design: 86 non-syndromic patients with cleft lip and palate were divided into 2 groups: a) patients with unilateral cleft lip and palate b) patients with bilateral cleft lip and palate. Patients: follow-up of hospital records of 86 patients aged 2-18 years. Main outcome: Based on standardised photos of the nose from 3 different directions, the nose symmetry was assessed. A new digital measurement system was used, which is integrated into proven clinical programmes. These were compared with a control group. In addition, a mirror fog test and a standardised questionnaire were used. Result: The overall results showed a good symmetry of the nose postoperatively, as well as a high satisfaction of the patients and their parents. Profile and angle measurements showed a better result. Conclusio: The presented measurement system and especially the Cleft Lip Component Symmetry Index (CLCSI) allows an individual and very effective assessment of the symmetry of the nose as well as a control of the growth in patients with CLP. The method is easy to apply in daily practice, even for untrained practitioners.

Candidaemia in a European Paediatric University Hospital: a 10-year observational study.

In this retrospective observational study covering 1998 to 2008, 32 patients (mean age: 7.50 years) were identified that had 35 episodes of candidaemia (0.47 cases/1000 hospital discharges). Cancer/allogeneic haematopoietic stem cell transplantation (43%) and congenital malformations/syndromes (21%) were the predominant underlying conditions. Central venous catheterization (90%), a history of antibacterial therapy (69%) and previous bacteraemia (54%) were frequent comorbidities. Candida albicans (46%) was most common, followed by Candida parapsilosis (17%) and Candida glabrata (14%). Resistance was infrequent and limited to non-albicans Candida spp. The 30-day and 100-day mortality rates were 11.4%.

Bird community in a forest patch isolated by the urban matrix at the Sinos River basin, Rio Grande do Sul state, Brazil, with comments on the possible local defaunation

We compared the avifauna recorded in a recent survey in an urban park (Parque Municipal Henrique Luís Roessler, Parcão) and surroundings, Novo Hamburgo, RS, with past data, to evaluate the possible alterations in species composition over time. Of the 265 species compiled as original elements of that region, 114 were found at Parcão. Among forest species, 37% were considered locally extinct. The most affected guild was the large frugivores, with nine extinct species and one survivor (Trogon surrucura). Birds highly sensitive to disturbance as well as endemic species were the most extinguished. The possible causes for this loss are fragmentation, hunting and environmental changes. The diversity today is threatened, thus conservation measures are necessary in that region. The most important actions are: maintenance of ecological corridors, protection of natural remnant areas and the establishment of protected areas.

Comparamos a avifauna registrada em levantamento recente no Parque Municipal Henrique Luís Roessler e arredores, Novo Hamburgo, RS, com os registros do passado, com o objetivo de avaliar as possíveis alterações na composição de espécies ao longo do tempo. Das 265 espécies compiladas como elementos originais da região, 114 foram registradas no Parcão. Dentre as espécies florestais, 37% foram consideradas extintas localmente. A guilda mais afetada foi a dos frugívoros de grande porte, com nove espécies extintas e uma sobrevivente (Trogon surrucura). Aves endêmicas e com alta sensibilidade à perturbação nos hábitats se extinguiram mais. As prováveis causas dessas perdas são fragmentação, caça e descaracterização dos ambientes. A diversidade atual encontra-se ameaçada e, portanto, medidas de conservação se fazem necessárias na região. As mais importantes são: manutenção de corredores ecológicos, proteção dos remanescentes naturais e criação de unidades de conservação.

Bird community in a forest patch isolated by the urban matrix at the Sinos River basin, Rio Grande do Sul State, Brazil, with comments on the possible local defaunation.

We compared the avifauna recorded in a recent survey in an urban park (Parque Municipal Henrique Luís Roessler, Parcão) and surroundings, Novo Hamburgo, RS, with past data, to evaluate the possible alterations in species composition over time. Of the 265 species compiled as original elements of that region, 114 were found at Parcão. Among forest species, 37% were considered locally extinct. The most affected guild was the large frugivores, with nine extinct species and one survivor (Trogon surrucura). Birds highly sensitive to disturbance as well as endemic species were the most extinguished. The possible causes for this loss are fragmentation, hunting and environmental changes. The diversity today is threatened, thus conservation measures are necessary in that region. The most important actions are: maintenance of ecological corridors, protection of natural remnant areas and the establishment of protected areas.

Infiltrates in protocol biopsies from renal allografts.

In renal transplantation, clinical decisions are based primarily on the Banff classification of biopsies. However, the incorporation of 'minor or nonspecific' cellular infiltrates into the Banff classification and their interpretation is uncertain. We analyzed 833 protocol and 306 indicated biopsies to test whether such infiltrates are harmless or whether they have a bearing on outcomes. We characterized morphology, localization and cellular composition of infiltrates, and correlated these findings to the Banff classification and allograft outcome. We found that protocol biopsies had the same prevalence of infiltrates as indication biopsies (87% vs. 87%). Diffuse cortical infiltrates, the hallmark of cellular rejection were more common in indication biopsies and related to tubulitis and a rise in serum creatinine. However, in biopsies with cellular rejection according to Banff criteria, we observed an increase in all infiltrate types (specific and nonspecific) and all cell types (T cells, B cells, histiocytes). The only predictor of allograft function outcome was persistent inflammation in sequential biopsies, irrespective of type, localization and composition of the cellular infiltrates. As detected by sequential biopsies, persistence of any inflammation including those infiltrates currently not considered by the Banff classification should be regarded as a morphological correlate of ongoing allograft damage.

Lymphatic neoangiogenesis in human renal allografts: results from sequential protocol biopsies.

Neoangiogenesis of lymphatic vessels may be important for the cellular immune response in renal transplants. To determine the prevalence and chronology of lymph vessel proliferation and its relation to cellular infiltrates and allograft function, we analyzed sequential protocol biopsies (n = 162), taken at 6, 12 and 26 weeks after transplantation. Biopsies were stained with an antibody against podoplanin and lymphatic vessel density was quantified per square millimeter. The prevalence of lymph vessel-positive biopsies and the lymph vessel density were similar at 6, 12 and 26 weeks after transplantation. Biopsies with acute cellular rejection showed no significantly different lymph vessel density compared to those below the threshold for acute rejection or chronic allograft nephropathy. While lymphatic neoangiogenesis was equally prevalent in biopsies with and without infiltrates, the lymph vessel density was significantly higher in areas with cellular infiltrates than in areas without. Graft function at 1 year after transplantation was better in cases with lymph vessels in their infiltrates compared to cases with lymph vessel-free infiltrates. In conclusion, lymphangiogenesis not only shows a clear association with cellular infiltrates but might also have an impact on the pathogenicity of these cellular infiltrates.

[Blood pressure self-monitoring as a basis for antihypertensive therapy]. / Echter Hochdruck oder Manschetten vor dem Arzt? Lassen Sie den Patienten messen--dann wissen Sie, was wirklich los ist.

The diagnosis of hypertension is complicated by the fact that the blood pressure varies greatly, depending on physical and mental stresses. In the doctor's office in particular, measurements are often too high (white coat hypertension). A practicable and inexpensive supplementary method as a means of avoiding inaccurate measurements, is to have the patient take his/her own blood pressure. This approach enables numerous measurements to be obtained, which more accurately reflects the true situation than the one-off measurement in the physician's office. Furthermore, self-measurement can also reveal therapeutic effects more reliably, and has a greater predictive value for organic damage. Patients who measure their own blood pressure should first receive comprehensive instruction in the technique, and should be required to record their measurements.

Maternal posttraumatic stress response after the birth of a very low-birth-weight infant.

OBJECTIVE: For parents, the premature birth of a child represents a traumatic event for which they are poorly prepared. To date, the focus of scientific interest has been on maternal psychological stress responses, such as anxiety and depression, or on appropriate coping mechanisms, whereas only scant attention has been paid to the traumatic aspect of the maternal experience after very low-birth-weight (VLBW) birth. The present study is the first to investigate the posttraumatic stress response of mothers after the birth of a VLBW infant in a prospective longitudinal study. METHODS: Fifty mothers of VLBW infants were examined at four measuring time points (1-3 days pp, 14 days pp and 6 and 14 months pp) with respect to posttraumatic symptoms [Impact of Event Scale (IES-R)], psychiatric diagnosis (SKID I for DSM-IV) and the extent of depression [Beck Depression Inventory (BDI) and Montgomery Asberg Depression Scale (MADRS)] and anxiety [State-Trait Anxiety Inventory (STAI) and Hamilton Anxiety Scale (HAMA)]. The control group comprised a group of 30 mothers after the uncomplicated spontaneous birth of a healthy child. RESULTS: At all four measuring timepoints (except 6 months pp), the mothers of the premature infants recorded significantly higher values for traumatic experience and depressive symptoms and anxiety compared with the controls. In contrast to the mothers in the control group, the mothers of the premature infants displayed no significant reduction in posttraumatic symptoms (IES-total), even 14 months after birth. CONCLUSION: The results indicate that the situation of a mother who has given birth to a VLBW infant is a complex, with long-term traumatic event necessitating ongoing emotional support extending beyond the period immediately after the birth.

[Long-term study of psychological effects in clinical rehabilitation (VESPER-study)]. / Verlaufsstudie psychologischer Effekte in der stationären Rehabilitation (VESPER-Studie).

OBJECTIVE: The course of chronic diseases does not only depend on the patients' physical situation but also on their psychological state of mind. Therefore, inpatient medical rehabilitation has to aim at including psycho-social features present themselves at the beginning and at the end of inpatient rehabilitation - and, even more importantly, six months afterwards. PATIENTS AND METHODS: For half a year all patients of an internistic rehabilitation clinic were taking part in a long- term baseline-study. They have been questioned about anxiety, susceptibility to depression, aspects of quality of life and about their body weight, using a standardized questionnaire. The analyzed total spot check (n = 1222) consisted of cardiological (n = 197; mean age 53,5 +/- 10,9 years), pulmonary (n = 709; mean age 47 +/- 11,2 years) and breast cancer patients (n = 277; mean age 54,2 +/- 8,8 years) and n = 39 could not be classified. RESULTS: At the onset of rehabilitation all patients suffered significantly more from anxiety than from depression. Accordingly, of the cardiological and pulmonary group 12.2 % or 10.9 % respectively showed a clinically strong depression and 27.9 % or 27.1 % respectively revealed remarkable values in anxiety. Moreover, 17.8 % of the cardiological and 14.7 % of the pulmonary patients stated a remarkable restriction of their fitness. Unexpectedly, the statements of the breast cancer patients group showed lower rates in all these categories. Six months after termination of rehabilitation, a significant long-term improvement of anxiety could be observed, especially for those patients who had had the highest values before. This also applies to patients who had stated the highest depression values initially. In addition, there was also a significant improvement in the capability for fitness, pleasure, relaxation and contact - while the BMI benefited, too. CONCLUSION: The data show that the psychological comorbidity of patients in inpatient medical rehabilitation is much higher than that of the general population and that of the general population and the psycho-social situation, especially for psycho-social very stressed patients, improves considerably on a long-term basis.

[Blood coagulation in normotensives and hypertensives in relation to their body mass index]. / Gerinnung bei Normotonikern und Hypertonikern in Abhängigkeit vom Body Mass Index.

UNLABELLED: BACKGROUND AND PERSPECTIVE: Various parameters of the coagulation cascade and fibrinolysis are important predictors of myocardial infarction and stroke, for which hypertension is a risk factor. It is unclear whether an elevated blood pressure by itself can produce activated clotting. PATIENTS AND METHODS: Coagulation tests were done on overweight hypertensive (n=40); aged 49 +/- 8 years; group 3), overweight normotensives (n=19; aged 51 +/- 8 years; group 2) and normal-weight normotensives (n=20; aged 51 +/- 8; group 1). RESULTS: Plasminogen-activator-inhibitor 1 (PAI-1), a measure of impaired fibrinolysis, was elevated in group 2 (20.5 +/- 11 U/ml; p < 0.001), compared with group 1 (11.6 +/- 6 U/ml), and was even higher in group 3 (27.5 +/- 9 U/ml; p < 0.05). Fibrinogen and factor VIII, parameters that promote clotting, were elevated in group 2 (360 +/- 61 mg/dl and 143 +/- 15 %, respectively; p < 0.001), and in group 3 (368 +/- 63 mg/dl and 146 +/- 18%; p < 0.001) compared to group 1 (304 +/- 40 mg/dl and 127 +/- 17%). Correspondingly, fibrin monometers, a measure of intravascular coagulation, were elevated in group 3 (p < 0.05) and partial thromboplastin time (PTT) decreased (p < 0.001). Pearson correlation showed a significant (p < 0.001) positive relationship between PAI-1 and body mass index (BMI) (0.539), triglycerides (0.512), blood pressure (0.388 to 0.534), fibrinogen (0.404, and a negative one with HDL-cholesterol (0.625). BMI also correlated with fibrinogen (0.509; p < 0.001) and factor VIII (0.337; p < 0.01). CONCLUSIONS: Fibrinolysis and activated coagulation are reduced in hypertensive subjects: this favours the occurrence of myocardial infarction and stroke. In addition to the level of blood pressure, the extent of the changes are effected especially by BMI and metabolic risk factors.

The effect of amlodipine on exercise-induced pulmonary hypertension and right heart function in patients with chronic obstructive pulmonary disease.

The aim of the study was to investigate the pulmonary vasodilator effect of the dihydropyridine calcium channel blocker amlodipine in patients with clinically stable chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH). Many patients with COPD develop chronic PH and this may predict mortality in this disorder. The treatment with calcium channel blockers is accepted as a therapeutic strategy for primary pulmonary hypertension. In twenty male patients (mean age 57+/-7 years) with clinically stable COPD and PH, we investigated whether amlodipine could effectively decrease pulmonary vascular resistance (PVR) and pulmonary arterial pressure (PAP) and improve right heart function. PAP was recorded by a balloon-tipped thermodilution catheter and cardiac output was determined in triplicate by thermodilution at rest and during exercise. In addition, blood gas values were determined from the capillary blood of the earlobe. All measurements were done under identical conditions before and after 18 days of chronic treatment: with 10 mg amlodipine once daily starting with 5mg in the first week. At a mean maximal achieved workload of 71.3+/-20 Watts, amlodipine achieved a significant reduction in PVR (-13.4%; p<0.01) and PAP (-12.1%; p<0.001) implying an improved right heart function assessed by a significant reduction in mean right atrial pressure (-20.6%; p<0.05). During the action of amlodipine there were no significant changes in pulmonary gas exchange and pulmonary capillary wedge pressure. Amlodipine given as a single daily oral dose of 10mg is a safe and effective pulmonary vasodilator in COPD patients with PH and leads to an improvement in right heart function.

[Fish, olive oil, fruit, vegetables and fiber. Therapy of hypertension a la carte]. / Fisch, Olivenöl, Obst, Gemüse und Ballaststoffe. Hochdrucktherapie à la carte.

A healthy diet has a positive impact both on elevated blood pressure and its associated cardiovascular risk. In particular the association between obesity and hypertension is beyond doubt. Accordingly, a calorie-controlled or low-calorie diet resulting in a reduction in weight, lowers raised blood pressure. Blood pressure is also determined by the composition of the diet. A substantial pressure-lowering effect has been shown to be associated with the regular ingestion of fish and olive oil. Evidence also points to a positive effect of a diet high in fruit and vegetables and low in fat. Also recommended for hypertensives is a low-salt and potassium-rich diet, and sparing use of alcohol. The impact of a healthy diet on the cardiovascular risk is particularly favorable when the patient also takes regular physical exercise.

[Head circumference in relation to sonographic morphometry of the cerebral ventricles in neonates and infants]. / Beziehung zwischen Kopfumfang und sonographischer Morphometrie der Ventrikelstrukturen im Neugeborenen- und Säuglingsalter.

AIM: To determine normal values of sonographic measurements of the brain in neonates and infants. METHOD: Cerebral ultrasonographic examinations were performed in 143 healthy newborns and infants. The size of the ventricles was determined by ascertaining distances as well as performing planimetric measurements of the ventricular area and circumference in standardized planes. RESULTS: Throughout the course of the study we observed a continous increase in size and a strong correlation with head circumference. The middle coronary plane used for the measurements allows the accurate representation of the ventricles and a more objective assessment of size. CONCLUSION: Based on the morphometric data, charts for the determination of ventricular size were developed.

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants.

UNLABELLED: This study was carried out to assess the feasibility of late cord clamping of 45 s in preterm infants delivered mainly by caesarean section and the effects on postpartal adaptation and anaemia of prematurity. Prior to delivery, 40 infants of < 33 gestational weeks were randomised to either 20 s or 45 s of late cord clamping. After the first shoulder was delivered, oxytocin was given intravenously to the mother in order to enhance placento-fetal transfusion while the infant was held below the level of the placenta. The 20 infants in group 1 (20 s) had a mean birth weight of 1070 g and a mean gestational age of 29 + 4/7 weeks versus 1190 g and 30 weeks in group 2 (45 s). On day 42 of life there were ten infants without transfusions in group 2 versus three in group 1 (P < 0.05). Out of the 20 infants in group 1, 19 and 15/19 in group 2 were delivered by caesarean section. There were no significant differences in Apgar scores, temperature on admission, heart rate, blood pressure and requirements for artificial ventilation. CONCLUSION: Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life.