"Still crazy after all these years"--tuberculosis as an old disease with diverse facets in a thirty-five-year-old male patient.

We report about a thirty-five-year-old male patient with miliary TB as first manifestation of HIV-infection.

Syndrome of inadequate antidiuretic hormone secretion in pulmonary tuberculosis - a therapeutic challenge.

A forty-nine-year-old female patient with pulmonary tuberculosis developed syndrome of inadequate antidiuretic hormone secretion. Consequent restriction of fluid intake as a therapeutic measure was just as ineffective as a medication with tolvaptan which was performed later on. A probable explanation for the inefficacy of the aquaretic drug is an interaction of rifampicine and tolvaptan. This case report gives a short summary of SIADH in pulmonary TB and discusses possible reasons for the difficult antituberculotic treatment in this patient.

[Catch me if you can--a case of endobronchial lipoma]. / Catch me if you can--Das endobronchiale Lipom.

Incidentally, a lesion in the right upper pulmonary lobe was found in a 74-year-old male patient. The flexible bronchoscopy revealed an endobrochial lipoma in the right lower lobe as the only pathological finding. Due to multiple co-morbidities, no intervention was performed initially. Since the endobronchial lipoma increased in size during follow-up, it was removed by cryoextraction. This case report on an endobronchial lipoma includes a short summary of this rare benign lung tumor.

Tracheal perforation by an oesophageal stent.

In a 63 year-old female patient with oesophageal carcinoma a tracheal perforation by an oesophageal stent was diagnosed. A first attempt of tracheal stenting was not successful due to spontaneous dislocation of the stent. Therefore, a shorter stent was chosen and correctly placed in a second session. This case report on an oesophagotracheal fistula provides a summary of this complication in advanced oesophageal cancer.

[Paraganglioma--a rare cause of mediastinal lesions]. / Das Paragangliom--seltene Ursache einer mediastinalen Raumforderung.

A 73-year-old female patient was admitted to our clinic for further clarification of a suspicious mediastinal lesion. Endosonographically, we performed a fine-needle aspiration biopsy. Clinical and radiological findings as well as cytology hardened the suspicion of a paraganglioma as being the cause of the mediastinal lesion. Finally, this diagnosis was confirmed histologically after complete surgical resection of the lesion. This case report on a mediastinal paraganglioma includes a concise summary of diagnostic procedures and therapeutic options for this rare disease.

[Management of severe asthma in childhood (author's transl)]. / Massnahmen beim schweren Asthmaanfall im Kindersalter.

Generally the severe attack of asthma can be diagnosed without problems. Before the beginning of treatment a short history should be taken, laboratory tests should be started and a chest X-ray be ordered. The administered drugs are supposed to treat the obstruction of the airways. The inspissated endotracheal secretions are liquified and mobilised by a consequent intravenous therapy. A selective beta-2-receptor stimulans and xanthines are administered to relax the bronchospasm. In severe cases glucocorticoids are given at the same time to diminish the inflammatory edema of the bronchiolar mucosa. Antibiotics are only used if indicated, nor routinely. Sedatives should be administered very cautiously.

[Special problems of asthma bronchiale in childhood (author's transl)]. / Besonderheiten beim Asthma bronchiale im Kindesalter.

Asthma bronchiale is one of the most common chronic diseases in childhood. The hyperreactivity of the bronchial system, the stimulation of the cholinergic receptors and the blockade of the beta-adrenergic receptors in the bronchial mucosa play a predominant role in the pathogenesis. These proceedings cause bronchial smooth muscle contraction in the larger airways and mucosal edema and mucus hypersecretion in the smaller airways. The diagnosis may be made on the basis of the recurring signs: cough, wheezing, and labored breathing with prolonged expiration. Asthma may be treated by therapy directed at its cause and if necessary by bronchodilators, mucolytic agents and corticosteroids.

[Nosocomial dyspepsia in newborn and young infants. A 15-month prospective study with continuous Rotavirus surveillance]. / Nosokomiale Dyspepsien Neugeborener und junger Säuglinge. Eine 15 monatige prospektive Studie mit kontinuierlicher Rota-Virus-Uberwachung.

A 15 months prospective study of gastroenteritis in hospitalized newborns and infants (N = 201) was combined with a Rotavirus infection surveillance. Stool specimens were investigated weekly (CFT). From patients with gastroenteritis (N = 320) an infectious agent could be detected on average in 41% of each patient group: Rotavirus N = 54, Staph. aureus N = 22, toxin producing E. coli N = 4, other bacteria N = 25, Candida albicans N = 17, Echovirus 11 N = 1. With certain exceptions, the pathogens were distributed equally within the patient groups. However, Candida albicans appeared most frequently in premature children and the highest incidence of Rotavirus infections was observed in premature small for date babies. Rotavirus caused the mildest illness. The severest forms had usually no detectable cause. Bacteria took up an intermediate position. 68% of patients with detectable Rotavirus in the faeces had symptoms. However, treatment was required in only 25% of premature and small for date babies and 40% of normal newborns. In newborns and infants an isolated tachypnoea was observed 3 days prior to onset of a Rotavirus induced gastroenteritis. Breast fed infants showed no evidence of increased protection. Rotavirus antibodies were detectable in 58% of children prior to infection. The study presents evidence for the value of separate of patient care and meticulous hand disinfection, especially in the case of Rotavirus induced gastroenteritis.

[The causes of short stature in children in ambulatory care]. / Ursachen des Minderwuchses bei ambulanten Kindern.

The data relating to all children referred over a 10-year period to the out-patient department of a children's hospital in a West German city because of growth retardation were retrospectively analyzed. A diagnosis of short stature was made in 306 patients. The proportion of boys to girls was 2.5:1. The average age of the patients was about 10 years (0.75-17.4); 9.8% of the children were less than 4 years old, and 5.9% were over 16 years. In 68.3% of the patients the Study revealed constitutional delay of growth or familial short stature or a combination of two. Twelve children (3.9%) were demonstrated to have growth hormone deficiency.

[Retrolental fibroplasia: retrospective study (author's transl)]. / Retrolentale Fibroplasie. Eine retrospektive Studie.

Retrolental fibroplasia (RLF) is an iatrogenic disease of immature or dystrophic newborns who had been given oxygen treatment. Exchange transfusions seem to be of aetiological importance because they change the oxygen dissociation curve. Oxygen treatment of the newborn requires exact monitoring which can be done only in specially equipped departments. The retinal changes, up to the full-blown picture of RLF, progress rapidly. Ophthalmological control is, therefore, necessary as early as four weeks of age. If early RLF changes are demonstrated serial examinations every two weeks are indicated so that, if progression is demonstrated, treatment can be instituted.

[Prenatally diagnosed fetal hydrothorax]. / Pränatal diagnostizierter fetaler Hydrothorax.

A predominantly unilateral hydrothorax in an unborn child was diagnosed by sonography during the 34th gestational week. Because of a pathologic cardiotocogram it was necessary to make a primary caesarean section one day later. The premature baby was intubated immediately and the pleural discharge was removed. Later developmental of the child was uneventful. The hydrothorax was interpreted as a partial factor of a hydrops fetalis. Controlling the fetal pleural discharge by ultrasound examination and regular cardiotocogram a caesarean section should be done between the 34th and 36th week of pregnancy.

[Bacterial growth in breast milk under various storage conditions]. / Bakterienwachstum bei unterschiedlicher Lagerung von Muttermilch.

To find the best temperature for storing human breast milk in the first test series, bacterial growth was determined and recorded at refrigerator temperatures of 8 to 10 degrees C and at 4 degrees C respectively. During a 3-day observation period, there was a slight decrease in bacterial count (b.c.) at higher temperature whereas the b.c. decrease at the lower temperature was more significant. In another test 72 samples of milk were kept for one month at a temperature of -20 degrees C; the b.c. observed after thawing was substantially smaller than that recorded before freezing. Pasteurized milk samples were found sterile with the method we used (in 0.1 ml). In a third test a measured quantity of specific bacteria was added to the milk samples which were first deep-frozen, thereafter pasteurized and finally stored in a refrigerator for 3 days at 4 degrees C. During this process, a decrease was observed in all the bacteria involved. In our opinion, breast milk is best stored at a constant temperature of 4 degrees C. Pasteurization and freezing are also recommended from a bacteriological point of view.

[Bacterial contamination of pump-collected breast milk]. / Untersuchungen über die bakterielle Kontamination von abgepumpter Muttermilch.

Breast feeding of premature, new-born babies is often difficult when they become sick and are transferred to a children's hospital. The mother's milk should be collected and provided to the child without a loss of quality or too high a bacterial count which could endanger his health. We collected 113 samples of milk using electric vacuum breast pumps and then determined the bacterial contamination. In most cases there was evidence of bacteria normally found on the skin although more than 10(5)/ml of these bacteria were found in only 11.5% of the samples. As potentially pathogenic germs gram-negative bacilli, beta-hemolytic Streptococci Group B and Staphylococcus aureus were found. The electric pumps were cleaned with two different methods: the usual technique (Series I: 41 samples) and second, sterilization or replacement of the various external pump components between the collection of individual milk samples (Series II: 72 samples). The total of bacteria was considerably reduced by these additional hygienic measures; 62.5% of the samples could now be given to the children unpasteurized whereas the former figure was only 29.3%. On the other hand there was no decrease in the number of milk samples containing either beta-hemolytic Streptococci (Group B) or more than 10(5)/ml bacteria normally found on the skin.

[Follow-up study results and lung function changes following lung resection in childhood]. / Nachuntersuchungsergebnisse und Lungenfunktions-veränderungen nach Lungenresektionen im Kindesalter.

101 patients were subjected to partial lung resection from 1962-1969 at the Division of Paediatric Surgery in the Department of Paediatrics of the University of Cologne. Follow-up examinations were performed in 38 patients. 24 patients were entirely without complaints, 9 had mild subjective complaints, and only 5 patients stated they were suffering continually from dyspnoea. Lung function tests were conducted in all patients, revealing a significant drop in vital capacity as the number of resected segments increased. The intrathoracic gas volume expressed in percentage of the standard value increased significantly with the number of resected segments. The flow volume curves dropped with the number of resected segments, whereas the airway resistance increased. These studies show that lung resections are not always tolerated without restricted function even by children. Hence, lung resection should be performed with utmost discretion and only if absolutely necessary. This is all the more important since adjacent pulmonary tissue may also be involved in the pathological process due to the underlying disease.

[Changes in lung function after lung resection in childhood]. / Lungenfunktionsveränderungen nach Lungenresektion im Kindesalter.

38 children and young adults were followed up 2-24 years after lung resection. A significant correlation between lung function studied by bodyplethysmography and the number of lungsegments resected was found. However, there was no correlation between either the age at operation, the kind of underlaying disease or the resected area and the postoperative lungfunction on the other hand.

[Lobar emphysema]. / Lobäremphysem.

The lobes most commonly affected are the left upper and the right middle lobes. The classical sign of respiratory distress is mainly found within the first two months of life. In 14 infants the diagnosis was confirmed by microscopic examination, 13 were treated by surgery and 4 infants, who had associated serious malformations or complications, died. In most cases hypoplastic bronchial cartilage of the concerned bronchi was seen, in some cases a stenosis of the lobar bronchi. It is of great importance to establish the diagnosis as soon as possible. The lobectomy is recommended if the respiratory or cardial failure is worsening despite artificial ventilation.

Lack of association between HLA specificities and Wilms' tumour.

HLA antigen distribution was determined in thirty patients with Wilms' tumour, and their frequencies compared with those of an ethnically matched control population. No statistically significant association was found between any single HLA antigen and Wilms' tumour disease. The value of prospective HLA typing studies, with special respect to genetic aspects, histopathological subgrouping and survival rate of Wilm's tumour patients is discussed.

[Evaluation of a rapid test for direct detection of group A streptococcal antigen in throat swabs. Study of 4 commercial test systems]. / Bewertung von Schnelltests zum Direktnachweis des Gruppe-A-Streptokokkenantigens in Rachenabstrichen. Untersuchung zu vier kommerziellen Testsystemen.

Four commercially prepared test reagent kits for the rapid screening of throat swabs for group A streptococci were examined in comparison to bacteriological cultures of 963 double throat swabs. The sensitivities of the test systems were 86.7% (Abbott Test Pack Strep A), 81.8% (Hybritech Tandem Icon Strep A), 79.6% (Pharmacia Phadirect Strep A), and 72.6% (Wellcome Reveal Colour Strep A) respectively. The specificity of the four tests was above 90%. Marked variations between different test reagent batches could be observed. The two tests based on the enzyme immunoassay principle proved to be superior to the agglutination tests investigated with respect to sensitivity and reading accuracy. Our results are evaluated in the light of the published literature on these tests.

[Postpartum care of premature and newborn infants]. / Postpartuale Versorgung von Früh- und Neugeborenen.

The most important task of the physician in the delivery room is the initial and continued assessment of the premature or mature newborn. The sequence of resuscitative efforts is determined by the respiratory and circulatory changes in the baby. The procedure is summarised in an action flow sheet. If spontaneous respiration is inadequate, artificial ventilation should be begun; if the heart rate remains below 80/min cardiac massage should be instituted. There are special indications for the intubation of the trachea and the tracheal suction. In some cases catecholamines and infusions are required. One must be certain that the necessary equipment is available and properly prepared.