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Synkopen im Kindes- und Jugendalter sind haufig und konnen zu erheblichem Leidensdruck fuhren. Meist handelt es sich um benigne Regulationsstorungen der Herzfrequenz und des Blutdrucks durch das autonome Nervensystem. Man kann Reflexsynkopen und Storungen der orthostatischen Regulation unterscheiden. Selten liegen potenziell lebensbedrohliche Ursachen zugrunde. Nichtkardiale Ursachen von Bewusstseinsstorungen aufgrund neurologischer, metabolischer oder endokrinologischer Storungen mussen abgegrenzt werden. Die Anamnese ist meist der Schlussel zum Verstandnis der Genese der Synkope und bestimmt die weitere Diagnostik. Therapeutisch reicht bei Kreislaufregulationsstorungen meist ein aufklarendes Gesprach mit Unterweisung in der Durchfuhrung von Allgemeinmasnahmen aus. Selten ist eine medikamentose Therapie erforderlich. Eine Schrittmacherimplantation ist bei neurokardiogenen Synkopen mit prolongierter Asystolie in Ausnahmefallen indiziert.

Zielsetzung. Untersucht wird der Einfluss einer lokalen Dorzolamid-Applikation auf das Gesichtsfeld und die okulare Hamodynamik beim Glaukom. Methodik. In einer retrospektiven, nicht maskierten klinischen Studie wurden 28 Patienten (28 Augen) mit primar chronischem Offenwinkelglaukom (PCOG), die 3-mal taglich 1 Dorzolamid-Augentropfen erhielten, uber den Verlauf von 9 Monaten hinsichtlich folgender Parameter untersucht: Augeninnendruck, pulsatiler okularer Blutfluss (POBF) und Humphrey 30-2 Gesichtsfeld. Der POBF wurde mit dem Pneumotonometer nach Langham (OBF-System, U.K.) ermittelt. Die statistische Analyse erfolgte mit dem Wilroxon-Test, die Signifikanzniveaus wurden nach Bonferoni-Holm adjustiert. Ergebnisse. Der Augeninnendruck sank unter der Dorzolamid-Therapie signifikant von 18 mmHg auf 15,5 mmHg nach 9 Monaten, und die Gesichtsfelddefekte verringerten sich signifikant um 18% gegenuber dem Ausgangswert. Es zeigte sich eine signifikante Anderung des POBF (Ausgangswert: 543 μl/min; 9 Monate: 675 μl/min). Schlussfolgerungen. Die Resultate zeigen die erwartete Augeninnendrucksenkung. Visuelle Funktion und POBF verbesserten sich signifikant. Eine Erklarung dafur konnte das Vorliegen eines analogen vasodilatatorischen Effektes sein, der bei systemischer Carboanhydrasehemmerapplikation beobachtet wurde.

· Purpose: The aim of this study was to determine allergic responses to clonidine hydrochloride 0.25% in glaucoma patients with proven allergic reaction to apraclonidine 0.5%. · Methods: Fifteen consecutive glaucoma patients with allergic reaction to apraclonidine were prospectively challenged with clonidine hydrochloride 0.25% and evaluated for recurrence of allergic reactions and efficacy of treatment. Intraocular pressure (IOP), conjunctival hyperemia, blood pressure and resting pulse rate were determined at baseline and after 1, 3, 6 and 12 months. · Results: None of the patients developed ocular allergic reaction during 12 months on clonidine therapy. Blood pressure and pulse rate did not change significantly with clonidine treatment. Clonidine caused a significant reduction of IOP from baseline. In one patient, topical clonidine caused fatigue, dizziness and dry mouth. · Conclusion: Clonidine did not cause allergic reaction in patients with proven allergy to apraclonidine, indicating that there is no cross-reactivity with apraclonidine. Due to the small series, however, we cannot assume that allergy will not occur with clonidine 0.25% given time and a larger number of patients.

The authors describe an atypical case of Kawasaki disease in a 9-month-old girl who presented with fever, coronary artery aneurysms, and acquired ischemic stricture of the proximal jejunum. Histology of the surgical specimen was consistent with mesenteric vasculitis. The infant had only some of the typical clinical signs of Kawasaki disease, suggesting that an atypical or incomplete form of the disease was present. To the best of the authors' knowledge this is only the third case to be reported of incomplete Kawasaki disease associated with ischemic bowel stricture. J Pediatr Surg 36:648-650. Copyright © 2001 by W.B. Saunders Company.

Background For decades, the well-established standard recommended treatment for patients with congenital lobar emphysema (CLE) and respiratory distress has been lobectomy of the affected lobe or lobes, whereas indications for conservative management have been controversially discussed. Patients/methods Description of the clinical courses including the results of diagnostic procedures and the resulting therapeutic strategies in 2 patients with congenital lobar emphysema. We review the literature on conservatively treated patients with congenital lobar emphysema. Results Considering that formerly asserted hypotheses postulating benefits of surgical treatment cannot unambiguously be corroborated from cases in literature, we could show that conservative treatment in patients with congenital lobar emphysema is appropriate in mildly to moderately symptomatic children. Conclusion Conservative treatment of children with congenital lobar emphysema is an attractive option, whenever justifiable on medical grounds. Our cases may serve as paradigms in decision-making processes in similar cases and - together with the literature review - may be helpful to avoid unnecessary lobectomies in children. Patients treated conservatively will need a close follow-up, and further data on long-term follow-up courses are desirable.

A specially designed heating system for temperature-programmed HPLC was developed based on experimental measurements of eluent temperature inside a stainless steel capillary using a very thin thermocouple. The heating system can be operated at temperatures up to 225 degrees C and consists of a preheating, a column heating and a cooling unit. Fast cycle times after a temperature gradient can be realized by an internal silicone oil bath which cools down the preheating and column heating unit. Long-term thermal stability of a polybutadiene-coated zirconium dioxide column has been evaluated using a tubular oven in which the column was placed. The packing material was stable after 50h of operation at 185 degrees C. A mixture containing four steroids was separated at ambient conditions using a mobile phase of 25% acetonitrile:75% deionized water and a mobile phase of pure deionized water at 185 degrees C using the specially designed heating system and the PBD column. Analysis time could be drastically reduced from 17 min at ambient conditions and a flow rate of 1 mL/min to only 1.2 min at 185 degrees C and a flow rate of 5 mL/min. At these extreme conditions, no thermal mismatch was observed and peaks were not distorted, thus underlining the performance of the developed heating system. Temperature programming was performed by separating cytostatic and antibiotic drugs with a temperature gradient using only water as the mobile phase. In contrast to an isocratic elution of this mixture at room temperature, overall analysis time could be reduced two-fold from 20 to 10 min.

In 51 untreated cases of ulcerative colitis and Crohn's disease some cellular (neutrophil alkaline phosphatase activity, neutrophil NBT reducing capacity, and neutrophil and plasma lysozyme activities) and humoral (serum orosomucoid and serum haptoglobin) indices of disease activity were quantitated. The most pronounced signs of disease activity, thus, were found in severe cases of ulcerative colitis. Combining lysozyme activities with other disease activity indices seems to facilitate the distinction between severe cases of Crohn's disease and ulcerative colitis. Beyond this the addition of the humoral indices seemed not to offer substantial help.

The M2, M3 transition of V0.976Fe0.024O2 was studied up to 60 kbar using the Mossbauer effect of 57Fe. A discontinuous change of the quadrupole splittings and a continuous change of the isomer shift with a crossing over at the M2, M3 phase transition is found.

Udgivelsesdato: 1984-null On return from Liberia, a previously healthy 36-year-old man showed signs of malaria accompanied by severe haemolysis and slight thrombocytopenia. We found evidence of a platelet-associated IgG being responsible for the thrombocytopenia, inasmuch as the direct platelet suspension immunofluorescence test was strongly positive, the indirect immunofluorescence test and tests for drug-dependent antibodies at the same time being negative. We suggest that autoimmunity may be a contributing mechanism for platelet destruction in acute malaria.