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Dysfunktionelle respiratorische Symptome sind durch rekurrierend oder chronisch auftretende respiratorische Krankheitszeichen charakterisiert. Diese lassen sich nicht durch strukturelle Besonderheiten der Atemwege erklaren und konnen Symptome somatischer Erkrankungen imitieren (somatoforme Atemstorungen). Die fruhzeitige Diagnosestellung ist erforderlich, um die Entwicklung von Fehlanpassungen zu vermeiden. Mindestkriterien stehen zur Abgrenzung von somatischen Erkrankungen und fur die korrekte Diagnosestellung zur Verfugung. Therapeutische Strategien schliesen je nach Krankheitsbild Aufklarung uber die Gutartigkeit der Erkrankung, Training von physiologischer Atemtechnik, Selbstkontrolltechniken zur Vermeidung unphysiologischer respiratorischer Symptome und psychologische bzw. psychotherapeutische Unterstutzung ein. Untersuchungen zur Effizienz therapeutischer Strategien sind erforderlich.

Background Acute rejection episodes (ARE) of kidney transplants are considered as risk factor in the development of chronic rejection. In adult renal transplantation (RTx), ARE have been significantly reduced by mycophenolate mofetil (MMF) in combination with cyclosporin (CyA) and steroids (Pred). Reports of pediatric RTx on a maintenance immunosuppression with MMF are restricted to patients (P) after antibody induction therapy. Methods. The efficacy and safety of MMF combined with CyA and Pred in pediatric RTx without induction therapy were evaluated in an open-labeled multicenter study. Results. From 10/1996 to 6/1996, 65 pediatric P (MMF group) were followed for at least 6 months, 58 of 65 for 12 months. These P were compared with 54 retrospectively analyzed pediatric P who were transplanted between 1990 and 1996 and had received CyA, Pred, and azathioprine for immunosuppression (historic AZA group). Within the first 6 months after RTx, 18 of 65 (MMF group) and 32 of 54 (historic AZA group) P showed clinical signs of acute rejection (P

A 6-month-old girl presented with hypotonia and mild psychomotor retardation. Subsequently, an atypical manifestation of a nonketotic hyperglycinaemia was diagnosed, confirmed by significantly reduced activity of the glycine cleavage system in the liver tissue. After the patient developed hypsarrhythmia and had a single cerebral seizure, treatment with both sodium benzoate and dextromethorphan was started. During the following year, the girl was free of seizures with improvement of the EEG activity and showed retarded but continuously progressing psychomotor development. At the age of 20 months she began to walk freely but had generalized muscular hypotonia and moderate mental retardation. Discontinuation of dextromethorphan medication after one year of treatment did not change the clinical and electroencephalographic status. However, after cessation of sodium benzoate therapy, epileptic activity in the EEG and behavioural changes occurred. These changes disappeared promptly after sodium benzoate therapy was reinstituted. Thus, this case of mild atypical nonketotic hyperglycinaemia with only moderate psychomotor retardation and without epilepsy benefited from treatment with sodium benzoate in terms of electroencephalographic and behavioural changes.

The aerobic microbial production of fine chemicals from liquid hydrocarbon substrates that are poorly soluble in water usually asks for a four-phase stirred tank fermentor (a continuous aqueous phase containing the cells, a dispersed organic phase and a dispersed gas phase necessary for oxygen supply). Depending on the operating conditions the gas/liquid oxygen mass transfer can be the rate controlling factor in the fermentation rate.The already complex behaviour of such four-phase reactors can be further complicated by the fact that hydrocarbon converting microorganisms commonly produce biosurfactants which can significantly influence gas/liquid mass transfer. Moreover, for hydrocarbon drop diameters below D/k(W) (diffusion coefficient/ mass transfer coefficient), the mass transfer coefficient for oxygen transfer from gas to liquid can be significantly enhanced by the presence of the dispersed organic liquid phase. One of the fermentation systems investigated at our laboratory is the growth of Pseudomonas oleovorans cells on n-octane as the organic substrate. The biosurfactant produced in this system is a lipopolysaccharide from the outer membrane of the cell.A dynamic method was developed to investigate the effect of the dispersed organic phase and of the biosurfactant on the volumetric gas/liquid mass transfer coefficient of oxygen.In the absence of the organic phase small amounts of biosurfactant were found to lower the volumetric mass transfer coefficient (k(W)a) and relatively large amounts of the emulsifier increase this coefficient. For surfactant concentrations typically found in the fermentation mentioned above approximately 70 % of the hydrocarbon droplets were found to have diameters below 0.5 * 10(-6) m. It could be shown that these small droplets are responsible for a significant enhancement of the effective gas/liquid mass transfer coefficient (k(W)) of. oxygen into the aqueous phase. As theoretically expected, the enhancement factor increases with the concentration of small octane droplets. As far as the authors know, such a mass transfer enhancement effect so far has been observed in stirred cells with a flat gas/liquid interface only where k(W) values usually are an order Of magnitude lower relative to the stirred tanks used in the present investigation. The results indicate that in hydrocarbon fermentation significant enhancement of mass transfer is possible, and that surfactants can be used to increase the relatively low fermentation rates.

Aminoglycosides (AG) provided for less than 5 days to newborn infants do not produce a marked disturbance of glomerular filtration rate (creatinine clearance) or tubular sodium handling (fractional sodium excretion). However, transient disturbances of proximal tubular cell functions can be noted: the excretion of N-acetylglucosaminidase, a lysosomal enzyme, is elevated, and mature not premature infants show a decreased tubular reabsorption of low-molecular-weight proteins during AG treatment. Preliminary investigations show an increased excretion of villin, a structural protein of proximal tubular cells, and a decreased secretion of Tamm-Horsfall protein by the cells of ascending limb of Henle and early distal tubule.

The authors point out that in situ particle monitoring has gained substantial acceptance as a manufacturing process control technique, with the capability of providing automated 100% inspection during process. This is significant for several reasons, including faster detection of out of control events and higher baseline count rates as a consequence of the ability to monitor continuously, the detection of process- and intertool-related particle sources as a consequence of the ability to monitor during process, and an increase in availability as a consequence of the ability to automate particle tests. To fully achieve these benefits, the in situ monitor must be integrated into the host tool, something that can be done by either the end user or the tool supplier. Progress toward host integration in VLSI process tools is discussed. >

Silicon monitor wafers are typically used to evaluate the cleanliness of an ion implanter in a production environment. Surface detection methods count particles on these wafers prior to processing. The same surface detection methods are used after implantation on the monitor, with the difference between the two measurements determining the cleanliness of the implant tool. This process may occur several times a day. Special monitor wafers and machine time are required to perform this technique, which provides only a snapshot of the machine's particulate performance. It may also, on occasion, yield incorrect results that can lead to unnecessary intervention. In-situ particle monitoring, on the other hand, allows real time particle detection without machine downtime, costly monitor wafers and the incorrect data usually associated with surface detection techniques. The High Yield Technology Model 20SX in-situ particle monitor was integrated into the Eaten GSD200 ion implanter and used at the IBM Microelectronics Division semiconductor manufacturing facility in Essex Junction, Vermont, to replace monitor wafers. The paper will discuss the integration of the 20SX sensor into the GSD200 and the characterization work that led to the elimination of silicon monitors.

In-situ particle monitoring (ISPM) is a key semiconductor initiative as wafer production facilities strive to reduce operating costs. The benefits of using ISPM include real-time process monitoring, reduced tool qualification costs and improved product cycle time (Pham et al., 1995; Scharnagl, 1996). All of these improvements lead to increased manufacturing productivity and a lower operating cost (Burghard et al., 1992). This paper describes the production implementation of an in-situ particle monitor on an LPCVD vertical furnace. The furnace is a high-risk, critical process to monitor in real time because of the large number of wafers processed in each batch. Correlation between surface scanner counts, ISPM counts, test yield and process trending is discussed, along with sensor reliability and a future plan for statistical control.

Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. The time period to establish normal colour in the babies was 2.2 min after epidural and 4.9 min after general anaesthesia. Three of the 24 general-anaesthesia newborns demonstrated a tendency to hypotonia compared to only one in the epidural group. Twenty-four hours and 7 days after delivery all infants of both groups were completely normal. At the time of delivery maternal PO2 was higher in the general anaesthesia compared to the epidural group, due to higher inspired oxygen concentrations. Comparable results were obtained in umbilical PO2 venous values; lower pH values, however, were observed in the umbilical artery after general anaesthesia. There were no significant differences in the glucose levels between the groups. A significant correlation was established between uterine incision-delivery interval and 1-min neonatal Apgar scores in the general-anaesthesia group, but not in the epidural group. Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.

Tropical diseases are rare in childhood in European countries, but tourism and an increasing number of immigrants from countries with endemic malaria may lead to a higher incidence. Our report is about a 24 year old german pregnant who was infected with malaria tropica in Togo during the last trimester of pregnancy. Twenty days after delivery by Caesarean section one of the geminies showed symptoms of florid infection: irritability, fever, haemolytic anaemia, hepato-splenomegaly, and thrombocytopenia. Both placenta and peripheral blood smear revealed plasmodium falciparum in the erythrocytes.

A rehydration with 7 ml/kg/h for six hours prior to indomethacin administration prevented the adverse effects of this drug on renal function in prematures with persistent ductus arteriosus. During the 36 hour observation period after indomethacin administration, no significant changes in serum creatinine, sodium, and potassium concentrations, or urinary flow, creatinine clearance, or filtered sodium could be detected. The only significant finding was a reduction in fractional sodium excretion. One can assume that this beneficial effect of the fluid load is due to a suppression of some parts of the vasoconstrictor mechanisms, which are responsible for the deterioration of renal function in newborns during indomethacin therapy. Using this modified fluid regimen, no cardiovascular side effects were noticed, a closure of the duct was achieved in 7 of 10 treatment courses.

In a pilot study 23 children with nephrotic syndrome were treated with cyclosporin A (Cs) for 6-45 months. 8 children suffered from steroid dependent minimal change nephrotic syndrome (MCNS) and had experienced at least one course with cytotoxic drugs, but had relapsed thereafter. 2 children had diabetes mellitus type I with nephrotic syndrome and 13 children had steroid resistant focal segmental glomerulosclerosis (FSGS). Cs was started with 100 mg/m2/day in two doses and increased stepwise to obtain a Cs whole blood trough level of 200-400 ng/ml. In steroid dependent MCNS treatment with Cs reduced relapse rate significantly, and prednisone therapy could be stopped completely. After discontinuation of Cs, relapses reoccurred as frequently as before. Renal function remained unimpaired despite repeated Cs treatment courses up to 38 months. In cases of nephrotic syndrome with diabetes type I Cs treatment led to complete remission without changing the insulin requirement. However, after discontinuation of Cs relapses reoccurred. In steroid resistant FSGS 6 children benefited from Cs treatment: 4 went into complete remission, 2 into partial remission. The 2 children with complete remission relapsed but remained Cs responsive. The remaining 7 children with FSGS did not respond to Cs but continued the course of their disease, with two patients rapidly progressing to terminal renal failure. Side-effects of Cs treatment were mild. It is concluded that Cs is an effective agent in steroid dependent MCNS and can be used as an alternative drug in specific cases like steroid toxicity or diabetes mellitus. In steroid resistant FSGS a trial with Cs seems to be warranted since some cases do respond favorably. To avoid nephrotoxicity treatment with Cs should always be monitored closely by determination of blood levels and renal function.

Micromolecular proteins (molecular weight < 68kD) in amniotic fluid are assumed to be derived largely from fetal urinary excretion and therefore may reflect fetal kidney function and maturation. Microprotein concentrations in amniotic fluid, neonatal urine and urine of fetuses with bilateral urinary tract dilation were analyzed using microgradient gel electrophoresis to separate proteins according to their molecular size. Alpha-1-microglobulin and β2-microglobulin were assayed as singular micromolecular marker proteins. Microproteins in amniotic fluid decreased progressively with advancing gestation during the 3rd trimester. Micromolecular protein concentrations in the first postnatal urine of healthy infants born prematurely or at term were similar to those in amniotic fluid of corresponding fetal age and yielded an identical developmental pattern. A strong correlation existed between the microprotein concentrations in amniotic fluid and fetal urine. It is concluded that fetal urinary production is the main determinant for the microprotein content of amniotic fluid and that a major fetal pathway exists for the intrauterine metabolism of these proteins. The 3rd trimester decrease in amniotic fluid seems to be dependent on the increasing reabsorption capacity of proximal tubular cells representing morphological and functional kidney maturation. The exact diagnostic value of microprotein analysis for the assessment of disturbed fetal kidney function has still to be defined by further investigation.

A second patient with N-acetylglutamate synthetase deficiency is described. The first symptoms were noted at 6 days of age. The course was lethal despite vigorous treatment. The diagnosis was established after death.

Die Sonographie wird im Rahmen der geburtshilflichen Vorsorgeuntersuchungen zunehmend auch zur Suche nach fetalen Misbildungen eingesetzt. Wir berichten uber 5 Kinder, bei denen pranatal mittels Sonographie zwischen der 34. und 37. Schwangerschaftswoche die Diagnose einer obstruktiven Harnwegsmisbildung gestellt wurde. Wahrend der folgenden Schwangerschaftswochen wurden wiederholte sonographische Kontrollen durchgefuhrt, alle Kinder wurden zum Termin spontan geboren. Postnatal konnten bei zwei Kindern Ureterabgangsstenosen links, bei je einem eine Uretermundungsstenose links mit funktionsloser Niere, Ureterocele rechts mit Harnstauungsniere rechts und Urethralklappe mit vesikoureteralem Reflux Grad 5 und Hydroureteren und -nephrosen beidseitig diagnostiziert werden. Bei 3 Kindern wurde eine fruhzeitige operative Therapie durchgefuhrt, zwei in ihrem weiteren Verlauf kontrolliert.

Anemia is an almost invariable feature of chronic renal failure and is particularly severe in children treated by long-term hemodialysis. Recombinant human erythropoietin (rhEPO) offers entirely new aspects in the treatment of renal anemia. This report presents three patients on maintenance hemodialysis aged 10, 10/10 12, and 18 years who were treated with rhEPO. Two suffered from hemochromatosis secondary to multiple transfusions. 100 U/kg rhEPO were administered three times weekly, and venesection after dialysis was performed when a target hematocrit value of 30% was achieved. Hematocrit, reticulocyte-counts and hemoglobin rose within 3 to 6 weeks after initiation of therapy in all patients. Serumferritin levels declined significantly in the two patients with hemochromatosis. No deterioration of the metabolic status (i.e. increase of blood urea nitrogen, serum-creatinine, -phosphate or -potassium) could be detected. Therapy had to be discontinued in one patient who experienced hypertensive ceisis. This patient, however, had suffered from severe hypertension prior to rhEPO therapy. Blood pressure remained stable in the other patients. We conclude that renal anemia can be effectively treated by rhEPO in children. Increase of blood pressure may necessitate discontinuation of therapy especially in primary hypertensive patients. Extensive studies are necessary to eluciate long-term effects of rhEPO in children.

Thrombin (Thr), plasmin (Pl) and elastase (ELP) are serine proteinases which are quickly inactivated by their specific inhibitors (AT III, alpha 2AP, alpha 1AT), if intravascular activation of coagulation and fibrinolytic system or if release from PMN granulocytes by different stimuli (F.I., endotoxin, activated factor XII, a.o.) occurs. The immunological determination of the developing proteinase inhibitor complexes (PIC) AT III-Thr, alpha 2AP-Pl and alpha 1AT-ELP gives information as to whether intravascular coagulation, hyperfibrinolysis or unspecific proteolysis induced by elastase have taken place. Despite the high antiprotease activity in the plasma the a.m. serine proteinases may exert their proteolytic activity towards their specific substrates in vivo. In infectious diseases, fulminant hepatic failure and cardiac shock a complex consumption of coagulation factors and inhibitors may cause severe coagulation defects, microcirculatory disturbances and bleeding tendency. The PICs behaviour was determined in more than 80 patients with infectious diseases, in 5 patients with fulminant hepatic failure (FHF) and 7 patients with cardiac shock. Only in infectious diseases, mainly in septic complications, and septic complications during FHF and cardiac shock, are alpha 1AT-ELP levels found to be highly elevated. After cardiac shock, in FHF and in infectious diseases coagulation and fibrinolysis may additionally be activated. In this case AT III-Thr and alpha 2AP-Pl complexes could be detected in the patients plasma. This indicates that intravascular coagulation and hyperfibrinolysis has additionally taken place. To prevent bleeding complications a replacement therapy with plasma derivatives (AT III, plasminogen concentrate, PPSB and FFP) has been successfully performed in several patients with septic complications and in the 5 patients with FHF and the 7 patients with cardiac shock. No bleeding complication occurred, and the haemostatic balance could be maintained in the treated patients. AT III replacement therapy is necessary to stop DIC, PPSB improves severe coagulation defects, only FFP may additionally provide alpha 1AT, alpha 2AP and factor V. In acute renal failure sometimes plasminogen replacement is necessary to maintain a normal activity of the fibrinolytic system. The complex consumption of coagulation proteins in infectious diseases, FHF and cardiac shock cannot successfully be treated with an anticoagulant such as heparin alone.

The prenatal diagnosis of urinary tract obstruction was made in 10 neonates. These findings were confirmed postnatally by sonography, urography, voiding cystourethrography, and scintigraphy. There were 8 neonates with unilateral obstruction of the ureter, and 2 with urethral valves and reflux. Nephrectomy because of hydronephrosis was necessary in 2 instances. The prenatal diagnosis of a urinary tract obstruction is of great importance, because the neonate may be operated upon without delay. Thus the diseased kidney can be saved. Diuretic radionuclide urography is helpful in differentiating between dilated obstructed and dilated nonobstructed kidneys.

Three children aged 11 to 14 years with acute interstitial nephritis (AIN) are presented. In one patient AIN developed following antibiotic treatment with trimethoprim/sulfamethoxazole (TMP/SMX). In two patients no infection, drug, or toxin could be implicated. Severe polyuric renal failure without elevation of blood pressure was the predominant clinical feature. Uveitis occurred either simultaneously with the nephritic symptoms or several weeks after complete recovery of renal function. Renal functions were characteristically altered and led to suspicion of AIN even prior to renal biopsy. Renal plasma flow was relatively more reduced than glomerular filtration rate (GFR) with an accordingly increased filtration fraction. Quantitative evaluation of selective tubular functions revealed significant transport deficiencies for glucose, amino acids, inorganic phosphate and low molecular weight proteins. In two patients GFR increased rapidly following initiation of steroid treatment and tubular symptoms simultaneously disappeared. In one patient spontaneous remission occurred. We conclude that--in contrast to adults--the prognosis of AIN in childhood is favorable. Although general clinical features are rather nonspecific, symptoms of decreased tubular reabsorption ability provide a good indication of the diagnosis and may contribute to enhanced recognition of this disease.

In a prospective cooperative study of gynecologists, anaesthesiologists and pediatricians we compared the effect of continuous epidural anaesthesia (23 cases) and of general anaesthesia (24 cases) on mother and newborn. All patients were delivered in the 39. to 41. week of an uncomplicated pregnancy by primary caesarean section for breech presentation or disproportion. Nearly one third of the patients with epidural anaesthesia showed an initial transitory decrease in blood pressure- up to 25%. The mean pO2 was higher (155 mmHg) in the group with the general anaesthesia than in the group with epidural anaesthesia (88 mmHg). Corresponding values for pO2 were found in the umbilical artery (22,8 mmHg after general anaesthesia, 16,6 mmHg after epidural anaesthesia). Concerning the pH in the umbilical artery, the better results were obtained in the group with continuous epidural anaesthesia (7,3 versus 7,27). After general anaesthesia 9 children had a one minute Apgar-score below 8 versus 3 children after epidural anaesthesia; five and ten minutes after birth the Apgar scores were practically identical. The neurologic examination 15 min after delivery revealed a pathologic muscle tone in three cases after general anaesthesia and in one case after epidural anaesthesia. After 7 days all children showed a normal neurobehavior. As no severe differences between the two types of anaesthesia in the effect on mother or newborn could be seen, in uncomplicated pregnancies the choice should be left to the mother.

Compromised kidney function in the perinatal period has been increasingly recognized during recent years, and acute renal failure is a frequent clinical situation in neonatal intensive care units. Renal underperfusion due to various prerenal conditions is assumed to be the most common cause of renal failure in neonates. With rapid restoration of renal blood flow, prerenal failure is completely reversible in the early course of the disease. If adequate treatment is delayed, however, structural damage to the kidneys by prolonged ischemia will ensue leading to a poor prognostic outcome. This review, therefore, mainly focuses on early diagnosis of disturbed neonatal kidney function and prophylactic therapeutical aspects which may be of particular benefit for critically ill newborns at high risk for developing acute renal failure.

Protein content and protein composition were studied in amniotic fluid obtained from 171 healthy pregnant women between the 16th and 38th week of gestation, using microgradient gel electrophoresis to separate proteins according to their molecular size into albumin (68 KD), proteins of low molecular weight (LMW proteins, less than 68 KD), and proteins of high molecular weight (HMW proteins, greater than 68 KD). Additionally alpha-1-microglobulin (alpha-1-MG, 33 KD) and beta-2-microglobulin (beta-2-MG, 11,8 KD) were analysed as micromolecular marker proteins. Concentrations of LMW proteins were 0.15-0.22 g/l, of alpha-1-MG 28.4-34.5 mg/l, and of beta-2-MG 7.2-11.6 mg/l during the second trimester of gestation, and thereafter decreased progressively to 0.03 g/l, 14.1 mg/l and 2.4 mg/l respectively near term. The same developmental trends were confirmed by calculating the protein/creatinine ratios in amniotic fluid. The concentrations of LMW proteins found in the first postnatal urine of 73 healthy infants born prematurely or at term were similar to those in amniotic fluid of corresponding fetal age. Concentrations of albumin and HMW proteins in postnatal urine were about 5% and 15% respectively when compared with amniotic fluid concentrations. No strong correlation existed between gestational age and either of the analysed proteins which would allow accurate assessment of fetal maturation by protein analysis in amniotic fluid. It is concluded that fetal urinary excretion is the major determinant of the microprotein content of amniotic fluid. Microproteins seem to reflect an increasing tubular reabsorption capacity, which accelerates rapidly after the second trimester of gestation.

Concentrations of sodium and creatinine were measured in serum and time collected urine samples of 72 newborn infants in the first ten days of life. Creatinine clearances, fractional and absolute sodium excretions were calculated. For analysis the group of newborns was divided into three according to gestational age: group A: less than 33 weeks; group B: 33-37 weeks; group C: greater than 37 weeks. The GFR was correlated to the conceptional age. Renal sodium losses exceeded alimentary supplementation in premature infants during the observation period. An additional supplementation of sodium seems therefore to be indicated early in life, as sodium balance is negative from the first day on. Individual investigations are necessary to evaluate the amount of sodium needed. 3-5 mMol/kg/day seem to be well tolerated and preventive for hyponatriaemia. Fluid administration during the first days should be calculated so that a weight loss of about 10% of body weight is achieved in premature infants in order to prevent cardiovascular and gastrointestinal complications. Because of a higher insensible water loss the amount of fluids administered per body weight should be higher in prematures than in matures.

Normal serum creatinine (Scr) and creatinine clearance (Ccr) values during the first 10 days of life were obtained in 63 very premature (28-32 weeks of gestation), premature (33-37 weeks) and term infants (38-42 weeks). Scr fell, and Ccr rose less markedly in the very premature infants. Scr was 80 mumol/l on the 1st day of life both in very premature and premature infants, and 77 mumol/l in full-term neonates. After 10 days, Scr was 73, 53 and 35 mumol/l respectively. There was an exponential correlation between Ccr and gestational age, indicating rapid maturation of glomerular function.

The purpose of the present longitudinal investigation was to assess the predictive value of urinary protein analysis in the early detection of rejection crisis after renal transplantation. Forty-one children were studied consecutively over a period of 6 months applying the following methods: creatinine clearance (Ccr); urinary total protein (UTP); and electrophoretic differentiation of urinary proteins according to their molecular size by microgradient-gel electrophoresis (MGGE) with a continuous concentration gradient of 4-40% of polyacrylamide. Protein fractions analyzed were albumin (69,000 d), low molecular weight proteins (LMW-proteins, less than 69,000 d), and high molecular weight proteins (HMW-proteins, greater than 69,000 d). No rejection was observed in 30 children (group A), a total of 18 rejection episodes occurred in 11 children (group B). UTP was significantly lower in group A as compared to group B (107 vs 376 mg/m2/24 h), but no differences in urinary protein pattern were observed between group A and group B prior to rejection. One to two days after rejection UTP increased to 938 mg/m2/24 h, and 3-7 days after rejection LMW-protein fraction increased from 9% to 23% with a corresponding decrease of albumin fraction from 71% to 56% of UTP. No qualitative changes were noted in respect to HMW-protein excretion. It is concluded that changes of UTP and urinary protein pattern occur during rejection episodes but are of no predictive value in detecting rejection before clinical symptoms appear.

Corticosteroids are often recommended for the treatment of severe Stevens-Johnson syndrome. We report about a 12 years old boy, who developed this syndrome during an immunosuppressive therapy with prednisone and cyclophosphamide for a frequent relapsing, steroid-dependent nephrotic syndrome. Most of the commonly mentioned etiologic factors for erythema exudativum multiforme could be excluded. The usefulness of corticosteroids for the therapy seems to be doubtful.