Klinische Pädiatrie
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Klinische Pädiatrie · Mar 2010
Randomized Controlled Trial Comparative StudyComparison of sufentanil versus fentanyl in ventilated term neonates.
Increasingly frequent applications of opioid analgesics in neonatal intensive care require the evaluation of efficacy and side effects. ⋯ In our study sufentanil did not reduce the weaning period in ventilated term neonates when compared to fentanyl. The equipotent dose ratio for fentanyl/sufentanil was 10:1. According to sedation scores both substances provided effective pain and stress protection.
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Klinische Pädiatrie · Mar 2010
Case ReportsCat scratch disease--heterogeneous in clinical presentation: five unusual cases of an infection caused by Bartonella henselae.
Cat-scratch disease (CSD) is common in children, however the wide spectrum of the clinical presentation of CSD may lead to delayed diagnosis. An atypical presentation of CSD includes in its differential diagnosis diseases such as tuberculosis, other mycobacterioses, Epstein-Barr-Virus infection (EBV) or malignant disease. Since, in a small number of cases, these diseases may be present concurrently with an active CSD, it is important to consider CSD early in the differential diagnosis and order the appropriate tests. These tests include serology and, where possible, histology including molecular diagnostic methods on tissue specimens. ⋯ CSD should also be considered in differential diagnosis of any patient with intraabdominal lymphadenopathy, abdominal pain and fever of unknown origin. A careful history is important, however, often patients with CSD have no history of contact with cats. Therefore in atypical cases of CSD the finding of other clinical symptoms and performance of specific diagnostic tests is important. Our experience suggests that early serological testing for Bartonella henselae should be performed and may avoid invasive diagnostic procedures.
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Vocal cord dysfunction (VCD) is an important differential diagnosis in acute dyspnoea. VCD is caused by adduction of the vocal folds during respiration typically leading to attacks of dyspnoea, stridor and coughing. Here we present an extraordinary case of an untypical paradoxical vocal fold adduction in a 15-year-old girl with stridor persisting over several weeks.
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Klinische Pädiatrie · Jan 2010
Case Reports[Spontaneously occurring pneumomediastinum related to a pneumopericardium, a pneumothorax and a skin emphysema in a 12-year old boy].
The spontaneous pneumomediastinum describes the existence of air inside the mediastinum, is caused by an alveolar rupture in most cases and occurs without influence of traumata, surgery or iatrogen interferences. This is a rare and, in most cases, benign disease. An association between a pneumomediastinum, a pneumopericardium, a pneumothorax, as well as a skin emphysema, is extremely rare in children and young adults. ⋯ In this case report and literature review possible causes, differential diagnoses, and treatments are summarized. Based on this, we suggest that this case report serve as a diagnostic guide for patients presenting with these symptoms.
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Klinische Pädiatrie · Jan 2010
Multicenter Study Comparative Study Controlled Clinical TrialSurfactant without intubation in preterm infants with respiratory distress: first multi-center data.
Recently in a report of a single center a method has been described to apply surfactant via a thin endotracheal catheter to very low birth weight infants spontaneously breathing with nasal continuous positive airway pressure. We now analyzed available multicenter data. ⋯ A new method of surfactant application was associated with a lower prevalence of mechanical ventilation and better pulmonary outcome. A prospective controlled trial is required to determine whether this approach is superior to standard care.