Klinische Pädiatrie
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Klinische Pädiatrie · Mar 1999
Clinical TrialDiagnosis and stage-related treatment of disseminated intravascular coagulation in meningococcal infections.
Disseminated intravascular coagulation (DIC) is a frequent complication of meningococcal sepsis in children. Despite the availability of potent antibiotics, mortality in meningococcal disease remains high (about 10%), rising to 40% in patients presenting in severe shock and consecutive DIC. As the clinical course and the severity of manifestations of systemic meningococcal infections varies there is a need for early diagnosis of the infection and of the stage of coagulopathy in order to reduce the high mortality rate. ⋯ Treatment consisted of shock control by liquid substitution, compensation of metabolic acidosis, correction of clotting disorders (AT III and heparin in case of pre-DIC; AT III and fresh frozen plasma in case of advanced DIC), antibiotic treatment (beta-lactam antibiotics e.g. cefotaxime or ceftriaxone), and--when necessary--catecholamine infusions. An early assessment of the coagulation disorders in meningococcal disease can be based on few coagulation parameters. Thus an appropriate treatment can be arranged in order to prevent a fatal outcome of meningococcal sepsis and to protect against the development of a Water-house-Friderichsen-syndrome.
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Klinische Pädiatrie · Mar 1999
Case Reports[Combination therapy of high frequency oscillatory ventilation, NO inhalation and surfactant replacement in a child with acute respiratory distress syndrome].
We report about a child with severe ARDS after burning trauma who did not respond to conventional treatment with controlled pressure ventilation under conditions of permissive hypercapnia and changing of the infants's body position. A combined treatment with high frequency oscillatory ventilation, inhalation of nitric oxide and surfactant replacement improved the pulmonary status. Twelve days after the accident the boy could be extubated and 5 weeks later he could be discharged without any pulmonary and neurologic handicap. The use of these therapeutic tools may help to avoid the necessity of the invasive extracorporeal life support.
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Pyogenic sacroiliitis is a rarely occurring disease. In recent years more reports have been published about this topic. We report on a case of infectious sacroiliitis in a young female patient. The multivarious clinical symptoms, the problems of diagnosis, differential diagnosis, treatment and prognosis of this disease will be described.
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Klinische Pädiatrie · Nov 1998
Case Reports[Miliary tuberculosis and adult respiratory distress syndrome in an infant].
We report on a 7 months old infant, who was admitted to our hospital with the tentative diagnosis of interstitial pneumonia. The infant was treated with erythromycin because of a positive mycoplasma antigen test in the nasopharyngeal mucus and the radiological findings. A tension pneumothorax led to rapid respiratory deterioration and a severe ARDS developed. ⋯ The source of infection could not be identified in the family or in persons known to have had contact to the infant. The tuberculin skin test (PPD) was negative. Clinical, radiological and pathological findings are demonstrated.
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Klinische Pädiatrie · Sep 1998
Review[Differentiated thyroid gland carcinoma in children and adolescents].
Differentiated thyroid cancer is a rare disease in childhood and adolescence. Most frequently, thyroid cancer in children belongs to the papillary variant, whereas a follicular histological pattern is much less frequently encountered. Dedifferentiated (anaplastic) cancers are very rare at this age. ⋯ Regional lymph nodes are involved in up to 90%, and distant metastases are present in up to 20% of the cases. Despite these much more advanced stages as usually found in adults, the prognosis of children is better than at advanced age, since these tumors are highly differentiated, and, even in the case of distant metastases, a curative approach is still possible. The therapy (surgery/radioiodine) and the follow-up follows the same principles as those which have been established for older patients.