Klinik fur Kinder und Jugendmedizin

Dortmund, Germany

Klinik fur Kinder und Jugendmedizin

Dortmund, Germany
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Rose E.,Klinik fur Kinder und Jugendmedizin
Intensiv- und Notfallbehandlung | Year: 2017

The diagnosis of diseases in children with symptoms of abdominal complaints is often challenging also for pediatricians. In the emergency medicine with it’s limited diagnostic possibilities it is even more difficult to make a diagnosis. Nevertheless, our main concern must lie in the recognition of situations which require immediate treatment. © 2017, Dustri-Verlag Dr. Karl Feistle.

The term Schutteltrauma-Syndrome (STS) (Shaking Trauma Syndrome) is prevalent and widely accepted in German medical community. Due to these reasons it will be maintained in this review, although it is not appropriate to reflect the wide spectrum of what interna-Tionally now has been termed Abusive Head Trauma (AHT). Classic STS is caused by violent shaking, with or without impact. It is characterized by a variable, but often serious brain damage (encephalopathy), subdural hematomas and mostly extensive retinal hemorrhages and unfavorable outcome. Triggers are situations of intense frustration, anger and despair of care takers. Although research has delineated plausible concepts for diagnosis, etiology and pathogenesis, evidence based research is limited due to obvious methodic reasons. Recent systematic reviews of the literature have been able to demonstrate significant statistic associations of different combinations of clinical symptoms and findings. Due to far reaching psychosocial und legal implications of the diagnosis (and failure to establish it as well), professionals must be aware of a number of controversial aspects.

Peinemann F.,Klinik fur Kinder und Jugendmedizin
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2017

Background Negative pressure wound therapy is believed to promote wound healing. However, the results from randomised controlled trials (RCTs) are inconsistent. Systematic reviews indicate unclear evidence, due in part to low-quality RCTs, calling for more RCTs of higher quality. Methods This study aimed to ascertain the number of RCTs as well as systematic reviews on RCTs published during the time period from 2000 to 2015. Various search strategies were used to identify studies in PubMed, Cochrane Library, Google, references lists of retrieved articles, and institutions that issue evidence reports. The study also aimed to investigate the quality of included RCTs. It evaluated whether or not the randomisation methodology was comprehensibly described and conclusions were based on acceptable endpoints. Results The search for studies resulted in 456 different references, which included a total of 49 RCTs and 81 systematic reviews. Randomisation was comprehensibly described in 37% (18 out of 49 RCTs) and concealment of allocation in 10% (5 out of 49 RCTs). Conclusions were based on acceptable endpoints in 55% (27 out of 49 RCTs). A superior efficacy of NPWT versus standard was stated in 65% (32 out of 49 RCTs). In studies based on acceptable endpoints, this proportion was 16% (8 out of 49 RCTs). Systematic reviews repeatedly included identical study data. Conclusion The published literature, reviewed over a period of more than 16 years, contains more systematic reviews incorporating secondary data from other RCTs than actual RCTs reporting primary clinical data. Many RCTs seem to be of low quality, which considerably limits the validity of the corresponding conclusions. The ongoing production of potentially unreliable RCTs and redundant systematic reviews does not seem to provide convincing answers to crucial clinical research questions. Therefore, a change in strategy should be contemplated to observe individual characteristics of the respective persons and the wounds in question. © Georg Thieme Verlag KG Stuttgart, New York.

Berlemann B.,Klinik fur Kinder und Jugendmedizin
Padiatrische Praxis | Year: 2017

Q fever is a ubiquitous, notifiable zoonosis, which can be transmitted especially by both dried-up and fresh excrement and the afterbirth of sheep and other ruminants. Human-to-human transmission is extremely rare. The clinical picture of an acute infection with Coxiella is unspecific and makes early diagnostic confidence difficult to attain, although diagnostic accuracy is a prerequisite for an adequate and potentially successful therapy. The bacterial infection - usually spread airborne - progresses asymptomatically in most cases. However, in five percent of the cases acute infections accompanied by high fever may occur, which may result in severe complications even in children. Both a timely diagnostic confidence and adequate measures at the beginning of therapy are very important in order to avoid chronification. Diagnostics should be performed at an early stage, especially in case of several disease symptoms occurring simultaneously, like pneumonia and hepatitis accompanied by high fever. When suspecting acute coxiellosis, patients should be treated with doxycycline primarily, even before receiving laboratory results. The treatment of chronic infections belongs in the hands of experienced infectiologists. Prognosis is very positive on the whole, provided these strategies are implemented. It seems certain that coxiellosis is generally underdiagnosed, especially in childhood.

Vagus nerve stimulation has become established as an effective and safe adjuvant therapy for drug-resistant epilepsy. In addition to invasive vagus nerve stimulation (i-VNS), transcutaneous vagus nerve stimulation (t-VNS) is also now available, where electrical pulses are generated by a stimulator unit connected to a special ear electrode. This article reports the case of an 11-year-old girl with Dravet syndrome. A therapy trial with t-VNS together with a combination therapy of zonisamide and phenobarbital was performed. The existing medication was maintained. The NEMOS® t-VNS device developed by the company Cerbomed was used. The child tolerated t-VNS well and for the most part the planned daily 4 h stimulation times were complied with. After 4 months, without changing the drug regimen, a 57 % reduction in seizure frequency (specifically from 30 to 13 seizures per month) was noted. No side effects were observed. © 2015, Springer-Verlag Berlin Heidelberg.

Severien C.,Klinik fur Kinder und Jugendmedizin | Teufel M.,Klinik fur Kinder und Jugendmedizin
Padiatrische Praxis | Year: 2014

We report 81 cases of foreign body ingestion in children managed at the Children's Hospital Böblingen over a 8 year period. Coins (52%) were the most common foreign body ingested. Other objects included food and tablet bolus, button batteries, magnets, safety pins, screws, needles and toy parts. The foreign body was lodged in the esophagus 59%, stomach 27% and gut 14% of cases, confirmed by radiographs in 90% and gastroscopy 10% of cases. Symptomatic children (n = 59) presented with vomiting 22%, retrosternal pain 16%, dysphagia 13%, drooling 9%, cough 8%, abdominal ache 5% and dyspnea 5%. Endoscopic removement of the objects occurred in 69%, surgery was required in 2% of cases. Surgical management was indicated in one child with gastric bezoar and another after swallowing multiple magnets with perforation of stomach and gut. Esophageal injury occurred in a one year old boy with a button battery lodged at the upper esophageal sphincter. No complications was seen in the other patients after endoscopic management. We conclude, that foreign body ingestion requires an immediate medical evaluation. Possible risks must be considered, when button batteries, magnets or sharp and long objects are ingested, particularely in the young or mentally delayed children.

Motivation: With respect to the devastating consequences of the increasing prevalence of diabetes mellitus, the main reason for end stage renal disease and dialysis in industrialized countries, and the very limited diagnostic and therapeutic possibilities to predict, monitor and prevent diabetic nephropathy (DN), new concepts for early recognition and quantification of the prevailing microvascular changes in DN are urgently needed. Materials and Methods: We present the first study of renal cortical tissue perfusion measurement by means of standardized color Doppler sonographic videos evaluated with the PixelFlux software 1 for Dynamic Tissue Perfusion Measurement (DTPM) in 92 patients with DM1 without MA compared to 71 healthy probands. Results: DTPM reveals a highly significant diminution of cortical perfusion in patients with DM1 compared to healthy probands by 31 %, most pronounced in the distal hemicortex (reduction by 50 %) compared to 21 % within the proximal hemicortex. Conclusion: Thus, DTPM offers a novel means of numerically describing the state of the renal microvasculature in DM in a patient-friendly, non-invasive, non-ionizing manner. © Georg Thieme Verlag KG.

Aim of the prospective study was to investigate perinatal parameters and outcome of term SGA neonates. 100 term neonates were enrolled into 2 groups: group 1: 50 SGA neonates with birth weight below tenth percentile, group 2: 50 appropriate-for-gestational-age neonates. Both groups were compared concerning parental anamnesis, perinatal parameters, postnatal adaptation and development during the first days of life. After discharge from the hospital all children were observed during the first 15 weeks. In all infants the gain of weight, length, head circumference and the amount and type of nutrition were recorded. It was observed that only 13% of the SGA neonates were small children of small parents. Most of the SGA neonates had a normal target high. We found a significantly increased number of mothers with disturbed uterine or placental perfusion in the SGA group as well as increased problems in postnatal adaptation. SGA children had a significantly faster increase of gaining weight and a higher amount of nutrition during the first 15 weeks of life. This could be an early sign of catch-up-growth in SGA neonates, which could be regard as a part of the complex risk for developing a metabolic syndrome in formerly SGA children. © Georg Thieme Verlag KG Stuttgart New York.

Von Moers A.,Klinik fur Kinder und Jugendmedizin
Nervenheilkunde | Year: 2011

Duchenne muscular dystrophy is an X-linked recessive disease that affects about 1:3 500 male birth. It is caused by mutations of the DMD gene. Mutations lead to a loss of dystrophin which results in progressive muscle degeneration. The phenotype is characterised by a progressive proximal pronounced muscle weakness. Without intervention a wheelchair is required in the beginning of the teens and death occurs at about 20th year of life because of respiratoy or cardiac failure. Comprehensive multidisciplinary management can improve the course of disease, in particular the implementation of non-invasive ventilation remarkably prolonged life expectancy. Several gene therapeutic approaches are under examination. At present efficacy of exon skipping is investigated in international multicenter clinical trials. © Schattauer 2011.

Windschall D.,Klinik fur Kinder und Jugendmedizin
Zeitschrift fur Rheumatologie | Year: 2016

There has been growing interest in the use of imaging modalities in pediatric rheumatology for the past 15 years. Nowadays, highly sensitive imaging techniques can be used to detect early stages of pediatric rheumatic diseases in addition to the physical examination. Magnetic resonance imaging and musculoskeletal ultrasound play the most important role. Moreover, these two techniques are of great value in differential diagnostics and therapy monitoring. The use of imaging methods with a high radiation exposure could therefore be greatly reduced over the last decade. © 2016 Springer-Verlag Berlin Heidelberg

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