A diffuse collateral network forms all around the body both in extrahepatic and intrahepatic portal hypertension and radiologic imaging of these collaterals is an important step in evaluation of a portal hypertensive patient. The intraabdominal collaterals and splanchnic hemodynamics of 17 portal hypertensive children in the endoscopic sclerotherapy program, were evaluated with Doppler ultrasonography. An increased blood flow of the hepatic artery was found in all cases independent from the underlying etiology. The decrease in the blood flow of the portal vein was more remarkable in the extrahepatic group. The diameter of the portal vein was not a determinant in the progression of the disease. More diffuse collaterals were found in the liver hilus and retroperitoneum in extrahepatic portal hypertension. On the other hand, the splenic hilus and splenorenal region were leading in intrahepatic cases. The blood flow of the left renal vein was evidently higher than that of the right in these cases. Demonstration of collateral anatomy is an important step in order to estimate the response, complications, treatment options and clinical outcome in patients with portal hypertension. Doppler ultrasonography is a non-invasive and easily applicable technique that provides valuable information about collateral pathways.
Intrauterine parvovirus B19-infection can lead to hydrops fetalis. In rare cases surviving newborns developed thrombocytopenia or chronic anemia. We compared the hematological values of 12 children with a connatal parvovirus B19-infection (study group) with a group of 12 control patients until the age of 2 years. Virological (PCR), serological (ELISA) and clinical follow-up was done in order to determine the risk of persistent infection, vaccinational complications or immunological disorders. We did not find a higher risk of chronic anemia, thrombocytopenia or leucopenia in children with a connatal B19-infection. One patient with persisting B19-viremia showed normal hematological values. Only one patient with connatal B19-infection seroconverted during the first year of life. Vaccinational complications or clinical signs of chronic immunosuppression were not observed. Conclusions: Chronic hematological abnormalities in children with a connatal B19-infection seem to be rare. Vaccinational complications or immunological disorders are probably not to be expected. B19-IgM-Antibodies at birth and seroconversion during the first year of life are often missing. Therefore postnatal direct viral demonstration is essential for the diagnosis of connatal parvovirus B19 infection.
We report about the determination of the regional cerebral oxygen saturation of 30 children without any cerebral diseases. The regional cerebral oxygen saturation is not used routinely to describe the oxygenation of the infant brain. Methods and patients: We used the near-infrared-spectroscopy equipment by Symanetics (USA). We examined prospectively the correlation between hyperoxygenation, hypercapnia and regional cerebral saturation in 30 children with artificial respiration after a cardiac operation. Results: We found an decreased regional cerebral saturation from 68.6% to 65.5% in children with hypercapnia. The regional cerebral saturation increased from 65.9% to 69.1% during the time of hyperoxygenation (100% O 2 ). Conclusions: The interpretation of the regional cerebral saturation is difficult, because there is a multifactorial influence on this. That is why this method is not used routinely. The following points influence the regional cerebral saturation: the distribution of the intracerebral blood pool, the oxygenation of the blood, the cerebral blood flow, and the oxygen consumption of the cerebral tissue. We found a significant correlation between an increasing of the regional cerebral saturation and a small increasing of CO 2 .
The aim of the study was to check and analyse the long-term outcome of infants and toddlers suffering from frequently relapsing and/or (with airway obstruction) and to find prognostic factors. Methods: We observed and analysed the clinical outcome for 2-7 years in 115 children (31 infants/babies and 84 toddlers) suffering from obstructiva recidivans and/or obstructiva chronica in a prospective study. A multivariate analysis was made for the factors disease in other family members/FA, infection of the sex of the patient, associated atopic diseases of the child/patient, the IgE serum (IgE) of the child/patient, chronic bronchopulmonary dysplasia of former pretem infants/bpD, pathological gastroesophageal reflux/GER, significantly secretory eosinophilia/SSE in nasal or bronchial secretion smears (> 13% eosinophils), the concentration of the eosinophilic cationic protein (ECP concentration) of serum and tracheobronchial secretions (TBA). Results: 2/3 of all children became healthy at the end of the study but 1/3 of the infants/toddlers developed a typical bronchial asthma. The FA, associated atopic diseases of the child/patient, the and total serum IgE level of the child/patient could be identified as positive predicting factors for the development of bronchial asthma and had a sensitivity of 50-90% and a specifity of 76-91%. The prognostic values of these 4 factors were increasing from 44-57% (only a single factor was existing) up to 64-91% (in two factors) and finally to 89-100% in 3 and/or 4 factors. Conclusions: In contrast to the literature we found, that the early RSV infection, GER, bpD and ECP of serum and TBA had no statistical link to the development of bronchial asthma in childhood. In young children suffering from frequently relapsing or the following signs have a predictive/prognostic value: Atopic diseases in other family members (FA), other atopic diseases of the child, SSE and elevated serum IgE of the child/patient. These factors indicate that the child's early bronchitis has a poor long-term prognosis and will become a bronchial asthma.
Based on previous studies on the influence of antiretroviral treatment on CD95-induced T cell apoptosis cross-sectional data on T cell apoptosis and T cell homeostasis were analysed from 29 pediatric patients treated for more than 6 months either with 2 nucleosidic inhibitors of HIV-1 reverse transcriptase (group A, 20 observations) or HAART containing at least 1 inhibitor of HIV-1 protease (group B, 16 observations). Seven patients were studied twice. The relationship between specific anti-CD95-induced apoptosis of freshly isolated peripheral blood CD4 + and CD8 + T cells with the percentage of circulating CD4 + T cells, HIV-1 RNA plasma viral load levels and the proportion of circulating resting/naive and primed/memory CD4 + T cells was assessed. Seven patients in each group had HIV-1 plasma viral load levels ≤ 3.0 log RNA-copies per ml. In group A, CD95-sensitivity of T cells increased significantly with low CD4 counts, and tended to rise with low proportions of resting/naive CD4 cells and high HIV-1 plasma viral load levels. In group B, the sensitivity of peripheral blood T cells towards CD95-induced apoptosis was not increased compared to controls and was not correlated with CD4 + T cell counts and CD4 + T cell subpopulations or HIV-1 plasma viral load levels. These data indicate that treatment with HAART including HIV-1 protease inhibitors has an inhibitory effect on CD95-sensitivity of circulating T cells. This effect, which is independent of the reduction of HIV-1 plasma viral load levels by HAART, may contribute to the amelioration of CD4 + T cell homeostasis frequently seen in HAART-treated patients despite virological treatment failure.
