Untersuchungen an Kindern mit Mukoviszidose zeigen, dass akute infiltrative Veränderungen mit hoher Sensitivität erkannt werden können.Andere Aspekte, wie beispielsweise Ventilationsraumveränderungen durch Emphyseme oder chronische Fibrosen mit Diffusionsstörungen werden mit der MRT nicht adäquat reflektiert. Deshalb wurden (zunächst am Tiermodell) Möglichkeiten einer komplexen, bildgebend und funktionell orientierten Lungendiagnostik erprobt. Wichtige Resultate der tierexperimentellen Studie werden demonstriert, insbesondere solche Aspekt, die sich schon jetzt aus dem tierexperimentellen Stadium in die klinische Forschung überführen lassen. Hierzu gehört die Visualisierung von inhaliertem molekularem Sauerstoff, sowie die Erkennung von obstruktiv überblähten Lungenarealen durch eine Exspirationstechnik nach der Inhalation eines Bronchialkonstriktors. Die Lungenperfusionsbeurteilung ist diejenige Lungenfunktion, die in Form der pulmonalen MRA eine Beurteilung bis in die Subsegmentebene erlaubt und Eingang in die klinische Praxis gefunden hat. Mit einer optimierten Bolustechnik und Akquisitionszeiten von 3–5 Sekunden lassen sich auch periphere Perfusionsdefekte nachweisen. Die Diffusionsstörungen der Lunge ließen sich bisher bildgebend nicht erkennen. Mit Hilfe der Gadolinium-Inhalation scheint auch für diese Lungenfunktion eine Quantifizierung möglich. Patientenuntersuchungen liegen hier aus zulassungsrechtlichern aus Gründen noch nicht vor. Die tierexperimentellen Untersuchungen belegen, dass eine MR-tomographische Beurteilung der wichtigen Lungenfunktionen möglich ist. Erste Untersuchungen an Patienten zeigen, dass sich schon zum jetzigen Zeitpunkt einige der erzielten tierexperimentellen Ergebnisse auf Patienten übertragen lassen.

Decompressive craniectomy can be the ultimate therapeutic possibility of severe traumatic brain edema. Indications, surgical techniques and results are presented.

High-dose chemotherapy with autologous stem cell rescue (PBSCT) is a therapeutic option for advanced solid tumours or recurrent disease in childhood. For repeated use of this procedure or for stem cell processing it is necessary to collect an adequate amount of CD34 positive cells through leukapheresis. In small children with body weight less than 20 kg, one is always confronted with problems of haemodynamics, homeostasis and compliance during apheresis. Our aim was to find out whether it is feasible to carry out large-volume leukapheresis (LVL) in small children with solid tumours who had previously been treated with intense cytotoxic chemotherapy. We carried out 12 leukaphereses in children with solid tumours (PNET, EWS, STS, nephroblastoma, brain tumour). The median body weight was 16.3 kg (13.2-19.1 kg), median age 5.2 yr (2.3-8.6 yr). We used the CS 3000 Plus (FENWAL) machine, collection volume 55 mi. The venous access was a central venous catheter (BROVIAC type) and a peripheral vein. The blood and albumin substitution was done through a bypass system using the reinfusion access, and was discussed case by case. For better compliance, the children received a continuous midazolam infusion during apheresis. A median of 6.24 x 10(6) (4.15-30.7 x 10(6)) CD 34 positive cells/kg bodyweight per separation was collected. The median processed volume was 3327.5 mi (2600-4359) mi, the median time for one separation being 205 (167-233) min. A temporary Ca++ deficiency was documented during separation. We did not experience any complications during the LVL.Conclusions: It is possible to carry out large-volume leukapheresis in small children without any complications. With midazolam sedation it is a well tolerated procedure. LVL enables the collection of stem cells, sufficient for one or two transplantation procedures. There is a need for initial blood transfusion, albumin and calcium substitution during the procedure.

Children suffering malignant diseases can experience phases of bone marrow depression during intensive chemotherapy. The influence of antibiotic sequence therapy on the course of diseases was examined in 41 pediatric patients with malignant diseases. Inclusion criteria were neutropenia (ANC < 500/microL), rectal body temperature over 38.5 degrees C, and increased C-reactive protein (CRP, cutoff > 5.0 mg/L). The first stage of therapy comprised the following antibiotics: piperacillin, teicoplanin, and gentamicin. In stage 2 imipenem, teicoplanin, and tobramycin were administered. Fluconazole was the antifungal drug of choice in stages 1 and 2. In the first level of antibiotic therapy 68% of the patients showed a positive reaction. The C-reactive protein was a sensitive parameter, which significantly decreased with 3 days of therapy. A total of 72% of the bacteriological smears were sterile. All patients survived the septic phase.

In some very rare cases children suffer from a combination of asthma and a malignant disease. This study investigated whether intensive chemotherapy might have a positive effect on asthma in these special cases and whether asthma generally relapses after completion of chemotherapy. The authors monitored clinical outcome and lung function of 43 children with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received chemotherapy at the University Children's Hospital of Greifswald between 1993 and 1998. Cytostatic chemotherapy was administered according to the German treatment protocols. Two of the 43 patients had asthma before leukemia was diagnosed. During the course of chemotherapy, asthma symptoms diminished promptly after beginning of chemotherapy but asthma was rediagnosed after completion of chemotherapy in both cases. The third patient developed asthmatic symptoms shortly after completion of chemotherapy for the first time. It can be stated that chemotherapy does not essentially cure asthma. Therefore, it seems mandatory to perform follow-up lung testings after chemotherapy, especially in patients with asthma.

The case of a 12-year-old boy with ectopic cervical thymus is reported. This is a rare differential diagnosis in cervical tumors in childhood. The clinical symptoms might present as complications; in rare cases malignant transformations have been reported. The diagnosis ectopic cervical thymus can be achieved only histologically. Due to possible malignant transformation, it is mandatory to excise this thymus tumor totally.

This study examined both the endogenous and exogenous (therapy-related) pharmacokinetics of the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) in neutropenic children with solid and systemic malignancies. The daily endogenous GM-CSF serum concentration before application was 29 pg/mL. During the 10 days of examination, the concentration rose to an average value of 1351 pg/mL 8 h after application. A significant stimulation of the neutrophils, monocytes, and eosinophils in peripheral blood was documented. No significant correlation between the GM-CSF concentration and peripheral blood cell counts could be documented. Paraclinically, there was no evidence for functional disturbance of either the liver or the kidneys, i.e., under the cytokine therapy. The therapy was well tolerated by all the children involved in the study.