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  • 1
    ISSN: 1432-1076
    Keywords: Shock ; Skin temperature ; Peripheral blood flow ; Temperature difference ΔT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zur Diagnose und Therapie eines Schockgeschehens sind neben zentralen Parametern auch Angaben über die periphere Durchblutung notwendig. Das am einfachsten zu erreichende Capillargebiet ist das der Haut. Die Hautdurchblutung stellt den wichtigsten Regulator für den Wärmestrom dar, so daß ein Zusammenhang zwischen Hauttemperatur und Hautdurchblutung zu erwarten ist. Vergleiche der tatsächlichen Hautdurchblutung gemessen durch Δλ mit verschiedenen Hauttemperaturen, integrierte Hauttemperatur und Burton-Indices ließen keinen Zusammenhang erkennen. Jedoch ist die Korrelation mit der Rectum-Zehen-Temperaturdifferenz ΔT statistisch hoch signifikant. Sie kann ohne technischen Aufwand als orientierendes Maß der Hautdurchblutung in der Diagnose des Schocks eingesetzt werden.
    Notes: Abstract Diagnosis and therapy of shock necessitates precise information on the peripheral blood flow as well as consideration of parameters relating to the central circulatory condition. The skin is the capillary area of easiest access. Peripheral circulation implies the most effective regulating system in heat transport; therefore one may expect a relationship between skin temperature and skin blood flow. Comparisons of the blood flow through the skin, as recorded by means of a Hensel Fluvograph and ascertained as Δλ, with the actual skin temperature (average skin temperature; Burton indices) did not reveal any correlation. The correlation with the difference between rectal and big toe temperature, however, is statistically highly significant. The determination of the proportion between the two values (rectal versus big toe temperature) can be used without technical difficulties as an orienting measure of skin blood flow in the diagnosis of shock.
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  • 2
    ISSN: 1432-1076
    Keywords: Congenital Sinus bradycardia ; Sick-Sinus-Syndrome ; Total atrioventricular block ; Bundle of His EG
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sinus bradycardia and total atrioventricular block were found at the age of seven months in a boy who is now 161/2 years old. According to Yaters (1929) criteria, these are likely to be congenital disorders. While the frequency of the ventricular impulse generator in the upper bundle of His only slowed in accordance with age during the period of observation, the sinus node activity deteriorated considerably. Finally potentials could only be sporadically demonstrated. Under heavy stress and with a simultaneous slight increase in ventricular frequency, a re-occurence of regular but slow sinus node activity came about. The cause of this binodal disorder of rhythm is unknown. There is no indication of family affliction or of myocarditis in early childhood. Congenital heart disease could also be excluded.
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  • 3
    ISSN: 1432-1076
    Keywords: Mucopolysaccharidoses ; Mitral regurgitation ; Aortic regurgitation ; Doppler echocardiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In echocardiographic and necropsy studies nodular thickening of the mitral valve and, less frequently, of the aortic valve has been found in 60%–90% of patients with mucopolysaccharidoses (MPS). Little is known about the haemodynamic consequences of these morphological changes. In this study 84 unselected patients with different enzymatically proven MPS and 84 age and sex matched, healthy persons were studied prospectively by colour Doppler flow mapping. The patients' age ranged from 1 to 47 years (median 8.1 years). Mitral and aortic regurgitation were defined as a holosystolic or holodiastolic jet originating from the valve into the left atrium or the left ventricular outflow tract, respectively, with peak velocities exceeding 2.5 m/s. Of the 84 patients with satisfactory studies, mitral regurgitation was detected in 64.3% and aortic regurgitation in 40.5%, respectively. Regurgitation was severe in 4.8% of mitral valves and 8.3% of aortic valves. The frequency of aortic and/or mitral regurgitation was 75% in all patients, 89% in MPS I, 94% in MPS II, 66% in MPS III, 33% in MPS IV, and 100% in MPS VI. Combined mitral and aortic regurgitation was present in 29% of our patients. None of the control persons showed mitral or aortic regurgitation.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 95 (1965), S. 53-60 
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Participation of the myocardium in sarcoidosis has been rarely described, but is nevertheless an important complication of this disease. Depending upon the localisation of the focus of the disease, disturbances of heart rhythm and of conduction or general heart insufficiency are observed. A case of sarcoidosis of the myocardium is reported. Frequent controls of the electrocardiogram may warrant speedy treatment of this complication.
    Notes: Zusammenfassung Eine nicht unerhebliche, aber klinisch selten beschriebene Komplikation der Sarc. ist der Befall des Myokards. Je nach Lokalisation des Krankheitscherdes kommt es dabei zu Herzrhythmusstörungen, Störungen des Erregungsablaufes oder zur allgemeinen kardialen Insuffizienz. Über einen Fall mit myokardialer Sarc. wird berichtet. Häufige EKG-Kontrollen können eine rechtzeitige Behandlung dieser Komplikation gewährleisten.
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  • 5
    ISSN: 1432-1076
    Keywords: QT-syndrome ; Adams-Stokes-attack ; Ventricular tachyarrhythmia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Forty children with presumed ventricular tachyarrhythmic syncopes in the absence of structural heart disease were studied. Twenty-nine patients, one of whom was deaf, had a prolonged QT-interval in the resting electrocardiogram (Group 1); eleven patients had a normal QT-interval (Group 2). The median QTc-interval was 0.51s in Group 1 and 0.40s in Group 2. Familial occurence suggesting autosomal dominant inheritance was found in 21 of 28 normally hearing patients in Group 1 and in 2 of 11 patients in Group 2. Syncopes were definitely stress-induced in 22 patients in Group 1 and in all 11 patients in Group 2. Of 23 patients in Group 1 in whom an electrocardiogram was obtained during physical exercise, only one showed severe ventricular dysrhythmia. In contrast, all eleven patients in Group 2 developed severe ventricular dysrhythmia with exercice. Treatment with beta-blocking medication prevented further syncopes in 15 of 19 patients with several previous attacks in Group 1 and in 3 of 5 patients of Group 2. Four of the 29 patients in Group 1 died suddenly and one more remained apallic after an attack. Of the 11 patients in Group 2, four died suddenly and one retains severe cerebral damage after resuscitation from ventricular fibrillation. We conclude that, besides the group of patients with the long QT-syndrome, there may be a distinct group of patients with a consistently normal QT-interval and severe ventricular dysrhythmia with exercise. Patients of both groups are threatened by sudden death and are improved by treatment with beta-blocking medication.
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  • 6
    ISSN: 1432-1076
    Keywords: Children ; Dobutamine ; Hemodynamics ; Improvement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of dobutamine, a synthetic catecholamine, was studied in 12 patients aged one day to 14 years with low cardiac output syndromes. After initial stabilization of the patients dobutamine was administered by continuous infusion in a dosage of 7.5 or 10 μg/kg/min. Heart rate, cardiac output (using thermodilution technique and/or pulse contour method), mean systemic and mean pulmonary artery pressures were determined before and after the dobutamine infusion. Systemic and pulmonary vascular resistances, cardiac index and stroke volume index were calculated. Cardiac output and cardiac index increased significantly in every patient, whereas the heart rate changed only slightly, suggesting that the increase in cardiac output was mainly due to the alteration of stroke volume. The mean arterial pressure increased significantly, but the mean pulmonary artery pressure was unchanged. No side effects were observed during the dobutamine infusion. Dobutamine is a potent inotropic drug with limited chronotropic and peripheral vascular effects in newborns, infants and chidren.
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  • 7
    ISSN: 1432-1076
    Keywords: Schock-Plasmaexpander ; Verweildauer von niedermolekularen Dextranen (NMD) ; Ausscheidung von NMD
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Therapie aller Schockformen muß auf die Normalisierung des Capillarkreislaufes ausgerichtet sein. Die hier abgelaufenen Veränderungen entscheiden über die Prognose und den Verlauf. Durch die desaggregierenden Eigenschaften und die gute Volumenwirkung sind niedermolekulare Dextrane dafür besonders gut geeignet. Das Ziel der vorliegenden Arbeit war, den Einfluß der verminderten Nierenleistung und der unterschiedlichen Verteilung der Flüssigkeitsräume des Neugeborenen und des Säuglings gegenüber den Erwachsenen auf die Verweildauer und Ausscheidung von niedermolekularen Dextranen zu untersuchen. Erstmals kam eine neue Mikroliterbestimmung für Dextran routinemäßig zur Anwendung. Dabei ergab sich, daß der Abfall des Dextranspiegels und die Verweildauer im Serum dem der Erwachsenen entspricht. Nicht gelöst ist, warum jedoch beim Neugeborenen die Urinausscheidung von niedermolekularem Dextran niedriger ist als beim älteren Säugling, während der Abfall des Serumspiegels gleichsinnig verläuft. Es wird eine schnellere Verwertung im Stoffwechsel angenommen. Auf Grund der raschen Ausscheidung empfiehlt sich niedermolekulares Dextran als “Initialtherapie” im Schock, auch bei Neugeborenen und Säuglingen.
    Notes: Summary The therapy of all types of shock must aim at a normalization of the peripheral circulation. The changes that take place in this region are decisive for the prognosis and the progress of the disease. Low molecular weight dextrans seem to be best suited because of their desaggregating quality and their influence on the volume. The present investigation was conducted to show the effect of the reduced renal output and the different fluid distribution in newborns and infants on the persistence and excretion of low molecular weight dextran as compared to adults. A new routine microliter determination for dextran was used. It was found that the decrease and the persistence of the dextran serum level was similar to that of adults. It is, however, not clear why the excretion of low molecular weight dextran in newborns is lower than that observed in older infants although the decrease of the serum level takes place in a similar manner. It is thought that a faster metabolic utilization might be the reason for this observation. Because of the fast excretion low molecular weight dextran is recommended as “initial therapy” of shock in newborns as well as infants.
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  • 8
    ISSN: 1432-1076
    Keywords: Newborns ; Dobutamine ; Systolic time intervals ; Echocardiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the effects of dobutamine on myocardial function in newborns, left ventricular systolic time intervals (STI) — normalized pre-ejection period (PEPI), normalized left ventricular ejection time (LVETI) and pre-ejection period to left ventricular ejection time ratio (PEP/LVET) — were assessed by echocardiography in 18 newborns treated with dobutamine for clinically diagnosed heart failure. Examinations were performed prior to and 30 min after starting dobutamine infusion (7.5 or 10 μg/kg per min). Patients were assigned to two groups according to their PEP/LVET prior to dobutamine administration: group I (n=9) with pre-treatment PEP/LVET ≤ 0.35 and group II (n=9) with pre-treatment PEP/LVET 〉 0.35. While there was no change of STI in group I, dobutamine infusion resulted in a significant decrease in PEPI (from 102±4.8 to 87.8±4.2; mean ± SEM;P〈0.01) and of PEP/LVET (from 0.56±0.05 to 0.45±0.05; mean ±SEM;P〈0.01) and in a significant increase of LVETI (from 237.6±5.6 to 253.3±5.2; mean ±SEM;P〈0.01) in group II. Heart rate increased significantly in both groups. Left ventricular end-diastolic dimension, also assessed by echocardiography, did not change in the eight studies performed. An increase in mean arterial pressure was found in three out of five newborns of group II and in one out of four patients in group I. It is concluded that dobutamine can improve cardiac performance in newborns with impaired left venfricular function. This effect is probably due to an improvement in myocardial contractility.
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  • 9
    ISSN: 1433-0474
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Um Belastungen, die aus soziologischer, psychologischer und präventivmedizinischer Sicht förderlich sind, eindeutig von solchen abzugrenzen, die potentiell schädlich sein können, ist in vielen Fällen eine Belastungsuntersuchung (Ergometrie) unerläßlich. Diese Arbeit soll eine Übersicht über Indikationen und Kontraindikationen sowie Durchführung und Beurteilung einer Ergometrie im Kindes- und Jugendalter geben.
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  • 10
    ISSN: 1432-1238
    Keywords: Digoxin intoxication ; Serum digoxin concentration ; Serum potassium level ; Diphenylhydantoin ; Atropine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a 10 year old boy 8 hours after taking about 16 mg β-acetyl-digoxin a maximum serum digoxin level of 31.8 ng/ml was measured radioimmunologically. This is the highest digitalis level in childhood described to date. The serum potassium level rose to 7.4 mmol/l. Complete atrio-ventricular block, and salves of ventricular premature beats were the most serious rhythm disturbances. The absence of life threatening rhythm disturbances is attributed to the early use of diphenylhydantoin in small frequent doses.
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