The organisation of paediatric renal care in different European countries: results of the PAC project.

The Paediatric Access Care (PAC) project, organised by the Research Board of EDTNA/ERCA, aimed to study the organisation of paediatric renal care in Europe and to investigate the practice of access care for both haemodialysis (HD) and peritoneal dialysis (PD) paediatric patients. This paper reports on the organisation of paediatric renal care. The majority of paediatric renal care units were located in specific paediatric units of university hospitals.

The role of interleukin-6 in nociception and pain.

That IL-6 is an interesting target in the study of pain is underscored by its biomolecular properties, its localization after experimental pain, and its modulating effect on pain after administration.

Outcome in shunted hydrocephalic children.

The purpose of the present study was to identify the main risk factors for poor outcome in children with shunted hydrocephalus, including the timing of the operation. The medical records of patients born between 1984 and 1992, who had undergone shunt operation for hydrocephalus before 1994, were analysed retrospectively. The following data were collected: aetiology of hydrocephalus, other pathology in addition to hydrocephalus, timing of drain implantation, number and indication of revisions and several outcome parameters such as school type, seizures and morbidity parameters.

Intraoperative values of S-100 protein, myelin basic protein, lactate, and albumin in the CSF and serum of neurosurgical patients.

Objectives: To assess the concentrations of S-100 protein, myelin basic protein (MBP), and lactate, and the (CSF)/serum albumin ratio (Qalb) during intracranial neurosurgical procedures.

Methods: Samples of CSF from 91 patients with various CNS diseases were obtained by aspiration of cisternal CSF at the beginning of surgery (before starting surgical manipulation of the brain) and concentrations of S-100 protein, MBP, and lactate, and Qalb were determined. At the same time blood was sampled for determination of serum S-100 protein concentration.

A controlled trial comparing two doses of cyclosporine in conjunction with mycophenolate mofetil and corticosteroids.

It is unknown whether the addition of mycophenolate mofetil (MMF) to cyclosporine (CsA) and prednisone after renal transplantation (RTx) allows for a reduced dose of CsA, to minimize the incidence of CsA-related side effects and to reduce costs. Therefore, 313 renal allograft recipients were randomized for treatment with MMF (1000 mg twice a day), prednisone, and either conventional- or low-dose CsA during the first 3 mo after RTx. The target trough levels were 300 and 150 ng/ml, respectively, during the first 3 mo and 150 ng/ml in both groups thereafter.

Successful out-of-hospital cardiopulmonary resuscitation: what is the optimal in-hospital treatment strategy?

Unlabelled: The aim of the study was to evaluate prognostic factors in patients after successful out-of-hospital resuscitation (sOHR) within 30 min after admission. A prognostic scoring scale in patients surviving OHR was analysed. We also studied the effect of these predictive factors and the in-hospital treatment (percutaneous transluminal coronary angioplasty (PTCA) vs.

A solitary manifestation of mastocytosis in the head and neck.

Solitary mastocytosis in adulthood is a rare finding. Only two such lesions have been reported in the head and neck. We describe a 27-year-old woman who had a 10-year history of a forehead swelling that had fluctuated in size.

Presence of diarrhea and absence of tendon xanthomas in patients with cerebrotendinous xanthomatosis.

Background: Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive disorder of bile acid synthesis. A diagnosis of CTX should be considered in patients with premature bilateral cataracts, intractable diarrhea, neurological signs and symptoms, and tendon xanthomas, especially in the Achilles tendons. The prevalence of these signs and symptoms increases with age.

X-linked Alport syndrome: natural history in 195 families and genotype- phenotype correlations in males.

Alport syndrome (AS) is a type IV collagen hereditary disease characterized by the association of progressive hematuric nephritis, hearing loss, and, frequently, ocular changes. Mutations in the COL4A5 collagen gene are responsible for the more common X-linked dominant form of the disease. Considerable allelic heterogeneity has been observed.

Hereditary prothrombin deficiency presenting as intracranial haematoma in infancy.

Hereditary deficiency of prothrombin is a rare autosomal recessive bleeding disorder, with severe bleeding diathesis in homozygotes, but rarely resulting in intracranial haematoma. We describe two infants of consanguineous parents, presenting with acute subdural haematoma. Because such haematomas in infancy are highly indicative of trauma caused by child battering and because the socio-economic status of the family was unstable, there was a suspicion of child battering.

Indomethacin for 3 days is not effective as prophylaxis for heterotopic ossification after primary total hip arthroplasty.

Although indomethacin is effective in preventing heterotopic ossification (HO) after total hip arthroplasty (THA) when used for 8 to 14 days, side effects are frequently observed. We conducted a prospective, nonrandomized pilot study of prophylaxis for HO in THA using indomethacin for 3 days. We used a 2-stage design for phase 2 clinical data, based on earlier studies in our department.

End-of-life decisions in neonates.

In a large percentage of the infants who die in the neonatal intensive care setting, an end-of-life decision was made before death, usually a decision to forego life-sustaining treatment. This was confirmed in a recent study in The Netherlands that showed also that a minority of cases include the administration of drugs to hasten death, usually in patients with severe congenital multiple or central nervous system anomalies. Over 80% of Dutch pediatricians support this option under certain conditions.

No effective prophylaxis of heterotopic ossification with short-term ibuprofen.

Ninety-five patients underwent primary total hip arthroplasty and routinely received ibuprofen for 5 days as prophylaxis for heterotopic ossification. This group was compared with a group of 99 patients who received indomethacin for 7 days as prophylaxis. After a follow-up of 1 year, the incidence of heterotopic ossification in the ibuprofen group was significantly higher than in the indomethacin group.

The use of Gore-Tex membrane for adhesion prevention in tethered spinal cord surgery: technical case reports.

Objective: The incidence of retethering caused by postoperative adhesions at the repair site after initial tethered spinal cord surgery is not uncommon. To assess the effectiveness of a Gore-Tex membrane in preventing these adhesions, only clinical radiological and experimental animal evaluation has been reported. In this report, we describe two cases in which Gore-Tex membrane was implanted at the initial untethering surgery and in which we were able to confirm the real effectiveness of the Gore-Tex membrane during a second operation.

Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa.

Objective: The supraorbital approach is well accepted for lesions in the anterior fossa, the sellar region, and the anterior circle of Willis. However, the usefulness of this approach has not yet been elucidated for lesions in the interpeduncular fossa. The technique of an endoscope-assisted, ipsi- and contralateral supraorbital approach to lesions within the interpeduncular fossa is described, and the initial results are reported.

Cardiac tamponade: a rare but life-threatening complication of central venous catheters in children.

The widespread use of central venous catheters in the treatment of pediatric patients has caused an increased incidence of complications. A rare, but potentially fatal complication occurs when the heart is perforated by the catheter tip causing a cardiac tamponade. This perforation of the heart generally is associated with the insertion procedure, but may also occur after some time because of displacement of the catheter tip.

Protective coating of cranial nerves with fibrin glue (Tissucol) during cranial base surgery: technical note.

Objective: Cranial nerve deficit, either transient or permanent, is a common postoperative complication after cranial base surgery. Frequently, this occurs because intracranial nerves are directly involved in the cranial base lesion. However, any cranial nerve adjacent to the lesion can be damaged because of direct or indirect manipulation during surgery, leading to severe morbidity.

Different roles of tumour necrosis factor alpha and interleukin 1 in murine streptococcal cell wall arthritis.

In this study two different aspects of tumour necrosis factor alpha (TNF-alpha) and interleukin 1 (IL-1) in locally induced murine streptococcal cell wall arthritis (SCW) were investigated. First, the kinetics and interdependence of TNF-alpha and IL-1 release; and second; their involvement in inflammation and cartilage destruction. Kinetic studies showed that the TNF-alpha peak level preceded the IL-1 peak level.

Analysis of DNA methylation of the 5' region of the deoxycytidine kinase gene in CCRF-CEM-sensitive and cladribine (CdA)- and 2-chloro-2'-arabino-fluoro-2'-deoxyadenosine (CAFdA)-resistant cells.

DNA methylation of the CpG-rich 5' region of the deoxycytidine kinase (dCK) gene is potentially involved in the suppression of the gene and the resistance of tumour cells to arabinosylcytosine (ara-C). 2-Chlorodeoxyadenosine (cladribine, CdA) and 2-chloro-2'-arabino-fluoro-2'-deoxyadenosine (CAFdA) are purine nucleoside analogues which are also phosphorylated by dCK. We observed a reduction in dCK activity in a number of CCRF-CEM-derived cell lines that are resistant to these drugs and hypothesized that this reduction is due to DNA methylation of the 5' region of the dCK gene.

Inhibition of DNA methylation in malignant MOLT F4 lymphoblasts by 6-mercaptopurine.

Treatment of MOLT F4 lymphoblasts with 6-mercaptopurine (6-MP) resulted in a decrease of ATP and a depletion of S-adenosylmethionine (AdoMet). To investigate whether this might affect the methylation of DNA, we treated MOLT F4 lymphoblasts with increasing concentrations of 6-MP, followed by labeling with [methyl-14C]methionine and [methyl-3H]thymidine. After DNA isolation, we measured the incorporated radioactivity and determined the 14C/3H ratio as a measure for the methylation of newly formed DNA.

Newer anticonvulsant drugs: role of pharmacology, drug interactions and adverse reactions in drug choice.

In the last few years a number of new anticonvulsants have been introduced into clinical practice mainly as add-on therapy in patients who do not become seizure-free while receiving established anticonvulsants. Up to now, no single drug has been shown to be more effective at controlling seizures of a particular type than another, so other factors such as mechanism of action, pharmacokinetics, dosage regimens or the spectrum of adverse drug reactions and interactions are used when making a choice between one agent and another. The mechanism of action of tiagabine and vigabatrin is very specific; both agents increase gamma-aminobutyric acid (GABA) levels through inhibition of reuptake and catabolism respectively.