Biomedical subjects

B Lettgen

Publications and source records attributed to B Lettgen.

28 records · Page 2Linked to original sources

PubMed1993

Bent subcutaneous peritoneal catheter shape for regular dialysis treatment in children.

A permanent bowing of the subcutaneous part of the Tenckhoff-type catheter (bent neck--Quinton, and swan neck--Accurate Surgical Instruments) enables the catheter to turn from an upward direction of the subcutaneous tunnel to a downward direction by a smooth 160 degrees-180 degrees bend creating a downward skin exit. We have used this catheter shape in combination with a coiled intra-abdominal edge. Two sizes are available for children. We use 2 cuffs and glue them ourselves according to the body size. In this study we compare the durability of the traditional subcutaneously straight catheter in 8 children aged 0.1-12.6 years (Group A) with the bent shaped catheter in 8 children aged 3.7-15.8 years (Group B). Median duration of function was 10.5 (2-34) and 8 (3-36) months, respectively. Frequency of complications was equal in both groups: peritonitis episodes 0.69/year in Group A and 0.53/year in Group B; tunnel infection 0.16 vs 0.11/year; skin exit infection 0.54 vs 0.53/year; noninfectious complications 0.16 vs 0.32/year; mean number of catheters used was 1.0 vs 1.1/treatment year. Treatment had to be terminated in some patients: kidney transplantation 5, kidney recovery 1, severe peritonitis 1. The bent subcutaneous catheter shape did not show any medical or technical disadvantage compared with the straight type, but the downward directed catheter skin exit can be covered invisibly under bikini or bermuda shorts which means aesthetic and social advantage. Whether the downward drainage of secretes and cell detritus influences the rate of tunnel infection positively cannot be answered to date.

Adolescent↗

PubMed1992

Atrial natriuretic peptide and cyclic 3'5'-guanosine monophosphate as indicators of fluid volume overload in children with chronic renal failure.

Plasma atrial natriuretic peptide (ANP) and cyclic 3'5'-guanosine monophosphate (cGMP) were investigated as indicators of fluid volume overload in children and adolescents with chronic renal failure. Plasma ANP and cGMP were measured in both paediatric patients with chronic renal failure (n = 17, mean serum creatinine 371 +/- 242 mumol/l) and those with end-stage renal disease on haemodialysis (n = 18). cGMP was higher in children with chronic renal failure than in 45 healthy controls (1.0 +/- 0.4 vs 2.1 +/- 0.8 nmol/l, P less than 0.01), whereas plasma ANP was similar (26.9 +/- 9.7 vs 34.0 +/- 12.3 pmol/l). Both ANP and cGMP were markedly elevated in children with end-stage renal disease before haemodialysis and fell significantly during dialysis. During dialysis body weight decreased by 1.6 +/- 0.7 kg, corresponding to 4.5 +/- 2.1% of body weight. Plasma ANP correlated positively with plasma cGMP in haemodialysed patients (r = 0.43, P less than 0.05). Reduction in body weight and in mean arterial pressure correlated more closely with plasma ANP than with cGMP. Therefore, elevation of plasma ANP appears to indicate volume overload in children undergoing haemodialysis, but whether it can be used also in children with chronic renal failure requires further investigation.

Adolescent↗

PubMed1992

Sudden death in cystinosis.

We report on an 8-year-old boy with infantile cystinosis. The patient died in hospital for unknown reason after cardiopulmonary arrest although resuscitation was started immediately. As opposed to other cases [1-3], neither laboratory investigations nor autopsy in out patient gave an explanation for the sudden death.

Child↗

PubMed1991

[Therapy of hyperammonemia in carbamyl phosphate synthase deficiency with peritoneal dialysis and venovenous hemofiltration].

Inborn errors of metabolism with hyperammonaemia cause emergency situations with unconsciousness, convulsion, hyperpnoea and hyperpyrexia. Therefore hyperammonaemia has to be treated immediately after diagnosis to avoid irreversible damage. Two newborns with carbamylphosphates synthetase deficiency are described. Both, continuous peritoneal dialysis and venovenous haemofiltration have proved to be effective methods to reduce serum ammonia concentration to values of less than 300 mu/l. Because of the severity of the enzyme defect in both cases, (carbamylphosphate synthetase was not detectable in liver tissue), treatment finally had to be stopped, and both patients died.

Amino Acid Metabolism, Inborn Errors↗

PubMed1990

[IgA nephritis: a frequent form of glomerulonephritis in childhood].

Since the introduction of immunohistological techniques in the evaluation of renal biopsies, IGA-nephropathy as first described by Berger in 1968 is diagnosed frequently. The diagnosis of IGA-nephropathy is based upon the demonstration of mesangial IGA deposits. IGA-nephropathy has to be differentiate from post-streptococcal glomerulonephritis, Schönlein-Henoch-nephritis and Lupus-nephritis. With increasing observation periods the prognosis has not been confirmed to be benign, as previously assumed. Every physician interested in paediatrics should be aware of this kind of nephritis, because early renal biopsy is essential for the diagnosis and the estimation of the degree of histological alteration. Furthermore renal biopsy is important for the decision for an aggressive immunosuppressive therapy and therefore for the prognosis.

Adolescent↗

PubMed1990

[The diagnostic value of captopril radionuclide nephrography for renovascular hypertension in childhood].

In four children the role of captopril-radionuclide nephrography in the diagnosis of renovascular hypertension was studied. Captopril (0.5-1.0 mg/kg orally) did not affect Iodine-123 Hippuran nephrography in two children with mild renal artery stenosis, but induced an accumulation of the tracer within the kidneys in two children with hemodynamically significant renal artery stenosis. As in adults Iodine 123 Hippuran nephrography appears to be a useful tool to identify patients with significant renal artery stenosis.

Adolescent↗

PubMedDate not supplied

[Prophylaxis of recurrent urinary tract infections in children. Results of an open, controlled and randomized study about the efficacy and tolerance of cefixime compared to nitrofurantoin].

UNLABELLED: Urinary tract infections are quite frequent in children. Urinary tract obstruction combined with recurrent urinary tract infections increase the risk for renal impairment. Therefore prophylaxis of reinfection is an important nephroprotective procedure. The aim of this open, controlled, randomised pilot study was to compare the efficacy and tolerance of a low dose prophylaxis with Cefixime versus Nitrofurantoin. 60 girls aged 1 to 11 years with at least 2 urinary tract infections within the preceding year were included in the study. The minimum duration of therapy was 6 months and was extended to 12 months for most of the children. The number of recurrent infections was the main criteria for efficacy evaluation, whereas adverse events were analysed to evaluate tolerance. Statistical significant differences between the two treatment groups, regarding recurrence rates could not be demonstrated. Tolerance was comparable in both groups. The influence on gut flora of cefixime given as a low dose regimen over a long period of time corresponds with already published results and was not correlated with a higher number of gastrointestinal side effects. CONCLUSION: Low-dose Cefixime (2 mg/kg bodyweight) is effective and well tolerated in the prophylaxis of recurrent urinary tract infections. Efficacy and tolerance of cefixime were comparable to the results obtained with nitrofurantoin. Due to the small number of patients this study was only a pilot study. Low-dose cefixime, however, could become an alternative to standard regimens in the prophylaxis of recurrent urinary tract infections. This should be investigated in further studies.

Age Factors↗

PubMedDate not supplied

[Urinary tract infections in childhood. Old and new aspects].

Urinary tract infections are one of the most frequent infections during childhood. About 5% of all girls and 0.5% of all boys are suffering from at least one urinary tract infection until the end of schooltime. While the boys predominate in the first year of life with decreasing incidence of infection later on the girls remain predisposed up to an age of twelve. Each pediatrician faces every day the problem of a quick diagnosis and an appropriate therapy of urinary tract infections. While symptomless bacteriuria and cystourethritis do not destroy the renal parenchyma recurrent pyelonephritis may cause irreversible parenchyma scars up to a dialysis demanding renal failure. Besides the well-known mechanical risk factors (i.e. obstruction, reflux) functional risk factors like impaired bladder function alone as well as combined with mechanical ones are gaining in significance. Another factor predisponing to recurrent urinary tract infections is a local immunologic impairment of the urinary tract (i.e. P1-blood-group antigen, decreased urothelial function, increased urothelial colonisation). Age-appropriate and individual diagnosis and treatment are necessary first to avoid late damages and second to protect the children against unnecessary diagnostic and therapeutical managements.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Acute reversible kidney failure in IgA nephritis].

Four patients with acute renal failure during an acute course of IGA-nephritis are described. Percutaneous renal biopsies showed only minor glomerular lesions in all patients. Immunosuppressive therapy was not necessary. In all patients acute renal failure was completely reversible. The four patient showed further episodes of macrohematuria without acute renal failure. All patients had normal renal function, normotensive blood pressure and microhematuria during interval. In three of the patients we found erythrocytes casts and a mild protein excretion. IGA-nephritis is one of the most common types of glomerulonephritis in adolescents and adults. If acute renal failure occurs during a course of IGA-nephritis with macroscopic haematuria a percutaneous renal biopsy has to be performed. Only in case of severe crescents formation (greater than 75%) immunosuppressive therapy is necessary. Glomerular lesions are responsible for long time prognosis.

Acute Kidney Injury↗

PubMedDate not supplied

[Bone density in children and adolescents with rheumatic diseases. Preliminary results of selective measurement of trabecular and cortical bone using peripheral computerized tomography].

UNLABELLED: Selective measurements of bone mineral density (BMD) of trabecular and cortical bone at the ultradistal radius were made in 27 children with rheumatic diseases and in age- and sex-matched healthy controls using peripheral quantitative computed tomography (pQCT). RESULTS: Mineral density of trabecular bone (-34,5%) and total bone mineral density (-18,9%) differed significantly between patients and controls (p < 0.01). BMD of the cortical bone (-13,6%) did not differ significantly between the groups. There was no difference in BMD in patients with systemic or non-systemic diseases. BMD did not correlate with duration of disease or steroid medication. CONCLUSIONS: Total bone mineral density and trabecular bone density are decreased in children and adolescents with sytemic and non-systemic rheumatic diseases. Age of onset of disease and steroid medication did not correlate with bone mineral density. PQCT has the advantages of low local and no total body radiation, high sensitivity, high reproducibility and selective measurement of different bone compartements. Because selective measurement can be made in metabolically active trabecular bone changes of BMD can be detected at an early stage before the whole bone is affected. With this method therapy for chronic diseases affecting bone density can be initiated and the course of the disease can be followed.

Adolescent↗