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Biomedical subjects

B Zeller

Publications and source records attributed to B Zeller.

At least 19 recordsLinked to original sources
PubMed2006

Vaccination associated thrombocytopenic purpura in children.

Patients who presented with purpura and blood platelets <30x10(9)/l within 1 month after vaccination were collected from a population based material of 506 consecutive pediatric patients with newly diagnosed ITP. Of the 35 such patients, 24 had thrombocytopenia after MMR vaccination giving an estimated ITP risk of approximately 1 in 30,000 MMR inoculations. Symptoms of the 35 patients were nearly always acute. Thrombocytopenia disappeared within a month in 74% of the study patients and lasted longer than 6 months in only 10%. Bleeding episodes were uncommon during the follow-up period. We conclude that the incidence of symptomatic thrombocytopenia after vaccinations is much lower than that after respective natural infections and that the outcome in most cases is excellent.

Adolescent↗
PubMed2005

Long-term results in children with AML: NOPHO-AML Study Group--report of three consecutive trials.

In all, 447 children with acute myeloid leukaemia (AML) have been treated on three consecutive NOPHO studies from July 1984 to December 2001. NOPHO-AML 84 was of moderate intensity with an induction of three courses of cytarabine, 6-thioguanine and doxorubicin followed by four consolidation courses with high-dose cytarabine. The 5-year event-free survival (EFS), disease free survival (DFS) and overall survival (OS) were 29, 37 and 38%. NOPHO-AML 88 was of high intensity with the addition of etoposide and mitoxantrone in selected courses during induction and consolidation. The interval between the induction courses should be as short as possible, that is, time intensity was introduced. The 5-year EFS, DFS and OS were 41, 48 and 46%. In NOPHO-AML 93, the treatment was stratified according to response to first induction course. The protocol utilised the same induction blocks as NOPHO-AML 88, but after the first block, children with a hypoplastic, nonleukaemic bone marrow were allowed to recover before the second block. Consolidation was identical with NOPHO-AML 88. The 5-year EFS, DFS and OS in NOPHO-AML 93 were 48, 52 and 65%. The new NOPHO-AML protocol has been based on experiences from previous protocols with stratification of patients with regard to in vivo response and specific cytogenetic aberrations.

Acute Disease↗
PubMed2001

[Acute pyelonephritis in children with minimal or normal urine findings].

BACKGROUND: Over the past years we have seen several children with serious bacterial infections in whom the focus of the infection was found in the kidneys despite of normal or minimal urine findings. MATERIAL AND METHODS: We review the cases of all children hospitalised at our paediatric department from 1995-2000 with normal or minimal urine findings, and in whom acute pyelonephritis was diagnosed by means of computerized tomographic imaging of the kidneys. RESULTS: All 10 children (aged 9 months to 9 years) had focal areas of decreased enhancement in the kidney parenchyma. All received intravenous antibiotic treatment. Vesicouretheral reflux was detected in four patients and required surgical intervention in one. One patient had considerable renal scarring and decreased renal function on dimercaptosuccinic acid (DMSA) scintigraphy. INTERPRETATION: In children with suspected serious bacterial infection, it is important to have the possibility of renal infection in mind in spite of normal urine findings. The importance of establishing the right diagnosis lies in the fact that patients with pyelonephritis need further investigation and follow-up.

Acute Disease↗
PubMed2001

Influenza A among patients with human immunodeficiency virus: an outbreak of infection at a residential facility in New York City.

Although annual influenza vaccination is recommended for persons who are infected with human immunodeficiency virus (HIV), data are limited regarding the epidemiology of influenza or the effectiveness of influenza vaccination in this population. We investigated a 1996 outbreak of infection with influenza A at a residential facility for persons with AIDS. We interviewed 118 residents and employees, reviewed 65 resident medical records, and collected serum samples for measurement of influenza antibody titers. After controlling for history of smoking, influenza vaccination, and resident or employee status, in a multivariate model, HIV infection was not statistically associated with influenza-like illness (ILI). Symptoms and duration of ILI were similar for most HIV-infected and HIV-uninfected persons. However, 8 (21.1%) of 38 HIV-infected persons with ILI (vs. none of 15 HIV-uninfected persons) were either hospitalized, evaluated in an emergency room, or had ILI lasting > or = 14 days (P=.06). Vaccination effectiveness (VE) was similar for HIV-infected and HIV-uninfected persons. Vaccination was most effective among HIV-infected persons with CD4 cell counts of >100 cells/microL (VE, 65%; 95% CI, 36%--81%) or HIV type 1 virus load of <30,000 copies/mL (VE, 52%; 95% CI, 11%--75%). Providers should continue to offer influenza vaccination to HIV-infected persons.

AIDS-Related Opportunistic Infections↗
PubMed2001

Fate of nitrogen released from 15N-labeled litter in European beech forests.

The decomposition and fate of 15N-labeled beech litter was monitored in three European beech (Fagus sylvatica L.) forests (Aubure, France; Ebrach, Germany; and Collelongo, Italy) for 3 years. Circular plots around single beech trees were isolated from roots of neighboring trees by soil trenching, and annual litterfall was replaced by 15N-labeled litter. Nitrogen was continuously released from the decomposing litter. However, over a 2-year period, this release was balanced by the incorporation of exogenous N. Released N accumulated mainly at the soil surface and in the topsoil. Microbial biomass remained almost constant during the experiment at all sites except for considerably lower values at Ebrach. The 15N enrichment of the microbial biomass increased strongly during the first year and then remained stable. The 15N released from the decomposing litter was rapidly detected in roots and leaves of the beech trees, increasing regularly and linearly over the course of the experiment. The uptake of litter-released 15N by the trees was reduced under conditions that reduced tree growth. Under these conditions, leaves and fine roots were the dominant N sinks, and little N was allocated to other plant parts. By contrast, N uptake and N allocation from leaves to stem and bark tissues increased when tree growth was enhanced. Budgets for 15N showed that 2 to 4% of litter-released N was incorporated into the trees, about 35% remained in the litter and about 50% reached the topsoil.

Biomass↗
PubMed2000

[Kawasaki disease].

Kawasaki syndrome was first described in 1967. The diagnosis is based on clinical criteria including fever for more than five days, conjunctivitis, lymph node enlargement and changes in the oral mucosa as well as in the palms and soles. Coronary complications including aneurysmal dilatation have been reported in 20-25% of untreated patients. Kawasaki syndrome is now the most common cause of acquired heart disease in children. Six patients were seen in our department during the period 1980-99. Five were treated with intravenous immunoglobulin. All of them showed immediate improvement of their general condition and were afebrile after 24-48 hours. One patient had a coronary aneurysm of moderate size, and four patients had signs of coronary vasculitis. All coronary changes were normalized after a maximum of 17 months. An update on Kawasaki disease is presented.

Child↗
PubMed1998

[Accidental administration of racemic adrenaline. Three life-threatening cases after intravenous injection in children].

The inhalation of racemic adrenalin is an important part of the treatment of inflammatory airway obstruction in children. In Norway during the last few years there have been several cases of adrenal solutions intended only for inhalation being accidentally administered as intravenous injections. The solution for inhalation contains an adrenalin concentration 110 times greater than the adrenalin intended for emergency use (0.1 mg/ml). The instant consequences of intravenous injections of inhalation adrenalin include arterial hypertension followed by hypotension, cardiac ischemia and cardiac insufficiency, pulmonary oedema, and respiratory failure and the need for artificial ventilation. The clinical picture in the three patients we describe was very dramatic. The injected doses were 0.16-1.1 mg l-adrenalin per kg body weight. All children survived without sequelae. In order to reduce the risk of accidentally administering intravenous injections of adrenalin intended for inhalation a set of guidelines is being proposed.

Child↗
PubMed1997

[Transient erythroblastopenia in children. Severe anemia with good prognosis].

Transient erythroblastopenia of childhood (TEC) is an acute form of anaemia characterized by a transient red blood cell aplasia, of unknown cause, in the bone marrow. The incidence appears to be increasing. 16 patients were seen in our paediatric department during the period 1990 to 1996. The ages varied from two to 48 months. All patients had severe anaemia, the lowest mean haemoglobin values being 4.9 (2.2-7.8) g/100 ml. The reticulocyte count was low in 14 patients, whereas two patients had reticulocytosis. No underlying haematologic diseases were found. Ten patients were tested for parvovirus B19 infection, all of whom were serologically negative. Apart from transfusion of red blood cells in six patients, no therapy was given. Reticulocytosis, indicating beginning recovery, was observed after a mean interval of 11.8 days. This article gives a short overview of transient erythroblastopenia of childhood, a form of anaemia which can initially represent a diagnostic challenge.

Anemia↗
PubMed1997

Cure of infantile myofibromatosis with severe respiratory complications without antitumour therapy.

UNLABELLED: The prognosis of infantile myofibromatosis (IMF) depends on the organs involved: the prognosis is very poor if vital viscera are affected, but excellent if there is no visceral involvement. We report the case of a boy presenting with a pathological fracture at the age of 6 weeks. Progressive osteolytic lesions in the whole skeleton until the age of 8 months led to respiratory failure due to a softened thoracic wall requiring mechanical ventilation for 11 months. No pulmonary, laryngeal or other visceral involvement was found. In spite of the rapidly progressing disease and serious complications only supportive therapy was given. The lesions subsided gradually leaving slight deformities but normal function. At the age of 3.5 years the boy has an excellent quality of life. CONCLUSION: This case illustrates that even in progressing, complicated multifocal infantile myofibromatosis (without visceral involvement) the lesions can resolve without antitumour treatment if high quality intensive care is supplemented.

Bone Neoplasms↗
PubMed1996

[Investigation and treatment of immune thrombocytopenic purpura in children in Norway].

The treatment of immune thrombocytopenic purpura (ITP) in children has been debated for a long time. Some years ago the Norwegian paediatric haematology and oncology group proposed guidelines for investigation and therapy. In order to assess the present management of ITP in Norway, we sent a questionnaire to all paediatric departments. Answers from 22 departments could be analyzed. The estimated number of new ITP cases was 54, giving an incidence of 6.7 per 100,000 children. Most of the departments treat only a few patients (one to three patients a year). Investigation and treatment of ITP follows roughly the Norwegian guidelines. Disagreement exists about the indication for start of drug treatment (the lowest accepted platelet count differed from < 5 to 30 x 10(9)/l) and about choice of drug (1/2 prefer steroids, 2/3 immunoglobulins). There seems to be great interest for this topic among the Norwegian pediatricians. A prospective registration of all ITP cases in Norway has now been started.

Child↗
PubMed1996

[Immune thrombocytopenic purpura in children--controversy and consensus. How much investigation and treatment is meaningful?].

Immune thrombocytopenic purpura (ITP) is a postinfectious thrombocytopenia with a general tendency to bleed. The disease is often self-limiting in children, but the risk of intracranial haemorrhage has led to some controversy about indications and intensities of treatment. In nearly all cases of intracranial haemorrhage documented in the literature since 1970, the platelet count was 15 x 10(9)/l) or lower and was observed in less than 1% of the patients. In typical cases of acute ITP no extensive laboratory investigation is required. Indications for treatment depend more on clinical bleeding symptoms than on platelet count. Up to now there is no proven difference in efficacy between steroids and immunoglobulins. In 10-25% the disease becomes chronic, but spontaneous remission can occur after many years. Management of the chronic form has to be adjusted to the individual patient. Continuous steroid treatment for more than three weeks is contraindicated. Splenectomy should be avoided if at all possible because the risk of sepsis after splenectomy is comparable with the risk of life-threatening bleeding.

Acute Disease↗
PubMed1995

[Fibrodysplasia (myositis) ossificans progressiva].

A seven-year-old boy with mental retardation and congenital skeletal malformations in the thumbs and big toes developed recurrent lumps in the shoulder and interscapular region. The lumps subsided slowly but left severe stiffness in the affected areas. The first biopsy revealed oedema and a chronic inflammatory response with fibromyxoid proliferation of the soft tissue. A second biopsy revealed ossification of muscle and fascia. The patient is a typical case of fibrodysplasia ossificans progressiva, an autosomal dominant inherited disorder characterized by congenital skeletal malformations in toes and fingers and progressive ectopic ossification, often combined with alopecia, deafness and in rare cases mental retardation. The disorder leads to severe physical disability in young age and respiratory and nutritional problems. No effective treatment is known, but it is important to avoid exacerbating factors such as biopsy, operations and intramuscular injections.

Child↗