Biomedical subjects

C Arndt

Publications and source records attributed to C Arndt.

At least 19 recordsLinked to original sources

PubMed2007

Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium.

In a randomised, controlled, double-blind, multicentre trial in 338 patients, we assessed the incidence of residual paralysis following administration of cisatracurium or rocuronium. The incidence at the end of surgery was significantly lower in patients treated with rocuronium (62 of 142 patients, 44%) than in those given cisatracurium (99 of 175 patients, 57%) (p < 0.05). In contrast, with rocuronium the mean (SD) time between skin closure and extubation was 28 (28) min vs 18 (19) min for cisatracurium, and the duration 0.9 (time from administration of last top-up dose to recovery of the train-of-four ratio to 0.9) was significantly longer and more variable for rocuronium than for cisatracurium. Thus, after repeated administration, the duration and variability of duration of action are greater with rocuronium compared with cisatracurium. These pharmacodynamic differences do not necessarily translate into a higher incidence of residual paralysis, because clinicians compensate for the longer duration of action and variability of rocuronium by terminating administration of the neuromuscular blocking earlier.

Androstanols↗

PubMed2006

[A murine model of transitory optic neuropathy based on small interference RNA-induced OPA1 silencing in vivo (gene mutation associated with Kjer's disease)].

PURPOSE: Developing a murine model of OPA1 linked optic neuropathy. METHODS: Intravitreal injections (in adult C57BL/6J mice) of small interference RNA (siRNA) specific to OPA1 were performed in the left eye. The right eye served as control, injected with nonspecific siRNA (siRNA scramble). Visual evoked potentials and flash electroretinograms were performed 5 and 12 days after injection. Three months after injection, microscopy of optic nerve sections was performed. RESULTS: The electrophysiological tests showed a significant reduction in the VEP when the siRNA OPA1-injected eye was stimulated, compared with the control eye injected with siRNA scramble. The electroretinogram was normal in both eyes: no significant difference between the right and the left eye was found. Three months after injection, no measurable axonal degeneration was found in either eye. CONCLUSION: The reduced expression of OPA1 based on RNA silencing in adult mice could induce reversible dysfunction of retinal ganglion cells.

Animals↗

PubMed2006

[Functional imaging of submandibular glands: diffusion-weighted echo-planar MRI before and after stimulation].

PURPOSE: To investigate the feasibility of diffusion-weighted (DWI) echo-planar imaging (EPI) to depict the submandibular glands and to measure different functional conditions. MATERIALS AND METHODS: Twenty-seven healthy volunteers were examined. Diffusion weighted sequence was performed prior to stimulation. Exactly 30 seconds after a commercially available lemon juice was given orally, the diffusion weighted sequence was repeated. All examinations were performed by using a 1.5-T superconducting system with a 30 mT/m maximum gradient capability and maximum slew rate of 125 mT/m/sec (Magnetom Symphony, Siemens, Erlangen, Germany). The lower part of the circularly polarized (CP) head coil and a standard two-element CP neck array coil were used. The flexibility of the neck array coil allowed positioning the N1 element (upper part of the coil) right next to the submandibular gland. The axial diffusion-weighted EPI (echo planar imaging) sequence was performed using a matrix of 119 x 128, a field of view of 250 x 250 mm (pixel size 2.1 x 1.95 mm), a section thickness of 5 mm with an interslice gap of 1 mm. The b factors used were 0 sec/mm(2), 500 sec/ mm(2) and 1000 sec/mm(2). Apparent diffusion coefficiant (ADC) maps were digitally transferred to MRIcro (Chris Rorden, Universitiy of Nottingham, Great Britain). After detecting the submandibular glands a region of interest (ROI) was placed manually exactly within the boarder of both submandibular glands, excluding the external carotid artery on ADC maps. These procedures were performed on all ADC slices the submandibular glands could be differentiated in before and after oral stimulation. For statistical comparison of results, a student's t-test was performed with an overall two-tailed significance level of p = 0.05. RESULTS: The visualization of the submandibular glands using the diffusion-weighted EPI sequence was possible in all of the 27 volunteers. Prior to oral stimulation an ADC of 1.31 x 10(-3) mm(2)/sec (95 % CI, 1.39 x 10(-3) mm(2)/sec, 1.44 x 10(-3) mm(2)/sec) was calculated which increased to 1.41 x 10(-3) mm(2)/sec (95 % KI, 1.39 x 10(- 3) mm(2)/sec, 1.44 x 10(-3) mm(2)/sec) 30 seconds after stimulation. This increase proved to be significant (p < 0.001). CONCLUSION: Diffusion-weighted echo-planar MR imaging allows non-invasive quantification of functional changes in the submandibular gland.

Adult↗

PubMed2005

Diffusion-weighted echo-planar MRI: a valuable tool for differentiating primary parotid gland tumors?

PURPOSE: To investigate the feasibility of using diffusion-weighted (DW) echo-planar imaging (EPI) for differentiating primary parotid gland tumors. MATERIAL AND METHODS: Fifty consecutive patients with a suspected primary tumor of the parotid gland were examined with a DW EPI sequence (TR 1,500 msec, TE 77 msec, field of view 250 x 250 mm, pixel size 2.10 x 1.95 mm, section thickness 5 mm). The b factors used were 0, 500, and 1,000 sec/mm (2). Apparent diffusion coefficient (ADC) maps were digitally transferred to MRIcro (Chris Rorden, University of Nottingham, Great Britain) and evaluated with a manually placed irregular region of interest (ROI) containing the entire tumor. Additionally, the contralateral, non affected parotid gland was measured and a circular ROI containing 100 - 200 pixels was placed in the cerebrospinal fluid (CSF) next to the spinal cord in every patient. For comparison of the results, the two-tailed Student's t test was used, based on the median ADC values for each patient, and a p-value <.05 was determined to indicate statistical significance. RESULTS: In 45 patients, a primary neoplasm of the parotid gland could be histologically verified. For the non-affected parotid glands of all 45 evaluated patients, the mean ADC value was 1.14 x 10 ( - 3) mm (2)/sec +/- 0.12 x 10 ( - 3) mm (2)/sec (mean +/- standard deviation). Seven different entities of parotid gland tumors were histologically discriminated. Pleomorphic adenomas (2.14 x 10 ( - 3) mm (2)/sec +/- 0.11 x 10 ( - 3) mm (2)/sec), Warthin tumors (0.85 x 10 ( - 3) mm (2)/sec +/- 0.1 x 10 ( - 3) mm (2)/sec), and mucoepidermoid carcinomas (1.04 x 10 ( - 3) mm (2)/sec +/- 0.3 x 10 ( - 3) mm (2)/sec) showed statistically significant different ADC values in comparison to all other evaluated tumors (p .001), and also among each other (p <.001). Additionally, ADC values presented by lipomas were statistically significant compared to all other entities (p <.001 to .015). Among all other [corrected] primary malignant parotid gland tumors, no statistically significant ADC values could be observed (p .18 to 1). CONCLUSION: Diffusion-weighted echo-planar MRI seems to be a valuable tool for differentiating benign from malignant primary parotid gland tumors.

Adolescent↗

PubMed2004

Age is a risk factor for chemotherapy-induced hepatopathy with vincristine, dactinomycin, and cyclophosphamide.

PURPOSE: To evaluate the spectrum of and determine the risk factors for the development of liver toxicity (hepatopathy) after therapy with vincristine, dactinomycin, and cyclophosphamide (VAC) for rhabdomyosarcoma in children and adolescents. PATIENTS AND METHODS: We prospectively captured all events of hepatopathy occurring on the ongoing Children's Oncology Group intermediate risk protocol, D9803, for children with rhabdomyosarcoma. Patients enrolled onto this trial were randomly assigned to receive either VAC alone or VAC alternating with vincristine, topotecan, and cyclophosphamide. In addition, we reviewed the toxicity database and requested additional information for all patients with elevated bilirubin or transaminase levels. Risk factors were analyzed. RESULTS: Of 339 patients enrolled through August 2002, 18 developed hepatopathy. All events were captured by mandated toxicity reporting and filing of MedWatch forms, with no additional cases found after the additional search of the database. Four children died after developing this toxicity. All cases occurred after cycles of VAC (n = 16) or vincristine and cyclophosphamide with concomitant abdominal radiotherapy (n = 2). The onset of hepatopathy was 5 to 16 days from the start of a treatment cycle. For the 89 patients under 36 months of age, the risk of hepatopathy was 15%, with two deaths. For the 239 children 3 years of age or older, the risk for hepatopathy was 4%, with two deaths. CONCLUSION: The greatest risk factor for development of hepatopathy after VAC therapy was age. Dose modifications for younger children receiving VAC therapy are recommended.

Age Factors↗

PubMed2001

Pupillary disturbances in multiple sclerosis: correlation with MRI findings.

UNLABELLED: Autonomic nervous system disturbances such as pupillary abnormalities have rarely been evaluated in multiple sclerosis (MS). However, pupillary impairment is not uncommon in MS and its origin is still unclear. The aim of this study was to investigate pupillary disturbances in MS and to try to correlate pupillary defects with spinal cord and brainstem magnetic resonance imaging (MRI) findings. We prospectively studied 45 MS patients and 30 normal subjects. METHODS: The pupillary contraction latency and the amplitude of contraction were recorded by pupillometry. We also determined afferent and efferent pathway defects by comparing the direct and consensual pupillary reflexes. We evaluated brainstem and spinal cord demyelinating lesions and spinal cord cross-sectional area on MRI. At least one pupillometric parameters were significantly impaired in 60% of patients and in none of the controls. We did not find any correlation between pupillary defect and demyelinating lesions on MRI. The most frequent abnormality was efferent pathway shift and this was correlated with spinal cord atrophy (P<0.02). These results confirm that the autonomic nervous system, and especially pupillary function, is frequently impaired in MS. The parasympathetic system is most commonly affected and this is most likely linked to axonal loss (demonstrated by spinal cord atrophy) rather than to demyelinating lesions.

Adult↗

PubMed2001

Preservation of canine and feline corneoscleral tissue in Optisol GS.

OBJECTIVE: The objective of the research was to determine whether preservation of corneal tissue of dogs and cats in Optisol GS (OGS, Bausch & Lomb Surgical, Irvine, CA, USA) is feasible for subsequent use in penetrating keratoplasty. ANIMALS: The study subjects were 33 dogs and 31 cats with no gross corneal pathology, which had been euthanised by pentobarbital overdose for reasons unrelated to this project. PROCEDURE: One cornea of each pair was evaluated immediately and the other was evaluated after storage in Optisol GS for either 5, 10, 15 or 20 days. The most important criterion was the preservation of the endothelial cell layer. RESULTS: Corneoscleral tissue of cats survived longer, when preserved in Optisol GS at 4 degrees C, than that of dogs. Light and scanning electron microscopy revealed good preservation of the endothelial cell layer for up to 10 days in dogs and up to 15 days in cats.

Animals↗

PubMed2001

Anaerobic sulfur metabolism in thiotrophic symbioses.

Hydrogen sulfide is generally accepted to be the energy source for the establishment of sulfur-oxidizing symbiotic communities. Here, we show that sulfur-storing symbioses not only consume but also produce large amounts of hydrogen sulfide. The prerequisite for this process appears to be the absence of oxygen. Anaerobic sulfide production is widespread among different thiotrophic symbioses from vent and non-vent sites (Riftia pachyptila, Calyptogena magnifica, Bathymodiolus thermophilus, Lucinoma aequizonata and Calyptogena elongata). The extent of H2S generation correlates positively with the amount of elemental sulfur stored in the symbiont-bearing tissues of the hosts. Sulfide production starts a few hours after anoxia sets in, with H2S initially accumulating in the circulatory system before it is excreted into the surrounding environment. We propose that not sulfate but the elemental sulfur deposited in the symbionts serves as a terminal electron acceptor during anoxia and is reduced to sulfide. In anoxia-tolerant symbioses such as L. aequizonata, anaerobic sulfur respiration may be important for producing maintenance energy to help the species survive several months without oxygen. The increased levels of cysteine in the gills of L. aequizonata may be caused by a lack of reoxidation due to the absence of oxygen.

Anaerobiosis↗

PubMed2001

Electrophysiological effects of corticosteroids on the retinal pigment epithelium.

PURPOSE: As corticosteroids appear to intervene in pathogenesis of central serous chorioretinopathy, ion transport changes within the retinal pigment epithelium (RPE) might be involved. Electrophysiological responses to corticosteroid administration were recorded in vivo and in vitro. METHODS: Clinical study: The standing ocular potential was recorded during intravenous (IV) infusion of glucose 5% and glucose 5% + prednisolone 0.2% in 14 patients with relapsing multiple sclerosis. The results were compared with a control group receiving two successive identical glucose 5% infusions. In vitro study: Native tissue explants (RPE + choroid, porcine, and bovine) were placed in a Ussing-type chamber. After baseline determination of the transepithelial potential (PD), short circuit current (I(sc)) and transepithelial resistance (R(t)), the effect of apical hydrocortisone (HC) 10(-4) M was determined. RESULTS: Clinical study: A significant rise of the standing potential was found after glucose infusion (P = 0.005), whereas no change was detected after IV glucose + prednisolone (P = 0.695). In vitro study: In the porcine RPE, the mean baseline PD and I(sc) were significantly reduced (both P: = 0.012) after applying apical 10(-4) HC. R(t) was also significantly reduced (P = 0.01). The same type of response, observed in bovine RPE, was reduced in low chloride/low bicarbonate conditions. CONCLUSIONS: Corticosteroids modified electrophysiological parameters representing RPE function in vivo. The existence of an RPE-specific effect was confirmed in vitro. Further work is required to link the observed ion transport changes to a reduction of apical, subretinal fluid absorption.

Animals↗

PubMed2001

[Intraocular lens implantation in the first year of life].

We evaluated 36 eyes in 23 infants between one and eleven months old who had primary posterior chamber intraocular lens implantation for congenital cataracts. All eyes had a capsulorhexis of anterior and posterior capsulae and anterior vitrectomy. In order to obtain an emmetropia at age 5 years, we chose a 35% undercorrection of lens power for infants less than six months old, and 25% for infants between seven and eleven months old. The average follow-up was 15.3 months. Nine eyes developed posterior synechiae and eight developed a posterior opacification. The average postoperative refraction was +5.81 dioptries at one month, +4.56 at four months, +1.5, at one year, and +0.19 at two years. There was a marked subjective visual improvement in 34 eyes.

Cataract↗

PubMed2000

Rothmund-Thomson syndrome due to RECQ4 helicase mutations: report and clinical and molecular comparisons with Bloom syndrome and Werner syndrome.

Rothmund-Thomson syndrome (RTS), an autosomal recessive disorder, comprises poikiloderma, growth deficiency, some aspects of premature aging, and a predisposition to malignancy, especially osteogenic sarcomas. Two kindreds with RTS were recently shown to segregate for mutations in the human RECQL4 helicase gene. We report identification of a new RTS kindred in which both brothers developed osteosarcomas. Mutation analysis of the RECQL4 gene was performed on both brothers and both parents. The brothers were shown to be compound heterozygotes for mutations in the RECQL4 gene, including a single basepair deletion in exon 9 resulting in a frameshift and early termination codon and a base substitution in the 3-prime splice site in the intron-exon boundary of exon 8, which would be predicted to cause a deletion of at least part of a consensus helicase domain. Each parent was shown to be a heterozygote carrier for one mutation. This report strengthens the association between mutations in RECQL4 helicase gene and RTS. Two other recessive disorders, Bloom syndrome and Werner syndrome, are known to be due to other human RECQ helicase gene mutations. These three disorders all manifest abnormal growth, premature aging, and predisposition to site-specific malignancies. The clinical and molecular aspects of RTS, Bloom syndrome, and Werner syndrome are compared and contrasted.

Adult↗

PubMed2000

Aggressive surgery is unwarranted for biliary tract rhabdomyosarcoma.

BACKGROUND/PURPOSE: Rhabdomyosarcoma (RMS) of the biliary tract is rare, and, in addition to multiagent chemotherapy with or without radiotherapy (RT), some investigators recommend aggressive surgery. To assess the role of surgery, records of all 25 eligible patients with biliary RMS enrolled in IRSG studies I through IV from 1972 to 1998 were reviewed. METHODS: Treatment included surgery with or without vincristine, dactinomycin, cyclophosphamide, doxorubicin, cisplatin, etoposide, ifosfamide, and with or without RT. Data evaluated included clinical presentation, treatment, complications, and outcome. RESULTS: Diagnostic imaging identified the primary tumor but failed to identify regional metastases. Despite aggressive surgery, gross total resection at diagnosis was possible in only 6 cases, 2 of which had negative surgical margins. Although only 6 (29%) patients without distant metastases underwent gross total resection, estimated 5-year survival rate was 78% (95% CI 58%, 97%). Infectious complications were common and frequently associated with external biliary drains. Five (20%) died within the first 2 months, 3 of sepsis. CONCLUSIONS: Surgery is critical for establishing an accurate diagnosis and determining the extent of regional disease. Gross total resection is rarely possible despite aggressive surgery, and outcome is good despite residual disease after surgery. External biliary drains increase the risk of postoperative infectious complications.

Biliary Tract Neoplasms↗

PubMed2000

Sulphide detoxification in Hediste diversicolor and Marenzelleria viridis, two dominant polychaete worms within the shallow coastal waters of the southern Baltic Sea.

The polychaete worms Marenzelleria viridis (Verrill 1873) and Hediste diversicolor (O.F. Müller) form the main part of the macro-zoobenthos in soft-bottomed shallow inlets of the Baltic Sea. Due to high eutrophication within these waters the animals are exposed to low oxygen and high sulphide concentrations. Specimens of both species from a low salinity location (S 8/1000) were compared concerning their physiological abilities in coping with this hostile environment. Sulphide detoxification occurred in both polychaetes even during severe hypoxia with the main end-product being thiosulphate. In absence of sulphide nearly no end-products of anaerobic metabolism were found in the worms during moderate hypoxia (pO2 = 7 kPa). In presence of hydrogen sulphide, succinate, a sensitive indicator of anaerobic metabolism, was accumulated in higher amounts at low sulphide concentrations (0.3 mM) already. Oxygen consumption and ATP production was determined in isolated mitochondria of both species. Both polychaetes were able to perform enzymatic sulphide oxidation in the mitochondria at concentrations up to 50 microM. This process was coupled with oxidative phosphorylation. At least in M. viridis sulphide respiration was not completely inhibited by cyanide, suggesting an alternative oxidation pathway, which by-passes the cytochrome-c-oxidase. The two species did not differ in the rate of sulphide detoxification, but H. diversicolor produced about as twice as much ATP from mitochondrial sulphide oxidation. Differences in mitochondrial sulphide oxidation are probably related to the different life strategies of the worms.

Adaptation, Physiological↗

PubMed2000

Visual evoked potentials study in chronic idiopathic inflammatory demyelinating polyneuropathy.

BACKGROUND: The frequency of the association between chronic demyelinating inflammatory polyneuropathy (CIDP) and central nervous system (CNS) demyelinating lesions is probably underestimated. OBJECTIVE: To investigate the occurrence of combined central and peripheral demyelination in CIDP patients and to correlate visual evoked potential (VEP) abnormalities with CNS demyelinating lesions, observed on brain magnetic resonance imaging, and antibodies against glycolipids. METHODS: Nerve conduction studies, brain MRI and antibodies against glycolipids were prospectively studied in 17 patients who fulfilled the diagnostic criteria proposed for CIDP (Cornblath DR, Asbury AK, Albers JW, Feasby TE, Hahn AF, McLeod JG, Mendell JR, Parry GJ, Pollard JD, Thomas PK. Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force. Research criteria for diagnosis of chronic inflammatory demyelinating polyneuropathy. Neurology, 1991;41:617-618). VEPs were performed in each case before and after 6 months treatment with either intravenous immunoglobulins (IVIG) or steroids. RESULTS: Eight patients (47%) had increased latencies in at least one eye or showed increased interocular latency difference. Four patients (23%) presented a significant high signal intensity on T2-weighted brain MRI images. Of these 4 patients, 3 had prolonged VEP latency. Two patients with delayed VEP latency had antibodies against GM1, and SGLPG and anti-sulfatides, respectively. One patient with normal VEPs also had antibodies to GM1. VEP results were not significantly modified after treatment, either with steroids or IVIG. CONCLUSION: This study confirmed the high frequency of abnormal VEPs in CIDP patients, and found that they are poorly correlated with CNS demyelinating lesions and antibodies against glycolipids. The VEP abnormalities of these patients may be explained by the susceptibility to immune-mediated damage of both the peripheral nervous system and the optic nerve.

Adolescent↗

PubMed1999

Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group.

BACKGROUND: In patients with persistent fever and neutropenia, amphotericin B is administered empirically for the early treatment and prevention of clinically occult invasive fungal infections. However, breakthrough fungal infections can develop despite treatment, and amphotericin B has substantial toxicity. METHODS: We conducted a randomized, double-blind, multicenter trial comparing liposomal amphotericin B with conventional amphotericin B as empirical antifungal therapy. RESULTS: The mean duration of therapy was 10.8 days for liposomal amphotericin B (343 patients) and 10.3 days for conventional amphotericin B (344 patients). The composite rates of successful treatment were similar (50 percent for liposomal amphotericin B and 49 percent for conventional amphotericin B) and were independent of the use of antifungal prophylaxis or colony-stimulating factors. The outcomes were similar with liposomal amphotericin B and conventional amphotericin B with respect to survival (93 percent and 90 percent, respectively), resolution of fever (58 percent and 58 percent), and discontinuation of the study drug because of toxic effects or lack of efficacy (14 percent and 19 percent). There were fewer proved breakthrough fungal infections among patients treated with liposomal amphotericin B (11 patients [3.2 percent]) than among those treated with conventional amphotericin B (27 patients [7.8 percent], P=0.009). With the liposomal preparation significantly fewer patients had infusion-related fever (17 percent vs. 44 percent), chills or rigors (18 percent vs. 54 percent), and other reactions, including hypotension, hypertension, and hypoxia. Nephrotoxic effects (defined by a serum creatinine level two times the upper limit of normal) were significantly less frequent among patients treated with liposomal amphotericin B (19 percent) than among those treated with conventional amphotericin B (34 percent, P<0.001). CONCLUSIONS: Liposomal amphotericin B is as effective as conventional amphotericin B for empirical antifungal therapy in patients with fever and neutropenia, and it is associated with fewer breakthrough fungal infections, less infusion-related toxicity, and less nephrotoxicity.

Adolescent↗

PubMed1999

Renal function following combination chemotherapy with ifosfamide and cisplatin in patients with osteogenic sarcoma.

BACKGROUND: Ifosfamide and cisplatin are active agents that are currently used in the treatment of osteosarcoma. Nephrotoxicity has been reported following their use in combination and alone. This study evaluates renal function in children and adolescents (median age 16 years) at least 3 months following completion of a chemotherapy regimen which included 54 g/m2 ifosfamide, 360 mg/m2 cisplatin, doxorubicin, and high-dose methotrexate. PROCEDURE: Mean glomerular filtration rate (GFR) was determined by inulin or iothalamate clearance; proximal tubular function was evaluated by measuring fractional excretion of glucose (FEglu), tubular maximum phosphate reabsorption per GFR (TMP/GFR), FE of urate, and 24-hour amino acid excretion. Distal tubular function was evaluated by 24-hour urinary calcium, FE of magnesium, and urinary osmolality after water deprivation. Twenty-four-hour urinary protein excretion was measured. RESULTS: The mean GFR was 97 ml/min/1.73 m2. Although 10 of 24 patients had GFRs lower than normal, the lowest value was only 22% below the lower limit of normal and would not account for any clinical compromise. Proximal tubular function evaluation revealed normal FEglu, normal mean TMP/GFR values, and high FE of urate (1 5.7%). Two of twenty-four patients were shown to have mild generalized aminoaciduria. Distal tubular function evaluation showed normal 24-hour urinary calcium levels (mean 3.4 mg/kg) and FE of magnesium as well as normal urinary osmolality. Twenty-four-hour urinary protein excretion was normal in all patients. CONCLUSIONS: The lack of clinically significant renal abnormalities observed in patients who received combination chemotherapy with ifosfamide and cisplatin for osteosarcoma is encouraging for future osteosarcoma protocol development.

Adolescent↗

PubMed1999

Amphotericin B lipid complex in pediatric patients with invasive fungal infections.

BACKGROUND: Lipid formulations of amphotericin B have been recently introduced for treatment of invasive fungal infections. However, little is known about their role in pediatric populations. METHODS: We studied the safety and antifungal efficacy of amphotericin B lipid complex (ABLC, Abelcet) in 111 treatment episodes in pediatric patients through an open label, emergency use multicenter study. Patients with invasive fungal infections were enrolled if they had mycoses refractory to conventional antifungal therapy, if they were intolerant of previous systemic antifungal agents or concomitant nephrotoxic drugs or if they had preexisting renal disease. RESULTS: All 111 treatment episodes were evaluable for safety and 54 were evaluable for efficacy. The mean serum creatinine for the study population did not significantly change between baseline (1.23 +/- 0.11 mg/dl) and cessation of ABLC therapy (1.32 +/- 0.12 mg/dl) during 6 weeks. There were no significant differences observed between initial and end-of-therapy levels of serum potassium, magnesium, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and hemoglobin. However, there was an increase in mean total bilirubin (3.66 +/- 0.73 to 5.31 +/- 1.09 mg/dl) at the end of therapy (P = 0.054). Among 54 cases fulfilling criteria for evaluation of antifungal efficacy, a complete or partial therapeutic response was obtained in 38 patients (70%) after ABLC therapy. Complete or partial therapeutic response was documented in 56% of cases with aspergillosis (n = 25) and in 81% (n = 27) with candidiasis. Among premature infants (n = 8) and allogeneic marrow recipients (n = 14), response rates were 88 and 57%, respectively. Response was similar in those patients enrolled because of intolerance to previous antifungal therapy or because of progressive infection. CONCLUSIONS: These data support the use of ABLC for treatment of invasive fungal infections in pediatric patients who are intolerant of or refractory to conventional antifungal therapy.

Adolescent↗

PubMed1999

[Simplified electroretinography protocol and diagnosis of retinal dystrophies in children].

PURPOSE: To report results of a simplified electroretinogram in children. PATIENTS: 124 children under 6 years of age with nystagmus, blindness, neurological disease, cone rod dystrophy in the family, or abnormal fundus appearance were examined. METHOD: The electroretinogram was recorded by corneal electrodes in an awake state without sedation. A light-emitting orange diode stimulator was used. Stimulation was performed subsequently after 3 minutes of light adaptation and after 8 minutes of darkness. If the electroretinogram was abnormal, a second recording was done a few weeks later using the same method. In some cases, the children were re-examined, and a ganzfeld stimulation ERG was recorded. RESULTS AND DISCUSSION: This method allowed a reliable diagnosis of photoreceptor dystrophy: Leber's congenital amaurosis with or without rare metabolic diseases, X link pigmentary retinopathy or retinal dystrophy with general disease in children. It helped to differentiate isolated retinal pigment changes with normal electroretinogram from functional retinal impairment and rod-cone dystrophy from other retinal dystrophies.

Adaptation, Ocular↗