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Biomedical subjects

F Grill

Publications and source records attributed to F Grill.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of long-term intravascular catheter-related bacteraemia with antibiotic-lock therapy.

BACKGROUND: Bacteraemia is a major complication associated with the use of long-term intravascular catheters. Conservative treatment using antibiotic-lock therapy (ALT) has been shown to be useful in some studies, but the evidence supporting its impact in clinical care is still scarce. METHODS: We evaluated the outcome of the episodes of catheter-related bacteraemia (CRB) associated with long-term intravascular devices used for chemotherapy or parenteral nutrition and that were managed with ALT during a 44 month period in our hospital. Episodes of CRB associated with catheters implanted in the same department during the same period, and that were managed with only systemic antibiotics were used as a control group. Antibiotic-lock solution consisted of a heparin solution of 20 IU/mL including vancomycin (for Gram-positive microorganisms) or ciprofloxacin or gentamicin (for Gram-negative bacilli), all at a concentration of 2 mg/mL. ALT was used for a minimum of 8-12 h/day, during 5-14 days. Effectiveness was assessed by clinical and microbiological criteria. RESULTS: A total of 801 long-term intravascular devices were placed in 105 patients during this period. There were 127 episodes of bacteraemia documented in these patients, with 92 being CRB. Of these, 48 episodes fulfilled inclusion criteria for the analysis. Nineteen episodes were treated with ALT plus systemic antibiotics, and 29 episodes were treated only with systemic antibiotics. Isolated microorganisms were similar in the two groups. The catheter had to be removed during therapy in one episode in the antibiotic-lock group and in seven episodes in the control group. Relapse of the bacteraemia with the same microorganism after stopping therapy was observed in two and three patients in the study group and the control group, respectively. Overall, successful treatment was achieved in 84% and 65% of the episodes in the antibiotic-lock group and the control group, respectively (P = 0.27). CONCLUSIONS: ALT appears as an effective conservative treatment in the management of CRB associated with long-term intravascular devices (84% in the present series), especially in infections caused by coagulase-negative staphylococci.

Anti-Bacterial Agents↗
PubMed2006

[Preoperative psychoeducation for a severely traumatized child].

N., an 8-year-old girl with a long term history of severe sexual abuse and maltreatment with consecutive mental disorders, was scheduled for surgery of clubfeet. The team consisting of an anesthesiologist, a psychologist and a pediatrician decided to prepare the girl for surgery without time pressure. In a first step we applied psychoeducation to obtain a certain degree of confidence. Psychoeducation is a special form of psychological treatment aiming to define cause and goal of surgery together with the patient and relatives. In a further step the anesthesiologist familiarized her with the surgical procedure and the operating theatre. Finally a careful anesthesia with a pain-free postoperative period was applied. Even extremely traumatized children can be prepared for surgery by the help of psychoeducative methods, without time pressure, a careful and pain-free anesthesia and an experienced team of doctors.

Anesthesia↗
PubMed2006

Knee deformity in congenital longitudinal deficiencies of the lower extremity.

UNLABELLED: The knee has various pathologic appearances in patients with congenital longitudinal deformities of the lower extremities. Radiographs from 39 patients with unilateral longitudinal congenital deficiencies of the lower extremities were analyzed to describe epiphyseal and metaphyseal configurations and position of the epiphyseal plate. We defined 22 radiographic parameters of the femur and tibia, calculated the mean values, and compared the parameters of the affected knee with the unaffected knee for patients in different age groups. In the femur, we observed hypoplasia of the lateral condyle in width and height. In the tibia, the lateral condylar hypoplasia was manifest primarily by lateral horizontal deficiency. Age group comparisons showed no horizontal epiphyseal deficiencies in the older patients, but there was persistence of vertical epiphyseal deficiencies. Bony deformities in congenital longitudinal deficiencies mainly were attributable to dysplasia of the lateral epiphysis in the distal femur and proximal tibia, whereas positions of the epiphyseal plate had varying physiologic values. LEVEL OF EVIDENCE: Diagnostic study, Level II. See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Treatment of reflex sympathetic dystrophy in children using a prostacyclin analog: preliminary results.

UNLABELLED: The aim of our study was to evaluate Iloprost, a prostacyclin analog, for treatment of reflex sympathetic dystrophy in children not responsive to conservative treatment. Seven female patients with a mean age of 9 years (range, 6-11 years) diagnosed with reflex sympathetic dystrophy Stage II were treated with infusions of Iloprost given on three consecutive days. Additionally, all patients had physiotherapy and were offered psychologic consultation. One day after the final infusion, all seven patients were free of pain and achieved full weightbearing. The side effects of Iloprost were headache in all patients and vomiting in two patients. Two patients experienced relapse--one patient at 3 months and the other patient 5 months after primary treatment--but both were free of pain by 5 days after a second series of infusions. During a mean followup of 30 months all patients remained asymptomatic. Our preliminary results suggest that temporary sympathicolysis with Iloprost, physiotherapy, and psychologic counseling is a safe and an effective treatment of reflex sympathetic dystrophy in children with a long history of symptoms or in those who do not respond to conservative treatment. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Instructions for Authors for a complete description of levels of evidence.

Child↗
PubMed2005

Pathomorphology and treatment of congenital anterolateral bowing of the tibia associated with duplication of the hallux.

Congenital unilateral anterolateral tibial bowing in combination with a bifid ipsilateral great toe is a very rare deformity which resembles the anterolateral tibial bowing that occurs in association with congenital pseudarthrosis of the tibia. However, spontaneous resolution of the deformity without operative treatment and with a continuously straight fibula has been described in all previously reported cases. We report three additional cases and discuss the options for treatment. We suggest that this is a specific entity within the field of anterolateral bowing of the tibia and conclude that it has a much better prognosis than congenital pseudarthrosis of the tibia, although conservative treatment alone may not be sufficient.

Abnormalities, Multiple↗
PubMed2004

Pronounced short stature in a girl with tricho-rhino-phalangeal syndrome II (TRPS II, Langer-Giedion syndrome) and growth hormone deficiency.

We report on a 10-year-old girl with tricho-rhino-phalangeal syndrome type II (TRPS II) and pronounced short stature (-4.8 SD). The patient has an interstitial chromosome 8q24.1 deletion of 12-15 Mb. The deletion spans all genes from CSMD3 to at least ANXA13 including the TRPS1 and EXT1 genes, which are responsible for the TRPS II phenotype. In addition to the features of TRPS II, the patient had growth hormone (GH) deficiency with diminished response in three stimulation tests. Therapy with 0.2 mg GH/kg/week led to an increase of growth velocity from 2.5 to 6.6 cm/year. To our knowledge, such a combination of TRPS II and GH deficiency has not yet been described.

Child↗
PubMed2002

Juvenile bone-marrow oedema of the acetabulum treated by iloprost.

The bone-marrow oedema syndrome is associated with local vascular disturbances and may be treated either conservatively or by core decompression after which recovery may take several weeks. We describe a 15-year-old girl with bone-marrow oedema of the left acetabulum which was confirmed by MRI. She presented with a four-week history of severe constant pain. Routine blood tests and plain radiographs were normal. She was treated with intravenous infusions of iloprost on five consecutive days (20 microg administered in 500 ml of sodium chloride). Iloprost causes vasodilatation with reduction of capillary permeability and it inhibits platelet aggregation. She had relief from pain at rest after three days of treatment and was completely free from symptoms after two weeks. MRI after six weeks showed almost complete resolution of the marrow oedema and was normal after four months. This is the first report of the pharmacological treatment of the bone-marrow oedema syndrome in children.

Adolescent↗
PubMed2001

Skeletal cystic angiomatosis with severe hip joint deformation resembling massive osteolysis.

An aggressive destruction pattern resulting in joint deformation has not been described in skeletal cystic angiomatosis (SCA) so far. We present the case of a 6-year-old boy with such findings strongly resembling Gorham's disease (massive osteolysis). Since the prognosis of the latter entity tends to be less favorable than in SCA, particularly SCA without extraskeletal involvement, careful differentiation of both disorders appears to be important.

Angiomatosis↗
PubMed2000

[Congenital pseudarthrosis of the tibia].

Congenital pseudarthrosis of the tibia (CPT) is one of the most challenging conditions in paediatric orthopaedics. The history of CPT treatment is characterised by repeatedly ineffective surgical interventions with the inevitable outcome of severe disability. Most procedures failed to account for the complexity of the problem. The past two decades have witnessed more experience having been gained with the Ilizarov technique. This method provides a comprehensive approach to all aspects of CPT problem, allowing the surgeon to simultaneously address the problems of union as well as those of deformity, length discrepancy joint function, ankle valgus and weight bearing. It appears that the goal to achieve stable fusion before the child begins school is attainable. In the pre-pseudoarthrotic stage, bracing should be preferred to surgery until the patient is in an older age group. This study reports on the results of 19 patients: 15 have finished treatment, and 14 of them with a stable fusion at follow-up. The results were highly encouraging in reaching the ultimate goal of avoiding amputation and achieving a well-functioning limb.

Adolescent↗
PubMed2000

[Ulnar lengthening in osteochondroma (multiple cartilagenous exostoses) of the forearm].

The osteochondroma is the most frequent bone tumor to occur during the period of growth. The multiple hereditary form often involves the forearms. Depending on localisation and size of the tumor, shortening of the bones in the forearm, angular malalignments and functional impairment of the wrist and elbow joints may result. Early diagnosis and surgery in the growing child can prevent these complications. 13 children were operated on altogether 15 forearms. In nine cases lengthening of the ulna was necessary to correct ulnar instability of the wrist as well as improving the support of the carpus and preventing dislocation of the radial head.

Adolescent↗
PubMed2000

Pathology of bone lesions associated with congenital pseudarthrosis of the leg.

Congenital pseudarthrosis of the leg remains one of the most controversial pediatric entities in terms of etiopathogenesis, pathology, treatment, and prognosis. The authors reviewed the pathologic material of 24 patients with congenital pseudarthrosis of the leg along with clinical and radiographic data. The tibia was affected in 22 patients; in two patients the disease was limited to the fibula. Fifteen patients were male and nine were female. Age at surgery ranged from 1 to 26 years. Nineteen patients were classified as having dysplastic type, one cystic, and four mixed. Clinical evidence of neurofibromatosis type I (NF-I) was found in 17 patients. The main histopathologic change observed was the growth of a highly cellular, fibromatosis-like tissue. In the dysplastic type, such tissue was associated with the periosteum. In the cystic type, a closely similar tissue occupied the lytic area. In case classified as of mixed type, the coexistence of endosteal/medullary and periosteal involvement by the fibromatosis-like tissue was observed. In the cystic lesion, evidence of de novo bone formation within the lesional tissue was obvious. Overall, the histologic features of the cystic lesion were similar to those of osteofibrous dysplasia. In the dysplastic type, the proliferation of the fibrovascular tissue was associated with active osteoclastic resorption of the cortex, which remodeled into a trabecular rather than a compact type of structure. Histologic comparison of the pathologic samples of patients with and without NF-I revealed no significant differences. The pseudarthrosis gap was continuous with periosteal soft tissues and filled by fibrous tissue, fibrocartilage, and hyaline cartilage with features of enchondral ossification. The authors suggest that the clinical diversity of congenital pseudarthrosis of the leg results from the diverse location of a single pathologic process--namely the growth of an abnormal, fibromatosis-like tissue either within the periosteum or within the endosteal/marrow tissues. It is tempting to suggest that such an "osteofibromatosis" represent a skeletal expression of neurofibromatosis, either within the fully expressed syndrome (patients with known neurofibromatosis) or as isolated lesion (patients with unknown/cryptic neurofibromatosis).

Adolescent↗
PubMed2000

Congenital pseudarthrosis of the tibia: history, etiology, classification, and epidemiologic data.

Congenital pseudarthrosis of the tibia is a rare disease with a variable history. The pseudarthrosis is usually not present at birth (and therefore is not truly congenital) but occurs during the first decade of life. Paget in 1891 was the first to describe a case. The etiology is unknown. Neurofibromatosis plays a role in approximately 50% of patients. In the others, hereditary and mechanical factors are debated. Various (morphologic) classification systems have been proposed (Andersen, Boyd, Crawford). Because the appearance changes during the course of the disease, all classification systems have limited value: the determining factor is the stage of the disease at which it was classified. Because of the rarity of the disease and the variability of its history, the European Pediatric Orthopaedic Society decided to carry out a multicenter study on this disease. This paper presents the epidemiologic data on the patients involved. Data have been gathered on 340 patients from 13 countries. Two hundred patients were male (58.8%), 140 were female (41.2%). The right side was affected in 165 patients (48.5%) and the left side in 172 (50.6%); 3 patients had bilateral disease. Symptoms of neurofibromatosis were present in 54.7%. Histologic examinations in 192 patients showed a nonspecific appearance in 45.3%; in 15.6% the ultrastructure resembled fibrous dysplasia, and in 39% there was histologic evidence of neurofibromatosis. Most of the lesions were initially localized in the middle or distal third of the tibia. In 29% the localization changed during the course of the disease.

Child↗
PubMed2000

The fibula in congenital pseudoarthrosis of the tibia: the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

Fibular involvement in congenital pseudoarthrosis of the tibia (CPT) can be either a rare isolated pathology or is in association with the tibial changes. Out of 282 patients with CPT who had complete radiographic work-up, 62% (almost two thirds) demonstrated fibular pathology: 36% had true fibular pseudoarthrosis and the rest, i.e., 26% had fibular hypoplasia or dysplastic fibula. Neurofibromatosis was found in 62% of the patients with fibular pathology. The typical radiological features of tibial pseudoarthrosis are often missing in patients with fibular pathology. It is most probably because fibular changes precede the tibial involvement. In 250 patients with tibial surgical treatment, the highest rate of fusion occurred in patients with fibular involvement compared with those with normal fibula.

Child↗
PubMed2000

Treatment approaches for congenital pseudarthrosis of tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

This study was designed to analyze the different therapeutic methods used by European Paediatric Orthopaedic Society members from 13 countries for congenital pseudarthrosis of tibia. The treatment data of 340 patients who underwent 1287 procedures for this condition were analyzed. The essential findings were that the method of choice needed to approach the biological problem with the aims of: (1) resecting the pseudarthrosis to provide stability, the basic requirement for bony consolidation; (2) correcting length discrepancy and axial deformity; (3) achieving fusion; and (4) solving the additional problems around the main deformity such as alignment, leg length discrepancy and ankle valgus. The Ilizarov technique emerged as being the optimal method, having the highest rate of fusion (75.5%) of pseudarthrosis and rate of success in correction of the additional deformities. There was also consensus that surgery should be avoided before the third year of life.

Adolescent↗