[Immune hemolytic anemia caused by antibodies of the ABO system following ABO-incompatible kidney transplantation. Gm allotyping of the immune antibody].
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Biomedical subjects
Publications and source records attributed to G Bein.
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Normal M-mode echocardiographic values were analyzed from premature and term newborn infants with a body weight of 500 to 4000 g (n = 105) as well as from children ranging in age from one to 15 years with a body surface area of 0.4 to 1.6 m2 (n = 80). Standardized positioning of the recorded M-mode beam was assured through 2-dimensional echocardiographic monitoring. The maximal diastolic dimension of the right and left ventricles as well as the diastolic dimension of the aorta and the maximal dimension of the left atrium were assessed. The normal values were found to demonstrate linear relationships with weights up to 4000 g and, for larger children, with body surface areas from 0.4 to 1.6 m2. A review of values reported in the literature, of which there is a scarcity in the premature age, showed good general agreement of the mea values. The normal ranges, however, differed markedly, in some cases to such an extent that interpretation of individual echocardiographic findings would be rendered quite problematic. The explanation for these discrepancies appears most likely based on inconsistencies in spatial orientation and, subsequently, inaccurate measurements. It is apparent that establishment of normal values in a large patient population prerequisites guidelines for standardization which should include monitoring of the M-mode beam with two-dimensional echocardiography as well as use of tracings of superior quality only.
The data of 343 newborns and young infants were reviewed who, from 1968 until August 1982, had undergone heart catheterization. Variations in frequency of catheterization and diagnoses as well as lethality were investigated. The first rise of heart catheterization performances could be noted in the years of 1968 and 1969 (by routine application of the Rashkind procedure), another remarkable rise took place in the years from 1971 to 1975, probably due to better feasibilities of modern cardiac surgery. Later on, a new dynamic plateau was developed. With the utilization of echocardiography, a significant decrease of heart catheterization performances in certain diagnostic groups (HLH, PFC) was registered. Nowadays, however, new diagnostic challenges (infants with low gestational age, respiratory problems, PDA) require heart catheterization. Comparison of the different diagnostic groups' lethality rate reveals that children undergoing heart catheterization, in order to rule out TGA, demonstrate a remarkably higher lethality rate (27%) than children suffering from TGA (3.7%). Introduction of echocardiography has decreased this risk significantly.
The clinical courses of three children with meningococcal meningitis and cardiac complications are described. In two patients a mixed peri/myocardial form of cardiac involvement is probable. One child showed a pericarditis with relapses as found in the postpericardiotomy syndrome. The pathogenesis of the cardiac involvement in meningococcal infections is discussed based on the literature. The three cases observed are tentatively classified accordingly.
Case report of an infant who, having been under cardiological observation since birth, developed the clinical symptoms of primary pulmonary hypertension at 12 months. The ECC showed right-ventricular hypertrophy, which progressed rapidly. Heart catheterization confirmed the suspected diagnosis of pulmonary hypertension without cardiovascular malformation. Treatment with isoproterenol and tolazoline was initiated but was unsuccessful: the child died at 18 months. The diagnosis was supported by the histopathology.
The American Society of echocardiography has agreed upon recommending both nomenclature and image orientation in two dimensional echocardiography. This recommendation and the basic consideration are explained. It seems reasonable to follow this in Germany in order to have better overall understanding by more uniformity.
We can sum up as follows: In special cases, tocolytics can lead to complications in the mother as well as in the foetus. These may be partly so severe that lead to patient's death, as some case histories show. In the majority of cases, however, there are only slight transient changes which are no longer manifest after a few weeks' time. Hence, it should be mandatory to initiate special cardiologic supervision of the children during the perinatal period if administration of tocolytics was unavoidable for the purpose of maintaining the state of pregnancy. It would be optimal if these patients, besides being examined clinically, would also be examined via echocardiogram, electrocardiogram and CK-MB determination. Since the echocardiographic examination, in particular, entails a great deal of expenditure of time and requires a relatively complicated instrumental set-up, we believe that recording the ecg and CK-MB should suffice, as practicable examination parameters in clinical routine, to detect this damage of the myocardium well in time.
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Various anomalies of the aortic arch have been examined angiographically and discussed in their embryological context. Theoretical concepts are based on Rathke's scheme of the aortic arch system. The importance of developmental aspects for the interpretation of anomalies of the aortic arch in angiography is emphasized.
We report the clinical and post-mortem findings of an infant with inborn short bowel. One sibling died because of the same malformation. The parents are cousins. This malformation is combined with malrotation, often with pylorus-stenosis too, and can cause an intestinal obstruction syndrome. All presently known cases in the pertinent literature are summarized. The occurence of familial cases suggest a rezessive autosomal disease.
Sufficient echocardiographic analysis of premature infants has not yet been presented. Therefore echocardiograms of 105 babies without cardiovascular disease weighing 0.6--4.0 kg were analyzed. Normal data for right ventricular dimension, diastolic left ventricular inner dimension, left atrium, aorta, septums left ventricular posterior wall, cardiac depth, amplitude and closing velocity of the anterior mitral leaflet have been established. All measurements are a linear function of bodyweight with a very good correlation.
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Twenty children with severe renal hypertension caused by renovacular lesions or chronic renal failure were treated with verapamil. The application of the drug as a single intravenous injection (0.1 mg/kg) during hypertensive crisis was followed by a drop of the systolic blood pressure which was highest 30 min after injection (--25% of the original value). In order to normalize the blood pressure during prolonged hypertensive crisis verapamil was used successfully as an intravenous infusion. For the long-term treatment of renal hypertension verapamil was given orally with success, alone or combined with other antihypertensive drugs. Verapamil has a lowering effect on the blood pressure even in the presence of advanced renal failure. Prolongation of atrioventricular conduction time is the most important side effect of the drug when given in high doses and, especially, when combined with digitalis.
The diagnosis of double aortic arch was suspected by oesophagography and subsequently proven by angiography in six children. The patients' age ranged from 14 days to 13 years. The diagnostic value of angiography in establishing the existence of two aortic arches is emphasized, which can easily be performed by right heart catheterization. In five patients the aorta descended to the right of the spine; the left arch was hypoplastic and became stenotic or atretic distal to the subclavian artery. In only one case the aorta descended on the left side. In this case both arches had approximately the same size. Four patients were symptomatic immediately after birth and presented with severe inspiratory stridor. The clinical course was so dramatic that surgery was inevitable at the age of four weeks, at 4, 6 and 7 months respectively. The youngest patient died postoperatively. In the other infants the stridor disappeared only months after surgery. One girl had a stridorous respiration occasionally during infancy, later on she complained of dysphagia. She was operated on at the age of 13 years. The double aortic arch was an incidental finding in a girl of 8 years; surgery was not performed.
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