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Biomedical subjects

H Hörnchen

Publications and source records attributed to H Hörnchen.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Persistent pulmonary hypertension of newborn. The PFC syndrome].

Persistent pulmonary hypertension of the newborn (PPHN), initially described by Gersony et al as persistent foetal circulation (PFC syndrome), results from a flawed transition from foetal to extrauterine pulmonary circulation. It is characterised by the maintenance of a high pulmonary vascular resistance and right-to-left shunting through the ductus arteriosus and foramen ovale. Infants with a wide variety of underlying clinical conditions develop PPHN. According to Rudolph three main anatomic types of PPHN can be identified: normal pulmonary vascular development increased pulmonary vascular smooth muscle development decreased cross-sectional area of pulmonary vascular bed. It is important to realize that several pathophysiologic mechanisms may coexist and interact. Besides metabolic and respiratory acidosis, hypercapnia and hypoxaemia some other factors induce pulmonary vasoconstriction. Thromboxane, leukotrienes and prostaglandins play a decisive role. Since PPHN can be associated with a broad spectrum of clinical conditions, a specific clinical picture is lacking. The baby is usually term or post-term, cyanotic immediately after birth or some hours later. Birth asphyxia, hyperviscosity, sepsis and aspiration of meconium have been recognized as predisposing factors. The diagnosis can be confirmed by echocardiography. Contrast echo will indicate right-to-left shunting with normal anatomy. Currently hyperventilation, tolazolin, chlorpromazin and dopamine/dobutamine have been advocated as central foci for clinical therapy. Recently prostacyclin was introduced as a specific pulmonary vasodilatator.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography↗
PubMed1987

Haemorrhagic shock-encephalopathy syndrome: plasmapheresis as a therapeutic approach.

We present the case of a 4.5-week-old boy with acute encephalopathy, shock, intestinal bleeding and disseminated intravascular coagulation. The clinical course and typical laboratory parameters were compatible with a diagnosis of haemorrhagic shock-encephalopathy syndrome (HSE). Immediate shock treatment, repeated haemodialysis and plasmapheresis did not prevent a fatal outcome 4 days after the onset of clinical symptoms.

Brain Diseases↗
PubMed1987

[Intracerebral hemorrhage at 2 different times in neonatal alloimmune thrombocytopenia].

We demonstrate the sonographic and computer-tomographic findings in a newborn with neonatal alloimmune thrombocytopenia (NAITP). Initial examination on the third day of life showed an extensive old and already partially resolved haematoma as well as a new perinatal haematoma in the left cerebral white matter. Follow-up investigations revealed enlargement of the cystic defect, midline-shift to the right and progressive dilatation of the right lateral ventricle caused by compression of the Foramina Monroi. Peritoneal drainage of the cyst resulted in prompt diminution of the enlarged right lateral ventricle. The case report emphasises that in patients with NAITP intracranial haemorrhage may occur in utero and during the perinatal period as well. In pregnant women suspected to produce antibodies against PLA 1 positive thrombocytes, we recommend regular ultrasonic cranial examinations of the fetus. Delivery should be as careful as possible.

Adult↗
PubMed1983

Microprocessor-based long term cardiorespirography. I. Heart rate changes and apneic attacks.

Cardiorespirography is a well-known method of continuous monitoring in neonatal intensive care. Apneic attacks, bradycardia and tachycardia are registered. In our experience we connected a cardiorespirography recorder to a microprocessor system. The processor consisted of a hardware part including a program (software) and a printer which provided printouts of alarm events. As alarm situations, which cause an alarm printout, we defined: 1. apneic episodes (duration 10, 20 or 30 seconds) 2. tachycardiac (beat-to-beat rate greater than 180/minute) 3. V-shaped and U-shaped bradycardia (beat-to-beat heart rate less than 80/min) and combinations. The reliability of the system of recognizing and classifying alarm situations was tested by comparing the alarm printouts with the simultaneously recorded cardiorespirograms. Fifty eight 12 hour records of 41 patients were evaluated. Six hundred alarm situations were counted. The alarm printouts were found in concordance with the cardiograms in all tachycardia alarms. Nearly all bradycardia (V-shaped, U-shaped bradycardia, combination of bradycardia and apnea) were correctly classified. A preset apnea duration of 10 seconds resulted in many false positive alarm printouts. With 20 second apnea time only few false positive alarms were seen, but nine apneic attacks were not recognized. Altogether 81.5% of alarm printouts were correct, 16.8% were false alarms, or V-shaped bradycardia were really U-bradycardia. Only 2% of all alarms were not recognized by the microprocessor system. We suggest to combine the microprocessor with a special alarm recorder, which is able to store beat-to-beat heart rate and respiration wave before alarm situations.

Apnea↗
PubMed1983

Microprocessor-based long term cardiorespirography. II. Status evaluation in term and premature newborns.

In 1965 URBACH et al. and RUDOLPH et al. [35, 39] described a loss of heart rate variability in severely ill neonates. In this study we investigated the correlation between instantaneous heart rate patterns and status diagnosis. We used a microprocessor-based cardiorespirography system. Seventy five newborn infants (51 prematures and 24 term neonates) were studied for about 12 hours each. Twenty nine patients had a second record after the first investigation. Parameters were: Type of frequency and oscillation, long time variability (LTV), short time variability (STV) and the newly introduced P-value (maximal difference between two successive R-peaks in five minutes). We found clear differences between the study groups. With increasing severity of illness mean values ("group mean values") of long time variability, short time variability and P-value decreased. Fixed heart rate became predominant. The most pronounced loss of heart rate variability was seen in infants with severe intracranial bleeding, thus offering a tentative diagnosis. For statistical analysis long time variability and the silent oscillation type have been proved as best parameters for this diagnosis. Severely decreased heart rate variations also have been seen in infants with acute renal failure--possibly because of brain edema--, after application of muscle relaxants, repeated doses of sedatives, and after prolonged anesthesia. Otherwise, the heart rate variability was probably dependent on age and gestational age in prematures and newborn infants without intracranial bleeding. It is possible to use microprocessor-based long time cardiorespirography as a simple screening method for the diagnosis of neonatal intracerebral bleeding. In future experiences transcutaneous measurements of oxygen tension should be included.

Cerebral Hemorrhage↗
PubMed1981

Hyperosmolar nonketotic diabetic coma.

The authors report the case of a 12-year-old boy with hyperosmolar nonketotic diabetic coma. Pathogenetic aspects and the HLA genotype are discussed. To reduce the hyperglycaemia, a continuous intravenous infusion of regular insulin at a low rate was used. The too rapidly infused sodium-bicarbonate overloaded tha body with sodium and caused intracellular sodium accumulation with edema. This could explain the disorientation after regaining consciousness. Much more important than the sodium-bicarbonate infusion is an accurate rehydration regimen.

Bicarbonates↗
PubMed1981

[The problem of intensive care of premature and newborn infants (author's transl)].

Today there is a controversy about the demand for the preservation of human life at any price. Special difficult problems result from intensive care of premature and newborn infants. The clinical criterions of cerebral death are different to those of adults, special investigations are restricted in their application. Often you cannot be sure of the prognosis in spite of knowing the diagnosis. Should the competent parents decide with us about the renunciation of a -- further -- intensive care? It is necessary to value all available factors to take the right decision. The paper wants to inform about some important criterions and stimulate the discussion.

Brain Death↗
PubMed1981

[Transepidermal water loss in preterm and newborn infants (author's transl)].

69 measurements of water loss from the skin were made on 57 preterm and newborn babies (gestational age 31-40 weeks; body weight 900 g-350 g) in their first week of life using the Evaporimeter-method. All measurements were made at 18 different skin sites of the naked baby in a standard single-walled incubator. A graphic method described the correlation between transepidermal water loss and body weight. The mean value of water loss in babies weighing greater than 1850 g was 6,6 g/m2h (10,2 ml/kg 24h) and increased up to threefold values when body weights were smaller. A similar course was found during phototherapy: average values of 8 g/m2h (12,7 ml/kg 24 h) were measured in babies weighing greater than 1900 g increasing markedly in lower birth weights. Some single observations are reported.

Body Weight↗
PubMed1981

Surgical separation of conjoined (Siamese) xiphopagus twins.

Conjoined twins of the xiphopagus type have been separated 24 hours after spontaneous delivery. Indication for early intervention was impending rupture of a large omphalocele as well as deterioration of one severely malformed twin who did not survive surgery, whereas the other one showed normal development up to 15 months after separation.

Abnormalities, Multiple↗
PubMed1980

[Early prognosis of cerebral haemorrhage in premature infants with birth weights less than 1500 g. A clinical and computed tomographic study (author's transl)].

22 premature infants with a birth weight less than 1500 g were studied by computed tomography. All of them needed intensive care therapy and had symptoms, which may have been caused by cerebral haemorrhage. In 15 cases (= 68%) we found subependymal and intraventricular bleeding. Clinical data showed that ventilated premature infants with subependymal and intraventricular haemorrhage needed respiratory support in the first hours p.p. because of hyaline membrane and aspiration syndroms. Premature infants without cerebral haemorrhage were ventilated much later (mean 96 h. p.p.). All patients with intraventricular haemorrhage and ventricular enlargement with and without parenchymal haemorrhage (grade III and IV) died. Prematures with subependymal haemorrhage (grad I) and intraventricular haemorrhage without ventricular dilation (grade II) may survive, depending on eventually present pulmonary complications. The introduction of computed tomography in the examination of the CNS on prematures can therefore help to give an early prognosis.

Birth Weight↗
PubMed1980

[Cranial computerized tomography of neonatal encephalopathies. Initial and follow-up studies (author's transl)].

60 premature and newborn infants with clinical evidence of hypoxia or traumatic encephalopathy were examined by cranial computerized tomography (CCT) during the first fortnight of life and their findings compared with those of a "control group", consisting of 7 infants with malformations. 48 patients showed pathologic findings in the initial CCT. With regard to type, topography and extension, two groups with two subgroups could be outlined: 1. lesions with low density due to hypoxic-necrotizing alterations. a) Bilateral in the white matter around the frontal and occipital horns of the lateral ventricles in both, premature and fullterm newborn infants. b) Corresponding to vascular distribution, focal or global, involving both gray and white matter in both, premature and newborn infants. 2. lesions with high density due to hemorrhages. a) Subependymal and intraventricular, mainly in asphyxiated premature infants. b) Subdural and intracerebral, probably of traumatic origin, involving premature and fullterm newborn infants. The morphological findings in the initial CCT were compared with the outcome in each case. Thus, it was possible to distinguish certain morphological patterns significantly associated with prognosis. 14 patients (23.3%) died in the newborn period. The surviving 46 children (76.7%) were at least once re-examined by CCT and followed up during 6-24 months. 16 patients (26.7%) had a normal development. 12 (20%) showed developmental retardation. 18 (30%) suffered from neurological sequela. Frequently the early follow-up CCT showed characteristic patterns. We believe, that the great number of pathologic findings with essential information warrant the application of CCT in premature and fullterm newborn infants with persistent neurological signs. Perhaps our CCT observations will lead to the consequence of a more controlled high care regimen.

Brain Diseases↗
PubMed1980

[Diabetic ketoacidosis in children. Effectivity of therapy with small doses of insulin applicated intravenously versus conventional therapy (author's transl)].

Since 1972, the treatment of diabetic coma, ketoacidotic or hyperosmolar, with regular infusions of low doses of insulin, is a well-established form of therapy. Pediatricians all over the world apply this regimen regularly since 1975. In contrast to this there is the regime of intravenous or intramuscular application of high doses of insulin. To control the effectivity of these two methods, we compared two approximately identical groups of patients and analysed 17 different parameters. The patients of the low dose insulin infusion regimen needed less insulin, potassium and bicarbonate and reached earlier a bloodglucose level of 300 mg/dl. They also had a rapid and uneventful restoration of their electrolyte metabolism. Hypoglycaemia did not occur. There was no significant hypokalaemia or hypernatraemia. In contrast to this, the conventionally treated group showed much more complications. The hospital stay and the daily requirement of insulin was significantly higher. We believe that the low dose infusion regimen of insulin is a safe and easy therapeutic method. It surely is an alternative way for treating diabetic coma.

Adolescent↗
PubMed1980

[The emergency transport of children (author's transl)].

We report upon the development of a special stretcher which allows the transportation of ventilated children without problem. It is a stretcher according to DIN 13025 with a guide-rail for a respirator, a suction pump, a heart rate monitor. There are two oxygen cylinders with accessories in a wooden box under the stretcher, which is detachable and portable.

Child↗
PubMed1979

[Transport of infants at risk (author's transl)].

We report upon a two-years experience with transportation of prematures, newborn infants and children up to two years of age. Most patients were prematures and newborn infants (1.38% of lifeborns in 1976 and 1.83% in 1977) out of the region of Aachen. They were transferred to the intensive care unit of the children's hospital (primary transport). 21.2% of them died. The mortality rate of all neonates, treated in the children's hospital, was reduced by 3.68% in comparison to the period before organized transportation system three years ago. The number of deceased was diminished by more than 40%. Some of the newborns remained in the maternity hospitals after first providing by the "transport-team". We also transported children up to two years of age with the mobile intensive care unit. Diagnostical and therapeutical procedures in other departments of the hospital of Aachen and other specialized centres became possible because of diminished risk.

Ambulances↗