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Biomedical subjects

J Feber

Publications and source records attributed to J Feber.

28 records · Page 2Linked to original sources
PubMed1996

Verocytotoxin-producing Escherichia coli in children with hemolytic uremic syndrome in the Czech Republic.

Since October 1988 till July 1995, 35 children (mean age 16 +/- 15.5 months) with classical hemolytic uremic syndrome (HUS) were examined for the presence of verocytotoxin (VT)-producing Escherichia coli (VTEC) infection. Stool samples from all patients were cultured for VTEC strains and tested for free fecal neutralizable VT. Serum samples from 18 patients taken on admission were also tested for antibodies to the lipopolysaccharide (LPS) from E. coli O157, O26, O55, O111, and O128 using the passive hemagglutination assay (PHA). Diagnosis of VTEC infection was established in 28 (80%) patients by the combined use of microbiological and serological techniques. VTEC were isolated from 16 (46%) patients, 5 of them had infection with 2 different VTEC serotypes; 11 (52%) VTEC isolates belonged to the serotypes O26: H11 (5), and O157: H7/NM (6). Free fecal VT was found in 21 (60%) patients. PHA antibodies to one or more LPS were detected in 14 (78%) of 18 patients; 9 had antibodies to O157 LPS and 6 to O26 LPS. We conclude from this study that VTEC are the important cause of pediatric HUS in the Czech Republic and the strains belonging to the serogroups O157 and O26 are the most prevalent.

Adolescent↗
PubMed1994

Residual renal function in children on haemodialysis and peritoneal dialysis therapy.

Residual renal function was studied in 28 haemodialysis (HD) and 31 peritoneal dialysis (PD) patients aged 1-20 years observed over 6-43 (median 19) months. After the start of dialysis urine volume (UV) decreased to 57%, 46% and 26% of initial mean values in HD patients after 6, 12 and 24 months, respectively. In PD patients the corresponding figures were 57%, 69% and 62%. Mean UV calculated from all individual mean UV measurements observed was higher in PD than HD patients (954 vs. 537 ml/m2 per 24 h, P < 0.01). A better conservation of diuresis in PD patients was also suggested by a significantly longer persistence of a UV greater than 500 ml/m2 per 24 h compared with HD patients. Cox proportional hazard analysis identified dialysis modality and pre-dialysis UV of less than 1,000 ml/m2 per 24 h as the only significant risk factors for UV survival. However, the decline of UV per time was similar in both modes of treatment. No significant changes of glomerular filtration rate were observed during both HD and PD treatment.

Adolescent↗
PubMed1994

Bone mineral density after renal transplantation in children.

Longitudinal bone mineral changes after renal transplantation were studied in 14 children aged 8 +/- 4 years. Combination immunosuppressive therapy was given to all patients (prednisone, azathioprine, cyclosporine). Bone mineral density (BMD) measurements of the first through fourth lumbar vertebrae by dual-energy X-ray absorptiometry were performed within 1 year preceding renal transplantation and 6, 12, and 24 months afterward (M0, M6, M12, and M24, respectively). The results of BMD obtained in grams of hydroxyapatite per square centimeter of spine projected area were subsequently transformed to standard deviation scores for a normal pediatric population. In addition, we used a mathematical spine volume correction to give the results in grams per cubic centimeter. All patients had a well-functioning renal graft at M6, M12, and M24 and a normal serum creatinine level. Significant decreases in BMD, standard deviation score, and spine volume-corrected BMD were observed 6 months after renal transplantation (p < 0.05, p < 0.01, and p < 0.01 respectively); the median loss of BMD and spine volume-corrected BMD was 9.2% and 15.6% at M6, respectively, and the median serum parathyroid hormone level dropped from 125 to 34 pg/ml. Between M6 and M12, BMD increased significantly up to 95% (median) of pretransplantation values and reached 97.2% (median) at M24. Similar but less marked improvement was observed in spine volume-corrected BMD results, reaching 87.7% and 87.4% at M12 and M24, respectively. A negative correlation was found between the cumulative prednisone dose and BMD in grams per square centimeter at M6 (r2 = 0.603; p = 0.006), M12 (r2 = 0.532; p = 0.015), and M24 (r2 = 0.40; p = 0.014). There was no correlation between cumulative prednisone dose and spine volume-corrected BMD or standard deviation score. Mean 6-month cyclosporine levels did not correlate with any measure of BMD. We conclude that after renal transplantation children have a significant decrease of BMD during the first 6 months after the operation, despite normal graft function and growth improvement.

Absorptiometry, Photon↗
PubMed1993

Renal concentrating capacity test by desmopressin in children: intranasal or intravenous route?

Intranasal administration of desmopressin (dDAVP) is frequently used to test renal concentrating capacity in children. However, the bioavailability of intranasal dDAVP is about 10% and may be modified by nasal congestion. The study aimed to compare the efficacy of intranasal dDAVP with an equivalent dose of intravenous dDAVP for a renal concentrating capacity test in children. We studied 18 children aged 12.6 +/- 3.8 years weighing more than 20 kg in whom a dDAVP test was indicated as part of global renal function evaluation. Spray applicator (Minirin Spray) was used for intranasal administration (20-40 micrograms according to BW); the dose of intravenous dDAVP (Minirin IV) was reduced to 10% (2-4 micrograms according to BW). A randomized sequence was used for the first intranasal or intravenous dDAVP test; the second alternate test was repeated in the same children in a time interval ranging from 1 to 3 weeks. Osmolality of the urine (Uosm, mosm/kg) was determined before (T0), then 2 (T2) and 4 (T4) h after dDAVP administration. There was no significant difference in Uosm at T0 (intranasal = 480 +/- 212, intravenous = 443 +/- 168 mosm/kg), T2 (604 +/- 226 and 542 +/- 173 mosm/kg, respectively), and T4 (657 +/- 206 and 629 +/- 190 mosm/kg, respectively). There was an obvious correlation between intranasal and intravenous Uosm at T4 (r2 = 0.826; p = 0.001). Even if intravenous dDAVP is of theoretical interest, intranasal administration of dDAVP using a spray applicator can be considered as first-choice method for a renal concentrating capacity test in children weighing more than 20 kg.

Administration, Intranasal↗
PubMed1992

[Determination of the calcium/creatinine index in urine in healthy neonates, infants and children].

The authors examined a total of 107 healthy subjects--neonates (n = 13), infants (n = 23), toddlers (n = 16), 3-6-year-old children (n = 15) and school children (n = 40). They correlated the urinary Ca excretion mmol/kg/24 h) with the Ca/cr index which was obtained by examination of postprandial urine sample. They revealed a significant correlation of the excretion and index in infants p less than 0.001, in school children p less than 0.01 with a regression coefficient of 0.9 and 0.7 resp. The index was significantly age dependent, the value of the 95th percentile in neonates was 1.38, in infants 1.025, in toddlers 1.26, in three-year-old children 0.835 and in school children 0.56. The urinary Ca/cr values must be thus interpreted in relation to the child's age; the index declines with age. The reason for high indices in young children is the low creatinine concentration in the excreted urine which rises significantly with age. Examination of the Ca/cr index should be part of routine screening in all cases with suspected nephropathy. The accepted upper range of the index, 0.6 (mmol/mmol), applies only to school children, but not to younger children.

Calcium↗
PubMed1991

[Severe Vicedrin poisoning in a 17-month-old girl].

The child ingested 7 tabl. of VICEDRIN (a combination of phenacetin, ephedrin, chinin, acid. ascorbicum), the total dose of phenacetin was 140 mg/kg of b.w. Lethal doses of phenacetin vary between 100-200 mg/kg, the sensitivity to phenacetin being increased in infants. Toxicological examination in this case revealed a high concentration of phenacetin in urine. The clinical signs of intoxication were vomiting (hematemesis), methemoglobinemia and somnolence. 2 hemoperfusions were performed lasting 6 hrs and 5 hrs resp. (HEMASORB 400 A 4), the second one were combined with hemodialysis because after the first perfusion a high concentration of metabolic products of phenacetin was detected in urine. After the second perfusion the status of the child rapidly improved and we could discharge the patient of the 10th day after admission. Hemoperfusion is recommended in severe intoxication with phenacetin, the combination with, hemodialysis is possible to remove its metabolic product.

Ascorbic Acid↗
PubMed1991

[The solitary kidney in children and adolescents. Morphologic and functional characteristics].

Reduction of the renal parenchyma in experimental animals can cause glomerulosclerosis in the single kidney and lead sometimes to functional failure. Data on the influence of nephrectomy or agenesis on the later fate of the patient in human medicine are controversial. The authors examined a total of 40 patients with single kidneys. In 23 agenesis was involved (15 boys, 8 girls) aged 6-22 years (mean = 11.9, s = 4.3). In 17 nephrectomy was performed (9 boys, 8 girls); time interval after nephrectomy 1-26 years (mean = 7.8, s = 3.9). Three quarters of all patients excreted increased amounts of albumin (detected as microalbuminuria by immunoturbidometry). The glomerular filtration rate (GFR) was slightly reduced in about one third of the patients but none suffered from renal insufficiency. In one half of the group the authors detected a slightly impaired concentrating capacity with an increased sodium fraction. In one third marginal diastolic hypertension was recorded. In half the group the single kidney was hypertrophic. Regression analysis did not reveal deterioration of the GFR in relation to age but revealed increasing renal hypertrophy in relation to height with accelerated hypertrophy during puberty. There was also a significant drop of the systolic blood pressure in relation to age in patients with agenesis. In none of the other parameters differences were found between the group with agenesis and nephrectomy. Patients with a single kidney deserve prolonged ambulatory follow up. In the investigated group the single kidney influenced in a substantial way also the selection of occupation.

Adolescent↗
PubMed1990

[Acute interstitial nephritis with uveitis in children and adolescents].

Acute non-suppurative tubulointerstitial nephritis was recorded within a five-month interval in 1988 in one girl and two boys aged 15, 16 and 12 years. The common feature was non-selective proteinuria, slight glycosuria, anaemia, a sedimentation rate of more than 100 mm/2 hrs hyperatotaemia not calling for dialyzation treatment (268, 354 and 266 mumol/l plasma creatinine resp.), a markedly impaired concentrating capacity (540, 593 and 520 mOsm/kg urine resp.). In all patients circulating serum immunocomplexes were elevated (PEG-IKEM). One patient developed acute uveitis at the onset of the disease, the remainder after 5 and 6 months resp. and in all there was a tendency of a protracted course and relapses resp. In two patients uveitis was diagnosed by an aimed examination by means of a slit lamp at a time when there were not yet any clear signs of affection of the eyes. All patients were subjected to percutaneous renal biopsy which revealed an interstitium with uneven lymphoplasmacytic cellulization with infrequent eosinophil and neutrophil polynuclear cells. Electron microscopy revealed sections of varying size with fibrotization of the tubular basal membrane; the glomerular changes were not typical. All patients had prednisone treatment and their renal functions were gradually restored. Despite extensive serological examinations, the aetiology was not cleared, however before the onset of the disease the patients had penicillin, cotrimoxazol and erythromycin resp.

Acute Disease↗
PubMed1989

[The physician and the computer. 22. Programming in the Prolog language].

A modern tool of interaction with the computer is the programming language Prolog. The authors discuss its position among other languages, emphasize its different character (declarative programming). They outline basic structures of Prolog and its type of function. They also give examples of creating data bases of patients and the possibility to use this language in the creation of expert systems in medicine.

Medical Informatics↗