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Biomedical subjects

K Harms

Publications and source records attributed to K Harms.

At least 37 records · Page 2Linked to original sources
PubMed1997

Airway humidification in mechanically ventilated neonates and infants: a comparative study of a heat and moisture exchanger vs. a heated humidifier using a new fast-response capacitive humidity sensor.

OBJECTIVE: To study the efficiency of a heated humidifier and a heat and moisture exchanger in mechanically ventilated neonates and infants. DESIGN: Prospective, controlled, clinical study. SETTING: University pediatric intensive care unit. PATIENTS: Forty neonates and infants who needed mechanical ventilation were enrolled in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A heat and moisture exchanger and active airway humidification were alternately used in the same patients to exclude interindividual differences in airway humidification. Airway humidity was measured by a new fast-response capacitive humidity sensor which measures airway humidity with an acquisition rate of 20 Hz throughout the respiratory cycle. The humidity sensor was placed at the endotracheal tube adapter. Measurements were done at the beginning and at the end of three consecutive sessions of passive, active, and again passive airway humidification, each session lasting 6 hrs. There was no significant difference between mean inspiratory airway humidity with the heated humidifier (33.8 +/- 2.9 mg/L) and with the heat and moisture exchanger (34.0 +/- 2.6 mg/L). Moreover, the mode of airway humidification did not significantly influence body temperature or PCO2. No serious side effects such as endotracheal tube occlusion were observed. CONCLUSIONS: Passive airway humidification by a heat and moisture exchanger is effective in mechanically ventilated neonates and infants over a 6-hr period. However, the performance and safety of a heat and moisture exchanger in prolonged mechanical ventilation remain to be proven.

Costs and Cost Analysis↗
PubMed1996

Granular cell tumor of the vulva: literature review and case report.

Granular cell tumors are an uncommon neoplasm of neural origin. They occur throughout the body; only about 10% are found in the vulvar region. Granular cell tumors are most frequent in the third and fourth decade of life, the African-American race, and the female. Generally, they appear as small, firm, painless, slow-growing subcutaneous nodules. They are rarely encapsulated and recurrence is common. The malignant granular cell tumor is rare, representing 1% to 2% of cases. This form is highly aggressive, unresponsive to treatment, and ultimately fatal. A third type of granular cell tumor has been described which has benign pathologic characteristics but behaves in a clinically malignant manner. The treatment of choice for all types is wide, local surgical excision. A case is described which typifies the benign type granular cell tumor.

Adult↗
PubMed1995

Randomized, controlled trial of amoxicillin prophylaxis for prevention of catheter-related infections in newborn infants with central venous silicone elastomer catheters.

OBJECTIVE: To clarify the effectiveness of amoxicillin prophylaxis in the prevention of catheter-related infections. METHOD: We performed a randomized, controlled, sequential, prospective trial in newborn infants undergoing percutaneous central venous catheterization. RESULTS: Seventy-five infants (median birth weight, 1240 gm; median age at catheter insertion, 3 days) received prophylactic amoxicillin (100 mg/kg per day); 73 infants in the control group (median birth weight, 1170 gm; median age, 2 days) received no routine prophylactic antibiotic treatment. No infant receiving amoxicillin had septicemia, whereas two infants (2.7%) in the control group did; suspected septicemia (positive clinical and laboratory findings but negative blood culture results) was found in 3 infants in the amoxicillin group and in 6 of the control group (not significantly). Bacterial contamination of the catheter tip at removal was significantly reduced in the amoxicillin group (13.3% vs 28.8% in control subjects; p < 0.05). Negligible differences were found in duration of catheterization (median, 15 days in both groups), or the number of thrombotic (9.3% vs 2.7% in control subjects) and other catheter-related complications between the groups. CONCLUSION: A low incidence of catheter-related infections can be achieved in neonates with central venous catheters without using prophylaxis with an antibiotic.

Amoxicillin↗
PubMed1995

Maternal hemolysis, elevated liver enzymes, low platelet count, and neonatal outcome.

Pregnancies complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP) have been associated with both a poor maternal and a poor neonatal outcome in several publications. Because many studies were small and gave only scant information regarding the infants, we analyzed the clinical course of 89 neonates born to mothers with the HELLP syndrome. Ninety-eight percent of the neonates were born by cesarean section. Infants with a maternal HELLP syndrome were often small for gestational age (39%). The incidence of perinatal asphyxia was found to be 5.6%. Additionally, the affected very low birthweight (VLBW) infants had relatively high incidences of leukopenia (21%), neutropenia (33%), and thrombocytopenia (33%). Initially, 54% of the LBW infants were found to have normoblasts and 25% erythrocytosis. The incidence of these changes in blood cell count increased with decreasing birthweight. Nosocomial infections occurred more often in infants with a reduced neutrophil count. The overall mortality rate was 56 per 1000. Comparing the statistics of the VLBW infants with a maternal HELLP syndrome (n = 32) to all infants with a birthweight less than 1500 g (n = 521) during the investigational period, we found a similar mortality rate (9.3% and 8.4%, respectively). The pulmonary morbidity was also similar. The incidence of intracranial hemorrhage in VLBW infants with a maternal HELLP syndrome was lower (12.5% versus 18.2%) and of necrotizing enterocolitis was higher (6.2% versus 1.9%).

Birth Weight↗
PubMed1995

Idiopathic intestinal perforations in premature infants without evidence of necrotizing enterocolitis.

In the past three years five premature very low birth weight infants (VLBW, birth weight 720-1,300 g) developed spontaneous localized perforations of the small intestine during the second week after birth. There was no evidence of intestinal obstruction or necrotizing enterocolitis (NEC). The clinical presentation and laboratory values as well as the radiologic, intraoperative and histologic findings were different from those of NEC. In four cases the initial symptoms presented as a gray-green discoloration of the flank and inguinal region with an otherwise unremarkable general condition. All patients exhibited a leukocytosis (range 14,700-19,300) and increased neutrophil count (range 9,900-14,800). Additionally, a pronounced increase in the activity of alkaline phosphatase (> 2.000 U/l in 3 cases) and a renewed increase of serum bilirubin was observed. Four of the five infants survived following laparotomy with ileostomy (n = 2) or primary anastomosis (n = 3).

Female↗
PubMed1995

Randomised clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome.

AIMS: To compare treatment regimens of two widely used natural surfactant preparations Curosurf and Survanta in respiratory distress syndrome (RDS). METHODS: The effects of the two treatment regimens on gas exchange, ventilatory requirements, and 28 day outcome in infants with RDS were compared. Seventy five preterm infants (birth weight 700-1500 g) with RDS requiring artificial ventilation with an FIO2 of > or = 0.4, were randomly selected at 1-24 hours of age. One group received an initial dose of Curosurf (200 mg/kg); the other group Survanta (100 mg/kg). Patients who remained dependent on artificial ventilation with an FIO2 of > or = 0.3 received up to two additional doses of Curosurf (each of 100 mg/kg) after 12 and 24 hours or up to three additional doses of Survanta (each of 100 mg/kg) between six and 48 hours after the initial dose. RESULTS: There was a rapid improvement in oxygenation and ventilatory requirements were reduced in both groups. However, infants treated with Curosurf had a higher arterial:alveolar oxygen tension ratio and required a lower peak inspiratory pressure and mean airway pressure at several time points within 24 hours of randomisation (p < 0.05-0.001). The incidences of pneumothorax in the Curosurf and Survanta groups were 6% and 12.5%, respectively; the corresponding figures for grades 3-4 intracerebral haemorrhage were 3% and 12.5%, respectively. Mortality was 3% in the Curosurf group and 12.5% in the Survanta group. However, these differences did not reach significance. CONCLUSION: The Curosurf treatment regimen resulted in a more rapid improvement in oxygenation than Survanta and reduced ventilatory requirements up to 24 hours after start of treatment. This was associated with a trend towards reduced incidence of serious pulmonary and non-pulmonary complications.

Biological Products↗
PubMed1994

Isolation and characterization of P-type H(+)-ATPase genes from potato.

H(+)-ATPase cDNAs were identified in a potato leaf library using an Arabidopsis gene as a probe. Based on their sequences, the clones could be grouped into at least two classes. A similar classification was obtained from the analysis of sequence data from four tobacco genes. Both potato genes are expressed in all tissues analysed, higher levels of expression were found in leaves and stem than in roots and tubers. For both genes, no significant differences in level of expression could be detected under a variety of conditions such as cold treatment, anaerobiosis, sucrose induction or treatment with a synthetic cytokinin. Only 2,4-D and prolonged periods of darkness lead to a slight reduction in mRNA levels. The reduction in darkness was compensated after transfer of the plants back into the light. Expression of the ATPase genes remained constant in transgenic plants which are inhibited in phloem loading due to antisense inhibition of the sucrose transporter. On the other hand, expression of the sucrose transporter is inducible by auxin and cytokinin but not by sucrose. Taken together, these data suggest that at least the two plasma membrane H(+)-ATPase genes analysed are rather constant in their expression and that either other genes respond to external stimuli or that most of the regulation occurs at the posttranscriptional level.

Amino Acid Sequence↗
PubMed1994

[Necrotizing enterocolitis: symptomatology, diagnosis and therapeutic consequences].

Within a 6-year period ten patients with necrotizing enterocolitis (grade II-III; Bell) have been treated at the University Hospital, Göttingen. The following NEC incidences were calculated: birth weight < 1000 g: 2.4% (3/123); 1000-1500 g: 0.6% (2/308); 1501-2000 g: 0.7% (3/436); > 3000 g: approximately 0.006% (2/30,000 live births). In all patients onset of necrotizing enterocolitis (NEC) was associated with typical clinical symptoms such as abdominal distension, feeding problems, bloody stools. Only four out of ten patients had positive blood tests of various inflammatory parameters when diagnosed (C-reactive protein, neutrophil count, I/T-ratio). However, increased CRP levels were observed in all patients during the course of the disease (maximum levels: day 2-4 after diagnosis). During primarily conservative therapeutic management only one out of ten patients developed bowel perforation (day 6 after diagnosis) and immediate surgical treatment was carried out. In addition, in three patients who acquired strictures with obstruction of the colon, elective surgery was performed at a postnatal age of 51-77 days. All patients survived NEC without longterm sequelae. We conclude that a primarily conservative therapeutic regimen-whenever perforation and gangrene are absent-may be an alternative to early surgical intervention in NEC.

Anastomosis, Surgical↗
PubMed1994

Infantile multiple system atrophy with cytoplasmic and intranuclear glioneuronal inclusions.

This report presents a case of infantile multiple system atrophy with probably autosomal recessive inheritance. The female patient developed generalized muscular hypotonia, myoclonias and tonic-clonic seizures at the age of 8 months, followed by gradual development of choreoathetotic hyperkinesia and increasing psychomotor retardation. Metabolic disease was ruled out and the child died of aspiration pneumonia at the age of 5 years. General autopsy was unremarkable, but neuropathological examination showed degeneration of cerebellum, inferior olives, medial thalamus, Clarke's nucleus, anterior horn cells, corticospinal, spinocerebellar tracts, and posterior columns. Immunohistochemically many neurons contained intranuclear and intracytoplasmic ubiquitin-positive inclusions, which did not contain neurofilament or tau epitopes and ultra-structurally consisted of granulofilamentous material. We tentatively classify this case as a form of infantile multiple system atrophy linked to neuronal intranuclear hyaline inclusion disease.

Cell Nucleus↗
PubMed1994

Intracerebral haemorrhages in surfactant treated neonates with severe respiratory distress syndrome: age at diagnosis, severity and risk factors.

UNLABELLED: Within a randomized European multicentre trial the time of onset, severity and progression of intracerebral haemorrhages (ICH) were investigated prospectively by serial cranial ultrasonography in 343 ventilated infants with severe respiratory distress syndrome (RDS) following instillation of single or multiple doses of a natural porcine surfactant (Curosurf). In 148/343 infants (43%) ICH was diagnosed (grade I or II: 22%, grade III or IV: 21%). In 26 cases (8%) ICH was present on the ultrasound scan prior to surfactant instillation at a median age of 6 h. Incidence and severity of ICH was similar after single- or multiple-dose surfactant treatment. Using a logistic regression model the following risk factors predictive of ICH were defined: low birth weight, allocation to certain hospitals, vaginal delivery, Apgar score < or = 6, rectal temperature on admission < or = 36 degrees C, primary anaemia, acidosis prior to treatment, RDS grade IV in pre-treatment chest films and poor response to surfactant treatment. CONCLUSION: Our study provides supportive evidence that multiple doses of Curosurf do not increase the risk for ICH as compared to single-dose administration.

Biological Products↗
PubMed1994

Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants.

From January 1986 to December 1992, 13 patients with necrotizing enterocolitis (NEC) (Grade II-III; Bell) were treated. The incidence was highest in the very immature infants with birth weight < 1000 g: 6/148 (4%). From onset, NEC was associated with clinical symptoms such as abdominal distension, bloody stools, retained gastric contents and septicemia. Indications of inflammation were seen in only 6 out of 13 patients at the time of diagnosis. No complications were seen in 10 patients during the acute phase. Two infants developed a bowel perforation and another one a gangrene. Immediate surgery was performed. In three other infants, elective surgery was performed because of colonic strictures. Twelve (92%) patients survived NEC. Five other VLBW infants developed spontaneous perforations of the bowel. The clinical presentation, laboratory and radiological findings differed greatly from those with NEC. Four infants survived. A primarily conservative therapeutic regime with close cooperation between the surgeon and pediatrician may be an alternative to early surgical intervention in NEC.

Enterocolitis, Pseudomembranous↗
PubMed1994

Successful surfactant replacement therapy in two infants with ARDS due to chlamydial pneumonia.

We report two cases of adult respiratory distress syndrome (ARDS) treated successfully with repeated doses of a bovine natural surfactant (Survanta). Two former premature infants developed severe respiratory failure as a consequence of a chlamydial pneumonia at the age of 3 or 12 weeks, respectively. As both patients were threatened by hypoxia in spite of mechanical ventilation with maximal pressures using 100% O2 and as the X-rays were compatible with the diagnosis of ARDS, we decided to perform rescue surfactant treatment. Following surfactant instillation, marked improvement in oxygenation and ventilatory requirements was observed. Within 2 h after surfactant replacement, the PaO2/FiO2 ratio increased from 52 to 84 (case 1) and from 35 to 94 (case 2), and the peak inspiratory pressure could be reduced from 47 to 40 cm H2O and from 35 to 28 cm H2O, respectively. Both infants received a second surfactant dose about 10 h after the initial treatment and survived without developing chronic lung disease.

Biological Products↗
PubMed1994

[Mortality of premature infants 1980-1990: analysis of data from the Göttingen perinatal center].

We analyzed retrospectively (1980-1990) the causes of death and by using a logistic regression model the perinatal and neonatal risk factors influencing the mortality in preterm infants < 34 weeks of gestation (n = 1132). When comparing the interval from 1980-1986 to 1987-1990 we observed a decreasing mortality in infants < or = 1000 g from 57% to 19% as well as in the preterm infants > 1000 g from 8.3% to 3.0% (p < 0.001). The causes of death changed considerably. During 1980-1986 fifty-two (8.2%) out of the 632 preterm infants and during 1987-1990 only seven (1.3%) out of the 600 preterm infants died in the course of a severe respiratory distress syndrome or intracranial hemorrhages. From 1980 to 1986 21% (n = 10) and from 1987 to 1990 77% (n = 10) of the neonatal deaths in preterm infants > 1000 g were attributed to lethal malformations. In those infants without lethal malformations (n = 1109) we performed a logistic regression analysis. 87 (7.8%) of these neonates died. The risk of dying was significantly higher in infants born before 1987, in male newborns and in infants suffered from a severe respiratory distress syndrome III-IV or septicemia (p < 0.0001). An increasing gestational age of one week resulted in a lowered risk of mortality (odds ratio 0.59, p < 0.0001). Adjusted for these basic variables the mortality risk was also significantly higher for birth weights < or = 1000 g, low Apgar scores, peripartal acidosis, hypothermia and intracranial hemorrhages. An intrauterine growth retardation < 10. percentile resulted in a lower mortality risk.

Birth Weight↗
PubMed1993

Mutation analysis in the diagnosis of cystic fibrosis.

Since the characterization of the gene encoding the cystic fibrosis transmembrane conductance regulator protein and identification of its main mutation, delta F508, causing cystic fibrosis (CF), more than 150 mutations in this gene have been reported, most of them only in a few or even single CF patients. Attempts to use mutation analysis in genetic counselling or for the diagnosis of CF depends on prevalence data of certain mutations in the respective population, and considerable ethnic differences have been reported. In this study we determined the prevalence of the mutations delta F508, G551D, R553X, and G542X and of genotypes defined by these mutations in 239 CF patients (444 independent CF chromosomes) seen in our clinic. The analysis for those four mutations alone now permits identification of approximately 75% of all mutations in our CF patients. The complete genotype can be resolved in approximately 63% of patients. This represents the diagnostic sensitivity which can be achieved by mutation analysis in patients without a family history of CF. We conclude that in situations where conventional diagnostic tests are not feasible or difficult to interpret, mutation analysis using a limited set of mutations can contribute significantly to an early and specific diagnosis of CF.

Adolescent↗
PubMed1993

[Variability of Jeune syndrome. Lung hypoplasia, renal failure and direct hyperbilirubinemia in a newborn infant].

Asphyxiating thoracic dysplasia (Jeune-syndrome) is an autosomal inherited disease which is characterized by bone dysplasia, renal and hepatic malformations of various expressivity. Newborns who have serious thoracic dysplasia with associated lung hypoplasia normally die during the neonatal period. Patients without signs of pulmonary defects may develop progressive renal failure due to an interstitial fibrosis. In addition, liver- and pancreas fibroses are found. We recently observed the greater variability of clinical manifestation in two patients with Jeune-syndrome. The first patient, a mature male newborn infant, presented early signs of respiratory disease and, more interestingly, had high serum levels of 5.1 mg/dl conjugated bilirubin at day 1; the maximal bilirubin-concentration was 26.5 mg/dl at day 9. Additionally, he developed progressive renal failure (maximal serum creatinin: 2.7 mg/dl at day 13). The patient eventually died of respiratory failure. To our knowledge such an early onset of severe hepato-renal manifestation has not been observed in patients with this disorder. A second term newborn infant with typical radiological signs of Jeune-syndrome and severe lung hypoplasia died within hours after birth. No hepato-renal defects could be documented in this patient.

Asphyxia Neonatorum↗
PubMed1993

[Effect of 2 different dosages of a porcine surfactant on pulmonary gas exchange of premature infants with severe respiratory distress syndrome].

BACKGROUND: Doses between 20 and 200 mg/kg body weight (bw) of different surfactant preparations have been recommended in clinical trials for the treatment of neonatal RDS; an optimal dose regimen of surfactant replacement therapy has not yet been defined. Aim of the present pilot study was the evaluation of pulmonary gas exchange in infants with severe RDS following the application of either a high (200 mg/kg bw) or a low (100 mg/kg bw) dose of a natural porcine surfactant (Curosurf). METHODS: 15 neonates were randomized to a high dose regimen, 17 infants to a low dose of surfactant. Apart from a lower 1 minute Apgar in the 100 mg/kg bw group, birth weight, gestational age, sex, 5 minute-Apgar and disease severity (arterial to alveolar oxygenation ratio (a/A-ratio): 0.10 +/- 0.03 [high dose], 0.11 +/- 0.06 [low dose], mean +/- SD) were well matched in both groups. RESULTS: Following surfactant instillation there was a rapid improvement in oxygenation in both groups. The a/A-ratio was slightly higher in the 200 mg/kg bw group during the first 12 hours following surfactant replacement, but statistically this was significantly higher only 4 hours after treatment (0.38 +/- 0.11 vs. 0.24 +/- 0.13, mean +/- SD, p < 0.05). CONCLUSION: The dose of 100 mg/kg bw Curosurf resulted in a rapid improvement in oxygenation and ventilatory requirements; only during the first hours following surfactant replacement there was a slight further improvement with the higher dose of 200 mg/kg bw. The impact of different dose regimens on outcome parameters still has to be defined by a larger clinical trial.

Biological Products↗
PubMed1993

[Thrombosis: an underestimated complication of central catheters? Subclavian vein, vena cava and renal vein thrombosis after silastic catheters].

Besides systemic infections venous thromboses constitute major complications of central lines used in neonatal intensive care. Male triplet born at 25 weeks of gestation, birthweight 460 g during his first developed a catheter-associated thrombosis of the left vena subclavia without clinical symptoms. In addition, a second catheter-induced thrombosis of the vena cava inferior and right vena renalis manifested with typical clinical symptoms at an age of 4 weeks. Coagulation tests were normal. 7 months later the size and the renal function of the right kidney were markedly reduced. The incidence of catheter-associated thrombotic complications has not been defined yet; thromboses may develop without clinical signs. There is evidence that the rate of this complication is higher than generally assumed.

Blood Coagulation Tests↗