Biomedical subjects
Publications and source records attributed to V Siller.
The unusual case of a 10-month-old infant with an ectopic refluxing ureter entering into a seminal vesical cyst associated with ipsilateral renal dysplasia is described. The embryology, differential diagnosis, and therapy are discussed.
Four infants with obstructive hydrocephalus caused by space occupying third ventricle and mesencephalic cysts are reported. Despite immediate shunt insertion in all patients, there was either lack of clinical improvement or late onset of clinical deterioration. Neuroimaging (CT, MRI, and ventriculography) diagnosed the presence of non-communicating midline outpouchings of the CSF pathways causing obstruction of aqueductal CSF flow and brainstem signs. The cysts were of different origin. In one patient it was caused by a previous thalamic haemorrhage, in another patient by neonatal Escherichia coli meningoventriculitis. In two cases with obstructive hydrocephalus at birth, the aetiology is unclear. Direct puncture and drainage of the cysts led to clinical improvement. The cysts were poorly visualised on CT and could be misinterpreted as an enlarged third ventricle, simulating congenital aqueduct stenosis. Careful neuroradiological investigation is necessary to establish an accurate diagnosis and neurosurgical management. In such cases with hydrocephalus and persisting ventricular enlargement despite shunting, CT ventriculography is a useful tool.
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.
Haemosiderosis is the most common cause of death in patients with thalassaemia major because of haemolysis and the necessary repeated transfusions. It is possible to reduce the lethal iron burden by means of iron-chelating agents. We combine a two-day-high-transfusion-regimen of packed cells with the application of high doses of desferrioxamine (500 mg/kg body weight) intravenously. This way we achieve good iron elimination with minimal psychological stress situations.
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