Agreement between capillary and arterial lactate in the newborn.

UNLABELLED: Arterial blood lactate is a reliable indicator of tissue oxygen debt and is of value in expressing the degree and prognosis of circulatory failure as a result of various diseases. Therefore, the practical issue of whether capillary lactate measurements might be of equal value was investigated in newborns. In total, 193 simultaneous measurements of capillary and arterial blood lactate concentrations were performed in 25 newborn babies with an indwelling umbilical arterial catheter. A strong linear correlation was found between capillary and arterial lactate concentration (Lcap = 1.02 Lart + 0.04; r = 0.98; p < 0.001). The mean difference was -0.08 mmol/l and the limits of agreement (+/- 2 SD) were +/- 0.69 mmol/l (-0.77 to 0.61 mmol/l). CONCLUSION: Our data show that capillary blood lactate measurements in newborn babies yield lactate concentrations equivalent to arterial measurements over a large concentration range.

[Reactive hemophagocytosis syndrome as a rare cause of fatal pancytopenia]. / Reaktives Hämophagozytosesyndrom als seltene Ursache einer fatalen Panzytopenie.

CASE REPORT: We present the case of a feverish 36-year-old female patient with unspecific pain and weight loss. After initial diagnosis of an unclear infection with Candida esophagitis, unspecific duodenitis, proctitis and liver damage there was a further clinical deterioration during antibiotic and symptomatic therapy. A newly developed pancytopenia could be identified as caused by reactive hemophagocytosis using bone marrow analysis. The patient died despite maximal supportive and specific therapy. Cause of death was a retroperitoneal hematoma and an invasive aspergillosis, the latter not identified premortem. CONCLUSION: The reactive infect-associated hemophagocytosis is a rare differential diagnosis in feverish pancytopenia. The prognosis is poor. In absence of a proven causal therapy supportive therapy and maximal diagnostics for detection of curable underlying diseases are essential. Antimycotic therapy should be considered generally.

Wolf-Hirschhorn syndrome due to a 3:1 segregation of a maternal balanced t(4;15)(p16.3;q11) translocation.

The Wolf-Hirschhorn syndrome (WHS) is characterized by severe pre- and postnatal growth retardation, specific pattern of dysmorphisms, and severe developmental delay. These clinical findings are the result of a deletion within the short arm of chromosome 4. Most cases occur de novo and are of paternal origin. Cases due to a balanced translocation are mostly of maternal origin and the deletion of distal 4p, including the WHS critical region, is often combined with a duplication of the other chromosomal segment involved in the rearrangement. Here, we report on a newborn female infant with WHS and pure tertiary monosomy due to a 3:1 segregation of a balanced maternal 4;15 translocation. In this context, importance of fluorescence in situ hybridization (FISH) with specific probes to determine the exact breakpoints in unbalanced chromosomal rearrangements with breakpoints localized around known microdeletion syndromes is emphasized.

Oral pH-modified release budesonide versus 6-methylprednisolone in active Crohn's disease. German/Austrian Budesonide Study Group.

OBJECTIVE: Corticosteroids are effective in acute Crohn's disease (CD). The present study assessed the effectiveness and safety of oral pH-modified release budesonide (BUD) in patients with active CD in comparison with 6-methylprednisolone (MPred). DESIGN: This was a prospective multicentre, randomized, double-blind, double-dummy study. METHODS: A total of 67 patients with active CD (CDAI > 150) were included. Patients were treated with 3 x 3 mg BUD (n = 34) or MPred (n = 33) according to a weekly tapering schedule (48-32-24-20-16-12-8 mg). The primary aim was remission of CD (CDAI < 150 and decrease by at least 60 points from baseline) after eight weeks. RESULTS: Baseline demographics, disease activity and localization of CD in the small bowel and the colon were similar in both treatment groups. On an intention-to-treat basis 19/34 patients in the BUD group (55.9%) and 24/33 patients in the MPred group (72.7%) were in remission after eight weeks (P = 0.237). Therapy failed in 15/34 patients (44.1%) of the BUD group and in 9/33 patients (27.3%) of the MPred group. The mean CDAI decreased from 262 +/- 50 to 118 +/- 69 in the BUD-group and from 262 +/- 81 to 95 +/- 61 in the Mored group (P = 0.183, final CDAI BUD vs. MPred). Steroid-related side effects appeared in 28.6% of the patients in the BUD group and in 69.7% of the patients in the Mored group (P = 0.0015). CONCLUSIONS: Oral pH-modified release budesonide (3 x 3 mg/day) is almost as effective as a conventional corticosteroid in patients with active CD but causes significantly less corticosteroid-related side effects.

Transcription signals for stable RNA genes in Methanococcus.

A previous survey of upstream sequences of tRNA genes from the archaebacterium Methanococcus vannielii has revealed that there are two boxes of sequence homology: A box "A" of about 20 conserved nucleotides at a distance of 30 to 49 basepairs upstream from the gene and a box "B" 18 to 19 nucleotides downstream from box "A" (Wich, G., Sibold, L., and Böck, A. (1985) System. Appl. Microbiol. (in press). Nuclease S1 mapping experiments were carried out with two of these tRNA transcriptional units and with a ribosomal RNA operon, to determine whether these consensus sequences have a function in the initiation of transcription. Use was made of the fact that cells from Methanococcus accumulate primary transcript and processing intermediates of ribosomal RNA under conditions of protein synthesis inhibition. The following results were obtained: (i) Transcription in all three systems starts at the G within the conserved trinucleotide TGC of box "B". Since the box "B" motif, 5'TGCaagT3', also occurs at the site of transcription initiation of protein encoding genes, both in methanogenic and halophilic organisms, it appears to constitute a frequently used transcription start signal within these archaebacterial groups. (ii) The box "A" motif occurs with constant spacing, relative to box "B", in all 10 tRNA and ribosomal RNA transcriptional units investigated from Methanococcus. Since it is not present in the leader region of genes coding for proteins, it seems to function as a specific element which is required for the expression of genes for stable RNA. (iii) Termination of transcription of the ribosomal RNA operon from Methanococcus occurs at a distinct T within an oligo-T stretch immediately downstream from the 3'-terminal 5S RNA gene. This signal occurs in all 3'-flanking regions of transcriptional units for stable RNA from the Methanococcus strains studied. Termination signals for stable RNA genes in Methanococcus appear to be similar with those of stable RNA genes in eukaryotes. (iv) By nuclease S1 mapping a recognition site was identified for a processing enzyme involved in the maturation of preribosomal RNA.

[Comparative treatment of gastroduodenal haemorrhage with secretin and cimetidine]. / Vergleichende Behandlung gastroduodenaler Blutungen mit Sekretin und Cimetidin. Eine multizentrische Studie.

In a prospective multicenter study 71 patients with acute, non-arterial gastroduodenal haemorrhage from ulcers or stress lesions were treated alternately with synthetic secretin (Hoe 0690 (n = 35) or with cimetidine (n = 36). Both medications were given by infusion over 48 hours. Prior to commencement of treatment the haemorrhage was verified gastroscopically. During infusion of secretin cessation of hemorrhage was achieved without recurrence in 30 out of the 35 patients within the 48-hour infusion time and in 3 patients with recurrence within the same period. Two patients failed to obtain discontinuation of haemorrhage within the infusion period. Cimetidine led to cessation of haemorrhage without recurrence within 48 hours in 20 out of 3 patients, 3 patients had recurrences. Haemorrhages could not be arrested in 13 patients within the two-day treatment period. Differences between success of treatment among the two groups are significant (P less than 0.01) favouring secretin.

[Complications after severe corrosive lesion due to acid in the upper gastrointestinal tract (author's transl)]. / Komplikationen der schweren Säureverätzung im oberen Gastrointestinaltrakt.

Case reports of 3 patients are given with severe corrosive lesions of the esophagus and stomach due to acid ingestion. All of them survived the initial phase and seemed to be expecting a favourable clinical course. In all of these cases however massive upper gastrointestinal bleeding, perforation, and death occurred in a later phase after an interval free of symptoms. Treatment of severe corrosions of the upper gastrointestinal tract differs significantly from treatment of less serious cases. In less severe cases care has to be taken to avoid later complications in the first place. If there are serious corrosions however vital indications are predominant in determining the course of treatment during the initial phase. An interval with no or rather few clinical symptoms of 3 weeks duration after severe corrosive lesions should not be considered to exclude the danger of later lethal complications, especially bleeding and perforation. In order to avoid such complications endoscopic and eventually surgical exploration after the acute initial phase is recommended.