Evaluation of respiratory syncytial virus detection by rapid antigen tests in childhood.

BACKGROUND: Rapid and reliable diagnosis is crucial for clinical management of respiratory syncytial virus infection in childhood. We assessed the performance characteristics of respiratory syncytial virus antigen immunoassays in children hospitalized for respiratory infection. METHOD: A total of 1600 children up to three years of age hospitalized for diseases potentially caused by RSV were included in the study. Nasopharyngeal secretions were obtained in a standardized manner in the first 24 hours after hospital admission and tested in parallel by PCR and rapid antigen tests for RSV. The following parameters were recorded: recruitment center, gender, age, presence of fever, rhinitis, stridor, barking cough, cough, wheezing, vomiting, disturbed eating or sleep, tachypnea, tachycardia, increased body temperature, decreased oxygen saturation, C-reactive protein, erythrocyte sedimentation rate and chest X-ray results. RESULTS: Considering PCR testing as gold standard, rapid antigen testing had a specificity of 89.9% and a sensitivity of 66.2% for all samples tested. Logistic regression analysis revealed age and recruitment center as the only parameters influencing sensitivity whereas no such influence on specificity was found. Positive likelihood ratios ranged from 4,9 to 6.9 in different age groups. Negative likelihood ratio was 0.24 (95% CI: 0.18-0.42) in children aged up to 3 months but 0.67 (95% CI: 0.53-0.84) for children older than 2 years. CONCLUSION: Rapid detection of RSV antigen in this study was useful in detection of RSV mediated disease in younger infants but shows decreasing sensitivity in children older than three months.

[Diagnosis of postpartal disorders of adaptation in hospital delivery of out patients]. / Diagnostik postpartaler Adaptationsstörungen bei der ambulanten Klinikentbindung.

Delivery in a hospital on an outpatient basis is increasingly accepted in obstetrics. In West Berlin about 15% of the mothers consider this as desirable, and about 10% actually utilize it. Delivery at home, which is associated with safety hazards, is getting less frequent. Since the problem of disturbed adaptation of the infant can be quite difficult, the method of choice is the easily manageable noninvasive monitoring of heart and respiratory frequency of the newborn during the first hour after birth. This can help to detect latent disturbances of adaptation and premature discharge of the infant from hospital is avoided. The following aspects must be considered: 1. Monitoring is noninvasive and does not exercise stress on the infant. 2. Mother and child are not separated during the monitoring. Hence, the early mother-child relationship is not disturbed. 3. The obstetrician can assess the state of adaptation of the newborn more clearly with the help of the cardiorespiratory diagram. This makes it easier for him to decide whether a child may be released or ought to stay in hospital. 4. If the paediatrician is consulted, he has at his command useful data on a child he does not know with the exception of a few anamnestic data and the actual examination findings.

[Wiedemann-Beckwith syndrome. Study of an oligosymptomatic form]. / Das Wiedemann-Beckwith-Syndrom. Beobachtung einer oligosymptomatischen Form.

An infant with an incomplete expression of Wiedemann-Beckwith syndrome during the neonatal period was suspected to suffer from hypothyroidism. However, after exclusion of this tentative diagnosis the phenotypic characteristics lead to the correct diagnosis. In addition to the macroglossia, the typical facial signs of this syndrome such as capillary haemangioma of the glabella, soft tissue folds under the eyes and linear indentations of the ear lobes are demonstrable. Gigantism and umbilical hernia are absent. A tendency to hypoglycaemia and the increased risk of malignancy are the important aspects of this syndrome, which may be expressed in a variety of clinical forms. So far the aetiology of this syndrome is unknown although familial cases implicate the involvement of genetic factors.

[Computer-assisted data analysis in a pediatric intensive care unit]. / Rechnergestützte Datenanalyse auf einer pädiatrischen Intensivpflegestation.

Computer assisted real time data analysis introduces a reasonable method of judgment into patient monitoring systems. From fast changing vital parameters discrete heart and respiration rate samples are immediately evaluated and presented as graphs near the bedside. Thus, statistical routines can increase the better understanding of instable clinical conditions and lend support to the decision making process. The early detection of a pathological trend in a patient whose ability to compensate is still present provides necessary time for diagnostic or preventive countermeasures in case of emergency.

[Clinical management of bronchopulmonary dysplasia]. / Klinisches Management der bronchopulmonalen Dysplasie.

Bronchopulmonary dysplasia is caused by several factors. Avoidance of bronchopulmonary dysplasia is directed at its causes and should always attempt the rapid weaning of the patient from the respirator. Some of the preventive measures include a) avoiding an oxygen injury; b) prevention of barotrauma; 3) sufficient moisturization and warming of the respiratory gases; d) regular cleaning of the respiratory tract and bacterial controls of the tracheal secretion; e) administration of vitamin E; f) reconsideration (restricting the use) of parenteral nutrition. Assistance in the weaning from the respiratory means a) avoidance of an open ductus arteriosus; b) paced reduction of FiO2, respiratory pressure and frequency up to intermittent mandatory ventilation and final transition to spontaneous respiration with increased mean respiratory pressure; c) avoidance of cardiac insufficiency; d) administration of corticosteroids; e) theophyllin, and f) physical therapy. The number of patients with bronchopulmonary dysplasia has remained the same in the last six years. However, the mortality until 1979 round about 50% has been reduced to 1/3, in the years 1980/81.

Liver abscess. A complication of regional enteritis.

A patient with liver abscess in association with regional enteritis is reported. Liver abscess should be suspected in patients with regional enteritis who present with fever, elevated serum alkaline phosphatase, liver tenderness, right upper quadrant pain or hepatomegaly.

Lymphangiomyomatosis with chylous ascites: treatment with dietary fat restriction and medium chain triglycerides.

Lymphangiomyomyoma is a tumor of lymphatic channels and lymph nodes, clinically manifested by recurrent chylous pleural effusions and ascites. The disease is usually progressive and unresponsive to surgery, chemotherapy, or irradiation. A case of lymphangiomyomatosis in a 24-year-old woman who presented with chylous ascites is described. The patient was treated with dietary fat restriction supplemented with medium chain triglycerides and has remained free of recurrent effusions for 2 years.

The training of social caseworkers for a multi-cultural society.

This paper examines problems which arise between immigrants and social workers: conflicts and misunderstandings related to lack of awareness of each other's cultural patterns; racial prejudice, particularly expressed towards 'coloured' clients by white social workers. It is suggested that these problems reflect a more fundamental problem in social work: the gulf in communication and understanding between middle class social workers and working class clients. The currently held argument is examined that it is best to use 'immigrant' soical workers to look after immigrant clients, and the more radical position that casework with immigrants does more harm than good. The paper then describes a practical innovation in social work education for training social workers to function more effectively within a multi-cultural society. A review of relevant studies and discussions is also presented.

An unusual clinical presentation of pancreatic carcinoma: Duodenal obstruction in the absence of jaundice.

A case of pancreatic carcinoma, presenting with the uncommon initial manifestation of vomiting secondary to duodenal obstruction without jaundice, is reported. A review of 72 consecutive biopsy-proven cases of pancreatic carcinoma admitted to our institution in the past five years revealed an 8.3% incidence of this unusual primary complaint. Although infrequently reported previously, pancreatic carcinoma should be considered in the differential diagnosis of gastric outlet obstruction in the absence of jaundice. The classic triad of progressive jaundice, weight loss and abdominal pain suggests carcinoma of the head of the pancreas. Emesis, secondary to high grade duodenal obstruction in the absence of jaundice, is an infrequent clinical presentation. The case described is illustrative of widespread pancreatic carcinoma that remained silent until obstruction developed.

Further improvements in the transport of high-risk neonates.

The transport incubator used since 1972 was modified for the CPAP method (continuous positive airway pressure). A very generous indication for the use of this ventilatory assistance in the presence of very early clinical signs of respiratory distress syndrome before or during the transport into the Children's Hospital has contributed towards improving the survival rate of infants with a birth weight of 1001-1500 grams to 84,8% and for those below 1000 grams to 39,4%.