Reference ranges for analytes of thyroid function in children.

Promptly detecting pediatric thyroid dysfunction requires age-appropriate reference ranges for serum thyroid-stimulating hormone (TSH), serum free thyroxine (FT4), and serum free triiodothyronine (FT3). We sought to establish such ranges, employing the widely-used Immulite® 2000 automated immunoluminometric assays in a large population. We assayed the analytes according to manufacturer's instructions in serum samples from 359 male and 297 female university hospital patients, aged between newborn to 18 years, without evidence of thyroid or pituitary dysfunction. As data were not normally distributed, the reference ranges were assumed to lie between the 2.5th and 97.5th percentiles. Curves for age-related changes in the reference ranges were calculated using the linearity, median and skewness method. TSH, FT4, and FT3 reference ranges showed a wide spread immediately after birth, rapidly decreasing within the first 2 years of life. Reference range width was fairly stable after about age 4 years. However, from that time, the ranges' lower and upper limits steadily declined, essentially reaching (FT3) or approximating (TSH, FT4) healthy adult values by age 18 years. Age-specific reference ranges should be used when measuring TSH, FT4, and FT3 in children. During very early life, values of these analytes range widely, making it challenging to interpret measurements in infants, and, especially, newborns.

[Anticoagulants of primary haemostasis]. / Antikoagulanzien der primären Hämostase.

Inhibition of platelet function plays an important role in the treatment and secondary prevention of cardiovascular or cerebrovascular ischemic diseases. Established antiplatelet agents use different pharmacological targets for this role. Acetyl salicylic acid achieves a reduction of thromboxane A2 formation by inhibition of COX-1. Ticlopidine or clopidogrel are ADP-P2Y12 receptor antagonists. Tirofiban, abciximab or eptifibatid are used for the inhibition of the glycoprotein IIb/IIIa receptor which is activated at the surface of platelets preceding the final step of their aggregation. The mechanism of dipyridamole is based on the inhibition of adenosine uptake and of phosphodiesterase-5. Efforts are made to improve antiplatelet therapy with the aim to find agents with favorable clinical outcome and lower bleeding risk. Current clinical studies focus on a new generation of ADP receptor antagonists (prasugrel, cangrelor and ticagrelor) as successors of ticlopidine and clopidogrel after coronary arterial interventions. Developments using platelet targets different from established drugs are thrombin receptor antagonists (like SCH530348) or thromboxane receptor antagonists (like S18886/terutroban) in patients with cerebrovascular events. Results from recent experimental studies could lead to new strategies for antiplatelet therapy (like inhibition of GP Ib receptor, GP VI receptor, platelet-leukocyte interaction, factor XII and others) in the future.

Atypical spontaneous factor VIII inhibitor: specific diagnostics and therapy of acute bleeding.

Differentiation of rapidly binding coagulation factor inhibitors from antiphospholipid antibodies is a challenge for the hemostaseologic laboratory, especially with respect to the different therapeutic consequences. Several immunological and functional assays for the diagnosis of these disorders have been proposed. Here we report the clinical and laboratory findings of a 65-year-old man who developed severe bleeding after a tooth extraction. The process leading to the diagnosis of a spontaneous atypical factor VIII inhibitor and the value of different laboratory tests are discussed.

Centrifugal and roller pumps--are there differences in coagulation and fibrinolysis during and after cardiopulmonary bypass?

A number of hemostatic parameters reflecting the activation of coagulation and fibrinolysis were investigated in a prospective study of 24 patients undergoing cardiopulmonary bypass (CPB) during heart surgery. The patients were randomized to a group in which either a roller (group 1) or a centrifugal pump (group 2) was used. Blood samples were taken preoperatively, at the onset of and every 20 min during CPB, after the administration of protamine, and 4, 20, 44, and 68 h postoperatively. The groups did not differ significantly in hematocrit, fibrinogen, factor XIII, and antithrombin III. Significant differences in favor of group 2 during and after CPB were found in prothrombin fragment F1 + 2, plasmin-antiplasmin complex (PAP), thrombin-antithrombin complex (TAT), and D-dimer (F1 + 2 P < 0.01 after 80-min CPB, PAP P < 0.005 after 40-min CPB, TAT and D-dimer P < 0.05 after 100-min CPB, D-dimer and PAP P < 0.05 after protamine administration, TAT and F1 + 2 4 h after CPB). These findings indicate the activation of fibrinolysis preceding thrombin generation during cardiopulmonary bypass. In addition, we conclude that centrifugal blood pumping is beneficial in avoiding excessive activation of both coagulation and fibrinolysis.

[Splenic rupture after minor accident. Significant intra-abdominal hemorrhage is tolerated without symptoms]. / Milzruptur nach Bagatellunfall. Erhebliche intraabdominale Blutung symptomlos toleriert.

In the framework of a case report the difficulty caused by splenic rupture after a minor trauma is discussed. In the case reported considerable asymptomatic bleeding into the abdominal cavity took place, which was only diagnosed accidentally by intravaginal ultrasound performed to exclude the tentative diagnosis of an endometrial carcinoma.

[Diagnosis of female urinary incontinence. Progress with urodynamic functional diagnosis]. / Diagnostik der weiblichen Harninkontinenz. Fortschritte durch die urodynamische Funktionsdiagnostik.

PROBLEM: Owing to its frequency and severe consequences for the women affected, urinary incontinence poses a considerable problem. Our knowledge about its pathophysiology, as also the diagnostic and therapeutic possibilities, remain remarkably limited. TYPES OF INCONTINENCE: The main types of incontinence are stress, urge, reflex and overflow incontinence. Other forms are rare. A major diagnostic and therapeutic problem is posed by the mixed type, which can account for up to 60 percent. DIAGNOSTIC EVALUATION: Owing to the morphologically and functionally complex nature of the lower urinary tract, the diagnostic approach to incontinence must involve various levels, and comprises careful history taking, a thorough physical examination, and special urodynamic evaluation. THERAPEUTIC CONCEPTS: Abundant therapeutic approaches, both pharmacological and surgical, are available, but opinion as to what constitutes the best therapeutic concept varies greatly. CONCLUSION: Despite the only moderate chances of successful treatment under realistic conditions, our present knowledge about the diagnosis and treatment of female urinary incontinence needs to become more widespread.