[Successful surfactant therapy of ARDS in an immunodepressed child]. / Erfolgreiche Surfactanttherapie eines kindlichen ARDS infolge Immunsuppression.

The acute respiratory distress syndrome in childhood is a rare disease, but as in the past still plagued with a high mortality rate. It is caused by severe pneumoniaes or infectious diseases with multiorgan failure, aspiration, trauma or immunodepression. There are no therapeutic guidelines based on controlled studies. Therefore different therapies i. e. high frequency oscillatory ventilation, nitric oxide application, surfactant therapy, extracorporal membrane oxygenation or a combination of these methods are used. We present the case of a 4 (3)/ 12 year old boy, who suffered from an acute lymphatic leukaemia. Caused by immunosuppressive therapy he got a severe broncho-pneumonia. During ventilation therapy an acute respiratory distress syndrome occurred. Due to a surfactant application over 7 days with a doses of 360 mg/kg body weight this RDS could be dominated. The extubation was possible after 17 days of ventilatory support. 3 weeks later the lung function was normalized and the chemotherapy resumed.

[Improved results in the treatment of acute myeloid leukemia - Results of study AML-BFM-93 in East Germany with comparisons to the preceding studies AML-I-82 and AML-II-87]. / Verbesserte Ergebnisse in der Therapie der akuten myeloischen Leukämie - Ergebnisse der Therapiestudie AML-BFM-93 in den neuen Bundesländern im Vergleich mit den Vorgängerstudien AML-I/82 und AML-II/87 der DDR.

BACKGROUND: Three multicenter studies were conducted in East Germany on the treatment of acute myeloid leukaemia in children. The latest of the three studies (AML-BFM-93-OST) was part of the common German study AML-BFM-93. PATIENTS AND METHODS: The total number of registered patients was 262. The number and dosage of administered chemotherapeutic agents was elevated with each new study. RESULTS: Both the remission rate (85 %) and the likelihood of an event free survival (52 % after 5 years) could be improved significantly in study AML-BFM-93-OST. The results of the common German study AML-BFM-93 were identical to those of the East German part AML-BFM-93-OST. Compared with international studies it was one of the most successful treatment strategies in children with AML. Patients who showed toxic side effects to heart, liver, kidneys, skin or nervous system during the chemotherapy had a significantly lower risk of relapse, once they overcame the intensive therapy. During the five years of study AML-BFM-93-OST, treatment results could be improved despite an unchanged therapy strategy. This may partly be due to the modernisations and restorations that were carried out in many East German hospitals in this time. CONCLUSIONS: The therapy regimen of study AML-BFM-93 allowed a substantial improvement in the treatment of children with AML. Further intensification of chemotherapy should only be undertaken in accordance to the individual sensitivity of each patient.