[Treatment of extreme tumour pain with morphine and s-ketamine A case report of an 11-year old girl]. / Therapie extremer Tumorschmerzen mit Morphin und (S)-Ketamin. Falldarstellung eines 11-jährigen Mädchens.

We are reporting on the case of an 11-year old girl with a malignant tumour. The extreme pain throughout the body could not be treated by conventional methods. By intravenous application of a morphine and s-ketamine mixture we were able to achieve a very effective analgesic result. Apart from the opiate effect of the morphine the decisive factor was the NMDA-antagonism of the s-ketamine. The latter suppresses central sensitisation and chronic pain and reduces or even prevents the development of opioid tolerance. It was possible to use smaller opiate doses more effectively, thus reducing the side effects of the pain therapy. Under associated whole-body thermochemotherapy the girl experienced general pain relief and we were able to return to conventional therapy with a fentanyl plaster.

Molecular mechanisms of hyperthermia- and cisplatin-induced cytotoxicity in T cell leukemia.

BACKGROUND: The prognosis of early and very early relapse in acute lymphoblastic leukemia of childhood is still very poor unless a hematopoietic stem cell transplant is performed if a second remission can be achieved by induction chemotherapy. Therefore an intensification of chemotherapy is required. MATERIALS AND METHODS: In the present study the molecular mechanisms of cisplatin- and/or hyperthermia-mediated cytotoxicity in CEM cells, a human T leukemia cell line, were investigated. RESULTS: Both hyperthermia and cisplatin induced the activation of the effector caspases-3 and -6. However, caspase activation followed different time kinetics. While hyperthermia exerted maximum caspase activation immediately after application, cisplatin activated caspase-3 and -6 after 24 hours. At both time-points significant caspase-3 and -6 activation was observed when the cells were stimulated by a combination of heat and cisplatin. The application of z-VAD-fmk, a general caspase inhibitor, showed that hyperthermia mediated cytotoxicity mainly via caspase-dependent mechanisms, while cisplatin induced both caspase-dependent and -independent cytotoxicity. Time kinetic experiments revealed that hyperthermia induced cell death immediately after the heating pulse. In contrast, cisplatin-induced cell death had its maximum between 6 hours and 12 hours after the heating pulse. The combined application of heat and cisplatin induced two peaks of cytotoxicity, one immediately after the heating pulse and the other between 6 hours and 12 hours. CONCLUSION: Hyperthermia and cisplatin induced cell death in T leukemic cells by different molecular mechanisms, which might explain the enhanced cisplatin-induced cytotoxicity by hyperthermia.

[Latex allergy in childhood--case reports]. / Latexallergie im Kindesalter--Kasuistik.

Three cases of latex anaphylaxis occurring during surgery are reported. Sudden cardiorespiratory collapse 40 to 90 minutes after induction of anaesthesia was treated with oxygen, crystalloid solution, adrenaline and methylprednisolone. Laboratory findings showed markedly elevated antibodies against latex postoperatively. All three patients had anorectal malformations. As children with malformations have to be operated on in early childhood, they have a high risk of developing antibodies against latex. Primary prophylaxis requires a general avoidance of latex products in children with malformations from the time of birth on.

[Propofol for intubation of infants after halothane induction]. / Propofol zur Intubation bei Säuglingen nach Halothaneinleitung.

UNLABELLED: The unwanted side effects of muscle relaxants used for anaesthesia in the newborn and infants resulted in a search for alternatives to atraumatic intubation (IN). The study was aimed to investigate conditions of intubation, time of intubation as well as changes in systolic, mean and diastolic blood pressure (RRs/RRm/RRd) and heart rate (HR) under the use of propofol (P) after narcosis induction by mask. PATIENTS AND METHODS: The study was approved by the local ethics committee. The data was analysed from 100 infants aged between 4 days and 56 weeks (weight 2110-9230 g) in the ASA I and II groups (Group [Gr] A and B both with 50 patients). In both groups induction was performed inhalationally with halothane (1.5-2.0 vol%) and pure oxygen. After that propofol for intubation was applied in a dose of 2 mg/kg i.v. In Gr A blood pressure and heart rate were registered at three measuring points (MP): MP 1 = before P administration, MP 2 = after P, MP 3 = following intubation; in Gr B at MP 1 and MP 3. Additionally in Gr B the intubation time was recorded in seconds (t1 = time after P administration to beginning of IN, t2 = time after P administration to the end of the IN, t3 = t2-t1). In both groups the conditions of intubation were assessed (score 1--excellent, 2--good, 3--bad, 4--impossible intubation). RESULTS: The means of RRs/RRm/RRd/HR varied in Gr A at MP 2 by -11.20*/-9.18*/-8.58*/-3.52 mmHg/bpm and at MP 3 by -2.74/-2.26/-2.04/+5.46 mmHg/bpm in comparison to MP 1 (p < 0.05 = significant*). Compared to MP 1 in Gr B the mean values of RRs/RRm/RRd/HR varied at MP 3 by -0.89/+0.50/-0.80/+4.20* mmHg/bpm. T1 (mean, SD) was 10.88 +/- 3.52 seconds (s), t2 26.22 +/- 6.12 s, and t3 was therefore 15.78 +/- 6.28 s. Conditions of intubation were found to be excellent or good in both groups (Gr A and B [100 patients]: score 1 = 95x = 95%, score 2 = 5x = 5%). CONCLUSION: In the observation period, changes in heart rate stayed in the range of reference. In our opinion the excellent and good conditions for intubation, as well as the ultrashort drug-onset and intubation time demonstrate the good characteristics afforded by propofol to perform intubation in infancy.