The significance of monoisotopic and carbon-13 isobars for the identification of a 19-component dodecapeptide library by positive ion electrospray Fourier transform ion cyclotron resonance mass spectrometry.

Harnessing the ultra high resolution capabilities of Fourier transform ion cyclotron resonance mass spectrometry (FTICR-MS) and positive ion electrospray, we have demonstrated the significance and utility of cumulative mass defect high resolution mass separation stable isotope distribution, exact mass measurement and elemental formula as a means of simultaneously identifying 19 components of the dodecapeptide library Ac-ANKISYQS[X]STE-NH(2). With an instrument resolution of 275 000 (average), isobaric multiplets attributed to monoisotopic and carbon-13 components of peptides: Ac approximately SLS approximately NH(2); Ac approximately SNS approximately NH(2); Ac approximately SOS approximately NH(2); Ac approximately SDS approximately NH(2); within the mass window of 1380-1385 Da, and Ac approximately SQS approximately NH(2); Ac approximately SKS approximately NH(2); Ac approximately SES approximately NH(2); Ac approximately SMS approximately NH(2), within the mass window 1395-1400 Da, were mass resolved, accurately mass measured and identified from the computed molecular formulas. This experimental procedure enabled the separation of monoisotopic and carbon-13 isobars yielding enhanced selectivity and specificity and serves to illustrate the significance of monoisotopic and carbon-13 isobars in final product analysis. Chromatographic separation (HPLC) was of limited utility except for monitoring the overall extent of reaction and apparent product distribution. Positive ion electrospray-FTICR-MS and fast atom bombardment (FAB) MS were used to assess final product quality and apparent component distribution.

Acoustic reflectometry in the detection of middle ear effusion.

Acoustic reflectometry, a new technique for detecting middle ear effusion, was compared with results from tympanocentesis or myringotomy in 75 patients (141 ears). There was a highly significant association (P less than .0001) for ears having middle ear effusion with high reflectivity (5 through 9 units) and for ears having no middle ear effusion with low reflectivity (0 through 4 units). In a pediatric population with middle ear effusion present in 98 of 141 ears and using reflectivity readings greater than 4 to indicate middle ear effusion, the sensitivity of this technique was 86.7% and the specificity was 69.8%. False-positive errors usually occurred in ears with thick tympanic membranes, or in ears in which reflectivity was determined prior to the induction of anesthesia. False-negative errors usually occurred in ears with both air and fluid. This technique was validated by direct comparison with tympanocentesis or myringotomy and can be used with pneumatic otoscopy and impedance tympanometry to follow children with middle ear effusion.

[Teratomas in the cervical region]. / Teratome der Halsregion.

Teratomas in the cervical region have rarely been observed in infants. There are only a small number of reports in the literature of teratomas in this region. The complication rate after sugical removal of such a tumour is relatively high. A case report is presented of a newborn with a cervical teratoma which was removed without serious sequelae and with acceptable cosmetic and functional results.

The immunological state of the neonate following surgery--consequences for immunotherapy of neonatal septicaemia.

In addition to an innate functional dysmaturity of the neonate's immune system, operation, anaesthesia, and intensive care measures can significantly worsen this physiological immune deficiency. Given the fact that antimicrobial therapy as well as progress in intensive care of infected operated neonates and prematures did not significantly decrease the high mortality rate in this patient age group we began performing fresh-blood exchange transfusions as supportive immunotherapy in the treatment of neonatal septicaemia. Since indication for exchange transfusion has been adopted as early as septicaemia was suspected only 46% of the operated neonates (13 out of 28) died of their infection, compared to 82% of the patients (23 out of 28) who did not undergo exchange transfusion.

Causes of death in 31 newborn infants with myelomeningoceles.

Eight of the ten premature infants died during the first ten days. Six of these were in poor general condition with cyanosis, respiratory distress or aspiration of amniotic fluid. One child died after a fit before he was operated upon for his myelomeningocele. Ventricular haemorrhages were found in two premature infants. Seven of the premature infants died of an infection. In 23 infants the myelomeningocele was not covered by a membrane. Approximately 75% of the infants, i.e. 15, died during the first week of life. A meningitis was found in five infants; in four cases it was due to E. coliand in one, due to klebsiella. It, therefore, appears from studying our case material that deaths in newborn infants with myelomeningocele depends on the following facts: 1) maturity, 2) associated malformations, 3) whether the myelomeningocele is covered by a membrane or not.

[Problems of enterectomy for diffuse peritonitis in children (author's transl)]. / Problematik der Darmresektion bei diffuser Peritonitis im Kindesalter.

An analysis was made of the author's own patients with diffuse perforative peritonitis (without appendicitis) in childhood. Most patients had a perforated enterocolitis. Treatment of choice: Resectioning the perforated areas of the intestine or Resectioning the intestine just before the perforation; anastomosis in the septic area should not be carried out, instead an enterostomy with two lumina should be performed; intensive therapy; therapy for sepsis with exchange transfusion. The reanastomazation should take place only after the patient has fully recovered; definite criteria for evaluation, when this is the case, were presented. The mortality rate for the author's cases was 46%; statistics taken from international literature indicate a mortality rate of 65%.

[Treatment and results in necrotizing enterocolitis in infancy (author's transl)]. / Therapie und Ergebnisse bei der nekrotisierenden Enterokolitis im Säuglingsalter

29 children aged between 1 day and 22 months were treated for enteritis with complications. 2 children were cured conservatively. In 27 cases surgery was needed; of these 13 children survived. In 19 patients bacteria were found in the stools. Operation was indicated when there was diffuse peritonitis or when perforation could be shown radiologically. In cases of intestinal perforation the following technique was used in the last few years: 1. resection of the segment involved and ileoor colostomy. 2. Anastomosis and closure of colostomy 4--6 weeks later. Among 29 children with necrotizing enterocolitis there were 12 who also had malformations of the heart and lungs. This made worse a prognosis which was bad anyway.