Case report-delayed splenic rupture in combination with medial femoral neck fracture after low energy trauma. Development of hemorrhagic shock 5 days after hip prosthesis due to a rare cause.

A 79 year old female patient was admitted to our emergency department with a fracture of the right medial femoral neck six days after a fall on her right side and a cemented hemiprosthesis was implanted. Five days later, she developed a hemorrhagic shock and was diagnosed with a delayed splenic rupture and the spleen was resected. Histopathological examination showed a delayed rupture of an otherwise normal spleen without signs of an underlying pathology. The outcome was fatal: In the postoperative course she developed pneumonia, three weeks later she succumbed due to multiple organ failure. Even careful reevaluation of the case did not provide any clues to expect an injury of the spleen according to trauma mechanism. This case shows that delayed splenic rupture of a normal spleen may occur even after a low energy trauma. Injury of the spleen should therefore always be considered, even with an uncharacteristic anamnesis. Physical examination after trauma should therefore always include a careful clinical evaluation. The clinical threshold for a FAST examination should be low. The coincidence of a femoral neck fracture and a splenic rupture after a low energy trauma has not been reported before.

Vaccination during concurrent subcutaneous immunotherapy: safety of simultaneous application.

BACKGROUND: During subcutaneous immunotherapy (SCIT), injections should be separated from vaccinations against infectious diseases by at least 1 week, because it is assumed that adverse reactions can result from the additional activation of the immune system. METARIAL AND METHODS: Data of a total of 875 individuals receiving SCIT and/or vaccination in one ENT-practice were included and analyzed retrospectively. 444 individuals had received vaccination against infectious diseases, 336 allergic patients received only SCIT. Moreover, 79 allergic patients had received vaccination and SCIT injections simultaneously on one day in different locations, while 16 patients inadvertently received SCIT injections within up to 4 days after vaccination. Some of the patients were observed for consecutive years receiving several vaccinations parallel to SCIT. Systemic reactions (SRs) during SCIT were classified according to the WAO (World Allergy Organization) grading. RESULTS: Patients exclusively receiving vaccinations did not report any drug-related SR. One SR third grade and two SRs second grade occurred in 3 asthmatic patients exclusively receiving SCIT. The patients simultaneously receiving vaccination and SCIT did not have any SR. This was also the case for the subjects consecutively receiving parallel SCIT and vaccination for up to 5 years. CONCLUSION: The international guidelines for allergen-specific immunotherapy (SIT) recommend an intermission of at least one week between SCIT and the administration of vaccines. However, these findings demonstrate the possibility to shorten or abolish this interval without increasing the risk of SRs.

[Long-term school-development of children with impaired language skills: 15-years follow up after dismissal from child care centres with speech therapy]. / Schulentwicklung bei Kindern mit schweren Sprachentwicklungsstörungen Nachbeobachtung bis zu 15 Jahren nach Entlassung aus Sprachheilkindergärten.

BACKGROUND: Severe language impairment (SLI) in children causes multiple developmental disturbances. Less is known concerning the long-term efficacy of Child care centres with speech therapy (CCC) and the validity of of IQ-testing. AIM OF THE STUDY: Follow-up of school-development of SLI-children from CCC and analysis of the the prognostic relevance of IQ-testing as monitored by the surrogate-parameter "school-development". METHODS: 1. Retrospective study with questionnaires; 2. Analysis of documents from CCC. 88 children (60 males, 28 females) were included. RESULTS: Median length of stay in CCC was 18 months (range: 12-36 months); present study was performed 0,5 to 15 years after dismissal from CCC. Due to parents;remembrance more than 90% of the children suffered on symptoms of SLI within the 2 (nd) year of life; about 30% of the children received grommets; IQ was determined by SON-R 2,5-7 in 68 children and amounted 99 (58-131). In 32 children (>10 years) school-careers were followed after termination of primary schools: 5 children visited "schools for handicapped children", 26 children attended mainstream-schools, 19 of them in schools with higher academic levels ("advanced-" and "integrated high schools", "grammar schools"). In 16 of 68 children the IQ amounted between 70 to 89, 11 of these children visited a mainstream school. In 45 of these children IQ was >90, 6 of these children had to attend a "school for handicapped children". CONCLUSIONS: IQ-testing is thought to be a limited prognostic parameter for long-term school-development of SLI-children. Findings indicate, that about 80% of the SLI-children benefitted by the therapy in specialized CCC and visited a mainstream school.

[Comparison of gold-plated silver- and silver oxide-impregnated silastic tympanostomy tubes: a randomized, prospective clinical trial]. / Vergleichende Untersuchung von Paukendrainage-Röhrchen: Eine randomisiert-prospektive Studie zur Verträglichkeit von Silberoxid-beschichteten Silikon- und Gold-beschichteten Silberröhrchen.

UNLABELLED: The insertion of tympanostomy tubes is the most common surgical procedure in the world. A major complication of chronic intubation is infectious otorrhea. The present study compares the rate of infectious otorrhea and survival rate of gold-plated silver tubes (GPR) vs. Silver Oxide-Impregnated Silastic Tubes (SPR). STUDY DESIGN: The prospective, randomized clincial trial was conducted with 116 children (59 female, 57 male) aged between 16 and 127 months (median: 51 months). Bilateral insertion of ventilation tubes was performed with SPR on one side and GPR on the other side in all children. The resulting data were compared using 2-tailed Wilcoxon-test. RESULTS: Out of 116 children, 11 left the study, 26 children finished the study by extrusion of both tubes, 32 children lost one tube and 47 children lost no tube. Total follow-up of GPR and SPR amounted to 703 and 949 months, respectively. Mean survival rate of SPR and GPR was 9.9 +/- 4.6 and 7.0 +/- 3.4 months, respectively (p < 0.001). During the first postoperative week, 13% of children suffered from otorrhea; after the first postoperative week until extrusion of the tubes, otorrhea was observed in 55% of children. The ratio otorrhea/months amounted to 0.046 and 0.05 in SPR and GPR, respectively (p: n. s.). CONCLUSIONS: Survival rate of SPR is significantly longer than compared to GPR. No differences in the otorrhea rate of SPR vs. GPR are detectable. The longer survival rate of SPR seems to be independent of the rate of infectious otorrhea but depends probably on other effects of biocompatibility.

[Environmental Survey for Children-- the environmental module of KiGGS. I. Design and research program]. / Kinder-Umwelt-Survey--das Umweltmodul im KiGGS. Teil 1: Konzeption und Untersuchungsprogramm.

The German Environmental Survey for Children (GerES IV) is the environment-oriented module of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS) which is being performed nationwide in Germany. From 2003 to 2006, a random subsample of 1800 children aged 3-14 years is being studied with regard to their body burden and health impairments linked to housing conditions and the personal environment- and health-relevant behaviour. The basic study programme includes the analysis of blood, urine, tap water and house dust as well as the application of an extensive questionnaire. The data gained from this population sample, which is representative for Germany's children, are the basis for deriving reference values to characterise the background exposure of children aged 3-14 years. Trends over time can be detected and the success of environmental policies verified by comparing the data with those of the German Environmental Survey 1990/92 (GerES II), also conducted in close cooperation with the National Health Survey, which included children aged 6-14 years. By linking the data from the Environmental and the Health Surveys, health-relevant environmental exposures can be detected and different scientific hypotheses can be tested. The main subjects that are being dealt with using subcollectives of GerES IV are 'VOC and eye and nasopharynx irritation', 'indoor allergens and allergic diseases of the respiratory system', 'chromium, nickel, fragrances and contact allergens', and 'noise, hearing capacity and stress hormones'.

[Might the cooperation with neuropediatricians improve the treatment of hearing impaired children: retrospective analysis of a small group of children with hearing aids]. / Sollte die neuropädiatrische Untersuchung integraler Bestandteil bei Diagnostik und Therapie von Kindern mit sensorineuraler Hörstörung sein? Retrospektive Analyse eines Kollektivs schwerhöriger Kinder mit Hörgeräteversorgung.

QUESTION: Present analysis was performed to test the hypothesis, that cooperation with neuropediatricians might improve the treatment of hearing impaired children. STUDY-DESIGN: In a retrospective study 31 children (21 females, 10 males) with impaired sensorineural hearing (27 binaural, 4 monaural) and hearing aids were analyzed: - 12 children with profound and severe hearing loss (HL), median diagnostic age (mda): 8 months; - 15 children with moderate and mild HL, mda: 58 months and - 4 children with monaural HL, mda: 29 months. Neuropediatric examination included physical examination as well as psychometric testing. RESULTS: 1. Despite various medical efforts hearing impaired children are diagnosed very late in Germany. 2. About 65 % of the children exhibited neurodevelopmental deficits; about 25 % showed profound disabilities: 7 children with an IQ < 80, 1 child with ADHD (Attention Deficit Hyperactivity Disease) and 1 child with cerebral seizures. Analysis indicates that especially in children with developmental disabilities and only mild/ moderate hearing impairment the risk for additional neuropediatric diseases is increased. CONCLUSION: In the present study a high portion of hearing impaired children exhibited additional neuropediatric diseases. Thus the regular cooperation with a neuropediatrician might be helpful for diagnosis and further treatment. The risk for additional neuropediatric disabilities might be enhanced especially in those children, which have been diagnosed late or in cases with mild/moderate hearing impairment and profound developmental disabilities.

Texas entry-year agriculture teachers' perceptions, practices, and preparation regarding safety and health in agricultural education.

The purpose of this study was to gather benchmark data for the assessment of the knowledge, attitudes, and perceptions regarding agricultural safety issues and curricula held by Texas agricultural teachers with less than two full years of teaching experience (entry-year teachers). Seventy-four of 118 well-distributed teachers responded to this survey. Researchers concluded that more females were entering a traditionally male-dominated field. Overall, teachers addressed safety within units of instruction rather than as separate units. The most useful forms of new teaching resources that this group of teachers would like to see produced were safety videos and study guides, and class demonstration/simulation activities. There was a significant difference in rankings between teachers less than 26 years old and teachers more than 26 years old regarding the usefulness of transparencies as a new teaching resource (F = 5.00, p = 0.0268). Few teachers were currently CPR and first aid certified, even though most had received training and completed a general safety and/or health related course while in college. Teachers generally agreed philosophically with most practices and exhibited personal beliefs consistent with proper safety preparedness and practice in agricultural settings. However, many of these teachers failed to practice what was expected of safe tractor operators, such as wearing safety belts and allowing younger drivers to operate the equipment.

[Physical and biomechanical aspects of cervical vertebrae dislocation syndrome]. / Physikalische und biomechanische Aspekte zum HWS-Distorsionssyndrom.

RESULTS: In car-accidents forces and torquets influence the cervical vertebra by traction and torsion. Moreover, due to different acceleration of head and body the cervical spine has to absorb and transmit--very often--great additional impulses. These different physical effects might cause damages of the cervical spine, whereby the acceleration (i.e. speed change per time) of the car, its passengers and organs--respectively--gives more physical informations than "speed change" alone. Important technical details influencing the extent of the damage of cervical vertebra are--the kind of collision (frontal, lateral, stern),--presence of belts and/or air-bags and--position of sitting and geometry. Preferentially cervical vertebra is injured at the levels C0/2 and C4/5 in adults and C0/2 and C2/3 in children. CONCLUSIONS: The documentation of physical details concerning the accident might be very important for the judgement of acute cervical spine injury as well as its prognosis, respectively.

The German Environmental Survey 1990/92 (GerES II): sources of personal exposure to volatile organic compounds.

In the framework of the second German Environmental Survey carried out in the Western part of Germany in 1990/91 (GerES IIa) 113 adults aged 25-69 years were selected at random from the total study population of about 2500 to investigate personal exposure to about 70 volatile organic compounds (VOCs). Each subject wore a diffusive badge-type sampler for 1 week. The VOCs determined included alkanes, aromatics, aliphatic halocarbons, terpenes, and oxygen-containing compounds. Multivariate regression analysis was carried out to determine and quantify the major sources of personal exposure to various VOCs. In this paper, results are given for benzene, and C8- and C9-aromatics. Being subject to environmental tobacco smoke was found to be the most important determinant of benzene exposure, but automobile-related activities such as driving a car or refuelling, were also associated with significantly increased levels of benzene. The major determinant of C8- and C9-aromatics concentrations was occupational exposure. Emissions from paints, lacquers, newspapers, magazines and print-works were also important contributors to C8-aromatics exposure. Renovation, painting and smoking were associated with a significant increase of the exposure to C9-aromatics.

[Nasal T-cell lymphoma of the lethal midline type. Case report and current aspects in the literature]. / Nasales T-Zell-Lymphom-Typ letales Mittelliniengranulom. Kasuistik und aktuelle Aspekte zur Literatur.

A case of nasal T-cell lymphoma as a cause of lethal midline granuloma in a 41-year-old woman is described. Primary chemotherapy as management failed, and tumor control was achieved thereafter by local radiotherapy to a dose of 52 Gy. Fourteen months after diagnosis the patient died in multiorgan failure with involvement of her skin, lung and liver. Present studies give strong evidence that lethal midline granuloma is very often a type of T-cell lymphoma that might be caused by Epstein-Barr virus. According to the literature our findings support the hypothesis that tumors are best treated by local high-dose irradiation.

Contrast dependency of motion-onset and pattern-reversal VEPs: interaction of stimulus type, recording site and response component.

We compared the contrast dependency (from 0.4 to 98%) of the visual evoked potential (VEP) to motion onset and to pattern reversal at an occipital and lateral recording site using sinewave grating stimuli of 0.9 c/deg, drifting at 4.9 deg/sec. Two differing VEP components were identified: a positive component, peaking at around 130 msec, dominating the occipital derivation, enhanced in pattern-reversal stimulation, a high-threshold, late-saturating contrast response characteristic with a half-amplitude contrast above 7%; and a negative component at around 180 msec, dominating the lateral derivation, enhanced in motion-onset stimulation, exhibiting a low-threshold, saturating contrast characteristic with a half-amplitude contrast below 4%. The results suggest: (1) The negative component (N180) represents motion mechanisms, located more laterally, while the positive component (P100-P130) represents form-processing mechanisms, located near the V1/V2 areas. (2) A pattern-reversal stimulus triggers both form-processing and motion mechanisms that can be discriminated by latency. In an occipital derivation, the clinical reversal VEP P100 will be little contaminated by motion responses.

Drug-metabolizing enzymes in pharyngeal mucosa and in oropharyngeal cancer tissue.

Cytochrome P4501A1 (CYP1A1) and the UDP-glucuronosyltransferase isoform UGT1A6 were studied in pharyngeal mucosa and squamous cancer tissue obtained from 27 male subjects (10 healthy nonsmoking volunteers, 10 smokers, and 7 smokers with pharyngeal cancer). CYP1A activity (7-ethoxyresorufin O-deethylase) was significantly induced in smokers as compared to nonsmokers (2.3 +/- 1.1 and 0.8 +/- 0.4 pmol x min[-1] x mg protein[-1], respectively). Immunoblot analysis demonstrated enhanced CYP1A1 protein in smokers. UGT activity towards 4-methylumbelliferone and 1-naphthol was also detectable in oropharyngeal mucosa. RT-PCR (reverse transcriptase-polymerase chain reaction) analysis indicated that UGT activity was at least in part due to the expression of UGT1A6. In cancer tissue, CYP1A activity was decreased in comparison with surrounding healthy mucosa (1.2 +/- 0.9 in tumor tissue vs. 2.2 +/- 0.7 pmol x min[-1] x mg protein[-1], respectively), whereas means and medians of UGT activity were unchanged. The results suggest that phase I and II drug-metabolizing enzymes are detectable in oropharyngeal mucosa and that CYP1A activity is inducible by constituents of cigarette smoke.

Isolation and characteristics of a steady-state visually-evoked potential in humans related to the motion of a stimulus.

We have examined the visual potential evoked by two motion stimuli. In the first stimulus (termed coherent motion) a random-dot pattern oscillated between phases of coherent and incoherent ("snowstorm") motion, and in the second a random-dot pattern alternated in direction of motion (termed direction change). We found that the response to the coherent motion stimulus is low-pass with respect to speed, has low contrast sensitivity and increases steadily with the contrast of the stimuli. The direction change visually-evoked potential (VEP) is band-pass with respect to speed, has high contrast sensitivity but then saturates and even reduces as the stimulus contrast is raised above 0.1. The behaviour of the direction change VEP is similar in nature to results from psychophysical experiments of motion perception and to the known properties of directionally selective cells of the cortex. On the other hand the behaviour of the coherent motion VEP suggests this may not be mediated by a mechanism specific to motion.

Asymmetry of motion VEP in infantile strabismus and in central vestibular nystagmus.

Norcia et al. [1] found a nasal-temporal asymmetry of visually evoked potentials (VEP) elicited by motion stimuli in patients with infantile strabismus. Patients with infantile strabismus typically present with an asymmetry of the monocular optokinetic nystagmus (OKN). We here address the question whether the asymmetry of the motion VEP indicates a sensory defect in the afferent visual pathway that could explain the OKN asymmetry. We recorded the VEP to a horizontally oscillating vertical sinusoidal grating in 20 patients with infantile strabismus (esotropia, asymmetry of the monocular optokinetic nystagmus, latent nystagmus) and in 10 normal controls. No asymmetry occurred in the 10 controls. Eight of the 20 patients with infantile strabismus showed a clear difference between the VEPs evoked by back and forth movements with a mirror-like asymmetry between the two eyes (phase shift 180 +/- 20 degrees). However, there was no significant correlation between the degree of VEP and OKN asymmetries. Therefore, we assume that the VEP asymmetry does not reflect the primary cause of the OKN asymmetry. Rather, the OKN asymmetry may be due to a sensory-motor defect in the efferent subcortical pathway, and the VEP asymmetry could be an epiphenomenon. Some of the VEP asymmetry may be a consequence of the latent nystagmus typically released under monocular stimulation, leading to adaptation of the afferent retino-cortical pathway. This suggestion is supported by a marked VEP asymmetry that we found in two patients with an acquired central vestibular nystagmus, an abnormality most likely not combined with a primary defect of the retino-cortical pathway.

Motion adaptation governs the shape of motion-evoked cortical potentials.

We recorded visually evoked potentials (VEPs) to motion onset/offset of square-wave gratings (dominant spatial frequency 0.69 c/deg, velocity 4.9 deg/sec, contrast 10%, luminance 15 cd/m2) with three electrode combinations (Oz vs Fz, Oz vs linked ears and parietal vs linked ears). In one experiment (seven subjects), we examined the effect of the duty-cycle of motion vs non-motion (5-80%) on the size of the various motion-evoked components. In another experiment (six subjects, duty-cycle 10%), we examined the effect of motion adaptation on the motion VEP. We observed both a positive VEP component around 110 msec (P1) and a negative component around 180 msec (N200). The amplitude of these components depended on duty-cycle and electrode position: N200 dominated at < or = 20% motion duty-cycle, P1 at > or = 50%; P1 dominated medially, N200 laterally. Motion adaptation enhanced the P1 and reduced the N200 by a factor of 3. Previous controversies regarding the major components of motion-evoked potential may be due to different duty-cycles. The effect of duty-cycle is probably caused by adaptation to the test stimulus; it can be predicted quantitatively by a simple one-parameter model based on the assumption that the VEP amplitude is proportional to the non-adapted proportion of motion-response generators.

Renal clearance of bilirubin conjugates in newborns of different gestational age.

The renal excretion of bilirubin conjugates was analysed in 22 newborns. Bilirubin monoconjugate was the only metabolite detectable in urine samples and its renal excretion correlated with the creatinine excretion rate (r = 0.91). The renal clearance of bilirubin monoconjugates in newborns ranged between 380 and 2160 ml/1.73 m2 per 24 h (median: 790). According to the present findings the renal function should be monitored in newborns and infants with conjugated hyperbilirubinaemia.

Horizontal and vertical reading: a comparative investigation of eye movements.

Electronystagmographic (ENG) recordings of eye movements were made during the horizontal and vertical reading of a standardized text. The text was rotated to one side through an angle of 90 degrees for vertical reading. A total of 35 normal subjects was investigated under identical conditions. The following differences were found: A "staircase" pattern of successive, remarkably regular eye jerks was observed during horizontal reading. The reading speed was significantly higher in the horizontal direction. Vertical eye movements during vertical reading were less regular and showed a greater number of small jerks of varying size. No significant difference in reading speed between the two vertical directions was found. The search coil method (Robinson), which was employed in one subject, yielded much more accurate recordings than did the ENG. As a control experiment for vertical reading, the letters were rotated through 90 degrees. Reading this transposed text took twice as long as reading a 90 degrees-rotated text.

[Minimally invasive surgery of sinugenic orbital complications in childhood]. / Minimal invasive Chirurgie bei sinugener orbitaler Komplikation im Kindesalter.

Orbital complications of acute sinusitis are classified into inflammatory edema, orbital cellulitis, subperiostal abscess and orbital abscess. The diagnosis is based on endoscopy of the nose, computed tomography of sinuses and orbit and an ophthalmological examination. Endonasal sinus surgery improves drainage and ventilation of sinuses and is free of long-term complications as observed with previous surgical techniques. Thus, the early surgical treatment of orbital complications is indicated even in children. Inflammatory edema and orbital cellulitis will still be treated conservatively. Subperiostal abscess and orbital abscess are treated surgically.

A prospective study of hyperlipidemia as a pathogenic factor in sudden hearing loss.

The pathogenic role of hyperlipidemia in sudden hearing loss (SHL) was examined in a prospective study. Twenty-five patients (14 males, 11 females; age range, 23-59 years) with a first event of SHL (group I) were compared with 9 patients (4 males, 5 females; age range, 28-86 years) with a repeated event of SHL (group II). Audiological examination revealed different types of SHL in group I vs group II: high-frequency loss, 76% vs 22%; low-frequency loss, 12% vs 22%; pancochlear hearing loss, 12% vs 56%. Serum lipid patterns and atherogenic risk factors in both groups were not different and corresponded to lipid patterns in the average population. These findings indicate that both hyperlipidemia and atherogenic risk factors are not of major pathological importance in SHL.