[Problems in early diagnosis of malignancies in general medicine]. / Die Problematik der Früherkennung von Malignomen in der Allgemeinmedizin.

If specialists expect general practitioners to carry out extensive investigations serving early detection of diseases they don't consider how limited in that respect the possibilities of general practitioners are. In general, practice however the early detection of malignancies is satisfactory if the doctor makes use of the short time available the best possible.

Danaparoid sodium (Orgaran) in four children with heparin-induced thrombocytopenia type II.

UNLABELLED: We report on four children with heparin-induced thrombocytopenia type II. In three patients, therapy with unfractionated heparin was associated with development of cardiac thrombi or with thrombosis progression up to the inferior vena cava or with aggravation of peripheral arterial occlusion. In the fourth child, the disease was recognized early on, and no complication occurred. Heparin-induced thrombocytopenia type II was confirmed by heparin-induced platelet activation assay and/or heparin/platelet factor 4-ELISA. Concomitant elevated antiphospholipid antibodies were seen in all patients. Danaparoid sodium applied at a dosage of between 1.2 and 7.1 U/kg/h stopped the disease progression in each patient. Three children had a clinical recovery with partial recanalization, but for the child with peripheral arterial occlusion disease, amputation of some of the toes became necessary. CONCLUSION: Our data indicate that heparin-induced thrombocytopenia type II is a potential life-threatening disease in children and danaparoid sodium is beneficial in this age group.

Stroke following appendectomy under general anesthesia in a patient with basilar impression.

We report a boy who developed a vertebral stroke immediately after an appendectomy. Basilar impression was diagnosed eight years after this event when skull roentgenograms revealed basilar impression with high standing tip of the odontoid. We speculate that muscle relaxation and cervical hyperextension during intubation in the presence of basilar impression resulted in vertebral artery dissection and stroke. We suggest that patients with vertebral stroke and no obvious risk factors should be evaluated for the presence of malformations of the craniovertebral junction to be able to take precautions against excessive neck movement during intubation.

[Acute erythromelalgia with hypertension in a 5-year old boy]. / Akute Erythromelalgie mit Hypertonie bei einem 5jährigen Knaben.

BACKGROUND: Burning pain of red and warm hands and/or feet are the classical symptoms of erythromelalgia. CASE REPORT: We describe the symptoms of acute idiopathic erythromelalgia and arterial hypertension in a five-year-old boy. Five days after a gastroenteritis the patient developed burning hands and feet in combination with arterial hypertension. Typically continuous cooling of all affected limbs was necessary to relieve the pain. Drug therapy with sodium nitroprusside only relieved the pain and dropped the blood pressure temporarily. Five weeks after onset of the disease all symptoms disappeared and the patient is still free of complaints (follow up period: 2 years). In the view of the presented case we discuss the differential diagnoses as well as therapeutical options.