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Intravenous administration of fluids, electrolytes and glucose are the most common interventions in hospitalized pediatric patients. Parenteral fluid administration can be life-saving, however, if used incorrectly it also carries substantial risks. Perioperatively, adequate hydration, prevention of electrolyte imbalances and maintenance of normoglycemia are the main goals of parenteral fluid therapy. Conceptionally, the distinction between maintenance requirements, deficits and ongoing loss is helpful. Although the pathophysiological basis for parenteral fluid therapy was clarified in the first half of the 20th century, some aspects still remain controversial. In newborn infants, rational parenteral fluid therapy must take into account large insensible fluid losses, adaptive changes of renal function in the first days of life and the fact that neonates do not tolerate prolonged periods of fasting. In older infants the occurrence of iatrogenic hyponatremia with the use of hypotonic solutions has led to a critical reappraisal of the validity of the Holliday-Segar method for calculating maintenance fluid requirements in the postoperative period. Pragmatically, only isotonic solutions should be used in clinical situations which are known to be associated with increases in antidiuretic hormone (ADH) secretion. In this context, it is important to realize that in contrast to lactated Ringer's solution, the use of normal saline can lead to hyperchloremic acidosis in a dose-dependent fashion. Although there is no convincing evidence that colloids are better than crystalloids, there are clinical situations where the use of the more expensive colloids seems justified. It may be reasonable to choose a solution for fluid replacement which has a composition comparable to the composition of the fluid which must be replaced. Although hypertonic saline can reduce an elevated intracranial pressure, this therapy cannot be recommended as a routine procedure because there is currently no evidence that this intervention improves long-term outcome in pediatric patients with traumatic brain injury. [ABSTRACT FROM AUTHOR]

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Immune Thrombocytopenia (ITP) is a rare and - in most patients - mild disease, but might be associated with severe or even life-threatening bleeding complications. The treatment of ITP has partly changed in recent years, due to new therapeutic options. International guidelines changed accordingly. This consensus statement by the Austrian Society of Hematology and Oncology (OEGHO) is not a new evaluation of the current evidence, but rather tries to discuss the available international guidelines and adapt them to the situation in Austria. The subject is primary ITP in adults only. Classification, epidemiology, clinical presentation and diagnostics of ITP, and especially the management of this disease, are discussed in detail. This includes current aspects of first, second, and third line therapies, splenectomy with its indications and contraindications, and the use of new therapeutic options like thrombopoetin receptor agonists (TRA).

Intravenous administration of fluids, electrolytes and glucose are the most common interventions in hospitalized pediatric patients. Parenteral fluid administration can be life-saving, however, if used incorrectly it also carries substantial risks. Perioperatively, adequate hydration, prevention of electrolyte imbalances and maintenance of normoglycemia are the main goals of parenteral fluid therapy. Conceptionally, the distinction between maintenance requirements, deficits and ongoing loss is helpful. Although the pathophysiological basis for parenteral fluid therapy was clarified in the first half of the 20th century, some aspects still remain controversial. In newborn infants, rational parenteral fluid therapy must take into account large insensible fluid losses, adaptive changes of renal function in the first days of life and the fact that neonates do not tolerate prolonged periods of fasting. In older infants the occurrence of iatrogenic hyponatremia with the use of hypotonic solutions has led to a critical reappraisal of the validity of the Holliday-Segar method for calculating maintenance fluid requirements in the postoperative period. Pragmatically, only isotonic solutions should be used in clinical situations which are known to be associated with increases in antidiuretic hormone (ADH) secretion. In this context, it is important to realize that in contrast to lactated Ringer's solution, the use of normal saline can lead to hyperchloremic acidosis in a dose-dependent fashion. Although there is no convincing evidence that colloids are better than crystalloids, there are clinical situations where the use of the more expensive colloids seems justified. It may be reasonable to choose a solution for fluid replacement which has a composition comparable to the composition of the fluid which must be replaced. Although hypertonic saline can reduce an elevated intracranial pressure, this therapy cannot be recommended as a routine procedure because there is currently no evidence that this intervention improves long-term outcome in pediatric patients with traumatic brain injury.

27 patients, clinically suspected of having parotid tumours, were examined prospectively by sonography (high frequency linear array) and MRI (1.5 T, T1- and T2-weighted SE sequences before, and T1-weighted SE sequences after contrast). In 23 patients, 25 intraglandular tumours were demonstrated (two were multicentric); they consisted of 6 malignant parotid tumours, 11 pleomorphic adenomas, 7 cystadenolymphomas and one oncocytic adenoma. 4 patients had extraglandular tumours. All tumours were demonstrated by either method, but two extraglandular tumours were incorrectly diagnosed by sonography as being intraglandular and 8 tumours (28%) were not completely delineated by sonography. MRI localised the tumours correctly in all cases and demonstrated all lesions accurately, independent of their position or size. In summary, sonography appears suitable as the primary imaging method in the investigation of parotid tumours but in case of large, parapharyngeal or malignant tumours, MRI is clearly superior to sonography.

A pulsed holmium: YAG-laser (lambda = 2120 nm) was used to reopen the basal turn of artificially obliterated human cochleas in freshly dissected cadavers for intracochlear insertion of the stimulation electrode of a cochlear implant under simulated surgical conditions. Laser energy was transmitted through a 400 microns nylon fibre via the opened facial recess directly to the round window niche. At an energy level of 500 mJ/2.5 microseconds pulse, a repetition rate of 2 Hz, and an exposure time of 20-30 s, the photo-ablative mechanism of laser-bone interaction, which has only a limited thermal component, led to recanalisation of the basal turn of the cochlea in a length of 8-10 mm without damaging the surrounding structures. Light microscopic changes in the cochlea were evaluated following laser recanalisation. The artificial bony occlusion and the recanalised basal turn of the cochlea were visualised by means of computed tomography and histological thin section technique.

Laser therapy in otolaryngology--head and neck surgery using laser types working in the range of the visible and infrared part of the electromagnetic spectrum is well established. The laser types usually employed for micro- and macrosurgery of the aero-digestive tract and for microsurgery of the middle ear, involving thermal ablation of tissue and extensive areas of damage are described, as well as recent advances in laser technology for future use. The mechanisms by which non-thermal, photo-ablative pulsed solid-state crystal infrared and UV-excimer lasers and photodynamic therapy affect biological tissues are reported. The advantageous main areas of application of the different types of laser according to their physical properties are compared on the basis of the results of our own studies and the relevant literature.

A rare case of a solitary extramedullary plasmocytoma of the nasal cavity and the paranasal sinuses with orbital and intracranial extension of a 61-year old male patient was examined clinically, histologically and immunohistologically. The interrelationship of the generalised disease (multiple myeloma = MM) and the solitary extramedullary form (extramedullary plasmocytoma = EMP) is discussed as well as the importance of the magnetic resonance imaging in the diagnosis of tumours of the facial part of the skull.

Cartilaginous tumours of the larynx are rare, altogether about 250 cases being reported in the literature. These tumours typically grow slowly and malignant types usually show only local infiltrative growth. Distant metastases are rarely observed. Up until the present CT has been the main diagnostic tool due to its excellent demonstration of intra-tumoral calcifications. In the German literature Grevers et al. reported on MRI in cases of laryngeal tumours. Since we do not know of any reports discussing the special situation of cartilaginous tumours in this location, we present three cases of cartilaginous tumours outlining the effectiveness of MRI.

A pulsed Holmium:YAG-laser (lambda = 2,120 nm) was used for the first time clinically in tumour surgery. The primary lesion of a transitional cell carcinoma of the nasopharynx with metastatic disease in the neck (T2N2Mo) was laser resected in a photoablative manner with a minor thermal component without danger of damage to the skull base. Neck dissection was performed by conventional surgery. In comparison to laser types depending primarily on the thermal effects of laser-tissue interaction the coagulative necrosis zone following Holmium:YAG-laser surgery is small and there is no area of carbonisation. Macroscopic wound healing showed no complications and was completed after three weeks. At this time radiation therapy was started. The results of the histological examination and the physical properties of this new infrared laser system are discussed as well as the possibilities of flexible fiber Holmium:YAG endoscopic laser tumour surgery in clinical use.

Chondrosarcomas of the nose and paranasal sinuses are extremely rare. The present report deals with a case of chondrosarcoma situated in the ethmoid, destroying the cribriform lamina and infiltrating into the orbit. Diagnosis and therapy are discussed. The possibilities offered by imaging techniques and the advantages of magnetic resonance imaging are presented.

A pulsed Holmium: YAG laser (lambda = 2120 nm) was used during functional endoscopic endonasal surgery in ten patients with recurrent chronic inflammation of the paranasal sinuses. The Holmium: YAG laser energy was coupled to a 600 microns core diameter nylon fiber. Power settings of 950 mJ per 2.5 microseconds pulse at 5 pulses per second were used. Tissue responses to treatment were examined by light microscopy. The photoablative mechanism of the laser-tissue interaction led to bone and soft tissue ablation with only a minor thermal component in the target zone. In comparison with other laser types available clinically, there was no carbonization zone after use of the Holmium-YAG laser. The area of tissue damage produced was significantly smaller (370-520 microns only) and wound healing proceeded without complication. The physical settings of the laser equipment are described with regard to their significance in photoablation when using flexible light-conducting fibers. The possible role of the Holmium: YAG laser in clinical surgery is discussed on the basis of the present experience.