He ended the war as a jet pilot, first being posted to Kommando Nowotny in October and then, with the rank of Oberst , as Geschwaderkommodore of Jagdgeschwader 7 in December. An antinuclear antibody test was negative and ANCA was still outstanding. Steinhoff scored six confirmed kills with the unit. Views Read Edit View history. HSP is a common type of small vessel vasculitis in the paediatric population.
Unlike other Steinwerk buildings it did not function as a castle tower as the construction style seems to suggest, rather as a warehouse. The entrance to the cellar — vaulted unlike usual castle towers — is situated at ground level and was therefore easier to access than the castle tower with its higher lying entrance, which was easier to defend. Originally the Steinwerk did not have a chimney.
In the 15th century the Steinwerk became a keep with seven floors and hatchways on the south side. The third Heinrich von Leden, who had the great hall built, created an entry point between the two buildings and also had a lavatory added. The great hall with two pediments was built in the 15th century by Heinrich von Leden — the third consecutive bearer of this name — as a prestigious residence.
The ground floor consists of a four-metre high hallway whose other dimensions are 9. The parlour was presumably the bedroom of Heinrich von Leden and his wife Margarete von Bar. A flight of stairs — replaced in the late 16th century with a polygonal spiral staircase tower made from oak — led to the upper floor, which includes a ballroom. This features much valuable ornamentation upon its beamed ceiling and used to be attached to a gallery room on its east side. This was removed when the stair tower was added.
There was also an entrance to the Steinwerk building on this floor. The great hall was furnished with decorative paintings from diamond-shaped bands on plaster in white and gold; these were restored during the renovation works.
From Wikipedia, the free encyclopedia. This article is an orphan , as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. Retrieved from " https: Buildings and structures in Osnabrück. Blood pressure was within normal limits. Full blood count and electrolytes were normal. C reactive protein CRP was The possibility of a connective-tissue disorder was considered and further investigations sent for auto-antibody levels, including antineutrophil cytoplasmic antibody ANCA.
Henoch-Schonlein purpura HSP was considered to be the more likely diagnosis at this stage and she was discharged pending further results. She was subsequently reviewed a number of times over several weeks as an out-patient. The follow-up blood tests during this period are shown in table 1. During this time her condition fluctuated. Urinalysis was persistently positive for blood while blood pressure was stable. Serial lab tests demonstrated an evolving trend with falling haemoglobin and rising creatinine, urea and CRP, the significance of which was not initially recognised.
An antinuclear antibody test was negative and ANCA was still outstanding. Management continued according to guidelines for HSP. When she attended for review, she had become systemically unwell with anorexia, weight loss, fever and a widespread erythematous rash.
The blood tests on this date also marked the progression of her illness. She was referred to the regional tertiary referral hospital for further management under the care of the renal team.
Treatments to control the immune mediated response are listed below. The trend of the laboratory investigations during this time is demonstrated in table 2. The trends in basic haematology, biochemistry and CRP are demonstrated in the above section. A renal biopsy was performed during the acute stage of the illness, which showed features consistent with active crescentic glomerulonephritis as in figure 2. Immunofluorescence on this sample was negative indicating that this process was not an IgA-mediated one as in HSP.
There is proliferation of parietal epithelial cells from Bowman's capsule together with infiltrating monocytes and macrophages. The silver stain insert highlights the partial obliteration of the glomerular tuft. This in combination with the clinical findings allowed the diagnosis of Wegener's granulomatosis to be made. Due to nose bleeds, she had an ear, nose and throat examination performed under general anaesthetic, which identified several bleeding points requiring cautery.
A subsequent CT scan of her nasal cavity and sinuses was normal. Given the diagnosis of Wegener's granulomatosis and its association with lesions in other body systems, ophthalmology and cardiology review with echo were carried out and noted to be satisfactory. CT scan of the chest was performed, which identified two asymptomatic nodular lesions in the right lung.
One of these is indicated by an arrow in figure 3. CT scan of chest showing asymptomatic nodular lesion in right lung as demonstrated by blue arrow. Initial management at the tertiary hospital consisted of induction of remission. This required pulses of methylprednisolone and the commencement of pulses of cyclophosphamide. Seven plasma exchanges were also carried out over a 2-week period from day 7 of her tertiary hospital admission.
Oral antihypertensive treatments were required furosemide and amlodipine. Aspirin was also added. She was discharged to continue with fortnightly pulses of cyclophosphamide. As the frequency of cyclophosphamide infusions were reduced, there was evidence of an escalation in disease activity such that rituximab treatment was started. This is a new chimeric monoclonal antibody against the protein CD20 on the B cell surface, which disrupts the action of B cells and so may be used in auto-immune conditions.
Two doses of this were administered 1 month apart, which helped to induce remission. Other ongoing medication includes aspirin, amlodipine, enalapril, calcium supplements, alphacalcidol, erythropoietin Epoetin beta weekly injections and omeprazole. Regular out-patient follow up is ongoing. The patient's clinical condition is currently stable. The prognosis is uncertain given the uncommon nature of this condition in the paediatric population and the potential side-effects of immunosuppressive treatment.
There is a range of known vasculitic conditions, which can be classified according to the size of vessel affected. The clinical signs associated with vasculitis affecting different vessel sizes are shown in figure 4. HSP is a common type of small vessel vasculitis in the paediatric population. This is an IgA-mediated vasculitis often following on from an upper respiratory tract infection.
Far less common in this population is the condition Wegener's granulomatosis. This is also a multi-system vasculitic condition affecting small to medium vessels. It can affect any area of the body, including the upper and lower respiratory tract, kidneys, heart, joints, central nervous system and skin.