[Diabetes in childhood: everyday burden and professional consequences for parents]. / Diabetesmanifestation im Kindesalter: Alltagsbelastungen und berufliche Entwicklung der Eltern.

BACKGROUND AND OBJECTIVE: To investigate the burden and the financial and professional consequences for mothers and fathers after the onset of diabetes in their child in relationship to age at onset and family structure. PATIENTS AND METHODS: All families of children with an age at onset < 14 years and a diabetes duration < 10 years treated at four large pediatric diabetes centers received a structured questionnaire (burden of diabetes, professional position and career development, financial consequences for both parents, demographic data). RESULTS: 580 families with 583 children with type 1 diabetes (46 % girls, diabetes duration 5.0 +/- 3.2 years, age at onset 6.9 +/- 3.9 years) participated. 42 % of the children had an age at onset below 6 years. 11 % had single parents. Before the onset of diabetes in their children 93 % of the fathers worked full-time, thereafter 4 % changed their employment. Mothers worked at onset full-time in 22 % and part-time in 38 %; thereafter 31 % reduced their working time or stopped working. 33 % of the mothers reported handicaps in their professional career development, especially those with a child with age at onset below 6 years (44 %). Negative financial consequences were present in 44 % of the families. The day to day burden on a scale from 1 to 5 decreased both in mothers and in fathers with increasing age at onset. The individual burden was higher in mothers (3.6 +/-1.1) than in fathers (2.8 +/- 1.1) (p = 0.000). CONCLUSIONS: Initiatives to reduce the burden on families with a child with diabetes are urgently needed. Particularly the social and professional integration of mothers with younger children at diabetes onset need to be improved through support measures outside the family.

Case-control study on stomach cancer in Germany.

A multicentric hospital-based case-control study was simultaneously performed in a high-risk and a low-risk area for stomach cancer in Germany, 143 patients with incident stomach cancer and 579 controls completing a retrospective interview about life style aspects. Periods of non-centralized water supply or well water as the only source compared to life-long central water supply, and preservation of meat by smoking it with spruce compared to no home smoking of meat, were significantly associated with an increased stomach cancer risk. use of a refrigerator at home for 30 and more years compared to 24 years or less showed an inverse relationship, whereas salt intake estimated by questionnaire showed no relationship to stomach cancer risk. Tobacco smoking was negatively associated with risk for current smokers of cigarettes compared to non-smokers but was presumably not causally related. After adjustment for other food constituents, only increased vitamin C consumption showed an inverse relation to risk. For food groups, increased consumption of fruit, citrus fruit, cheese and whole-meal bread were associated with decreased risk. A similar effect was also seen for increased consumption of raw vegetables. Total vegetable consumption was not particularly associated with risk. Increased consumption of processed meat and of beer showed a positive association with risk whereas increased wine and liquor consumption showed a significant negative association. The association of alcoholic beverages with stomach cancer risk may reflect a particular life style rather than being causally related to risk.

[Neurogenic tumours: clinical and therapeutic aspects (author's transl)]. / Klinik und Therapie neurogener Tumoren.

Tumours of the nervous system are rare. Clinical and therapeutic aspects are discussed with relation to 54 cases. The benign tumours of the peripheric nerves such as neurinomas and neurofibromas, show a high rate of malignant degeneration. For this reason, every tumour of the soft tissues has to be removed and should be examined by the pathologist. In cases of retroperitoneal and intestinal localisation an early diagnosis is frequently impossible. For differential diagnosis laparotomy or thoracotomy are always indicated. X-ray examinations of the kidneys, the thorax as well as the intestines and mesenteric vessels show satisfactory results. The neurogenic sarcomas and neuroblastomas are discovered late because of their hidden localisation and poor symptoms. The poor prognosis has not been improved by cytostatsis and radiation.

[Surgical aspects during the intensive care of chest trauma (author's transl)]. / Chirurgische Aspekte während der Intensivtherapie des Thoraxtraumas.

A wide range of surgical methods is available in the intensive care of patients with a chest trauma. Discussions with the anaesthetist as to the planning and co-ordination of diagnosis and treatment must take into consideration a great number of factors. The indications for surgery in polytraumatized persons are different from those that apply to single injuries. Table 6 which lists the cause and time of death of 52 persons with multiple injuries provides evidence that during the first 7 days after a severe accident all surgical intervention that is not absolutely necessary should be avoided and attention focused on the problem of adequate ventilation and primary and secondary complications of shock.

[The potentiation of betazol stimulated gastric acidity by prednisolone in dogs (author's transl)]. / Die Potenzierung der Betazol-stimulierten Magensaftsekretion durch Prednisolon beim Huud.

In a total of 46 dogs divided into 5 groups the acute effect of a high dose of prednisolone (40 mg/kg i.v.) on betazol stimulated gastric seccretion (5mg/kh s.c.) was investigated. There was no effect of prednisolone alone. The combination of betazol and prednisolone showed a significant potentiation of betazol stimulation. This effect was not seen after truncal vagotomy before stimulation. The mechanism is either cholinergic or an interaction in the metabolism of histamine.

[Differential therapy of bromcarbamide poisoning with reference to primary detoxication by means of gastro- or duodenotomy]. / Differentialtherapie der Bromcarbamid--Vergiftungen under Berücksichtigung der primären Detoxikation durch Gastro-bzw. Duodenotomie.

Different Therapy of Bromisoval Poisoning and Primary Detoxication by Gastrotomy or Duodenotomy: Bromisoval poisoning is encumbered with a high complication rate and mortality. Primary and secondary detoxication methods differ in efficacy and risk of the method. Primary detoxication deserves prefrence because it terminates the invasion of the poison, the duration of coma is shortened and complications due to poisoning are eliminated. An extremely effective, and at the same time involving little risk, primary detoxication can be undertaken by gastrotomy or duodenotomy, because the tablet substances remain visible for a long time as radiopaque conglomerates in the stomach and suprapapillary duodenum. In 5 cases with 30 to 70 g carbamide, the duration of the coma was cut by more than half compared with 25 equally severe poisoning treated in the usual manner.

[Stress-induced peptic ulcer; pathogenesis, clinical features, prevention and treatment (author's transl)]. / Das Stressulkus: derzeitiger Stand von Pathogenese, Klinik, Prophylaxe und Therapie.

Stress-induced ulcer is a fairly common acute erosive or ulcerative lesion of the stomach and duodenum that occurs in temporal relationship with, and in response to, stressful physical or mental situations in adults and children. Such situations may arise from surgical operations, severe injuries, especially cerebro-cranial trauma, septicaemia, during intensive therapy, in persons with respiratory or renal insufficiency, in cases of carcinoma, in moribund patients; also included, because of the identical symptoms, are ulcers developing during administration of glucocorticoids, salicylates, anti-rheumatic and anti-phlogistic drugs (pre-disposing factors). The stress-induced peptic ulcer manifests itself in haematemesis, melaena, blood in the stools and in perforation. The latter is often unrecognized because of its asymptomatic and frequently un-dramatic course. Two-thirds of the lesions are in the stomach, predominantly in the form of multiple haemorrhagic erosions; on-third of the cases are located in the duodenum, almost exclusively in the form of an acute ulceration; bleeding, due to arrosion, occurs in an high percentage of these cases. Pathogenetic factors are: shock-induced circulatory disturbances of the gastro-intestinal blood supply with necrosis of the apical mucosal cells, increased gastric acidity (increased histamine release, vagal stimulation and increased production of glucocorticoids), changes in the mucosal barrier (e.g. gastro-duodenal reflux). Cases of stress-induced peptic ulcers complicating a severe primary disease (which is often masked by the intestinal symptoms) carry an unfavourable prognosis. With conservative treatment the mortality rate is still 60 percent; with surgical treatment (neither advisable nor possible in every case) it is 40 percent.

[The potentiation of stimulated gastric juice secretion by prednisolone]. / Untersuchungen zur Potenzierung der stimulierten Magensäure-Sekretion durch Prednisolon.

In 5 series of dogs the acute effect of a high dose of prednisolone (40 mg/kg i.v.) on Histalog stimulated gastric secretion (5 mg/kg s.c.) was tested. There was no effect of prednisolone alone. The combination of Histalog and prednisolone showed a potentiation of Histalog stimulation in high range. The effect was not seen when truncal vagotomy was performed before stimulation. It is possible that there is a cholinergic reaction or an interaction in the metabolism of histamine.

[Surgery of chronic intestinal ischemia (author's transl)]. / Chirurgische Probleme der chronischen intestinalen Durchblutungsstörungen.

Chronic intestinal ischemia has to be diagnosed by an interdisciplinary approach. Clinical symptoms are unrevealing; usually the internist and the radiologist make the diagnosis after numerous special examinations and arteriography of the abdominal aorta in two planes. Indications for conservative treatment vs. surgery have to be discussed between the specialists involved, that is the internist, the radiologist, the anesthesist and the surgeon. Surgical problems in cases with chronic vascular occlusions are problems of vascular surgery and surgery may be well planned and performed electively. Acute occlusions of intestinal vessels however require mostly immediate surgery of the intestine itself which has to be performed as an emergency procedure because of the impending organ necrosis and complications; this is demonstrated in the case of ischemic colitis.

[Post-traumatic diabetes insipidus syndrome (author's transl)]. / Das posttraumatische Diabetes-insipidus-Syndrom.

Post-traumatic diabetes insipidus was observed in 14 among 702 patients with severe trauma. The cause of the abnormal vasopressin secretion may be cerebral oedema, cerebral contusion near the hypothalamus, pull on the hypophyseal stalk by displacement or gross destruction of the brainstem. The hormonal hypofunction disappears once the cerebral damage has regressed. Treatment consists of exact balancing of water and electrolyte loss, using salt-free solutions. Drug treatment with vasopressin and with ADH-secretion stimulators has given unsatisfactory results, but should be used. Seven of the 14 patients died of their injuries. The symptoms of the diabetes insipidus syndrome regressed in the survivors.

[Queens' technic in Pharaoh's ant control. 2. Synergistic effects]. / Königinnentechnik zur Pharaoameisenbekämpfung. 2. Synergistische Wirkungen

The alkylating (Tepa, Metepa, Thiotepa, Apholate) and non-alkylating (Hempa, Hemel) chemosterilants have been tested in a screening programme together with 6 synergists of insecticides (Pieronylbutoxide, Bucarpolate, Sulfoxide, Safroxan, Demethylsulfoxide, S-421) for cumulative and synergistic effects. Since all of the insecticide synergists were repellent in contrast to the chemosterilants, the substances have been screened only by the dipping test. The synergists increased in solutions of acetone in contrary to the chemosterilants not the mortality of the queens. A combination of Tepa acetone in contrary to the chemosterilants not the mortality of the queens. A combination of Tepa and Piperonylbutoxide resulted in real synergistic effects. The sterility of the queens of the pharaoh's ant was increased at a relation of 1 part of Tepa to 5 parts of Piperonylbutoxide up to twentyfold. It is probably the first evidence of synergism between conventional chemosterilants and insecticide synergists. Unfortunately this excellent effect can not be used for practical control measures because only the baiting method leads to an eradication. - All the other screened combinations showed neither cumulative nor synergistic effects.