[Cannabis--Position Paper of the German Respiratory Society (DGP)]. / Cannabis--Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP).

In this position paper, the adverse health effects of cannabis are reviewed based on the existing scientific literature; in addition possible symptom-relieving effects on some diseases are depicted. In Germany, cannabis is the most widely used illicit drug. Approximately 600,000 adult persons show abusive or addictive cannabis consumption. In 12 to 17 year old adolescents, cannabis use increased from 2011 to 2014 from 2.8 to 6.4%, and the frequency of regular use from 0.2 to 1.5%. Currently, handling of cannabinoids is much debated in politics as well as in general public. Health aspects have to be incorporated into this debate. Besides analysing mental and neurological side effects, this position paper will mainly focus on the influences on the bronchopulmonary and cardiovascular system. There is strong evidence for the induction of chronic bronchitis. Allergic reactions including asthma are known, too. Associations with other diseases like pulmonary emphysema, lung cancer and pneumonia are not sufficiently proven, however cannot be excluded either. In connection with the use of cannabis cardiovascular events such as coronary syndromes, peripheral vascular diseases and cerebral complications have been noted. Often, the evidence is insufficient due to various reasons; most notably, the overlapping effects of tobacco and cannabis use can frequently not be separated adequately. Empirically, early beginning, high-dosed, long-lasting and regular cannabis consumption increase the risk of various psychological and physical impairments and negatively affect age-based development. Concerns therefore relate especially to children and adolescents. There is only little scientific evidence for medical benefits through cannabis as a remedy; systematic research of good quality, in particular prospective, randomised, placebo-controlled double-blinded studies are rare. The medical societies signing this position paper conclude that cannabis consumption is linked to adverse health effects which have to be taken into consideration in the debate about the social attitude towards cannabinoids. The societies agree that many aspects regarding health effects of cannabis are still uncertain and need clarification, preferably through research provided by controlled studies.

[Substituting metasilicates in machine dishwashing agents prevents childhood corrosive injuries]. / Ersatz von Metasilikaten in maschinellen Geschirrreinigern zur Verhinderung kleinkindlicher Verätzungen.

In children unintentional ingestions of metasilicate- containing machine dishwashing agents have caused corrosive injuries of the mouth and esophagus in up to 50% of all cases. Whether substituting the corrosive ingredient by disilicates and carbonates reduces the number of corrosive injuries was studied in a 2-year prospective follow-up of 396 unintentional childhood ingestions. Symptoms of possible mucous membrane injury by machine dishwashing agents containing disilicates and carbonates (group DC) were compared to ingestions of irritating but definitely non-corrosive surfactants (group S). A total of 396 DC cases were followed, 86 of which showed initial symptoms such as crying, drooling, vomiting, or unwillingness to drink. Endoscopy of the esophagus performed in 17 children was normal in 13 cases and showed a general reddening of the esophageal mucosa in the remaining 4 children. None had corrosive oral lesions. This demonstrates a significant reduction of mucous membrane lesions compared to the older metasilicate-containing machine dishwashing agents. The toxic effects of the new dishwashing agents (group DC) are only slightly more pronounced than compared to 188 control cases of group S.

[Problems introducing a pediatric poisoning treatment set]. / Probleme bei der Einführung des pädiatrischen Notfallsets.

Between 1995 and 1998 the Berlin poison center conducted a case-control study supported by the Ministry of Science and Technology, the Berlin Medical Association, a health insurance company, and the Berlin Pediatric Society to test the efficacy of a pediatric poisoning treatment set. The aim of the study was to induce parents of small children to call the poison center immediately in cases of unintentional poisonings at home and to administer activated charcoal if advised to do so by the poison center specialist. This was achieved by handling over a so-called "emergency kit" to 24,000 parents during the regular pediatric office check-up when the children were 10-12 months of age. When an accident occurred, parents with an emergency kit at hand were able to give activated charcoal within 14 min compared to 51 min without this aid. Problems arose when attempts were undertaken to introduce the emergency kit into the routine counseling sessions throughout the country: restrictions imposed by the pharmaceutical law, lack of interest shown by pharmaceutical companies, and diverging responsibilities at county and federal political levels and between different health insurance companies have hitherto prevented the realization of this evidence-based method.

[Poisoning in small children--assessing the incidence and intervention. II. What is effective in prevention?]. / Vergiftungen bei Kleinkindern--Inzidenzschätzung und Intervention. II. Was wirkt präventiv?

A study was started a) to assess the incidence self-poisoning in pre-school children and b) to evaluate the impact of an emergency set containing activated carbon and an antifoam. Cooperation was established with the regional legal sickness funds, the regional physician association, and two pharmaceutical companies. Incidence and extent of unintentional self-poisoning among pre-school children are to be determined. The impact of an emergency specimen given to parents of one year old children is evaluated. Families with children aged 1 to 4 year living in boroughs of Berlin are the population at risk. Study period for measuring the incidence is from January 1995 to June 1998. Cases are all accidents of poison ingestion by children of the at-risk-population. Intervention was performed between July 1995 and June 1996. The sets were handed out to parents of children born in 1994. 85% of the selected parents could be interviewed. It was studied whether the behaviour of parents in accidents of poisoning differed between those given an emergency set compared to those who had none. Data were mainly collected by telephone interviews. In this paper the theoretical aspects of the psychological effect of the intervention are discussed.

[Role of medicinal coal in primary management of poisoning]. / Rolle der Medizinischen Kohle in der Primärversorgung von Vergiftungsfällen.

Primary detoxication by ipecac-induced emesis or gastric lavage is incomplete. In mild to moderate childhood poisoning administration of activated charcoal alone without gastric emptying is often more effective, because it binds toxins promptly. In-vitro and in-vivo studies of many substances have shown good adsorption to activated charcoal (e.g. digitalis, beta-blocking agents, phenobarbitone, carbamazepine, theophylline). If in-vitro adsorption is moderate to poor, administration of activated charcoal might nevertheless prove clinically valuable by altering the severity of symptoms such as has been shown with acetaminophen, salicylates or organophosphate insecticide intoxications. Possible risks are shown and dosage regimens of activated charcoal are given alongside an evaluation of additional cathartics in the initial treatment of childhood poisonings. The role of repeated doses of activated charcoal as a method of secondary detoxication in comparison with hemoperfusion techniques and its significance in clinical routine is pointed out. General conclusion: In mild to moderate childhood poisoning early administration of activated charcoal alone after consultation of pediatrician and/or poison center specialists is an adequate therapy.

Infantile isolated sulphite oxidase deficiency: report of a case with negative sulphite test and normal sulphate excretion.

We present the clinical and biochemical data of a patient with infantile isolated sulphite oxidase deficiency with late onset of symptoms. A comparison of the biochemical parameters is made with the neonatal type of this disease and with the data of described patients with the combined defect of sulphite oxidase and xanthine oxidase, due to molybdenum cofactor deficiency. False-negative sulphite dip stick test as a pitfall in the diagnosis of sulphite oxidase deficiency is discussed.

Acute hemiparesis as the presenting sign in a heterozygote for ornithine transcarbamylase deficiency.

Strokes in children occur in conjunction with cardiac disease, hematological disorders, trauma, intracranial infections and migraine. Recently several inborn errors of metabolism have been recognized as possible causes of stroke-like symptoms. We describe a female heterozygote of ornithine transcarbamylase deficiency, who presented with convulsions and right sided hemiplegia. MR-imaging of the brain demonstrated an acute ischemic lesion in the left hemisphere. In addition to other known metabolic causes of stroke like attacks urea cycle defects should be considered in the differential diagnosis of acute hemiplegia in childhood.

A new case of hyperargininaemia: neurological and biochemical findings prior to and during dietary treatment.

We present clinical and biochemical data on a further patient with hyperargininaemia and the results of neurophysiological tests both before and during dietary treatment with an essential amino acid mixture. With normalisation of plasma arginine concentrations, neurological functions improved and brain stem auditory evoked potentials normalized suggesting a partially reversible central conduction disorder. Neuroradiological findings included cerebral cortical atrophy on computed tomography scan and patchy abnormal myelination on magnetic resonance imaging (MRI). The typical clinical picture is discussed with reference to published therapeutical trials.

Plasma polyol levels in patients with cataract.

Galactitol and sorbitol concentrations in plasma were determined in patients (with or without cataract) in whom homo- or heterozygosity for galactokinase, galactose-1-phosphate uridyltransferase, systemic or peripheral UDP-galactose epimerase and sorbitol dehydrogenase deficiency was confirmed. For the above disorders it can be concluded that elevation of plasma polyols is not always related to the presence or absence of cataract. In all cases with cataract, however, the plasma galactitol or sorbitol levels were elevated. In another group of patients with unexplained congenital or infantile cataracts, but without apparent enzyme defects, mild to moderately elevated concentrations of plasma galactitol or sorbitol were found in about 45%. In 8% of this group the cataract and the elevated plasma galactitol concentration could possibly have been related to partial maternal enzyme deficiency. In all the other cases the elevated plasma polyol concentration remains unexplained but could indicate a further cause of cataract formation due to a hitherto unknown galactose or glucose metabolic aberration.

A new case of dihydropyrimidine dehydrogenase deficiency.

We present the clinical and biochemical features of a boy with dihydropyrimidine dehydrogenase deficiency, which seem to underline a disease entity of developmental retardation, epilepsy and muscular hypertonia.