[Pregnancy outcome with intensified insulin therapy in manifest diabetes]. / Schwangerschaftsausgang unter intensivierter Insulintherapie bei manifestem Diabetes.

In 1981, the intensified insulin therapy for achievement of euglycaemia in pregnant diabetics was introduced at the University Department of Obstetrics and Gynaecology in Cologne. This study compares the results of 112 pregnancies in women with overt diabetes monitored before (1971-1980) or after (1981-1988) changing the therapeutic regimen. In the period from 1981 to 1988, the proportion of euglycaemic patients (preconceptionally 19%, before delivery 79%) was clearly higher than from 1971 to 1980 (n = 42; 7% and 9%, respectively). The tight blood glucose control resulted in a doubling of hypoglycaemic episodes during pregnancy. The proportion of preterm deliveries was reduced from 47% to 24%. The rate of caesarean sections was nearly constant (1971-1980: 38%, 1981-1988: 34%). The marked success of therapy was the decrease of perinatal mortality from 20.9% to 2.9%. The perinatal morbidity also diminished, as shown by the decreasing rates (30-90%) of foetopathy, macrosomy, respiratory distress syndrome, birth trauma, hypoglycaemia, hypocalcaemia and polycythaemia. The malformation rate, however, remained high (1971-1980 = 7%, 1981-1988 = 11%). The results demonstrate the necessity of a strict blood glucose control during pregnancy, beginning before the time of conception.

Severe intra-uterine growth retardation: obstetrical management and follow up studies in children born between 1970 and 1985.

Peri- and postnatal data of 263 children with severe intra-uterine growth retardation (IUGR) born between 1970-75 (n = 145) and between 1976-85 (n = 118) are presented. The incidence of premature delivery in IUGR patients rose from 15% (1970-75) to 34% (1976-85). The rate of perinatal asphyxia in premature children with IUGR decreased from 64% during 1970-75 to 45% during 1976-85. Perinatal mortality in preterm SFD babies was higher in 1976-85 (20%) than in 1970-75 (14%), due to an 8-fold higher incidence of very low birth weight (less than or equal to 1000 g) SFD babies. Without this high-risk group perinatal mortality ranged between 2 and 3% in both groups. The incidence of deliveries by Cesarean section increased from 19 to 45% while vaginal deliveries decreased from 73 to 52% during 1976-85 compared with the 1970-75 age group. Follow up studies were carried out in 63 patients (1970-75) and in 41 patients (1976-85). Deficits of body height and weight persisted in one third of the patients, being severe in 10-20%. Infantile developmental milestones were retarded in 22-32%. Neurologic sequelae mostly of a mild degree were seen in 29% (1970-75) and 37% (1976-85). Psychologic testing showed abnormalities in 38% of the older age group, using the Göttinger Formreproduktionstest and in 21% of the younger age group, where the Denver Developmental Screening Test was performed. EEG investigations demonstrated unspecific abnormalities of a mild to moderate degree in one third of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reye syndrome]. / Reye-Syndrom.

Clinical course, laboratory findings and histopathological features of Reye's syndrome as described. Etiological and pathogenetic aspects are still under discussion although a viral infection preceding Reye's syndrome is a very common finding. Preceding Influenza B, Influenza A and varicella infections were most often seen in the United States. A genetic disposition seems to exists in some cases. Exogenic factors of pathogenetic relevances are aflatoxin, emulging agents, insecticides, paracetamol, acetylsalicylic acid and valproate. In the United States and Great Britain the incidence of Reye's syndrome is about ten times higher than in other European countries, as demonstrated by reports from Spain, Denmark and France. Results of an inquiry in Western Germany on Reye's syndrome between 1983 and 1985 are presented. 99 major pediatric hospitals were included into the study. Clinical data were obtained from 85 hospitals. The incidence of Reye's syndrome in Western Germany during 1983-1985 was 0.04-0.05 cases per 100,000 children under 18 years. 15 cases of Reye's syndrome were reported, i.e. an average of 5 cases per year. 8 children died. 3 patients had been treated with acetylsalicylic acid and 2 patients with paracetamol shortly before the onset of the disease.

[Child development following severe intrauterine growth retardation--results of follow-up studies]. / Die kindliche Entwicklung nach schwerer intrauteriner Wachstumsretardierung--Ergebnisse von Follow-up-Studien.

94 prenatally severely dystrophic newborn (year of birth: 1970 to 1982) of the Department of Gynaecology of the University of Cologne were catamnestically investigated when they 2 to 12 years of age; follow-up examinations were performed by paediatricians, neurologists, EEG specialists and by test psychology. In more than one-half of the children followed up in this manner delays in early childhood development were seen; there were no conspicuous differences between the two groups (classified according to years of birth). On comparing the age brackets 1970-1975 and 1976-1982 about one-third of the children in both groups presented at follow-up clearly evident signs of retarded growth. In 32% of the children born between 1970 and 1975 mostly mild neurological deficits or slight impairments of nerve function were observed, whereas in the 1976-1982 group this figure was 26%. The incidence of cerebral pareses was 7% and 9%, respectively. Disturbances of fine motor response were most frequently seen. Mild to moderate EEG changes occurred in both patient groups at about the same rate of incidence (34% and 32% respectively); one child in each group presented with definitely pathological electroencephalographic findings. Pathological test psychology results were seen in 38% (1970-1975) and 21% (1976-1982) of the followed-up children; the tests employed were the Göttingen form reproduction test in children born between 1970 and 1975 and the Denver development test in the younger children born between 1976 and 1982.(ABSTRACT TRUNCATED AT 250 WORDS)

[Follow-up study of former prenatally dystrophic newborn infants now 6 to 12 years old]. / Nachuntersuchungsergebnisse ehemaliger pränatal dystropher Neugeborener im Alter von 6-12 Jahren.

58 small-for-date (SFD) aged 6 to 12 years, born between 1970 and 1975 were followed-up. Retardation of motor skills and speech during early infancy was found in 20-30%. At 6 to 12 years of age one third still had deficits in body weight und height. Neurological abnormalities in 17 children were usually mild, most often affecting fine motor function. Significant impairment of visuomotor perception on psychological testing was seen in 21 children, and EEG abnormalities in 20 cases. The results in neurological, psychological and EEG investigations for 23 children (group I) were normal. 24 patients (group II) showed one or two abnormal findings. In 9 children (group III) results of all three examinations were abnormal. The follow-up results were influenced by socioeconomic factors. Small-for-date babies showed on the whole encouraging results on follow-up during later childhood, with 40% of the children being normal, and mostly mild abnormalities in the remaining patients. Prognosis may be further improved by preterm delivery, i.e. early termination of intrauterine growth retardation.

[Tolerable and intolerable side effects of antibiotic therapy]. / Tolerable und nicht-tolerable Nebenwirkungen der Antibiotikatherapie.

Frequently side effects of drugs are the reason for hospital admission. According to various studies 8-35% of drugs have side effects, which may be more acceptable in the context of serious disease than milder illnesses or situations where drugs are not really necessary. Side effects are seen independently of dosage, often with dosages too low to be effective. Since antibiotic therapy is widely used in children side effects are often seen. There are allergic or immunoreactive reactions of the immediate and delayed type, metabolic and neural or neurohormonal disturbances, built-up of resistant organisms or selection of unusual bacteria, finally there is local damage due to the technique of application here not discussed in detail. The antibiotics are classified according to the type and frequency of side effects: Cephalosporine and Penicillin - allergic and neurotoxic reactions. Tetracycline - chelating agent, photosensitivity. Chloramphenicol - bone marrow depression. Aminoglycoside - oto- and nephrotoxicity. Macrolid antibiotics e.g. streptomycin - cholostasis. Lincomycin - enterocolitis. Sulfonamides - allergic reactions. How compliance with consequent irregularity of drug intake frequently causes ineffectiveness of therapy, the most common side effect.

Use of antipyretic analgesics in the pediatric patient.

Fever and pain are the most common issues in pediatric patient management. Acetaminophen, aspirin, and dipyrone are the most commonly used drugs and are equivalent in their efficacy. Dipyrone, used in many parts of the world, but not in the United States, is an effective agent; however, it has been implicated in producing agranulocytosis and anaphylactic shock. The salicylates have anti-inflammatory effects making them appropriate for the treatment of patients with juvenile rheumatoid arthritis, but they are gastric irritants, may impair clotting, and, because of saturable kinetics, may lead to accumulation and toxicity. Acetaminophen is an effective antipyretic and analgesic with few side effects that is toxic only in massive overdose.

[Children of former cancer patients]. / Kinder ehemalig krebskranker Patienten.

Intensive chemo- and radiotherapy in many cases leads to cure of malignant diseases and thus to an increasing number of former childhood and adult cases of cancer who now wish to start a family. A survey among 58 oncologic-paediatric and 26 obstetric-gynaecologic centres and a review of the literature was meant to demonstrate the effects of cytostatic treatment on the issue of treated persons. A total of 627 children of 537 preconceptionally treated patients could be assessed. 59 (9.4%) of these showed abnormalities. This corresponds to the frequency in a normal population. On the basis of these results effects of intensive tumour treatment on subsequent deliveries cannot be demonstrated. Thus, too pessimistic an attitude towards conception after treatment for cancer does at present not appear justified from a medical viewpoint.

Plasmapheresis as a therapeutic measure in hemolytic-uremic syndrome in children.

Three children with hemolytic-uremic syndrome (HUS) were successfully treated with plasmapheresis (HUS) were successfully treated with plasmapheresis (PP) combined with early hemodialysis and administration of Aspirin and dipyridamole. Stimulation of vascular prostacyclin release with patients' plasma was measured before and after PP. It was reduced before and increased after plasma exchange. The data indicate that PP might be a useful tool in treatment of (HUS) in children.

Two cases of coxsackie B2 infection in neonates: clinical, virological, and epidemiological aspects.

Two cases of neonatal coxsackie virus B2 infection are described. One infant presented with meningitis and enteritis, the other with rhinitis, meningoencephalitis, and enteritis. Both infants made good recoveries. The virus infection could also be demonstrated in all nonimmune family members, most of whom gave a history of recent mild febrile disease (pharyngitis, diarrhea). Enterovirus infections may be suspected in cases of neonatal meningitis or myocarditis associated with gastrointestinal signs, especially 1. when it is during the hot season July-October, 2. when there has been febrile illness in other family members recently. For an effective and rapid isolation of the agent, rectal swabs or stool specimens not only from the patient, but also from household contacts should be sent to the virus laboratory on several consecutive days. Meningitic infection may be proved by an early c.s.f. sample. For serodiagnosis a first blood specimen should be drawn as soon as possible, a second one some days later. The importance of rapid virological diagnosis and of stringent hygienic measures to prevent spread of the infection is stressed.

[Ethical problems of clinical pharmacology in pediatrics]. / Ethische Probleme der klinischen Pharmakologie in der Pädiatrie.

There is no rational and safe treatment without knowledge of clinical pharmacology. Clinical pharmacology is based on data found in the human. Since results of animals trials cannot be used directly Absorption, Distribution, Metabolism and Elimination rates of drugs in children differ from those known in adults. Therefore pharmacological data in children have to be studied specifically. There are always some questions for the pediatrician whether he is allowed to administer a drug prescribed in adult medicine to children, whether he is allowed to obtain data for therapeutical control purposes and whether he may or even must publish these results for the sake of ill infants. Due to the facts that it is difficult to receive these informations, we do not find dosage schemes, for example in the Physicians Desk Reference or Rote Liste for more than 70% of all registered drugs. A new drug without governmental licence must not be employed in pediatric medicine. After its official approval we may use this new pharmaceutical agent in some circumstances this might be even a must. Especially in Pediatrics there is no strict borderline between the clinical trial of a new drug in a group of patients or its application to a single ill child. Whenever a pediatrician is convinced of the high value of a new drug he will certainly get the parent's permission to apply it for the sake of their child as well as to perform a close therapy control. This attitude and produce is medically, ethically and legally correct.

[Infectious gastroenteritis in childhood (author's transl)]. / Infektiöse Gastroenteritis bei Säuglingen und Kleinkindern.

Stool specimens from 126 children with acute gastroenteritis and from 42 controls were screened bacteriologically and virologically including electron-microscopy. Rota viruses were found in 36.5% of the children with diarrhoea, enteropathogenic E. coli in 13.5% and candida in 7.1%. These pathogens were not found in the controls. Enteroviruses were found in almost the same frequency in both groups (13.5% in children with gastroenteritis, 16.6% in the controls). The etiologic role of adenoviruses, which could be seen in 5.6% of the diarrhoea group, remains unexplained.

[Bioavailability of metoclopramide with special reference to relevant literature data]. / Zur Bioverfügbarkeit von Metoclopramid unter besonderer Berücksichtigung einschlägiger Literaturdaten.

An intraindividual comparative study of the pharmacokinetic properties of metoclopramide, the active principle of Gastronerton, and metoclopramide of a reference drug after one single administration was carried out on 6 male healthy volunteers. Gastronerton was available as ampoules, tablets, solution and capsules; the reference drug as ampoules, tablets and solution (all of them as commercial products). The concentrations of metoclopramide in the serum were determined until 24 h after administration. As one of the persons dropped out another volunteer was included. There were 6 cases for the intraindividual comparison of the parenteral/enteral form except for the comparison of the tablets/ampoules of the reference drug. An open 2-compartment model was taken as a basis for the calculation of the serum concentration curves and the pharmacokinetic parameters. With regard to the maximum serum concentrations, the preparations differed only insignificantly. The bioavailability results were as follows: metoclopramide of Gastronerton tablets 80.3%, metoclopramide of the tablets of the reference drug 57.6%, Gastronerton solution 76.7%, solution of the reference drug 49.7%. The bioavailability of metoclopramide of Gastronerton capsules was 54.8%. The half-life values were between 2.8 and 8.3 h with a mean value of 5 h.