[Language Competence and Behavioural Problems in Preschool]. / Sprachkompetenz und Verhaltensauffälligkeiten im Vorschulalter.

AIM OF THE STUDY: Children with language disorders are at increased risk of developing behavioural and emotional problems. The analysis focused on the question whether behavioural problems differ depending on the type of language deficit. The present study examines the behaviour of preschool children with different language impairments. METHOD: The results of N=540 children aged between 4;0 and 5;11 years were analyzed. Language impairments were classified into phonetics/phonology (n=44), vocabulary (n=44), grammar (n=58), pragmatics (n=26) and multiple language impairments (n=171). In addition, a distinction was made between deficits in language production and comprehension. The children were compared with an unimpaired control group (n=197). The extent of emotional and behavioural problems were analyzed. RESULTS: The results indicate that emotional and behavioural problems differ depending on the type of language deficit already in preschoolers. Especially deficits in language comprehension, pragmatic impairments and multiple language impairments increase the risk of behavioural and emotional problems and hyperactivity. CONCLUSIONS: The relationship between language skills and emotional and behavioural problems should be emphasized in the developmental observation and documentation in preschool. In particular, the distinction between deficits in pragmatics and behavioural problems requires a differentiated examination to ensure an optimal intervention.

[Results of therapy in pulmonary tuberculosis: outcome monitoring in northern Lower Saxony]. / Therapieergebnisse bei der pulmonalen Tuberkulose: Outcome-Monitoring im nördlichen Niedersachsen.

BACKGROUND: Despite it importance standardized treatment outcome-monitoring in tuberculosis patients is not officially done in Germany. METHODS: In this retrospective study we investigated tuberculosis outcome in 494 patients with pulmonary tuberculosis using the international recommended definitions. RESULTS: The median follow-up period was 62 month (36-180 month). A successful treatment could be observed in 378 (76.1%) of all patients. Treatment success was mostly documented as cure (n = 375). No documented treatment success was seen in 119 patients (23.9%). The most important reason for unsuccessful treatment was lost for follow up (transfer out) in 60/119 patients (51.2%), followed by death (24/119; 19.8%), an interrupted treatment (22/199; 18.3%) and treatment failure (13/119; 10.7%). No documented treatment success was significantly more common in retreatment cases compared to new cases (p = 0.0003) and in patients with at least a single drug resistance (p = 0.04). Beside these parameters treatment outcome was significantly superior in patients receiving a standard antituberculosis therapy including at least isoniazid and rifampin compared to patients treated with other regimens during both the initial phase (p = 0.0039) and the continuous phase (p = 0.0021) of therapy. CONCLUSION: In this retrospective study the use of the international definitions for outcome monitoring showed a substantial proportion of patients with unsuccessful therapy. For the evaluation of the success of the tuberculosis programme in Germany a prospective documentation of treatment outcome data in all patients using the international definitions seems essential.

[Treatment of severe haemolytic-uraemic syndrome by dialysis (author's transl)]. / Dialysebehandlung des schweren hämolytisch-urämischen Syndroms.

Since 1973 haemodialysis was performed on 30 children with severe haemolytic-uraemic syndrome. Serial measurements were made of blood pressure, blood picture, renal function, complement values, excretion of fibrinogen split-products and beta2-microglobulin in urine. Of 22 children in the acute severe stage two died, in one case treatment having been started too late, in the other as a result of fulminating pneumococcal pneumonia. Twenty children survived without residual symptoms and with normal renal function. Of six children with severe progressive haemolytic-uraemic syndrome two developed terminal renal failure. In one child a renal transplantation has since been performed. One child requires chronic dialysis after nephrectomy. Three children died as a result of arterial hypertension, one of yeast septicaemia. Of two children with recurrent haemolytic-uraemic syndrome one developed terminal renal failure which was successfully treated by renal transplantation. One child died in a hypertensive crisis. The overall death rate of the group was 23%, in the group with the acute severe haemolytic-uraemic syndrome it was 9%. The results suggest that haemodialysis significantly improves the prognosis of severe haemolytic-uraemic syndrome.

The ultrastructure of focal islet cell adenomatosis in the newborn with hypoglycemia and hyperinsulinism.

In a newborn severe persistent hypoglycemia due to an insulin-producing tumorous proliferation of pancreatic islet cells (insulinoma) was observed. The insulinoma showed the histologic pattern of focal adenomatosis of islet cells. According to the present literature the focal proliferation of islet cell complexes seems to be a frequent and particular feature of insulinomas in the newborn. Differential islet cell staining identified 80%-90% of the proliferated islet cells as B cells. 10%-20% of the cells were found to be A or D cells. Ultrastructurally the majority of the proliferated islet cells were well differentiated B cells. The remaining cells represented either A or D cells or a fourth islet cell type with small spheric granules. Electronmicrscopic evidence of transitions between differentiated islet cells, particularly B cells, and the fourth islet cell type suggests that the fourth islet cell type might represent a precursor cell within the APUD-cell system.