[The reciprocal reflecting team. A further modification of the reflecting team in inpatient child psychiatry]. / Das Reziproke Reflecting Team. Eine weitere Modifikation des reflecting teams im stationären kinderpsychiatrischen Bereich.

The purpose of reflecting teams is to instigate change in systems that have become bogged down, including helper systems. The modifications that have been made in the Andersen reflecting team since it was first described (1987) are summarized. The reflecting team technique derives from family therapy and is epistemologically based on the radical constructivism of Bateson (1981), von Förster (1985), von Glaserfeld (1985) and others. Making use of the information resources of the key workers on our child psychiatry unit, we developed another variation, a "reciprocal reflecting team". This model is suitable for use in a clinical setting because it involves all of the key individuals working with a given child. The fundamental difference between our model and Andersen's is that initially we have no reflecting phase for psychotherapists. Rather, we start with a reflecting sequence in which the multidisciplinary clinical team discusses observations, information and hypotheses about the index patient and his or her family. Our impression is that our results are compatible with those of Höger et al. (1994) that family therapy using a reflecting team effects positive change in two of three cases. Because we have no follow-up data and our sample is still very small we base this on spontaneous positive feedback from the family members regarding their satisfaction with treatment. Further evidence is provided by clinical observations on the children's behavior and on changes in family interaction.

Chronic granulomatous disease assessed by single-cell granulocyte oxidative burst activity.

Here we report on a case of chronic granulomatous disease (CGD) in a 3-year-old boy who suffered from severe repeated bacterial infections including multiple liver abscesses. The case is of interest because (1) the disease is very rare (it is the first case of CGD diagnosed at the Clinic for Pediatric Medicine, University of Innsbruck), (2) the diagnosis, based on clinical parameters and the nitrobluetetrazolium test was completed and validated by single-cell measurements of respiratory-burst activity of the patient's granulocytes in a fluorescence-activated cell sorter (FACS), and (3) the applied FACS method, adapted in our laboratory, presents one of the most sensitive and reliable methods to evaluate this aspect of disturbed granulocyte function.

A prospective study of the association of serum neopterin, beta 2-microglobulin, and hepatitis B surface antigenemia with death in infants and children with HIV-1 disease.

A high percentage of HIV-1-infected infants and children in Romania are coinfected with hepatitis B virus. Little information is available on the impact of concurrent hepatitis B infection on the course of HIV-1 infection. We conducted a prospective cohort study over 1 year in a group of 68 HIV-1-infected infants and children to determine whether hepatitis B surface antigenemia, neopterin, and beta 2-microglobulin (B2M) predicted death. Among the 44 hepatitis B surface antigen-positive (HBsAg+) subjects at enrollment, 13 (30%) died during 1 year of follow-up. In comparison, two of 24 (8%) HBsAg-negative subjects died (RR = 7.7; p = 0.05). Higher initial serum concentrations of neopterin and B2M were negatively associated with survival. After stratifying by baseline clinical evidence of HIV-related disease, survival was negatively associated with HBsAg+ status (p = 0.04) in 33 children in stage P-2, adjusting for age, serum neopterin, and serum B2M levels. The results of this study suggest that serum neopterin is a marker for severity of clinical illness and that HBsAg+ status increases the mortality rate among children with clinical evidence of HIV infection.

Constitutional interstitial deletion of 17(p11.2) (Smith-Magenis syndrome): a clinically recognizable microdeletion syndrome. Report of two cases and review of the literature.

We present two patients, a 12 year old Turkish and a 7 year old Italian girl, with severe mental retardation, multiple congenital malformations and a constitutional interstitial deletion of the short arm of chromosome 17, del(17) (11.2). The main clinical features of this syndrome which is also referred to as the Smith-Magenis syndrome consist of a broad flat midface with brachycephaly, broad nasal bridge, brachydactyly, speech delay, hoarse deep voice and peripheral neuropathy. Behavioural abnormalities include hypermotility, self mutilation and sleep disturbances. The remarkable consistency of the main clinical features of the 59 patients documented so far permits the clinical diagnosis of this syndrome; a fact which is of importance, since many of the reported patients--including ours--were considered normal on earlier cytogenetic studies.

Association between neopterin and beta-2-microglobulin levels and HIV status in Romanian orphanage children.

Serologic markers of immune activation, neopterin and beta-2-microglobulin (B2M), have been shown to predict progressive human immunodeficiency virus type 1 (HIV-1) disease based on cohort studies in adults. Both parameters appear also to be valuable in distinguishing HIV-1 infants with progressive disease from asymptomatic infants and HIV-1 seronegative infants. In a cross-sectional study we examined the utility of neopterin and B2M testing in 135 infants of an orphanage in Romania, 69 of the infants (51%) were found to be HIV-1 antibody seropositive; 95% of the 135 infants were either hepatitis B virus (HBV) antigen or antibody seropositive. In the HIV-1 seronegative infants B2M was higher in those with HBV antigenaemia. Serum neopterin and B2M concentrations were higher in HIV-1 seropositive than in seronegative infants (p = 7 x 10(-12) and 1 x 10(-6)). Children with CDC stage P2 had only slightly higher neopterin and B2M values as compared to stage P1 (P = 0.04 and 0.08). Our study indicates that measurement of neopterin and B2M is useful to monitor HIV-1 infection, particularly in areas where laboratory facilities are limited. Both parameters continue to be associated with HIV-1 infection even when there is a high background rate of other infections.

[Multiple liver abscesses in chronic granulomatosis]. / Multiple Leberabszesse bei chronischer Granulomatose.

We report on a case of a three year old boy, suffering from chronic granulomatosis disease, which led to repeated bacterial infections and finally to multiple liver abscesses. Diagnosis was based on the nitroblue-tetrazolium-test and histology. Antibiotic therapy over many weeks was not successful in spite of an adequate choice of medication against staphylococcal microorganisms and of good intracellular penetration, applicated parenterally. Only treatment by chloramphenicol after previous surgical drainage of the abscesses led to a dramatic clinical improvement and regression of the liver abscesses. The subsequent chemoprophylaxis with trimethoprim/sulfamethoxazole for at lest two years left the patient without clinical symptoms.

[Effects of health and medical undertreatment on the clinical status and social behavior of infants and small children in a Romanian orphanage]. / Auswirkungen von hygienischer und medizinischer Unterversorgung auf den klinischen Zustand und das soziale Verhalten bei Säuglingen und Kleinkindern in einem rumänischen Kinderheim.

The homage of 135 abandoned children in the city of Resita, south west Rumania, has been checked by a medical team from the University of Innsbruck for social, clinical and hyginical situation. The local government had applied for such an investigation. Most of the infections and other diseases are based on a dramatically bad hygienical situation. 52% of checked sera were HIV positiv by RIA and Western Blot, moreover 60% Hepatitis B antigen positiv. We assume a high rate of horizontal transmission of the HIV virus. One of the main clinical symptoms was maternal-deprivation syndrome, with an incidence of 80%. Consequences in personal policy of the homage as well as medical strategies have to follow.

Binocular utilization of monocular cues that are undetectable monocularly.

The latency time of tracking dynamic random-dot stereograms can be shortened by as much as 100 ms when monocular cues are added by introducing a difference in dot density between target and surround. It has been tacitly assumed that perception time will be reduced only if the added monocular cues are above the detection threshold for each eye. However, the experiments reported here clearly show that stereoscopic performance as measured by an eye tracking task can be greatly enhanced by added monocular cues that cannot be detected. Observers were instructed to track a suddenly displaced vertical bar (portrayed as a dynamic random-dot stereogram) while their eye movements were recorded by EOG. The bar had either a given binocular disparity or zero binocular disparity with respect to its surround. For the target with a disparity (in a wide range), the latency time of tracking decreased by more than 30 ms (10%) as density difference increased from 0 to 4%, whereas in the control conditions with no stereoscopic cues (zero disparity) subjects were unable to track the bar at all within that range of density difference. Thus stereopsis is greatly aided by minimal monocular cues that by themselves elude monocular detection.

Vestibular-related neuronal activity in the thalamus of the alert monkey during sinusoidal rotation in the dark.

1. In the alert monkey neuronal activity was recorded in the ventro-posterior nucleus (VP) of the thalamus in the dark during sinusoidal rotation over a frequency range from 0.01-1 Hz. 2. From 57 neurons 38 (67%) were activated with rotation to the ipsilateral side (type I) and 19 (33%) to the contralateral side (type II). The spontaneous activity was low (average 10.1 imp/sec) and irregular. No activity changes were found with eye movements. 3. At 0.2-0.1 Hz neuronal activity showed a phase lead of 10-20 degrees relative to chair velocity. At the lowest frequency (0.01 Hz) the phase lead was only slightly higher (about 30 degrees). Accordingly the decrease in gain was only moderate. 4. At lower frequencies the simultaneously recorded eye movements (nystagmus) showed an increase in phase lead comparable to the values for the neuronal activity in the thalamus. For both neuronal activity in the thalamus and nystagmus a time constant between 25-35 sec was calculated. 5. The data are compared with vestibular nerve and nuclei recordings. It is argued that the time constants of vestibular neurons in the thalamus are very similar to the time constants of neurons in the vestibular nuclei in alert animals.