Development of Healthy Cities networks in Europe

The Healthy Cities network in Europe was inspired by the Ottawa Charter for Health Promotion when it was launched in 1987. The networking process was initiated by the WHO Regional Office for Europe, but developed its own dynamics in different European countries during a time marked by fundamental political transformations in many of the countries of Eastern Europe. The networks then connected with the 'Local Agenda 21' and the 'Sustainable Cities and Towns Campaign' to create a new and broader programmatic agenda at the local level. In particular, the ''Aalborg plus 10 - commitments[quot ]--of local governments in 2004 have the potential to inspire a new phase of participatory and sustainable policies at the level of local communities in Europe. However, the extent to which these initiatives will influence the macro-politics of the European Union towards a proclaimed [quot ]Europe of Citizens[quot ] remains to be watched carefully during the coming years. (AU)

The effect of oxytocin, prostaglandin E2 and acetylsalicylic acid on flow distribution and on the transfer of alanine, glucose and water in isolated perfused guinea pig placentae.

The influence of oxytocin (OXY), sulproston (SUL) and acetylsalicylic acid (ASA) on L-alanine- (ALA), D-glucose- (GLU) or water- (H(2)O) uptake (maternal side) in the isolated perfused guinea pig placenta was investigated. Uptake was measured with a single injection, paired tracer dilution method. 'T50' values were derived from venous concentration curves (extracellular marker) as the distance (sec) between two concentration values at 50 per cent of peak concentration. T50 values were regarded to reflect the change of flow distribution on the maternal side. On average, there was a significant apparent inhibition of GLU uptake (by 27.2 per cent from control values) by OXY as well as of ALA uptake by OXY (26. 0 per cent), by ASA (56.6 per cent), and by SUL (56.7 per cent). The respective mean T50 values decreased significantly in the above groups by 15.9 per cent, 18.7 per cent (ns), 42.2 per cent and 56.7 per cent. However, it was not possible to generate dose-response curves whereas significant correlations of uptake values with T50 values were found. There was no dose-response relationship between T50 values and OXY or ASA concentrations but decreased mean T50 values were found. For SUL a weak correlation of T50 and SUL concentration was found. The r -value of GLU uptake and T50 was 0.57, for H(2)O uptake this value was 0.70, for ALA uptake the r -values were 0.51 (OXY), 0.35 (SUL) and 0.31 (ASA). Correlation of uptake and concentrations were not significant. We conclude that the 'inhibitory' effects of OXY, ASA and probably SUL on placental transfer are unspecific and the consequence of flow shifts from the placental exchange area to the uterine muscle.

[Non-puerperal mastitis: a disease without end? (Results of a long-term study)]. / Mastitis non-puerperalis: Krankheit ohne Ende? (Ergebnisse einer Langzeitbeobachtung).

Recently, the symptomatology and therapy of non-puerperal mastitis (N.P.M.) was investigated in more than 100 patients by Goepel u. Pahnke (1991). Because of the lack of information on the prognosis and rates of recurrence, the situation of our patients was reexamined by questionnaires or telephone calls. We wanted to know, if the recommended long term therapy with bromocriptine (BC) had been completed and which factors would influence the recurrency rates after primary treatment. During continuous observation (82 patients could be evaluated), the shortest disease-free interval was calculated to be 4 months, independent of the kind of therapy, up to 77 months for the greatest interval between primary and secondary manifestation of MNP. The primary recurrence rate during the first three years following primary therapy, was shown to depend on the kind of therapy with a clear advantage for BC therapy. This was also supported by the observation, that the mean disease-free interval was 36 months in case of BC therapy in contrast to 12 months in such patients without long term prolactin-lowering therapy. This advantage for the BC therapy was no longer observed later, if the so-called secondary recurrence rate was investigated. It was somewhat disappointing, that only 20% of the patients were treated further in an adequate manner by BC, and it was also surprising, that maintenance of BC therapy for more than six months had no additional positive effect on the secondary recurrence rate. The best results were obtained in patients with trauma to the mammary gland being responsible for the first N.P.M.(ABSTRACT TRUNCATED AT 250 WORDS)

[Special clinical and follow-up aspects of invasive lobular breast cancer]. / Besonderheiten in Klinik und Verlauf beim invasiven lobulären Mammakarzinom.

We examined 121 invasive lobular breast carcinomas (ILCs) with regard to certain standardised prognosis parameters, such as tumour size, receptor status, histological grading, the presence of lymphangiosis carcinomatosa, and the histological nodal status of the axillae and correlated these findings with follow-up data obtained over a mean period of 65 months. The parameters, tumour size, presence of lymphangiosis carcinomatosa, and nodal status, were found to be correlated and to have a significant influence on the patients' overall survival time, but not on relapse-free survival. Receptor status appeared to have no significant influence on patient survival. However, the incidence of death, owing to tumour-related causes, was higher among patients with receptor-negative tumours than amongst those with receptor-positive carcinomas. In contrast, the histological grading of a tumour appeared to exercise no effect on tumour prognosis. At 30%, the rate of local tumour recurrence at the primary site was markedly higher than for other histological types of breast carcinoma. In nearly one-half (45%) of such relapses, however, further tumour progression did not occur. Most tumours, exhibiting only local recurrence were initially node-negative, whilst those that produced distant metastases later had usually exhibited axillary lymph node metastases at primary therapy. Bilateral carcinomas occurred more frequently (15.6%) than is the case amongst ductal carcinoma. The observed tendency amongst ILCs toward local recurrence and bilateral growth might be accounted for in terms of their high incidence of multicentral tumour growth and associated pre-invasive neoplastic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Managing a high risk pregnancy after liver transplantation from the obstetrician's point of view. A case report]. / Betreuung einer Risikoschwangerschaft nach Lebertransplantation aus der Sicht des Geburtshelfers. Ein Fallbericht.

We report about a pregnancy and obstetrical management of a patient who had undergone a liver transplantation. Following a normal pregnancy, the newborn was born spontaneously in the 39th week of pregnancy. During the pregnancy the CSA blood levels were controlled frequently as well as the fetal development. An amniocentesis for chromosomal analysis, measurement of AFP blood levels, virus diagnostic and a phase III ultrasound diagnostic were performed. Immediately after delivery the baby was examined carefully by a pediatrician. Management of such a risk pregnancy, after organ transplantation, is possible if there is a close interdisciplinary cooperation between obstetricians, pediatricians, transplant surgeons and internal medicine specialist.

[The need for cooperation between the gynecologist and dentist in pregnancy. A study of dental health education in pregnancy]. / Die Notwendigkeit der Zusammenarbeit zwischen Gynäkologe und Zahnarzt in der Schwangerschaft. Eine Studie über die Zahngesundheitserziehung in der Gravidität.

The causes of tooth and gum disorders during pregnancy and possible prevention measures are discussed. The evaluation of a nation-wide survey comprising 700 pregnant women reflects the women's respective scope of knowledge in respect of mouth and tooth hygiene, 357 of the 700 women included in the investigation had no dental treatment in the course of their pregnancy. 57.7% showed incidence of gingivitis during gestation. 70.9% were not instructed regarding mouth and tooth hygiene in the respective period and 81.7% did not receive any written material on this topic. 41.3% of the respondents did not seek information on matters of mouth and tooth hygiene and 44.3% stated that they felt that their knowledge in these matters was sufficient. When questioned about the causes of the bad state of their teeth, 28.4% stated an actual cause (insufficient tooth hygiene, excessive sugar consumption). 262 (37.4%) suffered from morning sickness, 45% of these women (n = 118) stating that they subsequently brushed their teeth. 45.6% used their toothbrush for a period of six months and 67.9% had no knowledge of fluoride treatment. These findings high-light the need for more information for the prevention of tooth decay and more information on mouth and tooth hygiene during pregnancy. It is suggested to supplement pregnancy guidelines by including two visits to the dentist as an integral part of antenatal checkups.

[Successful therapy of nonpuerperal mastitis--already routine or still a rarity?]. / Erfolgreiche Therapie der Mastitis nonpuerperalis--schon routine oder noch Rarität?

The data from 102 patients with an average age of 36 +/- 14.4 years, who underwent treatment for nonpuerperal mastitis (NPM) were examined. After a definite diagnosis had been made, the patients were treated with a prolactin inhibitor either on its own, or in combination with antibiotics. In 34.1% of the patients, the abscess was either opened or tumour remnants were exstirpated. 51.9% of the patients acquired the disease between the ages of 18 and 40 years. In 62.7%, it was the first incidence of NPM. 86.3% had a previous history of other mammary disorders, e.g. mastodyny or macromasty. 55.9% were prone to irregular menstruation and 50% showed incidence of disorders of the thyroid gland. The characteristic clinical signs were reddening, infiltration, enlarged lymph nodes and in 37.5% of the patients a primary abscess. 75% of the patients, who underwent thermographic scanning, showed incidence of hot spots and 71.7% of the patients, who underwent a mammography, presented pathological results. 63% of the 54 patients, exclusively treated with antibiotics, showed incidence of abscesses as opposed to only 25% of the 48 patients treated with bromocriptin. In the first group, the overall rate of cure was 29.6% compared to 93.7% among those patients, treated with bromocriptin. An exact anamnesis highlights the pathophysiological mechanisms, that most probably leads to the disease. In 13.7%, a suspected inflammatory mammary carcinoma required a histological investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pregnancy following organ transplantation]. / Schwangerschaften nach Organtransplantation.

In 17 of 74 patients, in the 20-40 years of age group, who had undergone an organ transplantation (kidney or liver), the course and outcome of pregnancy were evaluated. In three cases, the pregnancies ended in premature miscarriage and in five cases they were terminated for medical reasons. Nine infants were born alive between the 32nd to the 40th week of gestation, six of them spontaneously, three of them by abdominal Caesarean section. One of these infants born in the 32nd week of gestation with a birth weight of 800 grams died on the second day after birth. One infant born in the 33rd week of gestation showed incidence of a persistent ductus arteriosis Botalli. Four of the nine newborns suffered from intrauterine dystrophy. The birth weight of four further infants corresponded to the 10th to 25th percentile. Neither the incidence of a maternal varicella zoster infection in the early stages of pregnancy nor the reactivation of a herpes simplex (HSV) and cytomegalia virus infection during the pregnancy resulted in any perceptible damage to the infant or transplant. During pregnancy, three of the mothers were treated with immunosuppressants, either with a combination of azathioprine and prednisone (conventional) or cyclosporine (CSA) and prednisone, or with a combination of all three drugs (triple therapy). As opposed to the newborn of those mothers, who had been treated conventionally, the newborn of those treated with CSA showed post partum a tendency towards hypocalcaemia. Two of the mothers gave birth to their infants outside the Federal Republic of Germany.(ABSTRACT TRUNCATED AT 250 WORDS)

High-risk pregnancies and amniotic fluid isoamylase activity.

A kinetic test (Phadebas) was employed to determine the isoamylase activity in 77 amniotic fluid samples taken from a total of 60 high-risk pregnancies at different gestational ages. It was ascertained that in high-risk pregnancies the s-type isoamylase level frequently deviates from the common scatter range of the respective week of gestation. The measured activity of the s-type isoamylase is subsequently set in relation to the pre- and postnatal state of the newborn. The findings support the assumption that in addition to ultrasound, hormone determination and cardiotocography, the estimation of s-type amylase activity in amniotic fluid may serve as an index for fetal well-being. A reduced secretion of the parotid gland as a result of fetal stress is discussed as a possible cause of the ascertained enzymatic changes in the amniotic fluid.

Endocrine profiles and luteal function during GnRH-analogue/HMG therapy.

We have found a significant improvement of pregnancy rates after pretreatment with an agonist of gonadotrophin releasing hormone (GnRH-a). The pregnancy rate in patients treated with HMG/HCG was 17% per patient and 5.5% per cycle, in patients treated with buserelin, 25% per patient and 15% per cycle and in the triptorelin group 25% per patient and 22% per cycle. From 740 HMG/HCG cycles without GnRH-a only 66% were sufficient according to the analytical data. In 16% we found a premature LH discharge and in 18% an irregular LH fluctuation during stimulation. It is clear that gonadotrophin stimulation during pituitary suppression provokes a more intense ovarian reaction with respect to the number of follicles, as well as the endocrine activity. There are also some important practical advantages: ovarian stimulation can be started without any respect to a definite time of menstruation or of the cycle. Of further importance is the much greater flexibility in the timing of HCG administration. Finally, it will be favourable for all patients who need ovulation induction, especially for oocyte retrieval for IVF or GIFT, because no cycle has to be cancelled.

[Prognostic factors in medullary breast cancer]. / Prognostische Faktoren beim medullären Mammakarzinom.

In 55 patients with medullary carcinoma of the breast follow-up data over an average period of 68.1 +/- 35.3 months were recorded. The histological slides of all tumors were retrospectively classified according to the same criteria. The parameters registered were: tumor-size, histological grading, receptor status, necrosis of tumor tissue, cellularity of the stroma, status of axillary nodes, reactive changes of axillary nodes and tumor invasion of lymphatic vessels. The importance of each parameter registered for disease-free survival and overall survival was calculated statistically using the log-rank-test. Of all parameters, only the nodal status of the axilla proved prognostically significant. Metastases of axillary nodes were demonstrable in only 31% of all MC. The incidence of nodal involvement proved to be less than in non medullary breast cancers. In 15 (27.3%) of the patients, progression of the tumor occurred. All women with distant metastases i.e. 12 (21.8%) died of the disease, whereas patients with only local recurrence of breast cancer are still alive. 72.7% of the patients showed relapse-free survival. Other parameters of proven prognostic value in breast cancers like receptor status and histological grading were of no relevance to the survival in MC. Prediction of prognosis depends on the correct classification of the tumor subgroup according to strict microscopical and macroscopical criteria.

Amniotic fluid isoamylase activity in uneventful pregnancies.

A kinetic test (Phadebas) was used to determine the isoamylase activity in 50 serum specimens and 159 samples of amniotic fluid. A highly significant difference between the isoamylase patterns of serum and amniotic fluid was ascertained which strongly supports the view that amylase activity in amniotic fluid is not of maternal origin. During the whole course of gestation the activity of pancreatic isoamylase was constantly low whereas there was an increase of nonpancreatic activity (S-type amylase) from 44 +/- 10 U/l in the 18th week of gestation to 445 +/- 170 U/l in week 39/40. A comparison between the dispersion of the ascertained values and the lecithin-sphingomyelin (L/S) ratio showed a clear overlapping. There was a correlation coefficient of r = 0.645 for 115 amniotic fluid specimens examined in our investigation. The findings show that the estimation of nonpancreatic isoamylase (S-type amylase) activity in amniotic fluid is a valuable indirect parameter for determining fetal maturity and fetal lung maturity. The easy and quick determination method will provide even those hospitals with an index of fetal maturity which are presently not in a position to estimate the L/S ratio, thus being of great assistance in the field of premature deliveries.

Premature labor contractions and the value of serum ferritin during pregnancy.

In general, the diagnosis of pregnancy-related anemia relies on the estimation of the hemoglobin level. The findings of this study suggest that the additional estimation of serum ferritin - a reliable index of the iron stores - can improve the diagnosis of anemia. Hematological data of 150 pregnant women were retrospectively related to the courses of pregnancy, in particular to the incidence of premature labor contractions. 70% of the pregnant women included in the investigation had a serum ferritin value below 20 micrograms/l and thus iron deficiency. If the hemoglobin value alone had been estimated, 50.6% of the women with iron deficiency (serum ferritin less than 20 micrograms/l) would not have been detected among those pregnant women with a hemoglobin value of more than 11 g/dl. These findings are also of particular relevance as a significant correlation has been found between the incidence of premature labor contractions and the serum ferritin level: only 11% of the pregnant women investigated whose serum ferritin values exceeded 20 micrograms/l had premature labor contractions, whereas premature labor was recorded in 48% of the pregnant women with serum ferritin values below 10 micrograms/l.

Anemia, ferritin and preterm labor.

The results of this study suggest that the additional determination of serum ferritin in pregnancy is necessary for a more reliable classification of iron deficiency. In 300 pregnant women the hematological values (Hb, MCH and serum ferritin) were determined toward the end of gestation. In 36 per cent of the women both Hb values greater than 11 g/dl and MCH values less than 28 pg fail to give evidence of an existing iron deficiency, indicated by serum ferritin values below 20 micrograms/l. The determination of serum ferritin is of particular relevance as a significant correlation was ascertained between low serum ferritin levels and the incidence of preterm labor: 52.3% of the women with serum ferritin levels below 10 micrograms/l and only 9.5% of the women with serum ferritin levels above 20 micrograms/l went into preterm labor. A convincing explanation for this has not yet been found.

[Locoregional breast cancer recurrence. Treatment following exclusively local therapy]. / Lokoregionäres Mammakarzinomrezidiv. Behandlung nach ausschliesslicher lokaler Therapie.

In 58 out of 515 patients with a primary carcinoma of the breast there was local-regional recurrence. Treatment consisted in generous excision and local radiation (50-60 Gy). After a mean observation period of 65.4 +/- 22.2 months, distant metastasization was found to have occurred in 22 patients (37.9%). Of the other 36 patients 23 (39.7%) had suffered no further recurrence at the end of this time, while 13 patients (22.4%) had a new local-regional recurrence. In a retrospective study a variety of parameters of prognosis were investigated in order to determine to their predictive value. It was found that there were significant differences in overall survival rates with tumors of histological differentiation stage I as compared to tumors of differentiation stages II and III (p = 0.003). There were no differences in the recurrence-free interval (p = 0.34). The presence or respectively lack of steroid receptors in the primary tumor made no significant differences to the recurrence-free interval and the survival rates. Those of the patients on whom this study was based whose axillary nodal status was N+ had received (adjuvant) treatment with cytostatics. This resulted in no differences in the recurrence-free interval (p = 0.28) or the overall survival rates (p = 0.3) when the N+ and N- patients were compared. The therapeutic conclusion drawn from these results is that breast carcinoma patients with an exclusively local-regional recurrence should initially receive local treatment only; systemic therapy should be reserved for the generalization stage.

[Is amniotic fluid prolactin an osmoregulatory hormone of clinical importance?]. / Fruchtwasser-Prolaktin, ein osmoregulatorisches Hormon mit klinischer Bedeutung?

The present paper reports on the amniotic fluid prolactin concentrations in 61 pregnancies with undisturbed amniotic fluid volume from the 17th to the 41st week of pregnancy. The amniotic fluid prolactin concentrations reach a peak in the 19th week of pregnancy with a slight decrease to the 21st week. After a plateau from the 23rd to the 31st week of pregnancy, prolactin concentrations decrease to very low levels in late gestation. In pregnancies with disturbed amniotic fluid volume the prolactin concentrations are pathologically changed in comparison with "normal" pregnancies. The authors conclude that the amniotic fluid prolactin concentrations have a characteristic profile depending on the stage of pregnancy. From the pathologic prolactin concentrations in patients with hydramnios and otherwise pathologic pregnancies it may be concluded that prolactin is a clinically relevant osmoregulatory hormone for humans too.

[Importance of clinically prognostic factors in the treatment of advanced ovarian carcinoma]. / Die Bedeutung klinisch-prognostischer Faktoren für die Behandlung fortgeschrittener Ovarialkarzinome.

25 patients with stage III and IV ovarian carcinoma were treated with radical surgery and postoperative chemotherapy. Analysis of the disease-free intervals and the survival rates indicated significant differences related to the stage of the disease. Furthermore patients with minimal residual disease (tumor mass less than 2 cm in diameter) had a far better prognosis than patients with extensive residual disease (greater than 3 cm). No correlation could be demonstrated between histological grading, in vitro proliferation rates, hormone receptor status, type of postoperative chemotherapy and survival rates.