Low body weight in male children and adolescents with schizoid personality disorder or Asperger's disorder.

This study explored the hypothesis that body weight is reduced in male children and adolescents with schizoid personality disorder or Asperger's disorder. The body weights of 33 consecutively admitted male subjects with one of these disorders were retrospectively assessed with percentiles for the body mass index (BMI). The mean percentile (+/- SD) for the BMI was 31.6 +/- 27.6 and differed significantly from the expected value of 50 (P<0.001). Ten subjects had a BMI of < or = 10th age percentile. Post hoc comparisons revealed that BMI percentiles were (a) reduced to a similar extent in patients with schizoid personality disorder and Asperger's disorder and (b) reduced to a greater extent in patients with abnormal eating behaviour. During childhood and adolescence both diagnoses are associated with an increased risk of being underweight. Population-based BMI percentiles are useful for detecting associations between specific psychopathological syndromes and body weight.

Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral.

OBJECTIVE: The authors investigated the hypothesis that in acute anorexia nervosa a low body weight predicts a poor weight prognosis for the future. METHOD: The body mass indexes at referral of 272 female patients were examined in relation to the body mass indexes of these patients after a mean follow-up of 9.5 years. RESULTS: The overall correlation between body mass indexes at referral and at follow-up was r = 0.33. Despite this low correlation, the 100 patients with body mass indexes less than 13 kg/m2 at referral had low weights at long-term follow-up. Eleven of the 12 deceased patients were among these 100 patients, as were 24 of the 46 surviving patients whose body mass indexes were 17.5 kg/m2 or less at follow-up. CONCLUSIONS: For patients with anorexia nervosa, a body mass index less than 13 kg/m2 at referral indicates a substantial risk for chronic anorexia nervosa and death related to emaciation.

Significant weight gains in a clinical sample of obese children and adolescents between 1985 and 1995.

OBJECTIVE: Within the past decades prevalence rates for obesity among children and adolescents have increased in different populations. The hypothesis of this study is that the degree of adiposity in clinical study cohorts of extremely obese children and adolescents increased within the past decade. DESIGN: In six different study cohorts of the time period from 1985-1995 body mass indices (BMIs) of obese children and adolescents who were treated as inpatients at a specialized children's hospital were evaluated. For this purpose body heights, body weights, ages and sex of all inpatients of three referring agencies were retrospectively assessed biannually. RESULTS: In these six cohorts a significant BMI-increase from 1985-1995 of 1.9 kg/m2 (P < 0.0001) for constant sex, age and referring agencies was found: Comparisons of the quartiles and the ninth decline in both sexes did not show any systematic increase at the first quartile. In contrast, BMI-increases at the ninth decile were approximately 5 kg/m2 for males and 2.5 kg/m2 for females. CONCLUSION: Within the decade studied a significant BMI-increase was detectable in this clinical population. This effect is especially discernible in the most extreme weight groups and in males.

Body weight in acute anorexia nervosa and at follow-up assessed with percentiles for the body mass index: implications of a low body weight at referral.

OBJECTIVE: A systematic epidemiological comparison of body weights of patients with anorexia nervosa can be enhanced by the use of age percentiles for the body mass index. METHOD: To demonstrate the feasibility of this approach, body mass indices of 81 female adolescents with anorexia nervosa were calculated from anthropometric data upon admission for inpatient treatment and at follow-up and set into relationship to the age-dependent distribution of the body mass index in a large and representative sample of the German population. The percentiles were used to visualize the weight increase over time of each former patient by aligning the body mass index at referral with the respective body mass index at follow-up. RESULTS: Upon admission most adolescents had body mass indices below the third age centile. The distribution of body mass indices at outcome suggests a continuum between death of complications related to starvation, chronic anorexia, residual anorexia, and a low body weight Patients with very low body weights at referral had a poor prognosis, because their body weights tended to remain below the minimal normal weight for height. These conditions were statistically best described by categorical analysis, because they were nonlinear to a certain extent. DISCUSSION: The results indicate that the body mass index at referral influences the amount of weight that an individual patient gains in the future.

Use of percentiles for the body mass index in anorexia nervosa: diagnostic, epidemiological, and therapeutic considerations.

OBJECTIVE: Percentiles for the body mass index (BMI) offer a possibility to epidemiologically assess the linear weight criterion of 85% average body weight commonly used for the diagnosis of anorexia nervosa. METHOD: BMI values corresponding to 85% average body weight were calculated and assessed with percentiles derived from epidemiological studies in both the United States and Germany. The underweight range was characterized epidemiologically. RESULTS: The weight criterion used for the diagnosis of anorexia nervosa corresponds to BMI values between the 5th and 10th centiles in both populations. In epidemiological terms the lowest BMI values in individuals aged 10 years and older occur during adolescence. In the general population BMI values <16 kg/m2 are rarely observed. Upon the use of higher BMI cutoffs in the underweight range females clearly predominate. The BMI increase associated with the 5th or 10th centile in the age range between 18 and 30 years is quite low suggesting that many underweight females in the general population gain only minimal weight during this age span. DISCUSSION: The diagnostic, epidemiological, and therapeutic implications for anorexia nervosa are discussed.

Peptic ulcer disease, irritable bowel syndrome and constipation in two populations in Iran.

OBJECTIVE: To determine the prevalence of peptic ulcer disease, irritable bowel syndrome (IBS) and chronic constipation in two Iranian populations (pastoral nomads and industrial labourers) with different life styles, and to evaluate the risk factors associated with these diseases. SUBJECTS: A total of 455 randomly selected pastoral nomads and 492 industrial labourers (all male) aged between 35-55 years. METHODS: Demographic and social data were obtained by interviews. An upper gastrointestinal tract endoscopy was performed and biopsy specimens were taken from subjects complaining of abdominal symptoms and randomly selected asymptomatic subjects. A urease test was performed on antral specimens. Serum pepsinogen I concentrations and Helicobacter pylori antibody titres were measured by radioimmunoassay and immunoglobulin (Ig) G enzyme-linked immunosorbent assay tests, respectively. RESULTS: Serum pepsinogen I concentrations were similar in both nomads and industrial labourers, and the percentage with positive antibody titres for H. pylori was high in both populations (86.3 and 91% in nomads and industrial labourers, respectively). Industrial labourers were twice as likely to have duodenal ulcer (P < 0.05) than nomads. The prevalence of duodenal ulcer disease and gastric ulcer was 4.6 and 0.6% in nomads and 10.3 and 0.4% in industrial labourers, respectively. The prevalence of IBS was similar in nomads (3.1%) and industrial labourers (3.6%). Fewer nomads (1.4%) than industrial labourers (3.3%) had chronic constipation. Logistic regression analysis showed that being an industrial labourer, or smoker and having undergone previous non-gastric surgery were risk factors for duodenal ulcer disease. When the variable 'urease test' was included in the logistic regression analysis, smoking, a positive urease test and the quantity of fruit eaten per week were associated risk factors. The risk factors associated with IBS were the use of analgesics and back pain. The only risk factor associated with chronic constipation was being an industrial labourer. CONCLUSIONS: Industrial labourers were twice as likely to have duodenal ulcer disease as nomads. The prevalence of IBS and chronic constipation in the two male Iranian populations was lower than that found in western countries. Duodenal ulcer disease was associated with H. pylori colonization but not with a positive serum antibody titre for H. pylori. H. pylori colonization of the antral mucosa and smoking are causative factors for duodenal ulcer disease and fruit intake is possibly an associated factor.

[Cement-free cup and cemented shaft--concept of a hybrid solution and results of a 3-to-6-year clinical experience]. / Zementfreie Pfanne und zementierter Schaft--Konzept einer "Hybrid-Lösung" sowie Ergebnisse einer drei- bis sechsjährigen klinischen Erfahrung.

Report about the Marburg Hybrid THA using a cementless cup and a cemented stem. The acetabular component consists of an hemispheric inner polyethylene cup and an outer five-layer sintered titanium wire mesh fused together. The socket is primarily anchored by one peg as well as 2 self-stabilizing titanium nails. The forged titanium alloy stems are meeting all the requirements of the latest biomechanic research. A total of 292 Hybrid THA were implanted in 273 patients from 1. 8. 1986 to 1. 1. 1989. 6 patients (2.1%) had to undergo THA exchange surgery (1 early, 3 late infections, 1 acetabular fracture after fall, 1 loosened stem). The clinical data of 62 patients (21.2%) had to be disregarded for various reasons. Thus the data of 212 (72.6%) implanted THA in 194 patients were analyzed. 204 of the analyzed THA (96.2%) judged the result of the operation as good or very good. Radiolucency at the bone-titanium-interface of the cementless cups was present in 60 of 212 cases (28.3%), in revision operations twice as often as in primary implantations. There were no signs of progression. Radiolucency at the bone-cement-interface of the cemented stems was present in 27 of 212 cases (12.8%), with radiolucencies > 1 mm only occurring in area 7 of Gruen (1979). The overall results are thus very promising and support the concept of a hybrid solution for THA.

Morphological predictors of survival in early and advanced gastric carcinoma.

In 351 patients with gastric carcinomas resected for cure, the relationship between macroscopic and microscopic features and survival was studied by univariate and multivariate analyses. In the multivariate survival analysis with covariates according to the Cox regression model, in early cancer all significant correlations to survival rate are covered by the stage grouping according to the UICC schedule of 1987. In advanced gastric carcinoma the UICC stage and, in addition, the Borrmann type and the intensity of cellular infiltration are effective. By additional consideration of these two variables an extended pathological staging schedule is proposed. It has the advantage of better discrimination between patients who differ in prognosis and seems to improve the prognostic prediction of outcome. Testing of this extended staging system in larger collectives is recommended.

[Changes in the ileal mucosa in Crohn disease. Endoscopic and histologic study]. / Veränderungen der Ileumschleimhaut beim Morbus Crohn. Endoskopische und histologische Untersuchung.

In 383 patients, suffering from Crohn's disease, ileum was studied both endoscopically and histologically. In patients without surgical interventions (n = 207), endoscopic lesions were observed in 69%, histologic lesions in 74%. Most numerous endoscopic lesions were redness (51%), vulnerability (29%) and ulcer (27%), most frequent histologic lesions discontinuous infiltration (30%) and ulcer (30%). In patients, operated on, endoscopic and histologic lesions were found more often in the ileal region, near to anastomosis than in the more proximal ileum. Overall, the endoscopic and histologic appearance of the distal segment of the ileum widely corresponded to that of the terminal ileum in patients without surgery. Several endoscopic parameters were correlated to histologic variables, but overall the correlation was low (maximal correlation coefficient 0.34). Granulomas were present in 7.4% of the biopsies and 9.1% of the patients. The occurrence was significantly correlated to the endoscopic variables cobblestone appearance and ulcer as well as to the histologic variables density of infiltration, ulcer, and activity of inflammation. In conservatively treated patients, the incidence of mucosal vulnerability, and cobblestone appearance significantly declined in long standing disease, the incidence of stenosis increased. In patients operated on, aphthous lesions and ulcers increased in longstanding disease.

Does quantitative histology of rectal biopsy improve the differential diagnosis of Crohn's disease and ulcerative colitis in adults?

The aim of this study was to clear up, whether in adults morphometric investigation of rectal biopsies could improve the differential diagnosis of Crohn's disease and ulcerative colitis. Rectal biopsies were available of 63 normal controls, of 65 patients suffering from Crohn's disease and 72 patients with ulcerative colitis. The serially cut biopsies were investigated histologically both by morphometric methods and by subjective rules of daily practice in five randomly chosen sections. The data were evaluated by multivariate discriminate analysis. Morphometric analysis on the basis of 16 variables brought a significantly better discrimination between Crohn's disease and ulcerative colitis than evaluation by means of 5 criteria of conventional daily routine. This improved discrimination, however, is at least partially produced by incidental variations between the subsets under study. Therefore, the functions of our multivariate discriminate analyses cannot be used for differentiation of chronic inflammatory bowel disease in daily routine. But the variables, most effective in these analyses, may be helpful for valid discrimination of Crohn's disease and ulcerative colitis in adults. These variables are "deformation of crypt", "stromal fibrosis" and "number of eosinophils".

Morphological predictors of survival in colorectal carcinoma: univariate and multivariate analysis.

In 150 curative resected adenocarcinomas of the large bowel we analyzed the morphological parameters of the primary tumor and lymph node involvement which most efficiently expressed the relationship to survival time. Using univariate survival analysis (product limit estimator according Kaplan-Meier), several macroscopical and microscopical parameters of the primary tumor and lymph node involvement significantly correlated with survival time. A multivariate survival analysis of covariates according to the Cox regression model revealed that the significant correlations of all these parameters were expressed by a set of five variables: pT stage, number of inflammatory cells, sex, age, and pN stage. As shown by the Kaplan-Meier test, this set of variables allowed a more precise prediction of survival time than mere staging according to the TNM system. Parametric multiple stepwise survival analysis was inefficient. No distinct relationship was found between the morphology of the primary tumor and the involvement of lymph nodes.

Morphological predictors of survival in advanced gastric carcinoma univariate and multivariate analysis.

In 76 curative resected advanced gastric carcinomas, the relationships between macro- and microscopy of the carcinoma and the survival rate were studied by univariate and multivariate survival analyses. In the Kaplan-Meier survival analysis (product limit estimator), significant influence on survival rate was found for tumor size, Laurén type, number of lymphocytes, tumor fibrosis, and N stage. In the multivariate survival analysis of covariates according to the Cox regression model, in macroscopically evaluable variables the tumor size was effective, in bioptically evaluable variables the number of plasma cells and the histological type. Concerning the primary tumor, the same set of variables presents significant correlations to survival time. Adding the involvement of lymph nodes, Laurén type, and N stage express all significant correlations of the tumor to survival rate. In parametric multivariate stepwise regression analyses of survival time, all variables working in the Cox proportional hazard model were very ineffective. But adaption of the Kaplan-Meier test to the effective variables of multivariate survival analysis elucidates the tight relationships between survival rate and these variables. No distinct relationships are present between variables of primary tumor and presence of lymph nodes metastases or N stage respectively.

Comparative radiological and morphological study of human pancreas. Pancreatitis like changes in postmortem ductograms and their morphological pattern. Possible implication for ERCP.

A postmortem study by ductography and histology was performed on 69 human pancreata with no clinical or histological signs of chronic pancreatitis. The ductograms, supplemented by five postmortem ductograms of chronic pancreatitis, were independently evaluated by six clinicians, skilled in ERCP; the degree of alteration was estimated by simple rating, forced choice rating, and by determination of the grade of chronic pancreatitis, Histologically, the amount of intraductal epithelial proliferation, periductal, intralobular and perilobular fibrosis, intraductal protein plugs, and fat necrosis was determined by semiquantitative methods. The six ductographical evaluations significantly differed in the level of their data, but corresponded in the range of distribution. All evaluations were correct regarding judgement of ductograms from patients with chronic pancreatitis. Ductograms of patients without chronic pancreatitis, however, were also frequently classified as chronic pancreatitis; overall 81% (minimal 37%, moderate 33%, severe 11%). This high level of false positive diagnosis indicates the frequency of pancreatitis like lesions in the main duct and its side branches in patients without chronic pancreatitis. Ductal lesions were significantly correlated with perilobular fibrosis. This finding favours the assumption, that in the non-inflamed pancreas, perilobular fibrosis plays a key-role in the development of ductal alterations, as in chronic pancreatitis. Perilobular fibrosis may result from intralobular inflammation caused by age-dependent intraductal epithelial hyperplasia.

Relationships between clinical data and histology of the large bowel in Crohn's disease and ulcerative colitis.

Histologic changes of rectal biopsies were compared with clinical data in 83 patients suffering from Crohn's disease, 78 patients with ulcerative colitis, and 87 normal controls. Additionally, colonic biopsies were studied in 82 Crohn's disease patients. The biopsies were cut in serial sections and examined by quantitative and semiquantitative methods, determining changes of superficial epithelium, crypts, stroma, and submucosa. The statistical evaluation was performed by univariate and multivariate analyses. In normal controls, 2.6 percent of the correlations existing between histologic and clinical data were significant; in rectal biopsies of Crohn's disease 8.9 percent, in colonic biopsies of Crohn's disease 6.7 percent, and in ulcerative colitis 10.4 percent. Multiple stepwise regression analyses revealed a distinct predictive value of histology of rectal biopsies for the clinical activity index according to Best et al. in Crohn's disease. Most effective histologic changes were content of goblet cells and acute inflammatory lesions. In colonic biopsies, significant predictive values were found for diarrhea, anal fissures, and meteorism. Most effective variables in prediction of diarrhea were granuloma and eosinophilic and histiocytic infiltration; in prediction of anal fissures increased basophilia of epithelium and leukocytic infiltration of crypts; in prediction of meteorism increased basophilia of epithelium and hyperemia. In ulcerative colitis, significant predictive values were present for activity of disease on colonoscopy and the blood content of thrombocytes. Most effective variables in the prediction of colonoscopically determined activity were histiocytic and neutrophilic infiltration, height of the cryptal epithelium, and cryptal distance; in the prediction of thrombocytic values cryptal length, cryptal distance, and plasmacellular infiltration. In normal controls, no consistent predictive value of histology was found. Though each multivariate statistical method depends on the underlying sample, at least the first variables entering the multiple regression analyses are of high value in the estimation of clinical parameters by morphologic methods. Thus, the study elucidates the high value of rectal biopsies in estimating the activity of illness, both in Crohn's disease and in ulcerative colitis.

[Studies of lipase-induced fat necrosis in rats (author's transl)]. / Untersuchungen zur lipaseinduzierten Fettgewebsnekrose bei der Ratte.

Disseminated fat necrosis can be produced by intraperitoneal injection of porcine pancreatic lipase. They get detecable by intravital staining with Phosphine 3R about 15 min after injection. The earliest fine structural findings are spotty destruction of the pinocytic invaginations and vesicles, combined with alterations of the cell membrane. Later there is a complete destruction and disintegration of the cytoplasm and its organels as well as the nucleus, whereas the cell membrane partly remains visible. At the same time the central lipid droplet shows cloudy disintegration and clumping as well as cristalline and granular structures. In the beginning the necrosis is limited to single cells. Later the adjacent fat cells also undergo necrosis, even when the applicated lipase has been removed after 30 min. In light microscopic studies fat necrosis are detectable 30 min after the application of lipase. During the first 48 hours they get demarcated by leucocytes. In the following days resorption and organisation take place. Lipolytic drugs facilitate the development of fat necrosis, whereas antilipolytic drugs inhibit it. In starvation the number of fat necrosis rises, after feeding it decreases. In the diurnal rhythm there is a maximum after midnight and a minimum in the early afternoon. The results support the hypothesis that pancreatic lipase only attacks fat cells, which are lipolytically active.

On the occurrence of sphaeridia in basalioma cells and the basal cells of the overlying epidermis.

302 nuclear sections of basalioma cells, 145 nuclear sections of the basal cells of the epidermis above the tumor, and 177 nuclear sections of the basal cells of normal epidermis were investigated and statistically evaluated with the aim of determining the presence of sphaeridia occur significantly more frequently in the basal cells of the epidermis above the tumor and in normal epidermis than in the tumor itself. These findings are discussed in connection with the degree of cellular protein synthesis.