[Infusion-associated kidney and liver failure in undiagnosed hereditary fructose intolerance]. / Infusionsbedingtes Nieren- und Leberversagen bei undiagnostizierter hereditärer Fructose-Intoleranz.

Appendectomy was performed in a 14 1/2-year-old boy with undiagnosed hereditary fructose intolerance because of chronic recurrent abdominal pain. During and after operation fructose containing solutions were infused. The patient received a total of 250 g fructose intravenously over 30 hours. Hours after onset of infusion he became soporous, hypoglycaemic and acidotic and was anuric after one day. Although the diagnosis was suspected by the end of the first postoperative day and fructose had been cancelled and haemodialysis been started, the boy died after a further 3 days with signs of acute kidney and liver failure. The diagnosis of hereditary fructose intolerance was biochemically established in post mortem liver tissue. This case recalls the fact that fructose, sorbitol or invert sugars should not be added to infusion solutions as they may be toxic for healthy persons and imply a lethal risk for patients with undiagnosed hereditary fructose intolerance, even well beyond the baby and infant period.

[Enuresis aetological approaches and therapeutic strategies (author's transl)]. / Enuresis. Atiologische Vorstellungen und therapeutische Möglichkeiten.

Enuresis is a frequent disease in childhood--entailing personal misery, shame, and discredit for the children concerned as well as irritation and a bigger workload for the responsible adults. Parents and teachers often tend to react to this uncontrolled urinating as to a personal provocation. The following study is meant to summarize different aetiological approaches from which therapeutic strategies are derived and classified according to pragmatic considerations. By resorting to common psychotherapeutic methods pediatricians can successfully treat 2/3--3/4 of all cases.

Cancer mortality in Württemberg, 1910 and 1970.

The results of a special survey of cancer mortality statistics in selected areas of the Ober- and Unterland of Württemberg in the period 1908--1912 were compared with the official mortality statistics of the same region for 1969--1972. In the Oberland, formerly part of an area of high cancer mortality comprising the adjacent regions of Bavaria, Austria, Switzerland, and Baden, the overall cancer mortality showed a marked fall in both sexes. In the Unterland, where cancer mortality was previously low, the overall death rate increased in men and did not change in women. These variations are largely accounted for by changes in mortality from cancer of the stomach and bronchus. The death rates from gastric cancer observed around 1900 in the Oberland of Württemberg and adjacent regions of the neighbouring countries are among the highest recorded even in the world. Since the fall of gastric cancer noted is very marked and this disease is still the leading cause of death from cancer today, the Oberland of Württemberg seems to be uniquely suited for the search of environmental factors which associate with this decline. In theremainder of cancer sites changes over time were less striking and/or observed already in other countries.