[Is hip sonography meaningful as a screening method?]. / Ist die Hüftsonographie als Screeninguntersuchung sinnvoll?

The results of screening 162 non-selected neonates by sonography of the hips indicate that this is not a desirable screening method. Sonography is, however, indicted in neonatal groups which are considered to be at risk.

[Growth curves as a screening instrument--possibilities and limits]. / Wachstumskurven als Screeninginstrument--Möglichkeiten und Grenzen.

The application of growth charts as screening tools for children is a commonplace. Growth charts published during the past 15 years in Germany are now under debate with respect to their validity. An analysis of the problems related to growth curves gave the following results: A clear, sharp boundary between normal and non-normal permitting reliable grouping of children does not exist. Due to the heterogeneity of the population of children coming for screening, the call for an allround optimal and representative growth-curve remains wishful thinking. The growth charts so far published, show marked differences in the course of the percentile lines. The discrepancies can be explained by different sample sizes and algorithms of calculation. In the example of the longitudinal Zurich growth study on normal children it can be demonstrated, that the change between percentile ranges during the initial 4 years of life often considered to be pathological occurs in almost 50% of the probands. By conservative interpretation all growth charts can be used, because only with rare exceptions the diagnosis of growth disorders will be solely based on the measurement of tallness and its comparison to percentile values. As a rule: The grouping of a child as having non-normal growth is the result of multiparametric medical considerations.

[First examination of neonates. Results of early diagnostic documentation]. / Die Neugeborenen-Erstuntersuchung. Ergebnisse aus der Früherkennungsdokumentation.

There is an annual statistical evaluation of documentation, done since 1971, of an early disease diagnosis programme for children. At first examination of neonates in the years 1977-1981, sex-specific difference was low as regards data on pregnancies at risk, but definite and constant differences were recorded as regards psychic and social stress during pregnancy. Pregnancies at risk without any special features at birth were registered in 12.5%. In 58.4% of newborns no special features with regard to pregnancy or birth were recorded. In contrast to all other markers, final pelvic position was more frequent for girls than boys. The proportion of operative obstetric procedures has slowly fallen from 1977 to 1981. Cesarean section has recently been practised in 12.4%. With regard to birth weight of children, the documentation revealed a difference from the Federal Statistical Office, which showed a higher number of low-birth weight new-borns. Comparing the results with those of other German or foreign statistics, there is a strikingly high frequency of cesarean section in the Federal Republic of Germany.

[Early detection program for children in West Germany]. / Das Früherkennungsprogramm für Kinder in der Bundesrepublik Deutschland.

Programs for early detection of diseases and developmental disorders during childhood, in order to prevent or to diminish permanent health damages, have a long history. The Federal Republic of Germany started in 1970 a legal screening program, in order to make such a service available to all children in the whole nation. The program consists of eight examinations, beginning at birth and spread over the first four years of life. Even by satisfactory participation a number of weaknesses, down-grading effectivity and efficiency, can be found. Overdiagnosis as well as missed cases do occur. A number of examples will serve to demonstrate shortcomings and possible causes thereof. From these, suggestions for improved strategies will be derived. The proposals include even those for improved monitoring of effectivity and efficiency, which should be already an integral part at the very beginning of every screening program.

Liver lectins: mediators for metastases?

Development of liver metastases in 1542 cancer patients was investigated. It was found that in certain liver diseases the incidence of liver metastases was reduced compared to that in cancer patients with otherwise normal livers. We propose that this reduction may be due to a reduced function of the liver-specific lectins.

[Significance of longitudinal analysis for the evaluation of early detection studies in childhood]. / Die Bedeutung der Längsschnittauswertung für die Evaluation der Früherkennungs-Untersuchungen im Kindesalter.

In 1971, the first preventive examination programme for children up to 4 years of age was started in the Federal Republic of Germany; in 1977 followed a completely revised programme. However, even with this altered documentation a longitudinal analysis is not feasible. An effective evaluation should yield the following results: 1. Assessment of the success through differentiated recording of sufficiently early recognized health disorders and treatment effects. 2. Availability of reliable, regional and nation-wide statistics on incidence and prevalence. 3. An estimate of the number of health professionals required. - These aims can be achieved only by a longitudinal record linkage of the data on individuals of a sufficiently large random sample. For this purpose a revised data-sheet is presented. In addition, specific suggestions are made for longitudinal evaluations.

[Postoperative radiotherapy of astrocytomas grade 3 and 4 with the radiosensitizer misonidazole. -End results of a multicentric controlled German study]. / Die postoperative Strahlenbehandlung von Astrozytomen Grad 3 und 4 mit dem Strahlensensibilisator Misonidazol. Endergebnis einer multizentrischen und kontrollierten deutschen Studie.

102 patients entered a multicentric randomized study from May 1978 till December 1980. After an operative removal of a supratentorial astrocytoma grade 3 or 4 all patients were treated by radiotherapy of the whole brain with 40 Gy, and after a rest of 1 to 2 weeks with a boost dose of 20 Gy to the tumor region. By randomization the patients got misonidazole (400 mg/m2) to each of the 30 fractions or a placebo. The overall tolerance was good. A mild transient peripheral neuropathy was seen only in 2 patients. The median of survival time was not significantly different for both groups with 16 months (grade 3) and 10 months (grade 4). Thus a radiosensitizing effect of misonidazole was not proven.