The combined effect of maternal body mass index and smoking status on perinatal outcomes - an analysis of the german perinatal survey.

BACKGROUND: Maternal body mass index (BMI) outside the normal range and smoking are both associated with adverse perinatal outcomes, but their interaction needs further investigation. AIM: The aim of this study was to analyse the combined effects of smoking and BMI on birth weight, preterm birth rate, the somatic development of neonates, and complications of pregnancy. MATERIAL AND METHODS: Data from 508 926 singleton pregnancies from the German Perinatal Survey of 1998-2000 were analysed according to maternal BMI and smoking. RESULTS: Preterm birth rates were higher for non-smoking underweight (8.3%) and obese women (6.7%) than for normal weight (6.0%) or overweight women (5.6%); rates were higher in smokers than in non-smokers for every BMI category. The mean birth weight increased with increasing BMI and was decreased by smoking; it was 2,964 g in underweight smokers and 3,556 g in obese non-smokers. Small for gestational age (SGA) rates were least in obese women and highest in underweight women; large for gestational age (LGA) rates varied in the opposite direction. In smokers SGA rates were higher than in non-smokers for every BMI category and LGA rates were always lower. Hypertension, proteinuria, oedema, and pre-eclampsia/eclampsia were more common as BMI increased but were always lower in smokers. Pre-eclampsia/eclampsia occurred in 0.7% of underweight smokers but in 9.6% of obese non-smokers. CONCLUSIONS: Smoking and low maternal BMI in combination can cause high rates of preterm birth and SGA neonates as well as low mean birth weight. Although smoking offers some apparent benefit regarding LGA rates and pre-eclampsia this should not distract from its overall adverse influence.

Genetic, psychosocial and clinical factors associated with hippocampal volume in the general population.

The hippocampus--crucial for memory formation, recall and mood regulation--is involved in the pathophysiology of dementia and depressive disorders. Recent genome-wide association studies (GWAS) have identified five genetic loci associated with hippocampal volume (HV). Previous studies have described psychosocial and clinical factors (for example, smoking, type 2 diabetes and hypertension) to have an impact on HV. However, the interplay between genetic, psychosocial and clinical factors on the HV remains unclear. Still, it is likely that genetic variants and clinical or psychosocial factors jointly act in modifying HV; it might be possible they even interact. Knowledge of these factors might help to quantify ones individual risk of or rather resilience against HV loss. We investigated subjects (N=2463; 55.7% women; mean age 53 years) from the Study of Health in Pomerania (SHIP-2; SHIP-TREND-0) who underwent whole-body magnetic resonance imaging (MRI) and genotyping. HVs were estimated with FreeSurfer. For optimal nonlinear model fitting, we used regression analyses with restricted cubic splines. Genetic variants and associated psychosocial or clinical factors were jointly assessed for potential two-way interactions. We observed associations between HV and gender (P<0.0001), age (P<0.0001), body height (P<0.0001), education (P=0.0053), smoking (P=0.0058), diastolic blood pressure (P=0.0211), rs7294919 (P=0.0065), rs17178006 (P=0.0002), rs6581612 (P=0.0036), rs6741949 (P=0.0112) and rs7852872 (P=0.0451). In addition, we found three significant interactions: between rs7294919 and smoking (P=0.0473), rs7294919 and diastolic blood pressure (P=0.0447) and between rs7852872 and rs6581612 (P=0.0114). We suggest that these factors might have a role in the individual susceptibility to hippocampus-associated disorders.

[Experiences with hypophyseal adenoma patients]. / Erfahrungen mit Hypophysenadenom-Patienten.

UNLABELLED: The treatment of 126 patients presenting surgically treated and histologically determined suprasellar hypophyseal adenomas is described and the catamnesis followed up in some cases over a period of ten years after the transfrontal operation. Particular value is attached to a comparison of pre- and post-operative disturbances of acuity and field of vision. Moreover, the experience gained in the treatment of the first decade is compared with that of the second decade. CONCLUSIONS: I. The results of the treatment of a hypophyseal adenoma will be the better, the earlier it is detected. Disturbances of the gonadal function in particular can be traced back over many years. When primary or secondary amenorrhoea is present, gynaecologists should more often think of the existence of a hypophyseal adenoma. --2. The restoration of the working capacity of the patients operated on largely depends upon the restitution of the vision and an optimum hormonal substitution according to requirements. Thus, an early recognition of the lesion and the surgical method which must be further improved by employing modern techniques, are decisive.

[The brain abscess today]. / Der Hirnabszess heute.

In spite of refined diagnostic and therapeutic possibilities, the cerebral abscess continues to be a disease involving great risks. A comparison of surgically treated groups of patients of the periods 1954 to 1962 and 1963 to 1977 does not show any reduction in lethality. This amounted to 15 per cent for the first group and 17.6 per cent for the second group. Extirpation of cerebral abscesses shows the most favourable results of treatment as compared to other surgical procedures. In our opinion, however, it will not remain the only method of treatment in future because it can only be employed if the patient is in a condition permitting an operation. That is why the open abscess treatment will continue to be justified for all cases where cerebral abscesses occur in combination with subdural or epidural empyemas. Certainly, modern anaesthesia methods as well as intensive pre- and postoperative therapy will further reduce the number of patients who are subjected to a primary puncture treatment. Since 1972, we have treated our patients exclusively by abscess exstirpations. Until 1977, none of the total number of 12 patients treated by us has died. We consider the use of scintigraphic and EEG controls of inflammatory cerebral processes to be of decisive importance. These controls enable a differentiation between diffuse and local inflammatory processes which are accompanied by a liquefaction and in this way permit the selection of the optimum time of operation. A basic condition, however, will always be a good interdisciplinary co-operation with infection departments, paediatric and ENT hospitals where in most cases patients suffering from brain abscesses are first admitted.

[Isoelectric EEG and residual activity in the EEG in clinical brain death syndrome]. / Isoelektrisches EEG and Restaktivität im EEG bei klinischem Hirntodsyndrom.

The brain death is defined as the complete and irreversible absence of the cerebral and brain stem functions. In case of the dissociated lack of these functions an EEG activity can still be recognizable even in the presence of a brain death syndrome. Own observations in 57 persons with brain death are discussed.