[Disability assessment for the statutory pension insurance: significance, need for research, and opportunities]. / Sozialmedizinische Begutachtung im Rentenverfahren: Stellenwert, Forschungsbedarf und Chancen.

Disability assessment is a complex and multifaceted process of exploration and evaluation, which in terms of legal evidence can be of far-reaching consequence for the claimant, the statutory pension insurance and finally for society as well. In the article the specifics of the assignment, the assessment situation, and the process of evaluation are described. Based upon an analysis of the so far only little research activities, the future need for research is subdivided into 4 thematic groups: 1 Operationalization and validation of central dimensions of evaluation; 2 Investigation of the structure of the expert decision-making process and the factors influencing it; 3 Investigation of the influence of sociopolitical, labour market-related and economical aspects on the evaluation; 4 Quality assurance. On the other hand the article describes the special quality of disability assessment. In a unique way it offers an integrated reflection of the medical history, limitation in capacity and participation and options for treatment and rehabilitation. Beyond the assessment of functional capacity, it could be of use for the development of innovative forms of support for the rehabilitation of working capacity.

[Intravenous immunoglobulin in the treatment of malignant epilepsy in children]. / Intravenöses Immunoglobulin bei der Behandlung von malignen Epilepsien bei Kindern.

15 children with malignant epilepsy showing no response to conventional antiepileptic drugs or hormone therapy were administered intravenous immunoglobulin (Endobulin, Immuno) at a dosage of 400 mg/kg per day on the 1st and 15th day and subsequently every three weeks for 6 months. 7 of these 15 patients showed IgG2 subclass deficiency. A significant reduction in attacks, or even absence of attacks was observed in 10 out of 15 children after six months of intravenous immunoglobulin therapy. Apart from one patient with ringchromosomopathy, all the children with IgG2 subclass deficiency responded to this therapy. The reduction of attacks after i.v. immunoglobulin therapy correlates with the improvement or normalization of the EEG findings. At present, the authors consider the number of patients still too small to make a final assessment, but they believe that intravenous immunoglobulin holds an important position in the treatment of malignant epilepsy in childhood.

[Rehabilitation in the view of small and midsized enterprises: knowledge, appreciation and possibilities to cooperate - results of the KoRB-project]. / Rehabilitation aus der Sicht kleiner und mittlerer Unternehmen: Wissen, Wertschätzung und Kooperationsmöglichkeiten - Ergebnisse des KoRB-Projektes.

UNLABELLED: The experiences of small and midsized enterprises (SME) with medical rehabilitation were investigated in the KoRB-Study (KoRB= KOoperation Rehabilitation und Betrieb) for the first time. Opportunities for a targeted cooperation between the statutory pension insurance and these enterprises were explored. Based on explorative interviews, Westphalian employers, members of the works council, occupational health practitioners and employees were interrogated about the image of and their appreciation of medical rehabilitation in the work setting. Experience with rehabilitation and the level of information on rehabilitation were recorded as well as the compatibility of rehabilitation with operative processes in the working site. In addition rehab hospitals were asked about their experience in cooperating with enterprises. 697 employers of small and midsized enterprises, 458 members of the works councils, 73 occupational health practitioners, 47 rehab hospitals and 3 509 employees, who are members of the German Pension Fund of Westphalia, took part in the survey. RESULTS: Especially employers perceived rehabilitation positively and reported good experiences. Among the employees, those who had taken part in rehabilitation showed the highest appreciation. Occupational health practitioners were more restrained in their appraisal. Some of them complained about a lack of sustainability. The different target groups of the survey felt differently well informed about rehabilitation - best ratings came from the occupational health practitioners, worst ratings from the employees. All groups would welcome more accessible information in case of need. Medical rehabilitation in its standard form of "3 weeks full-time" often causes severe logistic problems in SME (e. g., replacement of employee, loss of experience). However the financial burden is perceived as less problematic. Employers favour alternative rehab models, which allow part-time working. Many employees, who expressed a need for rehabilitation, refrained from applying for rehabilitation on account of worries about loosing their employment. Both rehab clinicians and occupational health practitioners argued in favour of improved communication and cooperation in order to adapt medical rehab to the specific requirements of the working place and to assure a smooth reintegration into work.

[The IREPRO List of Indicators--a tool for systematic evaluation of the prognosis for reintegration and the need for rehabilitation in the course of psychiatric disability pension assessment]. / Die IREPRO-Indikatorenliste--eine Arbeitshilfe zur systematischen Beurteilung von Reintegrations-Prognose und Rehabilitationsbedürftigkeit in der psychiatrischen Rentenbegutachtung.

There is little research on the process of decision making in sociomedical expert opinion especially on prognostic issues. Experts therefore have to rely upon experience and their own routines of judgement. The IREPRO List of Indicators offers a systematic scheme for the sociomedical exploration and evaluation of the prognosis for reintegration and the need for rehabilitation in claimants for disability pension due to mental illness. A set of ten indicators was defined and its practical use tested in an expert-based process of development. In a manual each indicator is thoroughly described in a standardized manner including a five-point rating scale. In a profile sheet the ratings of all ten indicators are visualized, appropriate therapeutical and rehabilitative means are assigned, and the final judgement of prognosis is deduced. At present the IREPRO List of Indicators offers a good tool to structure the process of decision making and contributes to enhancing transparency and uniformity of the process. It can also be used to discuss cases among colleagues. The basic principle can be transferred to other fields of sociomedical expert opinion-building. The article describes requirements and difficulties in psychiatric disability assessment, the list of indicators and experiences gained from the process of development.

[Idiopathic thrombocytopenic purpura in children]. / Idiopatska trombocitopenijska purpura u dece.

INTRODUCTION: Idiopathic (immune) thrombocytopenic purpura (ITP) is the most frequent hemorrhagic disease in children. It represents the acquired megakaryocytic thrombocytopenia with the shortened life of platelets because of immunologic damage (antibodies absorbed by platelets). In the case of this acquired hemorrhagic disorder, in spite of compensatory increased function of the bone marrow, there is a reduced number of platelets because of their increased destruction by the reticuloendothelial system (destructive thrombocytopenia). There are three forms of ITP: acute, chronic and intermittent. The acute form occurs in 80-90% of cases with bleeding episodes lasting a few days or weeks, but no longer than 6 months. The chronic form occurs in 10-15% of children, while the rarest-intermittent form is characterized by periods of normalization in regard to the number of platelets but also with relapse in intervals of 1-3 months. The disease is caused by an immunological disorder in the sense of an imbalanced immune response. Immunologic damages of platelets cause shortening of the opsonized platelets life span. The most frequent platelet opsonins are the immumoglobulin G (IgG) antibodies directed at the platelet membrane in the form of autoantibodies, alloantibodies or possibly absorbed antigen caused by microorganism infection or drug intake. CLINICAL MANIFESTATIONS: It is typical for the phenomenon of bleeding that it starts suddenly and without any other sign of illness. The most frequent acute form appears between the second and fourth year, and is characterized by seasonal occurrence usually after acute viral infections. Children older than 10 years of age, like adults, often have the chronic form associated with other immunologic disorders. The disease affects girls more often than boys (about three times more often) with moderate and constant increase of antiplatelet antibodies. Hemorrhagic manifestations include: petechiae, purpura, epistaxis, gastrointestinal and genitourinary bleeding. They depend on the grade of thrombocytopenia, although there is no strict correlation between the number of platelets and volume of bleeding. Low mortality of the acute ITP is almost exclusively due to intracranial hemorrhage. LABORATORY STUDIES: Thrombocytopenia represents a decrease in the number of blood platelets being a basic abnormality of the blood count. The half-life of platelets in ITP is shortened. Detection of antiplatelet antibodies is connected with technical difficulties, so they are established in about 30% of cases. Bleeding time is prolonged and so is the coagulum retraction which may be completely missed. The Rumpel-Leede test is positive. Clinical differentiation of drug-induced thrombocytopenia is not possible. However, other differential diagnostic possibilities are thrombotic-thrombocytopenic purpura and hemolytic-uremic syndrome. A child with aplastic anemia or acute leukemia, beside thrombocytopenia, has a characteristic finding of white and red blood cell count. Thrombocytopenia with absent radii syndrome is associated with skeletal system abnormalities. TREATMENT: New knowledge about the role of the immune system in ITP determines the modern therapeutic modalities. In cases of acute ITP in children, there are two therapeutic options or therapies of choice: corticosteroids and high doses of intravenous immunoglobulin. Immunosupressive therapy means anti Rh(D) immunoglobulin, cyclosporine, cytostatics, danazol, loaded platelets. In cases of distinctive hemorrhagic syndrome there are also indications for platelet transfusion. Nowadays splenectomy is more restricted, because one third of cases is unsuccessful, whereas plasmapheresis is rarely used in children because of possible complications. CONCLUSION: ITP is the most frequent hemorrhagic disease in children. The disease is basically caused by an immunologic disorder with platelet destruction due to increased immunoglobulin on their membrane. (ABSTRACT TRUNCATED)

[Bleeding in hemophilia as a function of meteorologic changes and the effect of tissue hormones]. / Krvarenje kod hemofilije u funkciji meteoroloskih promena i svetlu tkivnih hormona.

Hemophilia is a hereditary coagulopathy which has the characteristic of bleeding into various tissues, particularly joints and muscles, bearing the risk of early invalidity. A lot of bleedings in children with hemophilia occur without any recognizable trauma, spontaneously and during the night. By comparing the frequency of bleeding in hemophiliacs with meteorological phenomena, and by the one year material revision of the Hematology Department of the Institute for Child Care in Novi Sad (Yugoslavia) as well as the simultaneous recording of barometric pressure, it was found that the increase of atmospheric pressure was strongly associated with spontaneous bleedings in hemophiliacs. It is accompanied with a rise in negative air ions that when inhaled interact with platelets and decrease blood serotonin, thus blocking its vasoconstrictor effect and precipitating bleeding. Antiserotonin activity drugs can have a similar influence.

[Personal experience in the immunomodulation of immunothrombocytopenic purpura in children using high doses of i.v. immunoglobulin]. / Nasa iskustva u imunomodulaciji kod imunotrombocitopenijske purpure u dece primenom visokih doza i.v. imunoglobulina.

Twenty-three child patients with immunothrombocytopenic purpura ITP were treated with high doses of immunoglobulins for intravenous application. The dose applied was 400 mg/kg during five consecutive days. The immunological status of all patients was determined previously, and beside the normal values of the IgG serum, a deficit of the IgG2 subclass was discovered in 12 patients. The therapy effect was satisfactory in 19 patients, and 4 had an absence of a satisfactory response to therapy. There was an interesting observation that all patients with a good response to therapy had a deficit of the IgG2 subclass, while with all the other patients without a satisfactory response to therapy the, IgG2 subclass had normal values. On the basis of the results observed it can be concluded that i.v. immunoglobin therapy in high doses has it's place in the immunothrombocytopenia treatment of children, and especially of patients with an IgG2 subclass deficit.

[Intravenous immunoglobulin in the treatment of infections in children with acute leukemias]. / Primena intravenskog imunoglobulina u terapiji infekcija dece s akutnim leukemijama.

Infections are a common cause of complications in the course of applying highly aggressive combined cytotoxic therapy in children suffering from acute leukemias (ALL and ANLL). The effect of adjuvant therapy of intravenous immunoglobulins (IVIG) was investigated in cases of infections of children with ALL and ANLL (24 with IVIG and 24 without this therapy) according to the system of matched pairs. The polyvalent functionally intact monomeric i.v. immunoglobulin "Endobulin" Immuno, 100 mg/kg was applied in infections--febrile episodes combined, if possible, with an aimed antibiotic therapy. It was established that children with the intravenous immunoglobulin therapy had had statistically significantly less febrile episodes (p < 0.01), as well as less febrile days (p < 0.05). Although the acquired results speak in favor of this therapeutic possibility when applying this supportive therapy which is getting more and more important, authors made a conclusion that the final estimate of the value of this therapy remains open and requires further investigations.

[The role of toxocariasis in the etiology of hypereosinophilic syndrome in children]. / Udeo toksokarijaze u etiologiji hipereozinofilnog sindroma u dece.

Toxocariasis as a helminth zoonatroponosis is very common in dogs in our region, thus the infestation of human population, especially children, is frequent, 59 children with high blood eosinophilia, aged 18 months to 14 years, were examined on toxocariasis by indirect immunofluorescence test, 23 children were positive, with antibody titre 1:20-640. Dominant symptoms and signs were cough, allergic exantemas, lymphadenopathy and leucocytosis. One child had eosinophilic meningitis. Some of these children were addicted to geophagia, particularly those with clinical picture corresponding to toxocariasis. The original antigen for the indirect immunofluorescent antibody assay was made of mice brains previously infected with high dose of toxocara larvae (6000 per mouse). Two or three months later, mice were sacrificed and their brains were fixed and included in paraffin wax. Histological sections were used as antigen for titration of patient's serum samples. Authors conclude that all eosinophilias in children should be examined serologically for toxocariasis.

[Evaluation of certain hemostasis parameters in premature infants]. / Procena nekih parametera hemostaznog mehanizma u nedonoscadi.

In order to evaluate the specificity of hemostatic mechanism in premature Infants, the following examinations of coagulation and fibrinolytic parameters have been done: platelet number, concentrations of fibrinogen prothrombin, factors V, VII X, X, VIII, IX and XIII, antithrombin III, plasminogen, euglobulin lysis time, fibrin degradation products, alpha-1 antiplasmin and alpha-2 macroglobulin. The examinations have been done in the whole of 18 premature infants of both sexes. The obtained results show that lowered level of coagulant activity was not exclusively the consequence of low activity of vitamin-K dependent factors, but the result of more complex disorders partly connected with the transient reduction of factors VIII, XIII and fibrinogen. The total fibrinolytic activity, in the meantime, was of the normal intensivity. The established disorder of coagulation-fibrinolytic balance probably represents the certain contributing factor in more frequent occurrence of haemorrhagic syndrome in premature infants.

Quantitation of circulating hematopoietic progenitor cells early after transplantation.

By multicolor flow cytometry CD34 positive blood progenitor cells (BPC) were determined by standard procedures before and after reinfusion. Measurements of circulating progenitor cells after transplantation lead to cell numbers that are considered together with reconstitution potential, especially with the number of transfused apheresis platelet concentrates after transplantation. Decreased concentrations of CD34 positive cells are associated with an increased frequency of platelet transfusions after transplantation.

[Infiltration of the testes in acute lymphoblastic leukemia in childhood--personal experience]. / Infiltracija testisa u toku akutne limfoblastne leukemije decijeg uzrasta--nase iskustvo.

According to various literature data testicular leukemic infiltration occurs in 5-40%, while the mean time for testicular recurrence is 36 months. Hematologic recurrence usually occurs in the interval from 1-6 months. Although testicular leukemic infiltration clinically occurs as an isolated recurrence of leukemia, it usually presents only a clearly marked spot in the general recurrence of the disease. It is a painless enlargement of one or both testes. The diagnosis is made ultrasonographically and by histopathologic examination of the biopsied testicle tissue. This paper deals with 4 patients with acute lymphoblastic leukemia and testicular recurrence. In 2 patients the testicular recurrence occurred as a part of the general recurrence of the disease, while in the other 2 at the time of testicular recurrence diagnosis, the bone marrow was regular. All 4 patients were treated with combined radiotherapy and chemotherapy, in 3 cases successfully.

[Diagnostic approach to von Willebrand's disease in childhood]. / Dijagnosticki pristup von Willebrandovoj bolesti u decijem uzrastu.

Von Willebrand's disease seems to be the most common hereditary bleeding disorder in children. Every form of this disease is based on quantitative or qualitative disorder of von Willebrand's factor influencing adhesion of thrombocytes (primary hemostasis) and stabilization FVIII:C in circulation (secondary hemostasis). We present contemporary knowledge on epidemiologic investigations, molecular biology, classification and rational diagnostic approach to von Willebrand's disease in children. We also report on evaluating laboratory tests' reliability in 51 examined children with von Willebrand's disease. It can be concluded that most laboratory tests are highly specific and significant for diagnosis. Determination of vWF activity has optimal value for establishing laboratory diagnosis of von Willebrand's disease; RIPA and multimer analysis are valuable for subtype classification.

[Pulmonary neuroblastoma--a rare type of manifestation]. / Neuroblastom pluca--retka forma ispoljavanja.

We report a case of pulmonary manifestation of neuroblastoma, one of the most common malignant, solid tumors in children. Diagnostic approach and results of a combined cytostatic therapy are described. The nature of the tumor makes prognosis unpredictable.

[The frequency of infant anemia]. / Neka zapazanja o ucestalosti anemije u odojcadi.

In the group of 391 examined children in the third trimester of their life the mean values have been established for the principal hematological parameters of the red family (hemoglobin = 11,52 +/- 0,87 g/100 ml, hematocrit = 36,12 +/- +/- 3,12%), as well as anemia frequency which is 29,06% if the lower lewel of the normal hemoglobin value is 11 g/100 ml for that period of infants' life. These investigations have been stated statistically significant lower hemoglobin values and a higher anemia frequency in group of infants with low weight at birth (17,5 of anemic children were prematurely born, and 55,38% weighted under 3.250 g. at their birth), than in the group of infants with non-adequate nutrition, and among infants with frequent infections. The prophylactic measures were suggested to decrease frequency of sideropenic anemia - the most widely spread type of anemia in early life of children.