Comparison of environmental risk factors for esophageal atresia, anorectal malformations, and the combined phenotype in 263 German families.

Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) and anorectal malformations (ARM) represent the severe ends of the fore- and hindgut malformation spectra. Previous research suggests that environmental factors are implicated in their etiology. These risk factors might indicate the influence of specific etiological mechanisms on distinct developmental processes (e.g. fore- vs. hindgut malformation). The present study compared environmental factors in patients with isolated EA/TEF, isolated ARM, and the combined phenotype during the periconceptional period and the first trimester of pregnancy in order to investigate the hypothesis that fore- and hindgut malformations involve differing environmental factors. Patients with isolated EA/TEF (n = 98), isolated ARM (n = 123), and the combined phenotype (n = 42) were included. Families were recruited within the context of two German multicenter studies of the genetic and environmental causes of EA/TEF (great consortium) and ARM (CURE-Net). Exposures of interest were ascertained using an epidemiological questionnaire. Chi-square, Fisher's exact, and Mann-Whitney U-tests were used to assess differences between the three phenotypes. Newborns with isolated EA/TEF and the combined phenotype had significantly lower birth weights than newborns with isolated ARM (P = 0.001 and P < 0.0001, respectively). Mothers of isolated EA/TEF consumed more alcohol periconceptional (80%) than mothers of isolated ARM or the combined phenotype (each 67%). Parental smoking (P = 0.003) and artificial reproductive techniques (P = 0.03) were associated with isolated ARM. Unexpectedly, maternal periconceptional multivitamin supplementation was most frequent among patients with the most severe form of disorder, i.e. the combined phenotype (19%). Significant differences in birth weight were apparent between the three phenotype groups. This might be attributable to the limited ability of EA/TEF fetuses to swallow amniotic fluid, thus depriving them of its nutritive properties. Furthermore, the present data suggest that fore- and hindgut malformations involve differing environmental factors. Maternal periconceptional multivitamin supplementation was highest among patients with the combined phenotype. This latter finding is contrary to expectation, and warrants further analysis in large prospective epidemiological studies.

[Stress and susceptibility to infection]. / Stress und Infektionsbereitschaft.

The influence of various stressors upon the human immune system, was and presently is the subject of many clinically oriented as well as experimental studies. Even though it is not always clear how relevant the reported observations are in behalf to the beginning, the course and the outcome of infectious, neoplastic and autoimmune diseases, there is hardly any doubt, that stress may influence multiple aspects of the immune answer. The sensitivity of the immune system to stress factors is not merely fortuitous, but is an indirect consequence of the regulatory reciprocal influences between the immune system and the central nervous system. These interconnections seem to represent building blocks of a long-loop regulatory feedback-system, which plays an important role in the coordination of stressors and psychological influences upon the course of infections and inflammatory diseases.

[Clinical medicine versus homeopathy]. / Klinische Medizin versus Homöopathie.

Due to the advance of alternative medicine a critical synopsis by means of the comparison between scientific medicine (clinical medicine) and homeopathy is warranted. The review of studies carried out according to current scientific criteria revealed--at best--a placebo effect of homeopathy. Until now there is no proven mechanism for the mode of action of homeopathy. Sometimes so-called "alternative medicine" prevents effective curative measures. In spite of the justified criticism concerning the technical over-estimation of classical medicine, scientific research should remain the basis of clinical work.

Effect of cefotaxime, ceftriaxone and latamoxef on blood coagulation in patients on parenteral nutrition.

Plasmatic coagulation parameters were studied in patients on parenteral cephalosporins with different hepatic pharmacokinetics. Sixty patients received either cefotaxime (4 g/day), ceftriaxone (2 g/day) or latamoxef (4 g/day) pre- and postoperatively for at least 5 days at random. They received parenteral nutrition without vitamin K supply and had no oral intake. A significant drop (p less than 0.05) in vitamin-K-dependent coagulation factors was recorded in patients treated with latamoxef, while patients receiving ceftriaxone and cefotaxime did not exhibit a significant change in their plasmatic coagulation parameters. Interference of some cephalosporins with the vitamin-K-dependent hepatic metabolism of clotting factors seems to be likely, rather than a suppression of intestinal vitamin K production by the intestinal microflora.

[Antibiotic treatment of perforated appendicitis in childhood--a prospective study]. / Die antibiotische Behandlung der Appendicitis perforata im Kindesalter--Eine prospektive studie.

A prospective randomised study (I) was carried out on 130 children undergoing laparotomy for perforated appendicitis. The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications (intraabdominal abscess, ileus, wound infiltration or abscess). During the first year of this study two treatment groups were used. Group A consisted of 29 children treated with Sulfometrol/Trimethoprim; the rate of postoperative complications was 44.8%. Group B consisted of 36 children treated with mezlocillin, the rate of complications being 13.8%. However, the same treatment with mezlocillin during the second year of the prospective study showed an increase of this rte to 39% (28 children--group C). The final group of 37 children was treated during the second year with mezlocillin and metronidazole (group D). The postoperative rate of complications was 10.8%. A retrospective analysis of further 80 children (study II) with perforated appendicitis treated with mezlocillin and metronidazole showed a consistent low rate of postoperative complications at 10.2%. In 6.8% of children studied, an operative intervention was necessary (four cases of ileus, four wound abscesses). The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II. The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms.

["Essential hypernatremia" as a result of on increased osmoreceptor threshold in a boy with Pierre-Robin disease and corpus callosum agenesis]. / "Essentielle Hypernatriämie" infolge erhöhter Osmorezeptorenschwelle bei einem Knaben mit Mb. Pierre-Robin und Balkenagenesie.

Hypernatremia was found as a cause of recurrent fever episodes in a 18 month old boy with Mb, Pierre-Robin and agenesia of the corpus callosum. We found values of serum-sodium until 160 mVal/l. Examinations of the osmotic regulation showed a so called "essential hypernatremia" without polyuria and polydipsi. Therefore must be responsible a defect of the osmotic center and thirst center in the hypothalamic area. As therapy a diet of 1000 ml = 1000 kcal = 100 mg Sodium/d. was successful.

Effect of manual lymphdrainage massage on blood components and urinary neurohormones in chronic lymphedema.

In an earlier paper we have shown that manual lymph drainage massage of edematous limbs can result in the excretion of up to 1 liter urine derived from reabsorption and transport from the interstitial fluid, simultaneously with significant changes in the excretion of urinary neurohormones. These findings indicated that histamine and serotonin were released from the edematous tissue and that circulation improved through increased output of adrenaline and noradrenaline. The results achieved led us to assume that similar changes may have occurred in the blood during treatment, and induced us to study the effect of manual lymphdrainage on various blood constituents and urinary neurohormones.

[Experience with the combination mezlocillin/oxacillin in severe bacterial infections in a children's surgical ward (author's transl)]. / Erfahrungen mit einer Mezlocillin-Oxacillin-Kombination bei schweren bakteriellen Infektionen in einer kinderchirurgischen Klinik.

Severe bacterial infections accompanying conditions during childhood which demand for surgical intervention mostly are caused by Staph. aureus, E. coli, Klebsiella/Aerobacter or Ps. aeruginosa. 20 patients, 10 of them suffering from a putrid peritonitis, showed a good efficacy of Optocillin (Bay 1-1330), a combination of 6-((R)-2-[3-methylsulfonyl-2-oxo-imidazolidine-1-carboxamido]-2-phenyl-acetamido)-penicillanic acid sodium salt (mezlocillin, Baypen) and 5-methyl-3-phenyl-4-isoxazolylpenicillin (oxacillin, Stapenor), in 85%. Bacteria were eliminated in 79%.