Mumps mistaken for rubella in the first trimester of pregnancy. The role of the microbiology laboratory in the diagnosis of the infection. A case report.

A case of mumps with an exanthema is described. However, the parotid swelling was mistaken for enlarged lymph nodes, and the case was described as one of "typical rubella". As the patient was pregnant in her first trimester, an induced abortion was considered. Serum specimens for rubella antibody testing had been taken, but the information given by the consulting physician was incorrect and led to testing for past infection and immunity. After re-examination of the patient by a gynaecologist, mumps was suspected and the diagnosis verified serologically. The present case shows that in certain situations adequate information must be given to the laboratory in order to ensure a meaningful interpretation of the results of the serological examination.

Vascular dementia versus dementia of Alzheimer's type: do they have differential effects on caregivers' burden?

OBJECTIVES: We investigated homecare patients with dementia of Alzheimer's type (DAT; n = 36) or vascular dementia (VD; n = 36) and their care-providing relatives regarding clinical and psychosocial variables to determine whether DAT and VD impose different burdens on caregivers. METHOD: All patients were diagnosed according to ICD-10 criteria. The diagnoses were confirmed by internal medical, clinical-neurological, and psychiatric parameters. The severity of the dementias was graded according to the Global Deterioration Scale (GDS). Caregiving relatives responded to the Behavioral Pathology in Alzheimer's Disease Rating Scale (BAD), the Blessed Dementia Scale (BDS), and the Screen for Caregiver Burden (SCB). RESULTS: Analyses revealed that caregivers' burden (SCB), disease symptoms and personality changes of patients (BAD), and the patients' inability to cope with everyday tasks (BDS) were sharply higher for DAT than for VD patients in the group with severe dementia. Concerning patients with mild or moderately severe disease, scores in the DAT group were similar or lower than those in the VD group. CONCLUSION: In early stages, VD patients impose a greater burden on relatives than do patients with DAT. In severe stages this relationship undergoes a reversal, with relatives of DAT patients experiencing the burden more adversely than those of VD patients. The differences in the onset and course characteristics, as well as the specific differences between these two types of dementia with respect to caregiver burden factors, call for their diagnostic separation and the development of specific homecare support systems for family caregivers.

High hemoglobin levels during pregnancy and fetal risk.

In a series of 24 apparently uncomplicated pregnancies with small-for-dates newborn at or below the tenth percentile, 15 women had hemoglobin (Hb) levels 2 SD above the mean value of normal distribution in late pregnancy. Among these 15 was the only case with intrauterine death of unknown cause. In a series of 15 cases intrauterine fetal death of unknown cause, before start of labor 10 had Hb levels 2 SD above the mean, while in a series of 16 cases of late abortion where the fetus was alive until labor started, only one had a Hb level 2 SD above the mean. In three cases with serial Hb estimations, the levels were 2 SD above the mean one week or more before intrauterine fetal death. Two of these cases also had been observed during a successful pregnancy in which the Hb levels were within normal limits. It is concluded that high Hb levels during pregnancy may indicate a fetus at risk. High viscosity of the mother's blood may impede the uteroplacental circulation, casing placental infarction, growth retardation and ultimately fetal death.

[Endoscopic papillotomy - a new therapeutic approach to gall bladder diseases (author's transl)]. / Endoskopische Papillotomie - eine neue Methode in der Therapie der Gallenwegserkrankungen.

Endoscopic papillotomy (EPT) was performed in 66 patients, 59 of whom had choledocholithiasis and the remaining seven had stenosis of the papilla of Vater. The stones passed spontaneously in 37 patients, but had to be extracted in 10 cases. All seven patients with stenosis showed free bile flow following EPT. Four patients become anicteric although the stones persisted. Four patients had a febrile complication which subsided in response to antibiotic therapy.

[Postcholecystectomy syndrome: endoscopic and radiological aspects (author's transl)]. / Postcholezystektomiesyndrom: Endoskopische und radiologische Aspekte.

542 patients were subjected to ERCP at various periods after cholecystectomy. In this selected patient material there was a 56% incidence of morphological abnormalities in the biliary system, stenosis of the papilla and choledocholithiasis being the most frequent pathological findings. Laboratory examinations proved to be irrelevant with respect to the morphology of the bile ducts. A direct relationship between the clinical symptoms and the surgical procedure was established only in cases presenting with biliary duct stenosis (11% of all cases examined). In the majority of patients the postcholecystectomy complaints were due to incorrect surgical indication or inadequate surgical technique. Postcholecystectomy syndrome can be prevented by more accurate evaluation of the patient prior to and during surgery.

[Individual differences in solving spatial problems of the IST and IST-70 subtest on "cube problems"]. / Individuelle Unterschiede beim Lösen von Raumvorstellungsaufgaben aus dem IST-bzw. IST-70-Untertest "Würfelaufgaben".

Spatial ability is one of the primary mental abilities which has been subject of many empirical studies--especially in the factor analytical research. Analysing the mental processes when solving space tasks, e. g. by means of retrospective verbal reports, two different strategies can be distinguished. The first strategy (called "holistical" strategy) can be described as a mental rotation of the given stimulus, the second one (called "analytical" strategy) is characterised by nontransformal mental processes, e. g. pattern matching processes. In order to identify those different strategies, test items are required, which have different solution probabilities when being solved with different strategies. The "cube tasks" of the IST and IST-70 by Amthauer (1953, 1970) are of this type, as Putz-Osterloh (1977) has found in an experiment. The hypothesis of individual differences in solving space tasks was tested in two different samples. First the "cube tasks" of the IST-70 were administrated to 264 applicants for the pilot job. Data analyses using the mixed-Rasch-model (Rost, 1990) confirmed the hypothesis of an "analytical" and "holistical" strategy. In the second study 2558 pupils of the 7th grade were tested with the "cube tasks" of the IST. A latent class analysis of their response patterns revealed basically the "holistical" and "analytical" strategy and, in addition, four strategies which can be explained by motivational factors.

Stability of diagnoses in various psychiatric disorders: a study of long-term course.

The frequency of diagnostic shift was investigated in 267 patients diagnosed with various psychiatric disorders according to the 9th revision of the International Classification of Diseases (ICD-9). Forty-six patients fulfilled the diagnostic criteria for schizophrenic psychosis, 71 for affective psychosis, 66 for neurotic disorder, 24 for personality disorder, and 40 for psychogenic reaction. The remaining 20 patients were diagnosed with heterogenous disorders. The mean follow-up time was 12.5 years. Every episode of inpatient treatment was diagnosed cross-sectionally. Patients with an initial episode of schizophrenic psychosis showed by far the greatest stability (93%). A high stability was found in patients diagnosed with neurotic disorders (79%). Forty-two patients with an index diagnosis of affective psychosis suffered more than one type of episode during the course of disease. The lowest stability was noted in patients with a psychogenic reaction (10%). Eleven percent of patients with a final diagnosis of schizophrenia had an index diagnosis of psychogenic reaction. Our findings demonstrate that the course of disease should be considered in making the final diagnosis.

Clinical and psychosocial variables in different diagnostic groups: their interrelationships and value as predictors of course and outcome during a 14-year follow-up.

A 14-year follow-up study was conducted on 214 patients from the diagnostic groups schizophrenia, affective psychosis, and neurosis to determine the relationships between various clinical and psychosocial variables and to assess their value as predictors of long-term course and outcome. Particular emphasis was placed on ascertaining the interrelationships between the variables within the individual diagnostic groups. The results indicate that for schizophrenia, severity of disease at discharge from index hospitalization was the principal predictor of the number and duration of further hospitalizations. Furthermore, it predicted the severity of illness and social functioning at follow-up. For affective psychosis, the Global Assessment Scale score predicted the number and duration of further hospitalizations. Severity of illness, social functioning, and age at first hospitalization were predictors of occupational development. For neurotic disorders, severity of disease and social adjustment at discharge from index hospitalization were each predictors of themselves at final follow-up. In addition, age at first hospitalization was an important predictor of most course and psychosocial variables. Among the endogenous course variables within the schizophrenic group, the number and duration of further hospitalizations had a substantial bearing on severity of illness and social functioning at follow-up. For affective psychoses, indicators of occupational development and number of hospitalizations had an impact on severity of illness and social functioning at follow-up. Our findings reveal a good overall predictive value for the clinical and psychosocial variables within each of the diagnostic categories studied.

Psychiatric and somatic hospitalisations of different diagnostic groups: a long-term follow-up study.

Out of 328 cases with different diagnoses, including those without pathological findings at follow-up, the frequency and duration of in-patient treatment in psychiatric and somatic institutions was observed over an average 14-year period. Schizophrenics were more frequently and longer in psychiatric institutions, but they were less frequently and for shorter periods in somatic care compared with all other diagnostic groups. Patients suffering from affective psychosis had comparatively long psychiatric and somatic periods of hospitalisation. Dependents were hospitalised more frequently and longer for psychiatric rather than for medical reasons in somatic institutions. The total psychiatric in-patient treatment time was distinctly shorter for neurotic disorders compared with schizophrenic psychosis or affective psychosis cases.

[Duration of inpatient treatment of various psychiatric disease categories. A follow-up study]. / Stationäre Behandlungsdauer verschiedener psychiatrischer Krankheitsgruppen. Eine Verlaufsuntersuchung.

The frequency and duration of in-patient treatment in psychiatric and general hospitals was observed over an average 14-year period for 328 patients with different psychiatric diseases. Schizophrenics were more frequently admitted and spent longer in psychiatric institutions than all other diagnostic groups, but were admitted less frequently and for shorter periods to general hospitals. Patients suffering from organic mental illness and those with neurotic disorders had more frequent and longer periods of general hospital care. Drug dependent and neurotic patients were hospitalised more frequently and longer for psychiatric rather than for medical reasons in general hospitals. The total frequency and duration of psychiatric in-patient treatment was distinctly less frequent and of shorter duration for neurotic disorders as compared with schizophrenic or affective psychoses.

Late sequelae of induced abortion in primigravidae. The outcome of the subsequent pregnancies.

PIP: 137 women, who had legal abortions of their 1st pregnancies, were compared with a group of 133 who had spontaneous abortions before the 28th week, and a group of 129 who delivered their 1st pregnancy. The legal abortion group showed 3 ectopic pregnancies, while the other 2 groups showed none. Those who delivered their 1st pregnancy showed the best reproductive function, while the group of spontaneous abortions showed the highest frequency of early abortion. The artificial group showed the highest rate of late spontaneous abortion and premature delivery. There was a decline in the reproductive function of the artificial abortion group in the 3rd and 4th pregnancies, and an increase in the rate of late abortion. This group also showed an increased rate of spontaneous primary and premature rupture of the membranes and a trend toward lower newborn weight. A close correlation was noted between induced abortion before the age of 17 and repeated abortion. A significant correlation was noted between early menarche and legal abortion and also between early menarche and unmarried state in the 1st pregnancy, based on a random series of 250 primagravidae.^ieng