[Feeding disorders and failure to thrive in small and/or handicapped children]. / Fütter- und Gedeihstörungen bei kleinen und/oder behinderten Kindern.

Feeding disorders and failure-to-thrive (prevalence 2% to 4%) rarely have an isolated cause, but most often a number of inappropriate conditions are leading up to the development and, especially, the maintenance of the disorder. These can include organic causes like chronic diseases, peculiarities of the person, strange behavior of the child or the care person or of the interaction-problems. An obligatory classification of feeding disorders does not exist. Feeding disorders and failure-to-thrive can ask for a long-term additional or full tube-feeding or the child rejects age-appropriate food texture, has a very selective eating behavior or there are massive interaction problems during feeding. Feeding disorders and failure-to-thrive can not only have direct physical effects but also long-term unfavourable influences on behavioral aspects as well as on mental abilities. The diagnosis of feeding disorders and failure-to-thrive comprises next to the clarification of a basic organic disease, the clarification of swallowing and oral-motor capabilities as well as the exclusion of a gastroesophageal reflux. A differentiated feeding protocol must include the oral feeding as well as the tube feeding. A behavior observation comprises the feeding situation and, if necessary, further situations of interaction. Besides the treatment of the basic disease, a direct guidance in the feeding situation for the care person is necessary. Furthermore, a therapy of the oral motorics as well as one of the care person and guidelines for interaction during different situations can be important.

[Distance disturbance as a major problem in mental retardation. A case study]. / Distanzstörung als massives Problem bei geistiger Behinderung und ihre Therapie: Kasuistik.

Although "lack of distance" (indiscriminately friendly, attention-seeking behavior) is a wellknown problem behavior in children with psychiatric disorders and in those with mental retardation there is no exact definition of this behavior disorder and there are only vague indications as to its origins and how it is maintained. For a 14-year-old mentally retarded girl with frequent provocative-aggressive attention-seeking behavior we operationalized the disturbed behavior after observation of the phenomenology and frequency in different situations. Treatment began with training in cognitive discrimination of "known" adults and strangers, as part of pictures showing social interaction were used. This discrimination was then practiced with in-vivo therapy in everyday situations; in particular, unambiguous reactions to contacts with "known" adults and strangers were practiced. Correct responses (contact with "known" adults, turning away from strangers) were immediately reinforced socially and materially, and mistakes (i.e. making contract with strangers) were punished with time-out. In the course of these in-vivo sessions, behavior lacking distance ceased. Furthermore, the success of the therapy generalized well in everyday situations, which was assessed by another baseline assessment, and the effect on the girl's behavior in the home environment and at school was also stable.

[Differential development of 2 children with developmental dysphasia]. / Unterschiedliche Entwicklung zweier entwicklungsdysphasischer Kinder.

The development of two boys with the diagnosis of specific language impairment each of whom spoke only five words at the age of three is described through the third grade (regular school). In spite of similarities in nonverbal abilities and in conditions of therapy and general care the two children developed quite differently. One achieved an average language level by about age five, whereas the other seemed to stagnate from about this age on even though he made good progress in other areas. The author discusses the role of auditory perception, learning strategies, memory and behavior in the latter child's development.

[Onset of language development in general developmental delay at age 5]. / Sprachentwicklungsbeginn bei allgemeinem Entwicklungsrückstand mit fünf Jahren.

The course of development of a 5-year-old boy with a serious developmental retardation and massive behaviour problems who spoke only a few words is documented and described with psychometric tests and spontaneous language samples up to the age of 8-9. Inspite of this developmental retardation and poor care, the child reached until then an average to above-average intelligence in nonverbal functions. The symptoms were reduced only to a specific language impairment. At the age of 11, this disorder as well had practically disappeared. Such a course of development after the age of 5 is not common, whereas a specific language impairment normally remains a deficit. Possible causes for this favourable development are discussed.

[Language development and play behavior of retarded children]. / Sprachentwicklung und Spielniveau bei retardierten Kindern.

The relationship of symbolic play behavior, general cognitive functioning and language in 108 mentally retarded children was studied. Correlations between play and language measures were found with mental age partialed out. Clinical implications for planning language facilitation programs with mentally retarded children are discussed.

[Therapy of speech development delay in mentally retarded children]. / Therapie von Sprachentwicklungsverzögerungen bei mental retardierten Kindern.

Twenty-one mentally retarded children participated in 40 language training sessions each that were based on behavior therapy. The training program had four levels of difficulty. The appropriate level for a given child was determined by evaluation of the child's spontaneous speech. Of the 21 children, 8 started with a 6-week waiting period. During this time they had 40 sessions of occupational therapy. The effect of the waiting period and of therapy on the children's speech was assessed by analysis of spontaneous verbal utterances and by specially constructed imitation tests. The children were tested before the waiting period and before and after therapy. Whereas the waiting period by itself had no significant effect, the therapy led to a significant increase in the mean length of utterances (in morphemes) and to highly significant improvement on the imitation tests.

[Total endoprosthesis of the hip joint. Experience with 931 cases (April 1969-April 1976) in a general surgery department (author's transl)]. / Hüftgelenks- totalendoprothesen. Erfahrungen über 931 Fälle (April 1969-April 1976) an einer allgemeinchirurgischen abteilung

The total artificial replacement of the hip joint in dislocated medial fracture of the neck of the femur in elderly people and in coxarthrosis is the standard method today. While there is no better method at the present time for the older patient, loosening and infections in particular compel strict indication and a search for other solutions for younger persons. Taking these criteria into consideration, the operation has proved thoroughly reliable up to the present and it is also worth recommending for use in a suitably experienced general surgery department. In the 6 years, 193 medial fractures of the neck of the femur with sequelae and 704 coxarthroses were operated on and 34 prosthesis exchanges were also undertaken. In medial fracture of the neck of the femur in the elderly as an acute and life-threatening disturbance of function, the mortality was 15%, whereas in coxarthrosis patients it was 0,3%. The early and late complications lie within justifiable limits.

[Chylothorax: causes, diagnosis, therapy]. / Chylothorax: Ursachen, Diagnose, Therapie

The ductus thoracicus acts as the main vessel of the lymphatic system that flows into the venous system. It has the function of transporting lipis resorbed from the intestinal tract. Diseases of the thoracic duct are very rare and mostly result of injuries, tumors or as in most cases secondary infections. The main symptom in these cases is the presence of chylus outside of the ductus thoracicus, mainly in the thoracal spaces. Depending on the cause chylothorax is defined as traumatic, symptomatic or idiopathic. Therapy consists in drainage or ligature of the ductus thoracicus. The prognosis is good unless the cause is a malignant tumor resp. depends on the disease which is the cause of the chylothorax.