Auxology-based cut-off values for biochemical testing of GH secretion in childhood.

OBJECTIVE: The diagnosis of GH deficiency (GHD) in childhood requires GH tests with arbitrary cut-offs. We aimed to define GH cut-offs based on auxology. DESIGN: From a total of 349 children diagnosed with GHD between 1985 and 2005 at our hospital, we excluded all children who had additional characteristics likely to interfere with growth velocity. Age at start of therapy was defined as 4 to 8/9 years (girls/boys). Auxological inclusion criteria were pathological growth velocity, height at start of therapy >1.5 SD below the target, and efficient catch-up growth during GH therapy. Basal IGF-I/IGFBP-3, GH response to arginine and spontaneous GH secretion at night had been measured by the same polyclonal RIA. The reference was a group of 108 normally growing age-matched children with Turner syndrome or born small for gestational age tested during the same time period. RESULTS: We identified 52 children with GHD who fulfilled the inclusion criteria. ROC analysis showed the best diagnostic accuracy at a peak GH cut-off for arginine of 6.6 µg/L (sensitivity, 84.3%; specificity, 75.5%; AUC=0.83) and at a peak GH cut-off during spontaneous secretion at night of 7.3 µg/L (sensitivity, 96.8%; specificity, 82.4%; AUC=0.93). Our arbitrarily defined GH cut-offs had been higher. Children diagnosed with GHD in the past with GH test values above the new cut-offs were less responsive to GH therapy (P=0.007). CONCLUSIONS: Here we provide a new rational approach which allows the substitution of arbitrarily defined GH cut-offs by those based on auxology.

[Perspectives in rehabilitation. General position paper on future trends and challenges in rehabilitation by the Health Advisory Board of the German Federal Association for Rehabilitation]. / Perspektiven der Rehabilitation. Ein Positionspapier des Arztlichen Sachverständigenrates der Bundesarbeitsgemeinschaft f ü r Rehabilitation (BAR) zur Weiterentwicklung der Rehabilitation.

The Health Advisory Board of the German Federal Association for Rehabilitation (BAR) describes future trends and challenges in rehabilitation as deriving from the socio-demographic development in Germany and the structural characteristics of its Social and Health Care Insurance System. The focus is on elder employees to sustain and regenerate their capacity for employment, on people which are no longer employed to activate their autonomy and ability for self-support, and on rehabilitation as a holistic and integrative process extending through the social security and health insurances. There is an urgent need and a real chance to benefit from already existing scientific findings more frequently and to integrate them effectively into adequate further education and training programmes for professionals. Finally the conclusion summarises 8 theses to facilitate rehabilitation as an integral and essential part of the German social security and health sector. This paper was fully accredited by the members of the BAR Managing Board.

[Aspects of expertise which are jointly valid for German sociomedicine and statutory health care]. / Trägerübergreifende Aspekte der Begutachtung nach dem SGB IX - Teil II: Fallbeispiel -

A project group of the Medical Advisory Board of the German Federal Rehabilitation Council (BAR) developed fundamental joint principles on experts' opinions according to the social law code no. IX (SGB IX). The principles aim at medical experts working in different social organisations and statutory health care insurance. It was intended to create a "sociomedical language" which should be used as jointly as possible by experts in rehabilitation and social medicine and which is based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). Its stringent application will increase the utility of medical expertise across different institutions. The authors recommend to evaluate whether this model could provide a tool in the communication and cooperation between different sectors of the health system. Part I describes the theoretical model, Part II its application to a virtual individual case history.

[Aspects of expertising which are jointly valid for German sociomedicine and statutory health care]. / Trägerübergreifende Aspekte der Begutachtung nach dem SGB IX--Teil I: Grundlagen.

A project group of the Medical Advisory Board of the German Federal Rehabilitation Council (BAR) developed fundamental joint principles on experts' opinions according to the social law code no. IX (SGB IX). The principles aim at medical experts working in different social organisations and statutory health care insurances. It was intended to create a "sociomedical language" which should be used as jointly as possible by experts in rehabilitation and social medicine and which is based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). Its stringent application will increase the utility of medical expertise across different institutions. The authors recommend to evaluate whether this model could provide a tool in the communication and cooperation between different sectors of the health system. Part I describes the theoretical model, Part II its application to a virtual individual case history.

Steroid-1-dehydrogenases in nocardioform bacteria studied by electrophoresis and immuno blotting techniques.

Fifteen noncardioform bacteria strains, capable of transforming steroid compounds were investigated with regard to their range of inducible steroid-1-dehydrogenase (St1DH)1 activities. The St1DHs of these bacteria were compared due to their immuno reactivity in Western blot experiments with a rabbit antiserum raised against the purified St1DH of Rhodococcus rhodochrous 7030. Four strains exhibited a strong immuno reactivity, irrespective of differences in the electrophoretic mobility of the enzymes. Five strains revealed significantly diminished reactivities, and in five strains with a very low St1DH content, no reactivity was found. One strain, designated as Nocardiaspec. 7151, exhibited a high, inducible St1DH activity, but no immunoreaction was found. The absence of immuno reactivity is discussed in connection with the considerably diminished electrophoretic mobility of this enzyme.

[Spontaneous spinal epidural hematomas]. / Zur Problematik der spontanen spinalen Epiduralhämatome.

Until now, reports have been given on 249 spontaneous spinal epidural haematomas. Two own cases are included in the submitted analysis. In approximately 78 per cent, the disease begins with pain and radicular disturbances according to the lactation of the haematoma, in 18 per cent with a primary to the location of the haematoma, in 18 per cent with a primary transverse syndrome. The incidence peak is seen around the 60th year of liefe. Men are taken ill more frequently than women, the ratio being 5:3. At the age of 10 to 50 years, the ratio is 3:1. In one third of the patients, no cause of the disease can be detected. One quarter of the patients were given anticoagulants. The prognosis depends on the interval between the first symptoms and the transverse lesion of the cord with paraplegia as well as the time of the operation. For the myelon region (C 1-L 1), the remission rate obtained by an operation within 24 hours after formation of the transverse syndrome is bad in about 34 per cent, for the caudal region (L 2-S 1) it is better in approximately 57 per cent. It the operation is carried out within eight hours, the remission rate is about 84 per cent. In most cases, the disease is diagnosed with a delay and the patients are referred for a surgical treatment too late.

[Steroid transformation using immobilized microorganisms. II. Degradation of the sidechain of cholesterol by immobilized cells of Nocardia erythropolis]. / Steroid transformation mit immobilisierten Mikroorganismen. II. Abbau der Seitenkette von Cholesterol mit immobilisierten Zellen von Nocardia erythropolis.

The degradation of cholesterol side chain was studied by immobilized cells of Nocardia erythropolis in the presence of an inhibitor of the microbial steroid-skeleton-degradation. Different immobilized preparations such as DEAE-cellulose adsorbates, ionic cross-linked polymer gels, i.e., Al/Coalginates and polyacrylates, respectively, and polyethylene maleic acid anhydride supports have shown a high transformation activity yielding the C22- and C19-degradation products. No side chain degradation activity could be observed after immobilization of the cells in polyacrylamide gel under usual conditions caused by the toxic effect of the acrylamide monomer on the Nocardia cells.

[Steroid transforming enzymes in microorganisms. XIII. Relationship between steroid structure and induction of 4-ene-3-oxosteroid: (acceptor)-1-ene-oxidoreductase in Nocardia opaca]. / Steroidumwandelnde Enzyme aus Mikroorganismen. XIII. Bezichungen zwischen Steroidstruktur und Induktion der 4-En-3-oxosteroid: (Akzeptor)-1-en-oxidoreduktase in Nocardia opaca.

The induction of the 4-ene-3-oxosteroid: (acceptor)-1-ene-oxidoreductase in Nocardia opaca has been shown to be dependent on both hydrophilic and hydrophobic structural features of the steroid molecule, i.g. the nature of the oxygen function in positions 11 and 20 and the presence of the methyl group in position 10 influence the induction of the enzyme drastically. In this connection the metabolism of the steroid inductors being degradated during the induction process has been considered.

[Steroid transformation with immobilized microorganisms. I. Transformation of cholesterol to cholestenone in organic solvents]. / Steroidtransformation mit immobilisierten Mikroorganismen. I. Transformation von Cholesterin zu Cholestenon in organischen Lösungsmitteln.

The transformation of cholesterol to cholest-4-ene-3-one has been investigated in the presence of toluene and carbontetrachloride using cells of Nocardia erythropolis (IMET 7185) immobilized by different methods. The adsorption on DEAE-cellulose has been observed to be the most effective method. The stability of immobilized cells relating to cholesteroloxydase activity, transformation capacity, and the influence of water have been investigated.

[Steroid-transforming enzymes from microorganisms. XII. Induction characteristics of the 4-en-3-oxosteroid: (acceptor)-1-en-oxidoreductase in Nocardia opaca]. / Steroidumwandelnde Enzyme aus Mikroorganismen. XII. Merkmale der Induktion der 4-En-3-oxosteroid: (Akzeptor)-1-en-oxidoreduktase in Nocardia opaca.

17 alpha-Methyltestosterone and the corresponding 1(2)-dehydrocompound (Dianabol) are efficient inducers of the 4-en-3-oxosteroid: (acceptor)-1-en-oxidoreductase from Nocardia opaca. After a lag period of 4 hours the enzyme activity increases rapidly. During the induction the steroids are completely metabolized causing a drastical drop of specific enzyme activity. Using a fixed induction time the optimal steroid concentration and the temperature characteristic were found out. The influence of the concentration of the steroid water suspension on the induction effect is discussed to be dependent on the velocity of the dissolving of the steroid particles. Chloramphenicol and streptomycin are powerful inhibitors of the induction process.