[Has the pediatrician a future?]. / Hat der Kinderarzt Zukunft?

The article is concerned with the problem of the education of pediatricians. The main controversial developments are overspecialization and lack of understanding the psychodynamics of the patient and his environment in the education of young pediatricians. Solutions of this dilemma are proposed, for which a change of medical attitude seems necessary and to acknowledge the subjective reality of the patient.

[Endocrinological aspects of ketotic hypoglycemia and adrenal calcification (author's transl)]. / Endokrinologische Aspekte bei ketotischer Hypoglykämie und Nebennierenverkalkung.

Case report on a 2 6/12 years old girl with bilateral adrenal calcifications and ketotic hypoglycemia. Adrenal function tests showed a normal response of the adrenal cortex but signs of adrenal medullary insufficiency. Urinary adrenaline in samples before and after insulin did not increase significantly and plasma adrenaline was undetectable during hypoglycemia. We suggest, that the absence of adrenaline, caused by perinatal adrenal hemorrhagia, is one of the possible pathogenetic keys of ketotic hypoglycemia and examinations on this disease should always include the search for adrenal calcifications.

[The use of play therapy (Animazione) in the hospitalized child]. / Studie zur Verbesserung der Trennungssituation für hospitalisierte Kinder mittels Animazione.

In order to eliminate negative psychological sequelae of hospitalisation of children, Animazione was performed on 2 children wards. On the internal children ward Animazione was seen to be a valuable help to reduce fear by selfportrayal in play, into which also visiting parents could be introduced. On the psychosomatic ward Animazione could only be used in close cooperation with the psychotherapist of a particular child. Then it could be a fulfillment of therapeutic measures in contact with the therapeutic team of the ward. Animazione had to be used here in a modified way with aim in view: the therapeutic team on this ward after elimination of the hierarchic pyramid had taken over an increased initiative and selfresponsibility.

[Katamnestic study regarding patient-physician role in urban pediatric practice (author's transl)]. / Katamnestische Studie zur Arzt-Patienten-Rolle in einer städtischen pädiatrischen Praxis.

Criteria of patient-physician relationship are reported and give interesting results, so far to our knowledge not published in pediatric literature. Intrafamilial needs are registered out of a talk between doctor and visiting patients in a doctor's office. General functions of the pediatrician for his patients are analysed and found to exceed organic problems, a trend to increase in future. The role of the pediatrician is seen to include psychohygienic and psychosomatic knowledge in order to fulfill the patients needs in the face of social medicine and increasing psychological knowledge of childrens development.

[Transient hypoaldosteronism. A case report]. / Transitorischer Hypoaldosteronismus bei einem Neugeborenen.

We observed a 2-week old boy who developed a typical salt-losing syndrome. Urinary 17-ketosteroid excretion of 2.4 mg per day lead us to the diagnosis of congenital adrenal hyperplasia and the usual treatment with hydrocortisone, DOCA and NcCl orally was started. The 6-months old child will tolerate a reduction and subsequent withdrawal of hydrocortisone. Mineralcorticoid and NaCl treatment, however, is to be continued. Further studies clearly showed that in the 8 and 9-month-old child cortisol production could very well be stimulated by synthetic ACTH, but the base line plasma aldosterone was exceedingly low and stimulation by ACTH and salt depletion was impossible. Instant cortisol as well as aldosterone stimulation occurs not until the child is 14 months old. There is valid evidence for a defect in aldosterone biosynthesis, which may be caused by 18-hydroxylation or 18-dehydrogenation deficiency.

[Plasma aldosterone in childhood]. / Plasmaaldosteron im Kindesalter

According to a radioimmunological method modified in our laboratory we determined plasma aldosterone levels under standardized conditions in children of different age from 2 weeks to 14 years, in women undergoing uncomplicated vaginal delivery, and in the cord blood of the corresponding newborn babies. Furthermore, the effect of different stimulating factors (ACTH, salt restriction, severe vomiting, fever) in children was studied. In mothers and cord blood we found 68.6 +/- 39.3 ng/100 ml and 75.5 +/- 37.4 ng/100 ml, respectively. In the first two years of life there is a decrease in plasma aldosterone levels to the relatively constant concentration at the age of 2 to 14 years (7.3 +/- 4.7 ng/100 ml). The age groups 2 weeks to 1 year, 1 to 2 years and 2 to 14 years all show significant differences. A correlation of age (first two years of life) and plasma aldosterone level could be shown (correlation coefficient -0.50 according to Pearson). The stimulation results are comparable with literature data concerning adults. The mechanism of stimulation by vomiting and fever is discussed.

Determination of plasma aldosterone in children by thin layer chromatography and radioimmunoassay.

An accurate and relatively simple radioimmunoassay for the determination of aldosterone concentration in peripheral plasma has been developed, 0.5-2.0 ml plasma with added [1,2-3H]aldosterone is extracted with dichloromethane. Purification of the extract is achieved by thin later chromatography in the system benzene-acetone 1:1. Recovery of [1,2-3H] aldosterone is 58 +/- 6 (SD)%. Bound and free fractions are separated by dextran-coated charcoal. The intra-assay reproducibility is 8.8% and the inter-assay reproducibility varies from 11.4-16.1%. The sensitivity of the assay for a 5 ml plasma sample can be put at 0.2 ng/100 ml. Normal values determined in 52 healthy children of different age groups are presented. Furthermore the aldosterone stimulating effect of low sodium diet (17 children), severe and prolonged vomiting (19 children) and synthetic ACTH (10 children) has been studied by our modified method.

[Serum levels of LH and FSH in patients with adreno-genital syndrome (AGS) (author's transl)]. / Plasma LH und FSH beim adrenogenitalen Syndrom

Serum levels of LH, FSH, testosterone and 17beta-estradiol were estimated by radioimmunoassay in 13 children suffering from AGS. Hormone levels were determined during and after substitution therapy and were compared with values registered in normal subjects. After therapy was stopped a statistically significant rise of testosterone and 17beta-estradiol was observed, but no changes in the serum levels of LH and FSH was noted. The discrepancies between the two observations are discussed.

[Gonadotropin induced steriodogenesis in prepubertal boys (author's transl)]. / Gonadotropin-induzierte Steriodproduktion bei praepuberalen Knaben

We examined the capacity of reaction in the endocrine tissue of testes in prepubertal boys. 18 boys were endocrinologically healthy, six suffered from cryptorchidism on one or both sides. After a single dose of HCG (5000 IU/m) we found an increase of pregnantriol excretion in the 24 h urine in all subjects studied except in the case of surgically proved anorchia. In all except one boy we found a sharp increase in testosterone after HCG administration.

[The clinical value of the cortisol secretion rate determination in paediatric endocrinology (author's transl)]. / Die klinische Bedeutung der Cortisolsekretionsratenbestimmung in der pädiatrischen Endokrinologie

The cortisol secretion rate was determined in 18 children according to a modified and simplified method. In 7 cases the determination was repeated after stimulation with synthetic ACTH. 12 of these children suffered from diseases which may affect glucocorticoidsteroid production and the remaining 6 children served as normal controls. In some cases the plasma 11-hydrocorticoid level and urinary excretion of 17-ketogenic steroids were additionally determined. Differences in adrenal function were noted in 2 patients with congenital adrenal hyperplasia (one of the salt-losing type, the other nonsalt-losing type) and 5 patients with adrenal insufficiency. A normal cortisol secretion rate was found in 3 children with diverse disturbances of carbohydrate metabolism, as well as in a child with subtotal adrenalectomy. The clinical value of the determination of the cortisol secretion rate is discussed and was found to be a more reliable indicator of glucocorticoid activity than other parameters.

[Empirical Analysis of the Behaviour of the Nursing Staff of a Children's Hospital (author's transl)]. / Empirische Analyse des Schwesternverhaltens im Kinderspital

Using the method of systematic behavioural observation, an empirical analysis of the behaviour of the nursing staff was carried out. Nine observational categories of behavioural forms were elaborated. These were: administrative work; nursing; strength of contact in relation to nursing duties, i. e. contact of a positive or negative nature; spontaneous contact of a positive or negative nature; supervision; leisure; and absence f ;rom the ward. These points were evaluated for 12 nurses over a three-month period of observation. It was demonstrated that administrative and ward work constituted the greater part of the activities studied, contact on the other hand being only seldom observed. As a control on the external observation a questionnaire was elaborated to obtain the subjective value of the various work operations. The personal evaluations confirmed the observed findings: contact with the child ranked last in all questions.However, positive contact occurred more frequently than did negative contact. Considerable variation in the evaluation of the individual nurses was observed, which could be partly explained in the categories "administrative work" and "child-oriented activities" by the relative status of the nurses. The data can be interpreted as demonstrating that the nursing staff is overburdened with administrative work. They are also the result of an unsufficiently child-oriented attitude, which requires modification through explanation of the psychological significance of this aspect.

[Chronic adrenal insufficiency in childhood: clinical features and hormonal diagnosis (author's transl)]. / Die chronische Nebennierenrindeninsuffizienz (NI) im Kindesalter Klinik und hormonelle Diagnostik

An investigation was carried out on 6 children with clinical symptoms of adrenal insufficiency. The diagnosis was verified biochemically in 4 cases, 1 child was found to have secondary adrenal insufficiency and 1 had normal adrenal function. These findings demonstrate 2 types of adrenal insufficiency with different clinical pictures: Type 1 is characterized by cortisol deficiency with hypoglycaemia, low corticoid levels and a low cortisol secretion rate; Type 2 shows aldosterone deficiency with prominent salt loss. The clinical picture is correlated in extenso to the biochemical data in respect of ketosteroids, corticosteroids, plasma corticoids, cortisol secretion rate and aldosterone determination in a constant ACTH stimulation test. The methods of determination of the plasma aldosterone level and the cortisol secretion rate were greatly modified and redeveloped in this laboratory.