Epidemiology and course of psychiatric disorders in school-age children--results of a longitudinal study

In an epidemiological longitudinal study, 356 out of 399 8-yr old children were re-examined at age 13. Prevalence rates for psychiatric disorders of about 16% remained constant during adolescence. The course of emotional disorders proved very promising, while that of conduct disorders was extremely unfavorable. Remission of psychiatric disorders was also influenced by an improved psychosocial environment within the family. Development of disorders in initially healthy children was related to prior learning disabilities and stressful life events. More effective approaches in the treatment of conduct disorders as well as early detection of detrimental familial conditions and learning disabilities are called for.

[The Mannheim Rating Scale for the Assessment of Mother-Child Interaction in Infancy]

Within a prospective longitudinal study of the first eight years of life, which aimed determination of pathogenesis of neuropsychiatric disorders a qualitative rating system of mother-infant face-to-face-interaction was evaluated. The rating system consists of 8 scales for mother and 5 scales for infant behavior. The rating intervals had a length of 60 sec, whereas the whole video-taped interaction took 10 minutes. Analysing 48 dyads sufficient coefficients of interraterreliability and validity could be demonstrated for the rating system. It proved to be an appropriate measurement for mother-child interaction in early infancy. Behavior of the mother described by the rating system predicts behavior disturbances of the child better than the total of organic and psychosocial risk factors.

[A scale for assessing the social adjustment of children and adolescents]

In DSM-III the highest level of social adaptation attained is diagnosed on a special diagnostic axis. Thus, separate statements about general impairment in children and adolescents with psychological disturbances can be made independently of specific diagnoses and severity ratings. The present study reports theoretical considerations and the results of the construction of an operationalized scale that measures social adaptation in the areas of family, school and peer group using information about leisure time activities independent of an individual's psychiatric symptoms. In general, the correlations between the social adaptation level and psychiatric disturbances were rather low, the closest association being in the school domain (grade-point average). The reasons for this are discussed.

[The status of life events in causal analytic considerations in child and adolescent psychiatry: model development trials with LISREL (linear structural relationship analysis)]

An epidemiological longitudinal child psychiatric study with 334 eight- and thirteen-year-olds tried to put life events in an optimal order within a model of causal interrelations. The causal connections were tested by a Linear Structural Relationship Analysis (LISREL), which in addition to life events included child psychiatric disorders, adverse family factors and learning disabilities. By testing different models it could be demonstrated, that adverse family factors do not directly influence the number of life events of 8 to 13-year-old children. Adverse family factors influence life events as well as psychiatric disorders at age 13 predominantly by way of early psychiatric disorders. Psychiatric disorders at age 13 are best predicted by psychiatric disorders at age 8 and to a smaller degree by life events and learning disabilities.

Evaluating the significance of minimal brain dysfunction--results of an epidemiological study

An epidemiological field investigation of 399 8-yr-old children was unable to support basic assumptions of the clinical MBD concept (existence of a homogeneous syndrome, specific psychopathology, evidence of increased perinatal risks). Using a multi-level case definition procedure and factor-analytic data aggregation, nearly complete independence was found among the diagnostical levels of neurophysiology, neuropsychology and specific skills. Main results were replicated after the application of several alternative models of case definition and were further confirmed by data from a clinical sample. Present findings emphasize the necessity to reconsider the concept of MBD and its practical consequences.

[Preventive and simultaneous operations of the abdomen]

Prophylactic and elective operations have the same risk. They require detailed and extensive information of the patient and documentation thorough medical reasoning. Without preoperative planning prophylactic operations are justified in severe conditions. Simultaneous operations increase the risk in case they represent major procedures or in septic interventions. Simultaneous surgical interventions of the stomach and the biliary tract imply a high morbidity (13% pulmonary embolism and pneumonia) and a high lethality (15%). In simultaneous operations the fastest of the skilled surgeons is the one who is most successful.

[Significance of pregnancy and labor complications for the genesis of brain function disorders. Results of an epidemiologic study of 8-year-old children]

An epidemiological and a clinical study were conducted to examine the importance of pregnancy and delivery complications in the genesis of cerebral dysfunction, the studies comprising a total of 495 children of 8 years of age. In the case definition of cerebral dysfunction, methodic improvements were used that had been demanded by those who had been critical of the clinical procedure. The results showed that clinical dysfunction is a risk factor for diseases in child psychiatry. There were no signs pointing to uniform psychopathological patterns (on the lines of a hyperkinetic syndrome) in children with cerebral dysfunction. There was no enhanced incidence of other diseases in the anamnesis of children with cerebral dysfunction. On the whole, the concept of cerebral dysfunction cannot be upheld at least to the extent presumed so far. A comparison between field study random samples and clinical study random samples showed that the classical postulates of the concept apply at most to a negligible minority only.

[Embolization of the splenic artery. Emergency therapy in varices hemorrhage and in hypersplenism]

In bleeding of oesophageal varices with resistance to common treatment embolisation of the splenic artery causes depression of the portal hypertension by forty per cent. Thrombosis of the splenic or portal vein as in splenectomies are not to be expected. The splenic vein remains open for later spleno-renal anastomosis. By occlusion of the splenic artery we were successful in stopping oesophageal bleeding. In a patient with dominant hypersplenism in portal hypertension the severity of the syndrome decreased after embolisation of the splenic artery. Thrombocytes, leukocytes and gammaglobulin increased.

[Gastrectomies in the elderly as curative and palliative operations (author's transl)]

Out of 422 patients operated on for gastric carcinoma from 1970-1980, 152 were older than 70 years. We performed a total resection of the stomach on 145 patients: 63 were 60-69 years old, with a 14% mortality; 36 were 70-79 years old, with a 25% mortality. In curative gastrectomies, the mortality was 8% in patients in their seventies (4 cases out of 48) and 12% in their eighties (3 cases of 25). In additional resection of neighbouring organs (liver, colon, and pancreas) mortality was only increased to 17% in the seventh decade and 20% in the eighth. Therefore, radical surgery for carcinoma of the stomach in form of a gastrectomy is justified even in older people, as there is a curative chance. In palliative gastrectomies the mortality has been too high: 33% (5 out of 15) in the seventh decade and 58% (7 out of 12) over the seventh decade. Palliative gastrectomies are only justified in older people if there are special indications.

[Effectiveness of continuous drainage in diffuse bacterial peritonitis]

From 1975 to 1977 we carried out postoperative, continuous peritoneal lavage of th abdomen in 41 patients with diffuse bacterial peritonitis. Although the peritonitis was arrested more frequently and earlier, comparison to 71 patients treated conventionally since 1970 showed an increase of wound complications and a prolongation of hospital stay from 25 to 44 days. The higher frequency of complications led to increased lethality from 42% to 54%. The harm by continuous peritoneal lavage out-weights the advantages, except for stercoraceous peritonitis.

[Effect of oxygen in the tympanum on inner ear function (author's transl)]

Possible effects of extreme variations of oxygen concentration from 0% to 100% in the tympanic lumen on inner ear function were investigated through animal experiments. The experiments were performed with Ketanest anaesthetized cats under short-time acoustic irradiation (3 min 115 dB, pink noise). Inner ear function was measured by means of the stapedius reflex audiometry. On the nitrogen-flushed side (pO2 approx. 0%), the stapedius reflex threshold dropped significantly more after high-frequency irradiation than on the O2-flushed side. Even without acoustic irradiation the stapediusreflex threshold clearly recedes with the tympanic cavity being nitrogen-flushed. This shows that inner ear function in the cochlear base area depends on oxygen concentration in the tympanic lumen. It is pointed out that interrelations between disturbances of tubal and tympanic functions on the one hand, and internal ear function on the other hand may exist.

Antiphytoviral activity of 2,4 dioxo hexahydro triazine

Three treatments with 2,4 dioxo hexahydro triazine (DHT) significantly reduced the concentration of potato virus X (PVX) in systemically infected tobacco plants. In hypersensitive plants DHT caused a reduction in the number of local lesions produced by PVX. In systemic and hypersensitive hosts, treatment with DHT resulted in a more or less marked reduction in the concentration of, and in the number of local lesions caused by, potato virus Y (PVY), potato virus A (PVA), tobacco mosaic virus (TMV), and cucumber mosaic virus (CMV). Three days after treatment with DHT the incorporation of 32P into TMV RNA was significantly reduced, while that into host RNA was less affected.