Twenty years of the German Environmental Survey (GerES): Human biomonitoring – Temporal and spatial (West Germany/East Germany) differences in population exposure

The German Environmental Surveys (GerESs) are nationwide population studies, which have repeatedly been carried out in Germany since the mid-1980s. The subjects were representatively selected from the regional registration offices with regard to age, gender and community size. The first survey for adults (GerES I) was carried out in 1985/1986 (West Germany) followed by GerES IIa in 1990/1991 (West Germany) and GerES IIb in 1991/1992 (East Germany). In GerES II children were also included to some extent. In 1998, the third GerES for adults was conducted in both parts of Germany (GerES III). The current survey 2003/2006 (GerES IV) is focussing exclusively on children. A 1-year pilot study was conducted in 2001-2002 to collect information on parameters influencing the response rate and to test the suitability of the different instruments intended to be used for the main study. The main goal of the surveys is to analyse and document the extent, distribution and determinants of exposure to environmental pollutants of the German general population. Three main instruments of investigation were comprised in GerES: human biomonitoring (HBM), monitoring of the domestic environment, and collecting information on exposure pathways and living conditions via questionnaires. This paper is focussed on the general design of the GerESs, the trend over time and spatial differences (West Germany and East Germany) for HBM data on arsenic, cadmium, lead, mercury, pentachlorophenol (PCP), and polycyclic aromatic hydrocarbons (PAH). These substances have been determined in blood and/or morning urine of adults and children. All GerESs have been conducted in close connection with the National Health Interview and Examination Surveys performed by the Robert Koch-Institute, Berlin.

Kinder-Umwelt-Survey (KUS) im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS)

The German Environmental Survey for Children (GerES IV) is the environment-related module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute and the fourth GerES of the Federal Environment Agency. The main objective of GerESs is to analyse and document the extent, distribution and determinants of exposure to environmental pollutants of the German general population. GerES IV was performed from 2003 to 2006. A total of 1.790 children aged 3-14 years from 150 sampling locations participated in GerES IV. Samples of blood, urine, tap water, house dust and indoor air were analysed. Hearing tests, measurements of traffic noise and interviews to get exposure-related information were conducted. First results indicate a clear decrease of the exposure to arsenic, lead and mercury. Cotinine concentrations in urine can be used to classify the exposure of children to environmental tobacco smoke. The examination of the tap water used in the subjects' households indicates that in some households the guideline values of the German Drinking Water Ordinance were not always met. This is the case for nickel, copper and lead which are used as pipe material for domestic plumbing.

Diagnostic Management of Benign and Malignant Pheochromocytoma

As rare and thus often overlooked hormone-secreting tumors, pheochromocytomas pose a particular diagnostic challenge. Difficulties involve biochemical confirmation, localizing, and detection of malignancy. Measurement of free plasma metanephrines, genetic testing and specific imaging procedures--such as MIBG and octreotide scintigraphy or fluorodopamine PET--represent a considerable progress, and the management of benign pheochromocytomas has become very effective. However, a comparable improvement in the prognosis of malignant chromaffin cell tumors, which occur in approximately 10-15% of all cases, has not yet been achieved. Here, telomerase catalytic subunit (hTERT) activity and heat shock protein 90 expression could serve both as molecular markers allowing an earlier diagnosis of malignancy and as therapeutic targets. Familial syndromes should be considered both in benign and malignant pheochromocytoma, and should be tested for prior to surgery in selected patient groups.

The German Human Biomonitoring Commission

In Germany, the Human Biomonitoring Commission of the German Federal Environment Agency was established in 1992 to develop scientifically based criteria for the application of human biomonitoring (HBM). The goal is to clarify fundamental and practical issues related to HBM. Following the assessment of pollutants in body fluids, the commission derives two different kinds of guideline values: reference values and HBM values (HBM I and HBM II values). This article gives a review of the current reference values, HBM values, and the work of the German Human Biomonitoring Commission.

19-jährige Patientin mit akuter Promyelozytenleukämie und Knieschwellung

We report on a case of a 19-year-old female patient with acute promyelocytic leukemia suffering from febrile monarthitis of the right knee during neutropenia after consolidation chemotherapy caused by Geotrichum capitatum. Apparently this infection occurred due to a hematological reactivation since the patient had already developed Geotrichum capitatum fungemia during induction therapy. Under antimycotic therapy with voriconazole, flucytosine, and caspofungin as well as after two arthroscopic synovectomies with cleansing of the right knee, the infection could be controlled and the full clinical function of the knee joint could be preserved.