Breast feeding and obesity: cross sectional study

OBJECTIVE

To assess the impact of breast feeding on the risk of obesity and risk of being overweight in children at the time of entry to school.

DESIGN

Cross sectional survey

SETTING

Bavaria, southern Germany.

METHODS

Routine data were collected on the height and weight of 134 577 children participating in the obligatory health examination at the time of school entry in Bavaria. In a subsample of 13 345 children, early feeding, diet, and lifestyle factors were assessed using responses to a questionnaire completed by parents.

SUBJECTS

9357 children aged 5 and 6 who had German nationality.

MAIN OUTCOME MEASURES

Being overweight was defined as having a body mass index above the 90th centile and obesity was defined as body mass index above the 97th centile of all enrolled German children. Exclusive breast feeding was defined as the child being fed no food other than breast milk.

RESULTS

The prevalence of obesity in children who had never been breast fed was 4.5% as compared with 2.8% in breastfed children. A clear dose-response effect was identified for the duration of breast feeding on the prevalence of obesity: the prevalence was 3.8% for 2 months of exclusive breast feeding, 2.3% for 3-5 months, 1.7% for 6-12 months, and 0.8% for more than 12 months. Similar relations were found with the prevalence of being overweight. The protective effect of breast feeding was not attributable to differences in social class or lifestyle. After adjusting for potential confounding factors, breast feeding remained a significant protective factor against the development of obesity (odds ratio 0.75, 95% CI 0.57 to 0.98) and being overweight (0.79, 0.68 to 0.93).

CONCLUSIONS

In industrialised countries promoting prolonged breast feeding may help decrease the prevalence of obesity in childhood. Since obese children have a high risk of becoming obese adults, such preventive measures may eventually result in a reduction in the prevalence of cardiovascular diseases and other diseases related to obesity.

[Clinical and therapeutic aspects of essential blepharospasm]

The rare disease of blepharospasm which is nowadays believed to be an extrapyramidal dystonic movement disorder is discussed in clinical, differential diagnostic and therapeutic viewpoints. The abundant number of treatment methods proposed in the literature are critically reviewed. 13 cases are described, which were treated by our own surgical procedure - a modified neurotomy of branches of the parotid plexus. The importance of botulinum-toxin treatment in mild and moderate cases of blepharospasm, as well as the success and low rate of complications in neurotomy-treated patients with severe eyelid spasms, is stressed.

The calcium entry blocker nimodipine improves the quality of life of patients operated on for cerebral aneurysms. A 5-year follow-up analysis

Between 1981 and 1985 at our clinic 204 consecutive patients underwent surgical repair of cerebral aneurysms after spontaneous subarachnoid hemorrhage. Of these 113 were treated with Nimodipine, a predominantly cerebrovaskular-active substance. The preoperative condition according to Hunt and Hess (9), the locations of the aneurysms, and the ages of the two groups of patients were directly comparable. The incidence of postoperative cerebral vasospasm was however higher in the Nimodipine group (49%) than in the control group (33%). Retrospectively we analyzed the progress of the patients as to their neurological, intellectual, and social function for up to five years after the operation. Mortality and morbidity in the Nimodipine group amounted to 10% and 7% respectively, in the group without Nimodipine 20% and 17% respectively (p less than 0.001). Of the Nimodipine patients, 72% showed excellent neurological outcome, with 73% intellectually, and 72% completely resocialized, as compared to 53% in the control group with an excellent neurological outcome, 39% intellectually intact (p less than 0.0001, and 52% completely resocialized (p less than 0.01). These results suggest that Nimodipine not only increases cerebral blood flow, but also protects brain tissue from ischemic damage.

Photodynamic therapy of malignant brain tumours: a phase I/II trial

Twenty patients bearing malignant brain tumours (18 glioblastoma multiforme, one malignant meningioma, one melanoma metastasis) were treated 25 times with photodynamic therapy (PDT)--the combination of Hematoporophyrin derivative and light at 630 nm (40-120 J/cm2). Sixteen times the PDT was followed immediately by a single dose radiation of 4 Gy of fast electrons. Conventional radiotherapy following PDT was performed in eight patients. The median survival of three patients with multiple recurrences of glioblastoma grade IV and various chemo- and radiotherapy was 5 months. Four out of 10 patients with one recurrence and prior treatment died with a median survival of 5 months, six are still living up to 12 months. Six patients with a primary glioblastoma are surviving now up to 22 months. Phototoxicity to the skin, the only side effect of PDT, was noted in five cases, but did not pose any threat to the patients. The treatment did not affect the quality of life of the patients. Our preliminary results with the photodynamic treatment of malignant gliomas indicate that PDT might be a valuable addition to our armament in the treatment of such tumours.

A thrombosed giant MCA aneurysm in a ten-week-old infant

A 10-week-old child was operated upon for a left temporal intracerebral haematoma resulting from a ruptured giant MCA aneurysm. The aneurysm was found accidentally during the operation because there was no filling on angiography. The aneurysm was clipped successfully and the child's postoperative course was uneventful. Similar cases in the literature as well as possible aetiological circumstances in childhood aneurysms are discussed.

[Intracranial manifestation of so-called "melanotic neuroectodermal tumor of infancy"--a choristoma with neural crest potentials]

A case is reported of so-called "melanotic neuroectodermal tumour of infancy" (= MNTI) in a female newborn. The tumour, whose localization was intracranial, but extracerebral, could be removed subtotally. A further 22 cases of the MNTI with neurocranial manifestations reported in the literature, but differing from our case in their extracranial growth, are listed for comparison. We believe that the neural crest is the histogenic origin of the MNTI and, therefore, our proposed definition is: "Christoma with neural crest potencies."

[Hydrocephalus following spontaneous subarachnoid hemorrhage]

In the period 1980-1985 221 patients presenting with subarachnoid haemorrhage were operated on at the Department of Neurosurgery of the University of Innsbruck. 26 patients (11.7%) of them required a ventriculoatrial or ventriculoperitoneal shunt. The relationship between the incidence of this complication and the various clinical features of subarachnoid haemorrhage is discussed. Computed tomography is the most important investigative tool for diagnosis and follow-up of hydrocephalus. The results after shunt operation are correlated with the site of the aneurysm and the pre-operative grade of the patient.

[Photodynamic therapy of malignant brain tumors]

The combination of haematoporphyrin derivative (HPD) and visible light at 630 nm, termed as photodynamic treatment (PDT), provides a new tool in tumour therapy, causing selective tumour destruction initiated by photochemical reactions. Up to now 13 patients with malignant brain tumours (12 glioblastoma multiforme, 1 leiomyosarcoma) were treated with 40-80 J/cm2 light following parenteral or direct injection of HPD (5 mg/i.a. or 1 mg/ccm tumour volume). In 5 patients the PDT was followed by subsequent radiotherapy with 4 Gy. The patients with recurrent tumour showed a median survival time of 5 months, whereas the 6 patients with primary manifestations have survived so far for periods of up to 9 months. However, the follow up period is too short to allow final conclusions to be reached on the effect of PDT in the treatment of malignant brain tumours.

[Simultaneous occurrence of brain tumors and aneurysms]

Three patients with different types of intracranial tumour--glioma, meningioma and pituitary adenoma--and associated aneurysms are described. The aetiology of aneurysm formation in the presence of tumours is discussed and a review of the literature given.

Tractotomy and partial vertical nucleotomy--for treatment of special forms of trigeminal neuralgia and cancer pain of face and neck

The therapy of face and neck pain has often been elusive. We attempted to improve the condition of these patients and tried to influence 1. pain of trigeminal neuralgia, where other forms of therapy had failed, 2. pain due to tumours in the distribution of the Vth, IXth and Xth nerve, when all other methods had proved to be unsuccessful, 3. pain due to a traumatic lesion of the Vth nerve after severe injury of the face and 4. pain in the first division of the Vth nerve after herpes zoster infection, when other forms of therapy had failed. After tractotomy the subnucleus caudalis n.V. is partially destroyed. Aim of the partial vertical nucleotomy is the interruption between the first and second neuron of the Vth nerve conveying pain and thermal sensibility, but also of the IXth and Xth nerve, which end in the subnucleus caudalis n.V. as well. Tactile and some thermal sensibility in the face is so retained, and anesthesia dolorosa or keratitis neuroparalytica avoided. Medially of and vertically to the tractotomy a 4-6 mm long incision both cranially and caudally of the tractotomy was made. For the first division of the Vth nerve the nucleotomy is performed on the lateral end of the tractotomy incision. In the patients with cancer of the face and neck a rhizotomy C 1/2 was added. 7 of the 12 patients with trigeminal neuralgia and 3 of the 6 patients with tumors of the face and neck were pain-free. The rest also showed a marked improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

[Partial vertical nucleotomy as a modification of tractotomy of the trigeminal nerve]

The authors report on partial vertical nucleotomy, a modification of tractotomy of the quintothalamic tract. In 1979 eight patients underwent this procedure. Three of them showed a recurrence of pain from genuine trigeminal neuralgia. Three patients had symptomatic trigeminal neuralgia, one patient atypical neuralgia of the face without organic cause, whereas in one case the neuralgia occurred subsequent to a herpes zoster. At the time of examination all patients were free from pain.

[Epidermoid in the 4th ventricle]

A case of pearly tumor (cholesteatoma or epidermoid cyst) of the IV. ventricle in a patient aged 64 years is reported. The patient had been treated one year earlier for lumbar herniated nucleus pulposus. The symptoms, pathogenesis, CT-appearance and operative therapy of the cyst are discussed.

Neurosarcoid reaction in association with a ruptured ACA-aneurysm

A case of neurosarcoid reaction presenting itself as a mass lesion associated with a ruptured ACA aneurysm is reported. Diagnosis was established by histological investigation of the resected "brain tumour". The pre-operative diagnostic problems, similar cases in the literature as well as the possible pathogenesis are discussed.

Subarachnoid metastases from a prolactinoma

A 37-year-old man developed a left frontal metastasis from a prolactin-secreting pituitary tumour, which had been operated on nine years before. The metastatic tumour was totally excised. One and a half years later he was found to have multiple left temporal and parietal subarachnoid metastases. Because treatment with bromocriptine for five months and subsequent radiation proved ineffective, the tumour nodules were removed surgically.

Treatment of cerebral vasospasm following severe head injury with the calcium influx blocker nimodipine

8 patients suffering from severe head injury (Glasgow Coma Scale score of 3-5) were treated with the calcium influx blocker nimodipine (2-3 mg/h) for a traumatic cerebral vasospasm. In every case the spasm involved the frontal region of the circle of Willis with the first two segments of the anterior and middle cerebral artery. Control angiograms, recorded in 6 patients, revealed a dilated or normalized lumen of the vessels that the first angiography had revealed to be spastic. The intracranial and the mean arterial pressure were not altered by nimodipine during simultaneous neurosurgical intensive care therapy (dexamethasone, mannitol, relaxation, and controlled respiration for 2-3 days). Monitoring of the somato-sensory evoked potentials (SEP) showed a distinct improvement of the cortical response within 7 days. One patient died of sepsis 8 days after the accident and one remained in a vegetative state. The remaining patients reached Glasgow Coma Scale scores of 13.0 +/- 1.1. within 8.6 +/- 2.2 days, the initial scores having been 4.1 +/- 0.8. One year after their accident all the patients were once again fully able to work. The survival quality was therefore better than that reported in the literature for patients in similar conditions. We conclude from these preliminary results that calcium influx blockers can be used successfully in the therapy of traumatic vasospasm and of severe head injuries. A study involving a larger number of patients is currently in progress.

Multiple intracranial metastases from a prolactin secreting pituitary tumour

A 28 year old man presented with partial hypopituitarism and signs of a pituitary tumour. A chromophobe adenoma was partially removed by right frontal craniotomy. Seven years later complete hypopituitarism and hyperprolactinaemia were documented, at which time there was no evidence of tumour recurrence of CT scan. The patient was treated with bromocriptine but the pituitary tumour redeveloped a year later. Nine years after the original operation the first metastasis was demonstrated together with very high prolactin levels. The intracranial metastasis, and the pituitary tumour were removed at a second craniotomy following which the prolactin concentration fell. Further metastases developed subsequently and the patient died 12 years after the initial diagnosis. At autopsy multiple metastases were found in the brain, tumour cells were present in the subarachnoid space and in cerebral veins. The pituitary tumour and secondaries were shown by immunocytochemistry to contain prolactin but not ACTH or growth hormone. This appears to be the third well documented case of a metastasizing, prolactin secreting pituitary tumour.

Treatment of the traumatic cerebral vasospasm with the calciumchannel blocker nimodipine: a preliminary report

Five patients with severe head injury, rating between 3 and 5 on the Glasgow Coma Scale, were treated with the calciumchannel blocker nimodipine continuously for up to 12 days (2 mg/h) because of severe spasm of cerebral arteries. All cases involved the intracranial carotid artery and the first segments of the medial and anterior cerebral arteries. Control angiograms performed in 4 cases showed improved or normalized vessel calibre after the treatment. Intracranial pressure as well as blood pressure were not altered during nimodipine treatment. EEG improved within 7 days after treatment in all cases. Repeated CT scans showed reduction of cerebral edema. Hypothalamic disorders observed in 3 cases were stabilized. Based on these preliminary results, calciumchannel blocker reverses traumatic vasospasm and ameliorates physiologic function of the brain structures after severe head injury.

[Clinical experiences with nimodipine (Bay e 9736)]

In 27 patients, who suffered from SAH from a ruptured cerebral aneurysm direct operation and treatment with Nimodipine (Bay e 9736) was performed. Nimodipine was given intravenously over ten days (30 micrograms/kg bodyweight/hour) and thereafter orally over four days in diminishing dosages. There were no noteworth side effects. In comparison with a group of nine similar patients who were not given Nimodipine the study shows that Nimodipine is not able to reduce angiographic spasm or brain oedema in CT-scan. In spite of that the general recovery with Nimodipine was better than in the control group. The worse the initial neurological symptoms are, the more effective Nimodipine seems to be. The study shows that treatment should begin between the first and sixth day after SAH, at least two days before operation and at the latest two days after the onset of secondary spasm.

[Neuropsychologic aspects of spastic torticollis]

On behalf of the limited number of patients, statistical analysis and correlations had not been possible. It was evident however that two groups of patients can be differentiated: One with depressive-neurotic mechanisms and the other without signs of any neurotic-depressive state. It can be concluded that patients with depressive-neurotic signs give poor results after surgical procedures, whereas the other group gives satisfactory surgical results.

[A partly thrombosed basilar artery aneurysm simulating a tumor of the 3d ventricle]

The article reports on a giant aneurysm of the bifurcation of the basilar artery simulating a tumour of the third ventricle and producing a marked diencephalic syndrome. It was diagnosed and treated as a tumour. The symptoms are discussed and noteworthy similar cases are reviewed.