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Nutrition has a crucial influence on physical and mental performance ability and is an important measure along sidetraining in high-performance athletes. However, this form of nutritionis not applicable for every athlete and in every situation. The question of optimal nutrition requires involvement with the particular type of sports, an athlete's current training stage, and athletes' individual requirements and objectives. Implementation takes time and individual motivation on the part of athletes and the specialist staff who engage intensively with the nutritional needs of athletes. In addition to adequate energy provision, it is important to divide the energy sensibly among the energy sources carbohydrates, fats, and protein. Performance athletes' higher need for protein can usually be covered in their regular diet; supplements are needed only in exceptional cases. Studies have shown that small amounts of 15 - 25 g protein are sensible after weight training, in order to stimulate muscle protein synthesis. The need for carbohydrates increases dynamically with the intensity and duration of physical exertion. A sufficient supply is crucial for achieving maximum performance. Low carb diets are unsuitable for performance athletes. So called low-glycogen training, however, can lead to better adjustment/adaptation processes in selected training stages and can increase performance ability.

Fungal spores are frequent in air and their occurrence in the nasal mucus appears to be a common finding within the adult population, as we were able to show in recent studies. 91,3 % of CRS patients but also healthy controls grew positive fungal cultures out of their nasal mucus. The potential role of fungal elements in nasal mucus for the pathogenesis of CRS, with or without polyposis, is currently investigated intensely and discussed very controversially. However, it was still unknown, as of when fungi could be cultured from nasal mucus in humans. We attempted to identify this point of time, in the nasal mucus of neonates.In our study we examined nasal mucus from 30 neonates immediately after birth, on the first and fourth day post partum, and after two and four months of life. The samples obtained with sterile cotton swabs were cultured on agar plates. Fungal cultures were identified either conventionally by microscopy or with molecular techniques. To show whether fungi in nasal mucus of newborns were acquired by contamination during birth, mucus of the maternal vagina was examined as well.Just after birth we found in 6 of 30 (20 %) of our neonates positive fungal cultures out of their nasal mucus, in 3 of them Candida albicans, probably due to contamination passing the maternal vagina as cultures of vaginal mucus of their mothers were positive for Candida albicans too. Positive fungal cultures were obtained in 2 of 29 (7 %) neonates on the second and in 4 of 26 (15 %) neonates on the fifth day of life. In all our cases initial presence in nasal mucus contamination just after birth or on the second day of life was limited to one day only. None of the 12 of 30 (40 %) neonates with positive fungal cultures from nasal mucus in the first 5 days of life showed clinical symptoms of nasal fungal colonisation. Besides Candida albicans, Penicillium sp., Cladosporium cladosporioides, Acremonium polychromum, Beauveria bassiana and Epicoccum nigrum could be detected in the first 5 days of life. After the second month of life, examination of nasal mucus yielded positive fungal cultures in 8 of 11 (72 %), after four months even 17 of 18 (94 %) of babies, with a wide array of different species.Fungi can be cultured from nasal mucus as soon as contact with the environmental air exists. Furthermore, a transfer of fungi from the mother's birth canal into the nose during birth is possible. Presence of fungal spores is common but not persistent in the nose of babies in the first days of life. However, after four months the situation is similar to the one in adults: fungal cultures can be obtained from almost everyone's nose. Therefore fungal spores must be considered a normal content of nasal mucus. Fungal spores are inhaled with every breath, some stick to the mucus, are transported to the nasopharynx and swallowed. This does not cause any clinical symptoms and is therefore not a pathological finding at all.

To assess the value of two-compartment magnetic resonance (MR) wrist arthrography in comparison with diagnostic arthroscopy for the evaluation of defects of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments in patients with refractory wrist pain. The direct MR arthrographies were evaluated following arthroscopic classification with consideration of complete and partial defects. The distinction between these types of lesions has clinical implications for treatment procedures such as cast immobilization, arthroscopic debridement, surgical repair or partial intercarpal arthrodesis.Seventy-five patients (25 female, 50 males, mean age 38.3 years) who suffered from refractory wrist pain without radiography evidence of carpal instability underwent two-compartment wrist MR arthrography. Under aseptic conditions a solution of gadopentate dimeglumine and iodinated contrast agent (concentration 2.5 mmol/l) was injected into the radiocarpal and midcarpal joints under fluoroscopy guidance. Using a scanner of 1.5 T field strength and a wrist-coil following sequences were acquired: coronary and sagittal T (1)-weighted spin-echo (SE) sequences (TR 500 ms, TE 25 ms, matrix 512 x 512.3 mm) and coronary fast low angle shot (FLASH) 3D sequences (TR 24 ms, TE 11 ms, matrix 256 x 256, 1.5 mm, flip angle 50 degrees). All patients underwent subsequent arthroscopy of the wrist. The direct MR arthrographies were evaluated retrospectively by two observers experienced in the diagnosis of wrist pathology. They were not aware of the clinicial, arthrographic and arthroscopic findings. Pathology of the scapholunate ligament was classified according to the guidelines of the German Society of Hand Surgery (DGH), lesions of the lunotriquetral ligament according to Hempfling and lesions of the TFCC according to Palmer.Twenty-five complete and 47 partial defects were detected arthroscopically (TFCC: 21/20, scapholunate ligament: 3/18, lunotriquetral ligament: 1/9). The TFCC showed a higher prevalence for degenerative lesions (11 type 2C-lesions and 20 type 2A/B lesions) than for traumatic lesions (5 type 1A lesions, 5 type 1D lesions). For direct MR arthrography, the obtained sensitivities and specificities in assessing complete defects were 96 % and 99.6 % (T (1)-weighted SE) and 92 % and 100 % (FLASH 3D), respectively. For all partial defects, sensitivities and specificities were 68.1 % and 93.3 % (T (1)-weighted SE) and 63 % and 96.1 % (FLASH 3D), respectively. For depicting partial defects of the scapholunate ligament the T (1)-weighted SE sequence (83.3/95.5 %) was superior to the FLASH 3D sequence (64.7/96.6 %), p0.05. For the evaluation of the TFCC (T (1)-weighted SE: 65/94.4 %, FLASH 3D: 70/94.6 %) and the lunotriquetral ligament (T (1)-weighted SE: 44/89.4 %, FLASH 3D: 44 /96.7 %), direct MR arthrography showed an insufficient correlation with arthroscopy.Direct MR arthrography proved to be of equal value compared with diagnostic arthroscopy in detecting complete defects of the intrinsic ligaments and the TFCC. The method has the potential of replacing diagnostic arthroscopy for the evaluation of the intrinsic ligaments and the TFCC. The T (1)-weighted SE sequence appeared to be superior to the FLASH 3D sequence in evaluating partial defects of the scapholunate ligament. Direct MR arthrography did not reliably detect partial defects of the TFCC and the lunotriquetral ligament.

In the last fifty years, only 22 medical cases involving the basidiomycetous fungus Schizophyllum commune were reported. In a period of three years we have examined 270 patients suffering from chronic rhinosinusitis as well as from mycoses (fungus balls) within the paranasal sinuses. Either nasal mucus or fungal concrement from the sinuses were cultured and the resulting cultures identified microscopically. In cases, where a reliable identification of the fungi was not possible, DNA was extracted for molecular examination. The internal transcribed spacer (ITS) region of the ribosomal gene-cluster was amplified with fungus specific primers and sequenced thereafter. In addition, DNA of all fungi growing with sterile white mycelium was amplified with the primer pair scom1/scom2r, which is specific for S. commune. Altogether, within a three years period S. commune was isolated in twelve patients. It can be assumed, that with the presented methods S. commune will be found much more frequently in patients suffering from diseases of the nasal sinuses.

Hamartomas are tumour-like malformations, resulting from excessive proliferation of otherwise normal local tissue components. Hamartomas of the nasal cavity and paranasal sinuses are relatively rare, especially respiratory epithelial adenomatoid hamartomas. This benign lesion is characterized by a glandular proliferation originating from the surface of the respiratory epithelium. In the German speaking literature this entity has not been described before.We report the case of a 51-year-old white female, presenting with a respiratory epithelial adenomatoid hamartoma of her left nasal cavity. The patient suffered from nasal obstruction. The CT scan showed a soft tissue like lesion obstructing the patient's left choana. After local resection of the tumour, which originated from the superior turbinate through functional endoscopic sinus surgery the patient's symptoms were gone. Follow-up after six months showed no evidence of recurrence.The histopathological differential diagnosis of respiratory epithelial adenomatoid hamartomas includes inverted papilloma and adenocarcinoma. Therefore the histological recognition of these hamartomas impacts on therapy. Misinterpretation as a true neoplasm may result in unnecessarily radical surgery. Local surgical resection is the treatment of choice for this lesion.

Chronic Rhinosinusitis (CRS) is the most common chronic disease in the United States. Though for Europe no data are available, we have to assume that the situation is similar. Although the disease is defined very well by clinical symptoms, up to date the etiology and pathogenesis of chronic rhinosinusitis are unknown. CRS is considered to be multifactorial, with thickening of the mucosa and formation of polyps as an end stage of the disease. Treatment of choice includes corticosteroids and/or endoscopic or microscopic surgery. Antibiotics only help, if there is an acute bacterial exacerbation of the disease. They are not able to cure chronic rhinosinusitis per se. In 1999 Mayo Clinic researchers published data concerning the incidence of so-called "allergic" fungal sinusitis (AFS) in their patients suffering from chronic rhinosinusitis, demonstrating the majority of patients investigated presenting those criteria. Our own initial data from 2000 confirmed their findings.In an open prospective study fungal cultures were obtained from nasal mucus of 238 consecutive patients suffering from CRS. As control group acted 23 members of our staff, who did not show any evidence for CRS. In addition, in 37 CRS patients surgical specimens (mucus and tissue) were investigated histologically for evidence of eosinophilic granulocytes and fungal elements.Using new techniques for fungal detection in culture and histology as proposed by Mayo Clinic researchers, positive detection of fungal cultures of the mucus of our CRS patients developed from 7 % in the past up to 87 % at present. 91.3 % of our control group yielded a positive result in fungal culture. Histologically, eosinophilic clusters were evident in 94.6 % and fungal elements were detected in 75.5 % within the mucus of 37 surgical CRS patients. Overall, 89.2 % of our surgical patients thus fulfilled the criteria of so-called AFS. Compared to our findings in the past, our latest results show an increase of 80 % in detection of fungal elements in our CRS patients. In all we were able to identify 654 positive fungal cultures in 238 CRS patients and 23 healthy controls respectively. 88 different genera grew, with 2.4 different species per patient and 3.1 different species per healthy control, on average.Utilizing new techniques of fungal culturing out of the mucus of CRS patients and healthy controls, the number of positive fungal cultures increased dramatically from 7 % to 87 % in our patients and 91.3 % in healthy controls respectively. To obtain these results it is crucial to perform special techniques of mucus sampling and pretreatment for culturing as well as for histological investigations. Our results show, that with suitable techniques fungi can be identified in almost everybody's nose, CRS patient or healthy. When inhaled, those airborne fungi are only "in transit" through the nose. Positive fungal cultures from nasal secretion therefore have to be considered normal findings. The reason for this delayed recognition has to be attributed to our inadequate methods in the past. In contrast to healthy controls, clusters of eosinophils and fungal elements are present simultaneously within the mucus of CRS patients and appear to be a marker of the disease.

The intensity of the symptomatology of schizophrenia in adolescents is essentially the same as in adults. As a rule schizophrenic psychoses in adolescence are first manifestations, and other psychiatric disorders have to be ruled out. The classical differential diagnoses include: exogenous psychoses, in particular drug-induced; affective psychoses; pubertal crises; personality disorders. Special early-onset features arise because drastic behaviour of another nature is occasionally misinterpreted or--more commonly the case--early schizophrenia in adolescents is not recognised and treated in time because of the uncharacteristic initial symptoms.

The present study examines for the first time specific forms of coping in adolescents with schizophrenia during the initial phase of their illness. It was found that schizophrenic adolescents develop considerably less active coping compared to adolescents with other disorders. Active coping is least prominent for positive symptoms (delusions, hallucinations, thought disorders); the youngest first-manifestation adolescents are also impaired in other domains (irritability, psychosocial stability). The results have exploratory character as they are based on a small and thus not representative number of cases, but should prompt further investigations.

72 case histories of former adolescent psychiatric inpatients diagnosed on discharge as suffering from a personality disorder were evaluated. It was possible to re-examine 33 (46%) of them. The discharge diagnosis was made according to ICD 9, the follow-up diagnosis according to ICD 10 and DSM-III-R. Depending on the instrument and criterion, 40% to 87.9% of the discharge diagnoses made could be confirmed after an average follow-up period of 3.4 years. Only in 12.1% of the cases there was no personality disorder established. There was no indication of any change of diagnosis to other psychiatric disorders. The re-diagnosis rates obtained are thus similar to those for adults. The classifications of ICD 10 and DSM-III-R corresponded much better than those of ICD 9 to clinical reality. The classification systems and assessment instruments that have normally been verified only for adults thus also seem suitable for use among adolescents. In both adolescents and adults the avoidant personality disorder is a particularly frequent subtype. However, the current study was unable to resolve the question of what the decisive criteria should be in the case of competing definitions such as puberty crisis, personality development disorder, personality disorder and emotional or affective disorder. This issue requires further investigation.

Examination of a 14-year-old male who was admitted to an inpatient unit with an acute paranoid syndrome yielded serious organic findings: macroencephaly, head tilted to one side, strabismus, neurological deficits, hydroencephaly and an expressive speech disorder. The personal and family history revealed a disturbance of motor development since infancy and psychiatric illness in the immediate family. The medication and the surgical procedure selected--endoscopic third ventriculostomy--are described and the difficult differential diagnosis is discussed.

Needle aspiration is currently a widely used technique in the diagnosis of unclear lesions in the head and neck region. We present a modified technique of fine needle biopsy in ENT, "fine needle capillary technique". The basics of this technique were developed by Zajdela and coworkers (1987) as a cytological method of fine needle biopsy in benign and malignant mammary tumors. Fine needle capillary technique does not require aspiration of cell samples via negative pressure created by a syringe. A thin 25 G needle (outer diameter 0.50 mm, length 25 mm) is introduced into the lesion with one hand. The cells are detached by the cutting edge of the needle and are conducted into the lumen by capillary force. The needle is removed and the cellular material is expelled onto a glass slide, spread, and immediately fixed.In a series of 166 patients with unclear lesions in the head and neck region, we compared the fine needle capillary technique with the classic fine needle aspiration technique in each patient. Regarding quality and assessment of the cytological smear the fine needle capillary technique proved clearly superior in most of the cases. Lymph nodes, tumors of the salivary glands, thyroid glands, branchiogenic cysts, one atheroma, one lipoma, and one skin metastasis of a squamous cell carcinoma were punctured.In our study fine needle capillary technique showed a very good quality of the cytological smear in 24.7% of all cases, while fine needle aspiration technique reached 12.1% only. A good quality was obtained in 51.2% with fine needle capillary technique and in 51.8% with fine needle aspiration technique, poor quality in 24.1% with fine needle capillary technique and in 36.1% with fine needle aspiration technique. Nondiagnostic cytology was obtained in 21.7% with fine needle capillary technique and in 32.5% with fine needle aspiration technique. Both techniques together showed insufficient material in 10.8%. The quality of the cytological smear in each region was always better with fine needle capillary techniques than with fine needle aspiration technique except five punctures of the submandibular gland. Of 166 patients 113 (68.1%) underwent surgery, and a correlation of the cytologic report to the surgical specimen showed agreement in 95.7% with fine needle capillary technique and in 90.5% with fine needle aspiration technique. In 17.7% with fine needle capillary technique and in 25.7% with fine needle aspiration technique it was not possible to compare the cytological smear with the histological results because of poor quality of the cytological smear. In four cases (4.3%) with fine needle capillary technique the cytological diagnosis was wrong. With fine needle aspiration technique, a wrong diagnosis occurred eight cases (9.5%).Fine needle capillary technique offers several advantages. Without aspiration trauma to cells and tissues is reduced. Less blood in the samples results in higher quality of the cytological smear. These circumstances make it easier for the pathologist to comment the cytological findings. The handling of the needle is practiced with a wrist movement and not from the shoulder joint as in aspiration method using the Cameco syringe holder. This allows for a more sensitive puncture technique touching the lesion during sampling with the finger tips. The puncture causes less pain than the aspiration technique. Our results demonstrate that fine needle capillary technique is the better method of fine needle biopsy in the head and neck region.

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. The clinical findings when nasal mucosa is involved include nasal crusting, epistaxis, pain and/or anosmia, nasal polyps, or submucosal nodularity.We describe a case of sarcoidosis of the paranasal sinuses. In a 33-year-old man, the first symptom was therapy resistant putrid dacryocystitis. Further there had been symptoms of chronic sinusitis. A CT scan revealed swelling of the mucosa in the anterior ethmoid, frontal recess, and maxillary sinus. As the disease obviously affected the region of the nasolacrimal duct with consecutive stenosis of this canal, we opted for endoscopic sinus surgery. A few days after this endoscopic procedure, the dacryocystitis had healed.The histopathological examination showed the typical picture of sarcoidosis that had its primary manifestation in the paranasal sinuses. According to these findings further explanation of the patient was necessary. The diagnosis of sarcoidosis was confirmed by lavage and biopsy material of bronchoscopically suspect lung areas. Consequently, the patient underwent a long-term corticoid therapy and today, 10 months after the surgical intervention, the patient is free of symptoms. Follow-up endoscopy of the paranasal sinuses showed no further pathological findings.Our case demonstrates that the first manifestation of sarcoidosis can be in the paranasal sinuses.

Newborn dairy calves (n = 82) were investigated for relations between frequency and intensity of sucking movements at the one hand and course of parturition, values of a modified Apgar-Score, time between birth and first standing as well as parameters in the blood (lactate, glucose, immunoglobulins, pH, base excess, pCO2) and the incidence of newborn diseases at the other hand. In another group 101 dairy and 533 crossbred calves (dairy x beef) were compared with regard to the course of parturition, vitality, sucking behaviour and the ability to stand and drink without help 12 hours post natum. Sucking behaviour can be recommended as a criterion of vitality alone or as part of a modified Apgar-Score. A frequency of 80 and more intensive sucking movements/min sucking time and the ability to stand and drink without human help within 12 hours post natum are physiological. In milk x beef crossbred calves this ability can be impaired even in cases of normal birth.

The aim of the present study was to compare the efficacy and the tolerability of salmeterol and theophylline in patients with nocturnal asthma. 16 patients were entered into a randomized, double-blind, crossover trial. Using a double-dummy technique, salmeterol (50 micrograms b.i.d. by MDI) or theophylline (Uniphyllin; 600 mg nocte orally) were given for periods of 7 days with a wash-out period of 7 days between treatment periods. With salmeterol the number of nights with an overnight fall in peak expiratory peak flow rate (PEFR) of at least 20% was reduced by about 20% compared to about 10% with theophyllin (p0.05 for the difference between salmeterol and theophylline). With respect to nocturnal symptoms 62.6% of the patients had rare or non symptoms without and 84.7% with salmeterol, compared to 46.5% without and 67.3% with theophylline (p0.05). With respect to the improvement of early morning symptoms, the increase of nights with none or rare symptoms was 46.2% with salmeterol compared to 25.8% with theophylline. The overall parameter of efficacy defined as a) the number of nights with an overnight fall in PEFR or less than 20% als well as b) none or rare nocturnal symptoms and c) none or rare early morning symptoms increased from 23.4% at baseline to 75.1% during treatment with salmeterol compared to an increase from 24.5% at baseline with 54.8% during treatment with theophylline (p0.05). 12 patients preferred salmeterol over theophylline (p0.05). 3 patients had gastrointestinal disturbances during theophylline treatment. It can be concluded that both salmeterol and theophylline are effective in the treatment of nocturnal asthma. With respect to the overall efficacy and the tolerability salmeterol is superior to theophylline.

The fecal microflora of the breast-fed infant consists of nearly 100% Bifidobacteria. The importance of this long-known and unique phenomenon is still not clearly understood. Likewise, the presence of lysozyme in the feces of breast-fed infants, which is administered in significant amounts with the human milk is not adequately known. New hints and hypotheses concerning digestion in ruminants are cited. In ruminants Lysozyme c functions as digestive enzyme in the rumen. Lysozyme causes lysis of the bacterial cell membrane leading to the release of bacterial contents i.e. proteins. The proteins synthesised in bacteria are the main source of nitrogen for ruminants. The hypothesis is established, that the enormous amounts of Bifidobacteria in the colon of the human newborn can be made of use in a similar way. The lysozyme in the colon of breast-fed infants leads to lysis of Bifidobacteria in connection with tryptic digestive enzymes, in turn leading to release of proteins and protein substances. It has recently been demonstrated that catabolic products of these proteins can be absorbed in the colon. The same group has shown that lysis of Bifidobacteria can take place in the presence of lysozyme in connection with trypsin.

Ethmoidal cells that have developed into the floor of the orbit or into the roof of the maxillary sinus, respectively, are known as Haller's cells. 528 patients, in whom functional endoscopic sinus surgery was performed, were explored regarding the presence of Haller's cells. 43 patients presented with Haller's cells at least on one side (8.14%). CT scans of these patients were evaluated morphometrically measuring the dimensions of the Haller's cells as well as of the maxillary sinus. Further anatomical variations of the paranasal sinuses (concha bullosa, supraorbital cell, agger nasi cell) and the keros type of the ethmoid sinus roof were seen. A highly significant difference could be demonstrated between the incidence of Haller's cells in men (4.9%) and women (11.9%). For the first time it was possible to demonstrate a frequency distribution between Haller's cells deriving from the anterior ethmoidal cells (88%) and those originating from the posterior ethmoidal cells (12%). In 56% Haller's cells were opacified on CT-scan showing a mucosal swelling respectively a retention of secretion during endoscopic surgery.

Heinrich Braun was born on January, 1, 1862. He attended school in Dresden and was a student of Medicine at the Universities of Strassburg, Greifswald and Leipzig between 1881 and 1887. In 1887 he acquired his doctorate degree. Von Volkmann was his teacher in surgery in Halle. From 1891 to 1905 he worked in different non-university hospitals in Leipzig. In 1894 he was promoted "doctor habilitatus" under Thiersch as an extern. He lectured on general and local anaesthesia as a "Privatdozent". In 1905 he was appointed extraordinary Professor at the Medical Faculty of the University of Leipzig. 1906 he left Leipzig and became Chief Surgeon and Medical Director of the Royal Saxonian Hospital in Zwickau. In this position he worked until his retirement in 1928. He died on April, 26, 1934 in Uberlingen. Heinrich Braun's contributions to the development of anaesthesiology are numerous. They concern general as well as local and regional anaesthesia. In 1901 he designed an apparatus for mixed-gas anaesthesia and reported on experiences with combined inhalational anaesthesia with ether and chloroform. In 1903 he recommended on the basis of profound experimental investigations to add adrenalin as a vasoconstrictor to local anaesthetics. In 1905 the first edition of his manual "Local Anaesthesia--Scientific Basis and Medical Practice" appeared. Braun extended the general practice of local and regional anaesthesia significantly. Famous representatives of his school are Läwen, Peuckert, Kulenkampff, Härtel and Kappis. In Zwickau he extensively dealt with problems of hospital organisation and -construction. In 1921 the new "Krankenstift Zwickau" constructed on the basis of his plans and recommendations was inaugurated.(ABSTRACT TRUNCATED AT 250 WORDS)

Patients with pulmonary diseases and reduced respiratory reserves live 'higher' than healthy persons. Nevertheless, they tolerate staying at medium altitudes ranging between 1500 and 2500 m a.s.l. surprisingly well. In order to establish patients' high-altitude fitness, it is necessary to examine them individually. It is important to differentiate between reversible obstructive and irreversible pulmonary diseases. Despite a drop in arterial oxygen pressure and oxygen saturation, many patients suffering from average obstructive illness feel no discomfort at high altitude and are surprisingly fit. Patients with irreversible pulmonary diseases, pulmonary emphysema or pulmonary fibrosis feel often more comfortable in the mostly drier and cooler mountain air; however, they are physically less fit when compared at lower altitudes. In contrast to the reversible obstructive pulmonary diseases, only slight adaptation is possible. In judging the tolerance to high altitude, one has to consider that a large number of patients suffering from chronic obstructive pulmonary illnesses simultaneously suffer from coronary heart diseases.

Although in his time a well-known and high esteemed surgeon, the data of Heinrich Braun's life are nearly forgotten, but his (now 100 year old) description of enteroanastomosis as a routine addition to gastroenterostomia made his name immortal. The author himself was not too enthusiastic about his idea, because he applied the new technique only to a few patients suffering from inoperable cancer. Apparently he never thought of the possibility nor expected the great success of the combination with the Billroth II operation as it is practised nowadays.

Six female in-patients suffering from anorectic reaction are described. Difficulties in diagnosis and differences between these patients and anorectic patients of normal intelligence are discussed. The main finding is that in all six cases there was an extremely close and symbiotic mother-child relationship and a weak or absent father. Relevant life events in the nuclear family (new partner for the mother, illness in the father) then triggered the eating disorder.

The distribution of disorders in a one-day sample of 1806 adolescents receiving inpatient psychiatric care and classified with the diagnostic system ICD-9 is described. Of the inpatient psychiatric facilities for adolescents in the Federal Republic of Germany and West Berlin, 85% responded to our questionnaire. The main findings were: 1) More of the inpatients were male than female (1:0.8); 2) 80% of the patients were being treated at non-university facilities; 3) differences in diagnose between university and other hospitals were small and concerned only psychosis, eating disorders and oligophrenia; 4) the most frequent diagnoses were psychosis and neurosis (20% each), followed by special symptoms/syndromes and conduct disorders (between 10% and 15% each) and emotional disorders (10%); 5) other disorders were less common (under 10% each); 6) a comparison of the different Länder in the Federal Republic indicated that some regions do not have enough inpatient facilities.

Adolescent schizophrenics show obsessive-compulsive symptoms as often as adult patients. Obsessive-compulsive symptoms occur generally both in premorbid and post-acute states, whereas they are rarely observed in acute states. A particular preference of any schizophrenic subgroup doesn't seem to exist. Obsessive-compulsive phenomena are not the same as coping-techniques or (pseudo)-neurotic defense mechanisms, and don't allow a prediction of a distinct outcome. The relationship between schizophrenia and obsessive-compulsive symptoms is variable, and doesn't follow a set pattern.

Clozapine is an effective antipsychotic agent with atypical neuroleptic and side effects. The risk of pathological changes in the EEG and of seizures is correlated to the dosage administered. With dosages of 300 mg/day or higher the EEG should be monitored regularly. The neurophysiological effects of this drug, known only in adults up till now, were also found in adolescents suffering from schizophrenia.

Over two years 206 neonates received their mothers milk, 308 were given a formula milk. A dip-slide method, well-known from urine diagnostics (Uricult) was used for bacteriological examination. Breast milk in good condition was given untreated to the neonates. The incidence of intestinal infections was much less in babies who received breast-milk. The anti-infective properties of human milk could be demonstrated.

A sample of 148 child and adolescent psychiatric patients with hysterical neurosis is described as to the variables features and extent of symptomatology, age and sex distribution, psychosocial adversity and prognostic factors. Out of the "classical" symptoms seizures, walking disturbances, twilight attacks and paralyses were seen most frequently whereas vision and hearing disturbances were rather rare. Only one fifth of the patients presented a monosymptomatological pattern of disturbance. Mean age at falling ill was 13.4 years, just three children were younger than 6 years. Our clinical results buttressed by other reports of the child and adolescent psychiatric literature indicate that the traditional concept of hysteria postulating a close link between somatical symptom development and a specific intrapsychic conflict is hardly tenable at least for childhood and adolescence. Classification should be rather grounded upon an essential phenomenological approach as designed by ICD 10.

Problems of genetic counseling in connection with Duchenne progressi ve muscular dystrophy are discussed. The disorder is transmitted by a sex-linked recessive mechanism; thus, it rarely appears in women, although it is transmitted from mother to son. Sons of a carrier mother have a 50% chance of receiving the pathological chromosome (and manifesting the disorder clinically), while daughters have a 50% chance of being carriers themselves. Carriers may be identified from studies of family trees and by elevated creatine phosphokinase levels. In the case of a carrier who desires children, amniocentesis and termination of pregnancy in the case of a male fetus is the only possibility for preventing the birth of a boy with the disorder. Prospective parents must be informed of the risk as well as of the means of prevention.

The protective effect of breast feeding against infections is well proved by the experiences in underdeveloped countries and in industrial countries as well as shown by numerous investigations in several populations of different social structure. Various factors are meant to be responsible for this special property of human milk, the importance of which is to be discussed. The lysozyme and the lactoferrin are two different antibacterial factors well known since a long time, the former of which is mainly directed against grampositive organisms and against gramnegative ones only under special conditions. Lactoferrin is effective against E. coli and Staphylococcus as well. The neuraminic acid of which the human milk contains a larger quantity than cow's milk also inhibits the growth of E. coli and Staphylococcus. A further factor consisting of isomers of linoleic acid protects mice against lethal Staphylococcus - infections. The most important antibacterial principles of human milk are meant to be specific immunoglobulins, specially secretory IgA. The immunoglobulins are mainly important for the young baby in the early stage of life. The fecal bifidusflora specific for the breast-fed infant is also meant to be protective against several infections. The factors of human milk provoking this special kind of intestinal flora are to be discussed. In the artificial-fed infant bifidus flora like that of breast-fed one can arise by application of lactulose. Nowadays, bifidus-flora can probably be obtained by application of beta-lactose. It is suggested, that infants with bifidus-flora provoked by one of this means are protected against intestinal infections. The results of all investigations on mother's milk lead to the conclusion, that breast-feeding is the optimal kind of alimentation in the first time of life, not only concerning the composition of the food, but concerning protection against infections.

In 35 patients with normal renal function antidiuretic hormone (DDAVP) effected a significant contraction of renal pelvis and calices, while in 10 other cases an enlargement of the roentgenological size of the kidneys was caused by the administration of the diuretic furosemide (Lasix). These results suggest a dependence of urographic findings from the state of diuresis.

A case is reported of a 12-year-old boy with the XYY syndrome and unusual clinical symptoms. In addition, past research on the XYY syndrome and the current state of knowledge is reviewed, with special emphasis on psychopathology, psychiatry and genetic counseling.

Newborn babies transported in an incubator are obviously exposed to considerable mechanical vibrations. We measured these vibrations with the aim to improve these conditions. The vibrations measured on transportation by R.T.W. ambulance (Daimler-Benz 508 with an "anti-vibration platform") are almost tolerable; however on the K.T.W. ambulance (Volkswagen Type 2) the registered vertical accelerations were much greater and gave an unacceptable level of gravitational forces. Small constructive corrections to the stretcher and the connection between stretcher and incubator lead to a marked decrease in peak acceleration and the value of effective acceleration. We also found that it is of great importance to drive smoothly and that the vibrations are more pronounced with hasty driving. The influence of these vibrations as a possible co-factor in the pathogenesis of intracranial haemorrhage is discussed.

The leucocytes and erythrocytes in spontaneous urines were determined in the counting chamber at native and experimentally reduced pH values after standing for various periods. The pH value remained constant for up 6 h, whereby the disintegration of cells increases with rising pH values. The investigations do not rule out a circadian rhythm of cell excretion referring to the quantity of cells/time. Depending on the absolute number of cells the methodic variation coefficient lies between 4 and 25%.

The study is based on interviews made with women who care for an elderly relative. The activities which they perform can be classified to five basic forms of assistance: basic care and nursing, psycho-social care, obligatory attendance, house keeping, and supporting contacts to the social environment. The relationships between these women and the elderly contain a certain amount of reciprocity, which is reflected in material and emotional gratifications for the person rendering help. The burdens on the helper result from constant awareness of the decrepitude of a relative, from fear of the future, and from the necessity of constantly being in attendance of a dependent person. Women who feel burdened by their tasks perceive few rewards from the relationship, and have the impression that the person being cared for has no adequate idea of the efforts made. Because of the burdens on the relatives, the continuation of care of the elderly in their familiar social environment remains precarious. This finding is not an argument against care in familiar surroundings, but it does call attention to the importance of mobile social services for stabilizing primary assistance.

C.S.F. lactate- and lysozyme concentrations were determined in 74 children with bacterial and aseptic meningitis, combined with other laboratory findings (white-cell count, differential blood count, total protein, glucose). Lactate and lysozyme concentrations proved to be best for the differentiation between bacterial and aseptic meningitis.

In 3,8% of 2,437 in-side patients, examined by x-rays, septs of the gallbladder, supposed to be congenital form variations, were found. There were no differences in sex distribution of the segmented organs and no recognizable correlation to increasing age. Usually, septations were found by accident without clinical relevance. In the proximal parts of the gallbladder located septs occasionally cause symptoms not to be differentiated from those of cholelithiasis. In these cases ectomize is indicated. Calculi are found to be more frequent in septate gallbladders than in unsegmented ones. Sex differences between concrement-bearing, septate gallbladders and unsegmented organs containing stones, were not observed. Likewise, there was no correlation of gallbladder-septs to other diseases, particularly to hepatitis.