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Medizinische Fachgebiete entwickeln sich in historischen Zeitrahmen, in denen die gesellschaftlichen und die wissenschaftlichen Bedingungen vorangeschritten sind. Einzelpersonlichkeiten wie Prof. Otto Heubner wirkten in ihrer Zeit als Pioniere ihrer Fachgebiete. Otto Heubner war das unbestrittene Haupt der Kinderheilkunde seiner Zeit. Seine Aufforderung „die Kranken pflegen und die Wissenschaft“ ist auch heute noch ein Credo der modernen Kinderheilkunde. Der vorliegende Beitrag gibt einen Einblick in das Leben und Wirken von Otto Heubner.

Fur deutsche Kinder im Alter von 0–6 Jahren lagen keine in Langsschnittuntersuchungen ermittelten aktuellen Mase des Kopfumfangs (KU), der Brustkorbentwicklung, der Skelettrobustizitat (Epikondylenbreite), der relativen Skelettmasse (Frameindex) sowie des Metrikindex, der den Korperbautyp charakterisiert, vor. Wie sind die aktuellen altersabhangigen Mase der o. g. Parameter bei Jungen und Madchen? Wie verhalten sich die Wachstumsgeschwindigkeiten des KU sowie des Brustumfangs, der Brustbreite und Brusttiefe im Alter von 0–6 Jahren? Der altersabhangige Kopfumfang ist gegenuber fruheren Langsschnittstudien nicht wesentlich verandert, die Wachstumsgeschwindigkeit ist jedoch im 1. Lebensjahr z. T. hoher. Die Kopfumfang/Korperhohen-Perzentilen prazisieren die altersgerechte Beurteilung des KU. Die Brustkorbmase haben sich im Sinne eines sakularen Trends verandert. Die Epikondylenbreite ist im Vergleich zu fruheren Untersuchungen bis zum 2. Lebensjahr geringer und vom 4. bis zum 6. Lebensjahr groser. Der Frameindex (Epikondylenbreite/Korperhohe) steigt im 1. Lebenshalbjahr an und fallt nachfolgend bis zum 6. Lebensjahr kontinuierlich ab. Die im Langsschnitt erarbeiteten Vergleichswerte der alters- und korpergrosenabhangigen Kopfumfangperzentilen sind von Bedeutung fur Praxis und Klinik und fur die Vorsorgeuntersuchungen U1–U9. Es besteht eine Neuproportionierung der Brustkorbmase, die Veranderungen des Metrikindex bedingen. Die Epikondylenbreite und der erstmals fur diese Altersgruppe berechnete Frameindex sind zur Gesundheitsvorsorge geeignet.

Zur adaquaten Beurteilung der kindlichen Entwicklung sind zeitaktuelle Normwerte von Wachstumsparametern, welche die altersabhangige Gewichtszunahme 0‑ bis 6‑jahriger Kinder charakterisieren, erforderlich. Dies ist insbesondere im Rahmen der Adipositasepidemie von besonderer Bedeutung. Wie sind die altersgemasen Normwerte des Oberarm-, Taillen- und Huftumfangs 0‑ bis 6‑jahriger Kinder, wie verhalten sich die fur die Adipositasbeurteilung wichtigen Taillen/Huftumfang-, der Taillenumfangs/Korpergrose-, der Huftumfang/Korpergrose-Quotient und die Hautfettfalten in ihrer Altersabhangigkeit? Welche Korrelationen bestehen zwischen diesen Parametern und dem KMI/BMI? Eine statistisch enge Korrelation besteht ab dem 2. Lebensjahr zwischen den KMI/BMI-Werten und dem Huft- und Taillenumfang, dem Taillen/Korpergrose-Quotienten, dem Huftumfang/Korpergrose-Quotienten sowie ab dem 3. Lebensjahr zum Oberarmumfang. Die Fettfalten zeigen ein unterschiedliches Verhalten, wahrend die subskapularen und suprailiakalen Fettfalten nach einem Anstieg im 1. Lebensjahr kontinuierlich bis zum 6. Lebensjahr abfallen, nimmt der Umfang der Trizepsfettfalte bis zum 4. Lebensjahr zu. Zur Ermittlung des kritischen abdominalen Fettanteils wird die Nutzung der hier erstmals in einer Langsschnittstudie erarbeiteten altersabhangigen Vergleichswerte des Taillen/Korperhohe-Quotienten empfohlen. Als Mas des Ernahrungszustandes kann zusatzlich zum KMI/BMI ab dem 3. Lebensjahr der Oberarmumfang, der eng mit dem KMI korreliert ist, genutzt werden.

Die heute z. T. noch in Deutschland genutzten Langsschnittdaten des Wachstums 0‑ bis 6‑jahriger Kinder sind mehr als 35–50 Jahre alt. Wie sind die aktuellen altersabhangigen Werte der Korperlange/Korperhohe, des Korpergewichtes, des Somatogramms, des KMI/BMI (kg/m2) und des Ponderal-Index (kg/m3) 0‑ bis 6‑jahriger deutscher Kinder? Gibt es Veranderungen des sakularen Trends? Longitudinale Wachstumsstudie an 212 Berliner Kindern (112 Knaben und 100 Madchen) im Rahmen der deutschen Sprachentwicklungsstudie (DFG Res, Gr. 381) mit Messung von jeweils dreizehn Korpermasen und vier Index- und funf Korpermasquotientenberechnungen. Die Korperlange ist im 1. Lebensjahr gegenuber fruheren Studien nur gering verandert. Vom 2. bis 6. Lebensjahr ist die Korperhohe groser als die der Vergleichsstudien. Die Kopergewichte sind vom 2. bis 6. Lebensjahr auch in Relation zur Istgrose hoher. Die KMI/BMI-Werte zeigen keine weitere ansteigende Tendenz. Die 97. Perzentilen sind deutlich niedriger als die von derzeit genutzten BMI-Normwerten aus Querschnittsuntersuchungen und liegen nur gering uber den Werten von Langsschnittuntersuchungen vor der Adipositasepidemie. Es besteht weiterhin ein leichter Trend einer sakularen Akzeleration im Vorschulalter. Die BMI-Werte zeigen keinen weiteren Anstieg. Die neuen altersabhangigen Wachstumsdaten und die Wachstumsgeschwindigkeitswerte der Korpergrose, des Korpergewichtes und des KMI/BMI, des Ponderal-Index sowie das neue Somatogramm konnen als aktuelle relevante Wachstumsnormwerte 0‑ bis 6‑jahriger Kinder fur Praxis und Vorsorgeuntersuchungen genutzt werden.

Background The influence of physical strain on the esophageal motility has already been examined in a number of studies. It was found that high physical strain compromises the sufficient contractility of the esophagus. However, it needs more examinations to verify these findings. Methods To validate these results healthy volunteers were examined using gas-perfusion manometrie. Bicycle ergometry was performed to generate an exactly defined physical exercise. After a pilot study, the changing of the contraction amplitude was determined as the main variable to evaluate the esophageal motility, and the sample size was calculated. Eight subjects without esophageal diseases or symptoms were examined by simultaneous gas-perfusion esophageal manometry and bicycle ergometry. Key Results The results showed that high physical strain during bicycle ergometry can induce a significant decrease of the contraction amplitude (α = 5%, β = 10%). The 95% confidence interval of the quotient of contraction amplitude at rest and under physical strain is (1.074; 1.576). This effect is more pronounced in liquid acts of swallowing than in dry and is also more obvious at the middle measuring point (7.8 cm above the lower esophageal sphincter) than at the distal and proximal point (2.8 and 12.8 cm). Furthermore, a decreasing tendency of the contraction duration could be found. Conclusions & Interferences Gas-perfusion manometry is an inexpensive examination method, which enables the evaluation of the esophageal motility in moving test subjects under conditions of physical strain. It could be proved that physical strain negatively influences the esophageal motility by a decrease of the contraction amplitude.

Der gastroosophageale Reflux (GOR) besitzt fur Patienten mit zystischer Fibrose (CF) eine besondere klinische Bedeutung. Zwolf Patienten mit CF im Alter bis 25 Jahre unterzogen sich freiwillig einer Osophagusmanometrie und einer 24-h-Impedanz-pH-Metrie. Diese Patienten litten nicht unter GOR-typischen Symptomen. Die Untersuchungen ergaben den Nachweis eines sauren GOR bei 42 % der Patienten. In der Gesamtbevolkerung liegt die Haufigkeit bei unter 10 %. Bei 11 von 12 Patienten war ein pathologisch erniedrigter Ruhedruck des unteren Osophagussphinkters (UOS) nachweisbar. Es bestand kein signifikanter Zusammenhang zwischen dem DeMeester-Score und dem Ruhedruck des UOS, den vorhandenen Atemwegssymptomen, der Lungenfunktion und der Lebensqualitat der Patienten. Es bestanden Hinweise auf beginnende Motilitatsstorungen und eine eingeschrankte Saureclearance. 37 % der registrierten Hustenstose traten in zeitlichem Zusammenhang mit einem GOR auf, von diesen wiederum 78 % mit einem sauren GOR. Die Reflux-Husten-Sequenz war mehr als doppelt so haufig wie die Husten-Reflux-Sequenz. Der fruhzeitige Nachweis eines asymptomatischen GOR konnte dazu beitragen, eine durch diesen induzierte Verschlechterung einer bereits durch die Grunderkrankung beeintrachtigten Lungenfunktion zu verhindern.

There is a linear relationship between maternal height and birth weight. For each 1 cm increase in maternal height, birth weight increases by 16.7 g. Birth weight percentiles should be calculated by taking maternal height into account. We present birth weight percentile values for girls and boys born after 23-43 completed weeks of gestation for 5 maternal height groups. With these percentiles "genetically" small and "genetically" large, but healthy, neonates can be classified more adequately. The calculations are based on data of about 2.2 million singleton pregnancies from the German Perinatal Survey of 1995-2000.

BACKGROUND AND AIM: Maternal smoking and body mass index (BMI) affect the somatic classifications of neonates based on birth weight, length, and head circumference. Here we investigate the somatic classifications of neonates based on weight-for-length and Rohrer's ponderal index. MATERIAL AND METHODS: Singleton neonates (n = 433 643; data from the German perinatal survey of 1998–2000) were classified as small, appropriate or large for gestational age (SGA, AGA, LGA) based on the 10th and 90th population percentiles of weight-for-length (weight/length) and ponderal index (weight/length 3 ). Maternal BMI was classified as underweight (< 18.5 kg/m 2 ), normal weight (18.5–24.99 kg/m 2 ), overweight (25–29.99 kg/m 2 ), or obese (≥ 30 kg/m 2 ). Smoking during pregnancy was categorized as 0, 1–7, 8–14, or ≥ 15 cigarettes per day. The somatic classification of neonates was compared between different maternal BMI and smoking groups. RESULTS: Classifying neonates by weight-for-length we found that the SGA rate was greater for underweight women (16.3 %) and smaller for overweight (7.5 %) and obese women (7.0 %) compared with the normal weight reference population (9.9 %, all data for non-smokers). Furthermore, SGA rates increased with increasing cigarette consumption. The combination of smoking ≥ 15 cigarettes per day and being underweight was associated with a very high SGA rate of 35.7 %. Classifying neonates according to ponderal index showed qualitatively similar but smaller changes: here smoking ≥ 15 cigarettes per day and being underweight was associated with an SGA rate of 14.4 %. CONCLUSIONS: The somatic classification of neonates according to weight-for-length illustrates the effects of maternal BMI and smoking more clearly than the classification according to the ponderal index.

We defined neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) based on birth weight, length, and head circumference. We analyzed the effects on the somatic classification of maternal body mass index (BMI) (

Aim: To compare anthropometric characteristics of German-born vs. Asian-born mothers and their neonates. Material and Methods: We analysed data from the German Perinatal Survey of 1995–2000; 1 907 265 singleton pregnancies occurred in women originating from Germany and 23 206 occurred in women originating from Asia. We compared maternal height, weight, and body mass index (BMI) as well as birth weight, neonatal body length, and neonatal head circumference. Neonates were classified by birth weight percentiles: neonates 90th birth weight percentile were “large for gestational age” (LGA), all others were “appropriate for gestational age” (AGA). Results: German-born and Asian-born mothers differed considerably in anthropometric measures; German-born women were taller, heavier, and more likely to be obese. Neonatal anthropometric measures also differed; mean birth weight, body length, and head circumference all indicated that neonates of Asian-born mothers were smaller. For term births, birth weight percentiles of neonates of Asian-born mothers were mostly below those of neonates of German-born mothers. Neonates of Asian-born mothers were more often classified as SGA and less often as LGA when birth weight percentiles of the overall population (regardless of maternal country of origin) were used. Conclusions: Considerable differences exist in the anthropometric characteristics of German-born vs. Asian-born mothers and their neonates. Awareness of such differences is important in obstetric and neonatal practice, especially with regard to the somatic classification of neonates as SGA, AGA, or LGA. Zielstellung: Vergleich der Korpermase von in Deutschland geborenen und in Asien geborenen Muttern und deren Neugeborenen. Material und Methoden: Wir analysierten Daten der deutschen Perinatalerhebung der Jahre 1995–2000: 1 907 265 Einlingsschwangerschaften von in Deutschland geborenen Frauen und 23 206 Einlingsschwangerschaften von Frauen aus Asien. Verglichen wurden mutterliche Korperhohe, Korpergewicht und Body-Mass-Index (BMI) sowie Geburtsgewicht, Korperlange und Kopfumfang der Neugeborenen. Der somatische Entwicklungsstand der Neugeborenen wurde mithilfe von Geburtsgewichtsperzentilen klassifiziert: Neugeborene 90. Geburtsgewichtsperzentile waren „large for gestational age“ (LGA), alle anderen waren „appropriate for gestational age“ (AGA). Ergebnisse: Aus Deutschland und Asien stammende Mutter unterschieden sich deutlich in ihren Korpermasen. In Deutschland geborene Mutter waren groser, schwerer, und haufiger adipos. Die Korpermase der Neugeborenen unterschieden sich ebenfalls. Mittleres Geburtsgewicht, neonatale Korperlange und Kopfumfang belegten, dass Neugeborene aus Asien stammender Mutter kleiner waren. Die Geburtsgewichtsperzentilen von Termingeborenen aus Asien stammender Mutter lagen meistens unter denen von Neugeborenen in Deutschland geborener Mutter. Neugeborene aus Asien stammender Mutter wurden bei Anwendung von Geburtsgewichtsperzentilen der gesamten Studienpopulation (ohne Berucksichtigung des mutterlichen Herkunftslands) haufiger als SGA und weniger haufig als LGA klassifiziert. Schlussfolgerungen: Es bestehen deutliche Unterschiede in den Korpermasen zwischen in Deutschland geborenen und in Asien geborenen Muttern und deren Neugeborenen. Diese Unterschiede sollten in der Geburtshilfe und Neonatologie bedacht werden, besonders im Hinblick auf die somatische Klassifikation von Neugeborenen als SGA, AGA oder LGA.

The toxicity of 17 alpha-cyanomethyl-17 beta-hydroxy-estra-4, 9-dien-3-one (STS 557) was studied by its oral administration of 0.1, 1.0 or 10.0 mg/kg/day to Wistar rats for six months, and of 0.01, 0.1 or 1.0 mg/kg/day to beagle dogs for six months, respectively. Levonorgestrel at a dose of 1.0 mg/kg/day was used as the standard in the dog study. With respect to the progestational activity of the compound the main target organs were the hypophysis, the reproductive organs and the adrenals. Mammary hyperplasia was observed in dogs treated with STS 557 or levonorgestrel at the dose of 1.0 mg/kg/day, but in no case mammary nodules could be detected. At the dose of 1.0 mg/kg/day STS 557 and levonorgestrel were found to increase the plasma insulin response to i.v. glucose in bitches, but neither the mean blood glucose levels nor the glucose utilization were affected. Moreover, during administration of both steroids to dogs temporary changes in serum concentrations of triglycerides and total cholesterol were noted. The results obtained in rats and dogs from functional and morphological investigations did not reveal any toxic side effects of STS 557 on the liver, the kidneys, the bone marrow or on blood coagulation. The effects on the reproductive organs observed following STS 557 especially in dogs are related to both the hormonal effects of the compound and the specific response of the dog to potent progestagens.

By means of 3 endurance exercises, the effect of a several-hour intensive somatic stress on the changes of the Sm-C/IGF-I concentration was tested during, immediately after and on the day following the exercise. Exp. 1: Marathon with 17 male sportsmen in 2 groups with different glucose supply. Exp. 2: 45-km crosscountry run with 41 males. Exp. 3: Three 20-km runs with 8 young females at intervals of 3 months. In the marathon, no significant changes of the Sm-C/IGF-I concentration were found between the start, half distance and final values. The exogenous glucose supply (continuous or discontinuous) had also no effect. The tendency of a slight decrease of the Sm-C/IGF-I concentration by 0.14 U/ml (p greater than 0.05) was observed between start and finish in the 45 km crosscountry run lasting one hour longer. In the three 20-km runs, reproducible, slightly increased levels were measured at the end, whereas a decrease to the initial value or even below was detected on the following day (p greater than 0.05). The insignificant alterations of the Sm-C/IGF-I concentration measured in the 3 variants of races show that neither the hormonal changes stimulating the Sm-C/IGF-I synthesis (e.g. increase of GH and prolactin) nor inhibiting factors (energy deficiency) clearly dominate during strenuous exercises. The binding of carrier protein prevents great variations of the Sm-C/IGF-I level even under the condition of 3- to 4-hour extreme endurance exercises.

Sm-C concentrations in serum were found significantly different in either active acromegaly or following successful treatment with pituitary adenomectomy. Although after normalization of serum GH the Sm-C levels sometimes exceeded the normal range no overlap was found between both groups. Exceptionally two acromegalic patients showed elevated Sm-C levels in spite of normal GH values. Likewise, a high Sm-C concentration was found in one patient suspective of ectopic GH secretion with only moderately elevated serum GH. Sm-C determinations are judged as a good adjunct to usual diagnostic methods which in special cases of acromegaly can be even superior to measurements of serum GH.

In two runs over a distance of 75 km and 45 km as well as in a marathon (42.2 km), the thyroid hormones (T4, T3 and TSH in all runs and rT3 in two of them) were determined before and after the runs. The performance of the runners was analyzed, with their age considered in the analysis. We found that the changes of thyroid hormones are characterized by individual differences. Younger runners and those with better performances had significantly higher T4 serum concentrations and unaltered T3 and TSH concentrations, whereas older sportsmen and those with worse performances reacted to the stressful stimulus with a significant decrease of T4, T3 and TSH. This response was interpreted as an exhaustion reaction, i.e. reduced adaptation responses of thyroid hormone metabolism. Therefore, these investigations provide an assessment of the state of fitness, the optimization of training and the avoidance of damage caused by overly stressful physical exercise

Background: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. Aim: It was investigated whether a systematic difference of treatment quality between smaller (1000–2000 births/year; ≤20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. Methods: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (≤1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed. Results: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Wurttemberg, a predominately rural state, with different medical infrastructure than Berlin. Conclusion: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure.

Objective: The group of low birthweight infants (≤2499 g, LBW) infants includes eutrophic preterm infants and growth retarded term infants. These subgroups may vary considerably in morbidity and mortality. Analysis of LBW infants requires a precise and immediate classification of neonates on the basis of gestational age and birthweight. The aim of this study was to analyze according to gestational age the collective of infants with a birthweight ≤2499 g. Methods: The birth data of 559833 singleton infants born in Germany in 1992 with gestational age confirmed by early sonography were analyzed. The basis for the evaluation of gestational age and birthweight were perinatal parameters routinely documented in Germany. The somatic development state was examined with recently developed percentile curves. Results: A total of 26083 (4.7%) of the nenates had a birthweight ≤2499 g and 6.24% were preterm. Of the LBW infants, 37.2% were born at term or posterm and 62.8 % were born before 37 completed gestational weeks. Only 47.9% of LBW infants were appropriate weight for gestational age. Conclusions: Precise postpartum classification of neonates according to their somatic development requires improved documentation with perinatologic questionnaires.

Using data from the perinatal statistics of 8 German federal states collected between 1998 and 2000 of a total of 508 926 singleton pregnancies, we present a subgroup analysis that assesses the relationship between overweight status or obesity of the mothers at the beginning of the pregnancy and maternal diseases associated with pregnancy. We show that a high body mass index (BMI) - as an indication of being overweight or obese - is a risk factor for These parameters are directly or indirectly included as pregnancy risks in the perinatological assessment sheet completed for all pregnant women in Germany. Furthermore, a high BMI seems to predict the future development of a metabolic syndrome - a condition that is associated with obesity, hypertension and type 2 diabetes mellitus. Advanced age and smoking before and during pregnancy further increase the BMI-dependent risk of maternal disease during pregnancy. During prenatal consultations these risk factors can be addressed. Nutritional counseling - if possible prior to conception - and education about the consequences of smoking are especially important here. Our results support the introduction of a screening program for gestational diabetes mellitus using the oral glucose tolerance test. Rigorous use of preventive measures (particularly nutritional counseling with the aim of weight reduction and cessation of smoking) may not only decrease maternal and fetal morbidity but also reduce the cost of curative medical treatment.

We investigated the sex-specific risk of maternal smoking during pregnancy on the birth weight and the proportion of small-for-gestational-age (SGA) newborns in 888,632 (49.9%) of 1,815,318 singleton births (ca. 80% of all singleton births in Germany from 1995 to 1997) in whom data on maternal cigarette consumption were available. Newborns below the 10th percentile for weight and duration of pregnancy were classified SGA. Maternal smoking during pregnancy lowers the mean birth weight and increases the risk of SGA newborns. The negative effect depends on the daily number of cigarettes consumed, and is greater in girls than in boys. In non-smokers, 9.8% of the newborns were SGA, with a sex-ratio of females:males=1, but this percentage increased with increasing number of cigarettes consumed (p

Based on the perinatal data for the years 1995 - 1997 of 1815318 singletons, the somatic development of newborns was investigated with due consideration of the ethnic origin of their mothers. The proportion of foreigners was 16.7%. German newborns weighed 32 g more than the newborns of any other country. The incidence of small-for-gestational-age newborns or preterm newborns of German mothers was 0.2% and 0.3% lower, respectively. When evaluating all newborns evaluated on the basis of German norm figures, 9.5% of the German, 12.1% of the Asian but only 7.7% of the East European newborns were classified as hypotrophic. In the Asian population the low maternal body mass and size might be responsible for that result. The relatively high newborn birth weights from mothers from Eastern Europe with comparable body measures were surprising. However the perinatal data are not consistent enough to allow a scientific explanation. Grouping of the patients does not allow an exact attribution of the mothers to specific countries. Likewise in the questionnaire the duration of the maternal stay in Germany or the ethnic origin of the father could not be evaluated. This first review should demonstrate the range of important somatic parameters of newborns with respect to the ethnic origin of their mothers. In an increasingly globalised world this paper can give important indications for further investigations into these correlations.

Using data from the German Perinatal Registries, we analyzed all singleton deliveries in Germany during the years 1995 to 1997 in terms of birth weight variation and prematurity rates, and their distribution in the different German federal states. Prematurity rates, birth weight and height are influenced by multiple factors, such as biological, medical, psychosocial, economic, and demographic characteristics of the maternal population, working together in a complex manner. These factors are variable influenced by social changes. Maternal age and parity, which are biological and demographic characteristics, influence fetal development including weight and height, but also the preterm delivery rate. There is a close correlation between the preterm delivery rate and maternal age, while the importance of the other factors cannot easily be ascertained. On the other hand, age correlates with many other characteristics such as pre-gestational body weight or parity, which influence birth weight and gestational age at delivery. For differences in prematurity rates between the German federal states (Northern vs. Southern), constitutional maternal factors seem to be especially responsible. The higher prematurity rates in the former Western part of Germany (7.3%) compared to the Eastern part (6.7%) during these years might partially be explained by the still more favourable mean maternal age in the Eastern German countries. For the first child, maternal age range with the lowest prematurity rate is 21 to 24 years, and for the second child it is 25 to 31 years. As a consequence, due to the increasing maternal age at delivery in this part of Germany, an increase in pre-term delivery can be expected during the next years.

BACKGROUND AND OBJECTIVE To investigate the burden and the financial and professional consequences for mothers and fathers after the onset of diabetes in their child in relationship to age at onset and family structure. PATIENTS AND METHODS All families of children with an age at onset < 14 years and a diabetes duration < 10 years treated at four large pediatric diabetes centers received a structured questionnaire (burden of diabetes, professional position and career development, financial consequences for both parents, demographic data). RESULTS 580 families with 583 children with type 1 diabetes (46 % girls, diabetes duration 5.0 +/- 3.2 years, age at onset 6.9 +/- 3.9 years) participated. 42 % of the children had an age at onset below 6 years. 11 % had single parents. Before the onset of diabetes in their children 93 % of the fathers worked full-time, thereafter 4 % changed their employment. Mothers worked at onset full-time in 22 % and part-time in 38 %; thereafter 31 % reduced their working time or stopped working. 33 % of the mothers reported handicaps in their professional career development, especially those with a child with age at onset below 6 years (44 %). Negative financial consequences were present in 44 % of the families. The day to day burden on a scale from 1 to 5 decreased both in mothers and in fathers with increasing age at onset. The individual burden was higher in mothers (3.6 +/-1.1) than in fathers (2.8 +/- 1.1) (p = 0.000). CONCLUSIONS Initiatives to reduce the burden on families with a child with diabetes are urgently needed. Particularly the social and professional integration of mothers with younger children at diabetes onset need to be improved through support measures outside the family.

With the aim of creating a norm curve of maternal weight gain during pregnancy, data from 1763063 women between 1995 and 1997 were analyzed. The weight gain ranged from - 2 kg to + 24 kg, the mean value was calculated as 13 kg. With these results it was possible to create percentiles of maternal weight gain in Germany for the first time.

Hintergrund. Die Hypophosphatasie ist eine seltene angeborene Erkrankung, die durch eine Unterfunktion der gewebeunspezifischen alkalischen Phosphatase mit den Folgen eines gestorten Knochenstoffwechsels gekennzeichnet ist. Entsprechend des zeitlichen Auftretens erster klinischer Symptome wird die Erkrankung in 4 Unterformen unterteilt. Die Schwere der Erkrankung hangt von der Restaktivitat der alkalischen Phosphatase in Leber, Knochen und Nieren ab, was die Vielfalt klinischer Verlaufe erklart. Fallbericht. Es wird uber eine Patientin mit einer infantilen Form der Hypophosphatasie berichtet. Die Mutationsanalyse ergab eine bereits bekannte Punktmutation fur das materne sowie eine bisher nicht beschriebene Mutation des Gens fur die gewebeunspezifische alkalischen Phosphatase fur das paternale Allel. Das Madchen entwickelte sich wahrend der ersten beiden Lebensjahre trotz ungunstiger Prognose altersentsprechend. Ein chronisch erhohter intrakranialer Druck offenbarte sich klinisch lediglich in einem Wachstumsstillstand im 2. Lebensjahr. Bei der infantilen Form der Hypophosphatasie ist ein chronisch erhohter Hirndruck aufgrund einer pramaturen Nahtsynostose trotz fehlender hinweisender klinischer Symptomatik in regelmasigen Abstanden auszuschliesen.

We have previously analysed neonatal characteristics and duration of pregnancy in Germany based on data from the German Perinatal Survey of 1995–1997. Here we describe neonatal characteristics and duration of pregnancy based on the German Perinatal Survey of 2007–2011. We had been provided with data from the German Perinatal Survey of 1995–1997 by the chambers of physicians of all the states of Germany except Baden-Wurttemberg (1 815 318 singleton neonates). We were also provided with access to the perinatal survey data of 2007–2011 by the AQUA Institute in Gottingen, Germany (3 187 920 singleton neonates). We investigated regional differences within Germany and also compared the 2 periods of time. We used the computer programme SPSS for data analysis and performed plausibility checks on the survey data. Comparing the states of Germany, we found that birth weight was largest for neonates born in Schleswig-Holstein (3 407 g) and Mecklenburg-Western Pomerania (3 392 g); the lowest mean birth weight was observed in the Saarland (3 283 g). Preterm birth rate varied between 6.3% (Saxony) and 8.1% (Bremen, Saarland). Comparing 1995–1997 vs. 2007–2011, deliveries after 37 and 38 weeks of gestation were more common and deliveries after 39 and more weeks of gestation were less common in the later period of time. Regional differences in the anthropometric characteristics of neonates exist between the states of Germany. The proportion of deliveries after 39 and more weeks of gestation has decreased.

Objectives To evaluate the use and necessity of obtaining histopathology on patients undergoing tonsillectomy, and to provide indications and guidelines for requesting histopathology on tonsillectomy patients. Study Design At the University of Mississippi Medical Center, we have been routinely obtaining histopathologic diagnoses on every patient undergoing tonsillectomy or tonsillectomy and adenoidectomy. Specimens are separated into left and right tonsils and adenoids. This study was designed at our tertiary care academic center to evaluate the necessity for obtaining histopathologic diagnosis on each of these patients. Methods A retrospective review of histopathologic reports on all patients in both pediatric and adult age groups undergoing tonsillectomy or tonsillectomy and adenoidectomy between January 1994 and December 1999 was performed. Results A total of 2438 reports were reviewed. There were 2099 in the pediatric age group and 339 were adults. None of the children had an unusual histopathology finding other than lymphoid hyperplasia. Of the 339 adults, 34 had squamous cell carcinoma and 6 had lymphoma; however, these findings were suspected preoperatively by history and clinical manifestations. Conclusions The general practice guidelines mandate obtaining histopathologic diagnoses on most of the tissues received. Based on our review, histopathology of tonsillectomy and/or adenoidectomy may not be necessary, especially in children. In this era of cutting excess costs of health care dollars, waving histopathology in these cases may have major implications without compromising delivery of quality care.

Background and Aim: We have previously presented analyses of data obtained from the German Perinatal Survey for the years 1995–1997. Here we present an analysis of data from the years 2007–2011 and compare the data to the previous data from the 1990s. Material and Methods: For the years 1995–1997, the data on 1 815 318 singleton pregnancies were provided by the Chambers of Physicians of all the states of Germany except Baden-Wurttemberg. For the years 2007–2011, the data on 3 187 920 singleton pregnancies from the German Perinatal Survey (all states of Germany) were obtained from the AQUA Institute in Gottingen, Germany. SPSS was used for data analysis. Plausibility checks were performed on the data. Results: Mean maternal age has increased over the years, from 28.7 years in 1995 to 30.2 years in 2011. We observed a decrease in smoking. While not all cases included data on maternal smoking after the pregnancy was known, when the cases with data on smoking were analysed, in 1995–1997 23.5 % of pregnant women were smokers compared to 11.2 % smokers in 2007–2011. Maternal body mass index (BMI) also changed; 8.2 % of women were obese (BMI: 30–40 kg/m2), while 13.0 % were obese in 2011. In 1995, 0.6 % of women were morbidly obese (BMI ≥ 40 kg/m2) compared to 1.8 % of women in 2011. The mean maternal body weight at the time of the first obstetric consultation also increased from 65.9 kg in 1995 to 68.7 kg in 2011. Conclusions: While the decrease in the number of women smoking over time is clearly a positive development, increasing maternal age and obesity present challenges in clinical practice.

Twin gestations require different normal values than singleton pregnancies. The aim of this study was to define percentiles of birth weight, length and head circumference for twin pregnancies according to gestational age. 80000 twins born at 21 to 42 weeks' gestation between 1990 and 1995 in Germany of German citizens were analyzed. Percentiles were calculated from cumulative frequencies. The advantage of twin-specific percentiles are discussed.

Von November 1995 bis April 1996 wurde bei 120 freiwilligen Probanden der Brandenburger Ernahrungs- und Krebsstudie eine 24-Stunden-Urinsammlung durchgefuhrt. Bei 108 Personen — ohne medikamentoser Jodzufuhr — betragt die mittlere Jodausscheidung 99,0 µg Jodid/g Kreatinin, und der Median liegt bei 94,2. Nur 45,4 % der Probanden haben eine ausreichende Jodversorgung. Ein Jodmangel I. Grades ist bei 43,5 % und II. Grades bei 11,1 % nachweisbar. Ein Jodmangel III. Grades kommt in der untersuchten Population nicht vor. Mit dem Wegfall der Deklarierungspflicht fur mit Jodsalz hergestellte Nahrungsmittel sowie durch die intensive Aufklarung und der vermehrten Nutzung von Jodsalz in Fleisch- und Backwaren scheint sich die individuelle Jodversorgung gebessert zu haben. Fur die Jodmangelprophylaxe kann aber noch keinesfalls Entwarnung gegeben werden.

Background and Aim: The classification of weight gain during pregnancy and the somatic classification of neonates according to birth weight and duration of pregnancy can be done using percentile values. We aimed to compare such classifications using percentiles of the overall study population with classifications using percentiles that were calculated taking account of maternal height and weight. Material and Methods: Using data from the German Perinatal Survey (1995–2000, over 2.2 million singleton pregnancies) we classified weight gain during pregnancy as low ( 90th percentile), or medium (10th–90th percentile). Neonates were classified by birth weight as small for gestational age (SGA, 90th percentile), or appropriate for gestational age (AGA, 10th–90th percentile). Classifications were performed for 12 groups of women and their neonates formed according to maternal height and weight, either with the percentiles calculated from the total study population or with group-specific percentiles. Results: Using percentiles of the total study population there was large variability between the 12 groups in the proportions with low and high weight gain and in the proportions of SGA and LGA neonates. The variability was much lower when group-specific percentiles were used. Conclusions: Classifications of maternal weight gain during pregnancy and birth weight differ substantially, depending on whether percentiles calculated from the total study population or group-specific percentiles are used. The impact of using percentiles that take account of maternal anthropometric parameters for the medical care and health of neonates needs to be elucidated in future research.

Aim: “Late motherhood” is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what “late motherhood” associated with “high risk” is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998–2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of “late” mothers (with high preterm birth rates) with “control” groups of younger women (with relatively low preterm birth rates). Data of 208 342 women were analysed. For women with zero (one; two) previous live births, the “control” group included women aged 22–26 (27–31; 29–33) years. Women in the “late motherhood” group were aged > 33 (> 35; > 38) years. Results: The “late motherhood” groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89 % (92.7 %; 93.3 %) in the “control” group, but only in 84.5 % (90 %; 90.4 %) in the “late motherhood” group. The mode of delivery was spontaneous or at most requiring manual help in 71.3 % (83.4 %; 85.8 %) in the “control” group, but only in 51.4 % (72.2 %; 76.4 %) in the “late motherhood” group. Five-minute APGAR scores were likewise worse for neonates of “late” mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: “Late motherhood” that is associated with greater perinatal risks can be defined based on parity and preterm birth rate.

Maternal height and weight are important determinants of perinatal outcomes. Height and weight can be combined in the measure of body mass index (BMI). We aimed to investigate the utility of maternal BMI as a predictor of perinatal outcomes. Based on data collected between 1995 and 2000 as part of the German perinatal survey, we examined singleton pregnancies of women with BMIs of 18, 24, or 30. We compared preterm birth rate, birth weight, and the somatic classification of neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) for women with heights of 150 cm and 180 cm for each BMI. For women with a BMI of 18 (24; 30) and a height of 150 cm, the preterm birth rate was 13.9% (9.1%; 12.5%); for women with the same BMI and a height of 180 cm the preterm birth rate was 12.1% (6.1%; 4.4%). Birth weight for women with a BMI of 18 (24; 30) and a height of 150 cm was 2 889 g (3 170 g; 3 147 g); for women with the same BMI and a height of 180 cm it was 3 314 g (3 629 g; 3 753 g). The LGA rate for women with a BMI of 18 (24; 30) and a height of 150 cm was 2.1% (5.2%; 5.2%); for women with the same BMI and a height of 180 cm it was 7.7% (20.5%; 27.7%). There is considerable variability in perinatal outcomes between women with the same BMI but different heights. This limits the utility of BMI as a predictor of perinatal outcomes.

In 1988 and in 1991, i.e. two and five years after the introduction of a general iod salt supply (32 mg KJO2/kg salt) in our region, we investigated the frequency of goiters and the level of iodine excretion in urine in 504 and 336 school children of 11 to 16 years of age. In 1988 the assessment of goiter size was made by inspection and palpation according to the recommendation of WHO. 36% of the school children were found to have goiters of type I b or II. The average urine excretion of iodine amounted to 46.2 +/- 37.2 micrograms Iod/g creatinine (n = 353). In 1991 we selected school children with goiters by the same criteria and found frequency (34%) to be nearly unchanged compared to 1988. Furthermore we investigated these goiters with ultrasound and confirmed the diagnosis in 100 from 107 children. The average daily urine excretion of iodine was significantly higher in 1991 (57.7 +/- 24.8 micrograms/Iod/g creatinine, n = 328) than in 1988. However this value is below the level recommended by the WHO (minimum 75 micrograms Iod/g creatinine). Despite the increase of the iodine intake over the last years, the frequency of goiters in pubertal school children in the Jena region is endemic. This fact supports the demand for a general and sufficient iodine supply.

Ten children age 1 1/2 to 14 years, had bilateral nephrocalcinosis and hypercalciuria, but normal serum calcium (Ca) and phosphate (P) concentrations. Patients with hypercalciuria were divided into absorptive (n = 4) and renal (n = 6) subgroups, and in the latter four patients had a primary Ca-leak and two had a P-leak. All the children had received intermittent high dose vitamin D prophylaxis during infancy. At the time of investigation all had normal serum levels of 25-hydroxyvitamin D, yet all but one had elevated values of 1,25-(OH)2D. Although the hypercalciuria was indistinguishable from the various known forms of idiopathic hypercalciuria, the previous clinical course and the pattern of bone mineral homeostasis suggest that both clinical features, namely nephrocalcinosis and hypercalciuria were related to vitamin D toxicity through various pathogenetic pathways.

Using data from a sample of German women, this paper analyzes the relationship between maternal characteristics and infants' birth weight and pre-term delivery. Besides typical epidemiological factors that influence the weight of infants, such as the gestational age and maternal BMI at the beginning of the pregnancy, we find a West--East gradient. Within West Germany, there is a small North-South gradient in birth weight, with larger birth weights in the north. Better educated mothers give birth to heavier babies and have a somewhat decreased risk of pre-term delivery. Income plays a minor role, while occupational status is not associated with the weight of infants at all.

Objective To examine the effects of the socioeconomic changes occurring during the German reunification on anthropometric data of newborns, children, and young adults. Study design Data were drawn from different perinatal surveys and cross-sectional studies that were conducted in the newly formed German states before and after reunification (1984-2000). Results The mean birth weight of newborns increased 151 g between 1984 and 1985 (n = 51,447) and 1997 (n = 83,052), whereas length increased by 0.2 cm. Among 7- to 10-year-old school children in the federal state of Saxonia between 1984 and 1985 (n = 2359) and 1999 and 2000 (n = 11,575), an increase of height by 1 to 2 cm and weight by 1.2 to 2.6 kg was observed. Average body mass index (BMI) increased by 0.7 to 0.9 kg/m 2 . Among military recruits from Eastern Germany, an increase in weight and height was observed between 1985 and 1998. BMI values rose from 21.5 to 22.6 kg/m 2 , and "centimeter weight" increased from 381 to 405 g/cm. Conclusion The results show that the change in socioeconomic conditions was associated with alteration in anthropometric measures within a short period. This may have been caused by changes in the nutrient supply and composition as well as reduced physical activity. (J Pediatr 2003;142:259-62)

In the eastern part of Germany, in the former GDR representative epidemiological surveys were performed between 1975–1985. From regional and countrywide studies a considerable incidence of endemic goiter and iodine deficiency (ID) as the main etiological factor could be proved 1986 (3, 6, 8). Namely in southern counties over 90% of children, adolescents and adults were exposed to ID grade II to III I/g (Table 1). Particularly susceptible periods to develop goitre being found the newborn period, puberty and pregnancy. In addition, during pregnancy ID grade II intensified to grade III.

In the new federal states of Germany (former Eastern Germany) there has been an endemic goiter situation, like in the whole of Germany, until 1982. Goiters were as frequent as 12.4 to 2.1% in different areas. In 13–15 year old pupils we found a goiter frequency of 46.3% (Hesse et al. 1978). Up to 58.5% of the women and 34% of the adult men investigated had a goiter in the southern districts of the Eastern part of Germany (Knappe 1984). It was clearly proven that nearly 50% of the newborns with goiter had a transient hypothyroidism (Table 1).

Multiple endocrine neoplasia, type II B (MEN II B) includes thyroid carcinoma, pheochromocytoma, ganglioneuromatosis and marfanoid habitus. Its short-term prognosis is determined by the tumour of the adrenal gland, whereas long-term prognosis is determined by the thyroid carcinoma. Often the well-defined but rare syndrome is diagnosed late. The MEN II B's therapy consists of thyroidectomy and adrenalectomy uni- or bilateral. The 5 year-rate of survival is 75%. Own observations are reported.

After administration of combined T3/T4 preparations (ratio of 4 : 1) to juveniles with goitre, size II-III (WHO), and hypothyroid T4 or PBI levels, the T3 value reached hyperthyroid levels 7-8 hours afterwards. The increased T3 level with normal T4 blood levels can lead to iatrogenic T3 hyperthyroidism. Serial tests demonstrated that at increasing doses a raised T3/T4 ratio, which is observed with low T4 values, can return to normal but with increasing doses this ratio, caused by T3 rise, can again become elevated. For this reason one should reconsider treatment with T3/T4 preparations and, if necessary, replace it by monotherapy with L-thyroxine.

Bei 23 Kindern mit primarer Hypothyreose, die mit Thyroxin (T4) und Trijodthyronin (T3) enthaltenden Kombinationspraparaten behandelt worden waren, wurden TRH-Teste, TBI, T3- und T4-Bestimmungen durchgefuhrt. Die T3/T4-Quotienten wurden berechnet. 7 von 10 Patienten mit TRH-refraktaren TSH-Werten und normalen T4-Spiegeln wiesen uberhohte T3-Werte auf. Bei 6 von diesen Patienten konnten pathologisch uberhohte T3/T4-Quotienten beobachtet werden. Eine TRH-refraktare TSH-Suppression wurde nur bei hohen T4-Werten gefunden. Nach einer Reduktion der Substitutionsdosis normalisierten sich die uberhohten T3-Spiegel. Die Befunde zeigen, das nicht nur die T4-Werte sondern auch die TSH- und T3-Spiegeln unter der Behandlung mit Schilddrusenhormonen kontrolliert werden sollten. Die Durchfuhrung der Substitutionstherapie der Hypothyreose mit T3/T4-Kombinationspraparaten im Verhaltnis 1:4 sollte uberdacht werden.