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In children with an average diabetes onset at 11 y of age, the first retinal changes can be expected after a median diabetes duration of 9 y, while the median time until clinically relevant background retinopathy is 14 y. Periodic examinations of the retinal status become necessary with the onset of puberty or after 5 y of diabetes duration. Only sensitive methods should be used for retinopathy screening; the minimum recommended standard is a stereoscopic slit-lamp biomicroscopic examination in mydriasis. The degree of glycaemic control, both before and after puberty, appears to be of outstanding importance for the development of retinopathy, but the contribution of other factors (arterial blood pressure, lipid abnormalities, sex steroids, smoking and genetic factors) may be of varying relevance in the individual patient. Thus, to improve the long-term prognosis for children with diabetes appropriate screening for retinopathy and associated risk factors is mandatory. [ABSTRACT FROM AUTHOR]

The Berlin Retinopathy Study follows children from the onset of diabetes with serial retinal examinations by fluorescein angiography. It confirmed that long-term poor glycemic control, both before and after puberty, is the major risk factor for the development of retinal changes. The relationship between long-term HbAlc and background retinopathy follows an exponential, non-linear function. Apart from glycemia, several other factors (age at onset, puberty, lipids, blood pressure, genetic factors, smoking) may be of varying relevance in the individual patient. Nevertheless, best glycemic control from the onset of diabetes appears to be of outstanding importance as the HbAlc levels already during the first year of diabetes are related to the later development of background retinopathy.

We report on the results of longterm treatment of 466 children and adolescents with Type I diabetes (IDDM) between 1980 to 1989. Of these, in, 1989, 240 patients, aged 1 to 20 years, were under continuous treatment, 168 (70%) with CT and 72 (30%) with ICT. For 112 of 466 patients (24%) the medians of all measured HBA1c values were calculated to be less than or equal to 7.7%, for 53% between 7.8 and 9.6%, and for 24% greater than or equal to 9.7%. The respective percentages for the ICT patients were found to be 32, 48, and 20%. Medical treatment was accompanied by the continuous offer of education and psychosocial support. In order to reduce the risks for secondary vascular complications, good glycemic control is important in particular during postpubertal years. Therefore children and adolescents need support to obtain both, the acceptance of their disease and the individual responsibility necessary to endure any intensified treatment regimen. Furthermore, the effects of any therapeutic approach should not be measured by glycated haemoglobin only, but in particular by the young subject's individual development and his gain in courage to go on.

Changes in thoracic water content are measurable by determining basic impedance (Zo). In 57 cardiac surgical patients Zo decreased postoperatively by an average 24% corresponding to water retention of about 1.51. On the second postoperative day the difference to the initial preoperative value was still 8.5% corresponding to a water amount of over 500 ml. A close mathematic correlation exists between changes in the basic impedance (delta Zo) and fluid balance with a correlation coefficient of 0.94. The simple, non-invasive method is suitable for therapeutic control of fluid balance and quantitative diagnosis of pulmonary hyperhydration forms of various causes.

The introduction of the "rooming in" system to maternity wards of many hospitals has been accompanied by additional demands on the hospital made by parents together with their desire tor "natural birth". Therefore, additional factors have to be taken into due consideration in the context of "family-oriented obstetrics". Interviews were made with 1,000 mothers, just after delivery to find out what they thought about certain marginal conditions in maternity advisory centres, delivery rooms, and on maternity wards. Their replies were statistically evaluated.

For checking the possibility of using impedance cardiography in intensive care, 10 patients were examined before and up to 2 days after cardiac surgery with extracorporeal circulation. The comparison of stroke volumes examined by thermodilution with those calculated from impedance cardiography showed a good correlation (r = 0.933). The cardiac output measured by impedance cardiography was reduced to 77% of the initial preoperative value. It increased again to 94% on the second postoperative day. HEATHER-index and dZ/dt are well suited for supervision and quantitative treatment control in the postoperative period. The thoracic impedance was diminished more than 20% after extracorporeal circulation and did not yet reach the preoperative value on the second day. The continuous measurement of the thoracic impedance proved to be particularly helpful for assessing the pulmonary hydration and for controlling the fluid balance.

Inasmuch as recombinant human growth hormone is now more generally available for the treatment of different types of short stature, there is a need for better short-term indicators of treatment success. In healthy children, serum concentrations of antigens related to the aminoterminal propeptide of type III procollagen (P-III-NP) closely follow the growth velocity curve. P-III-NP was measured longitudinally in 20 children with growth hormone deficiency during 6 months of human growth hormone substitution therapy. Two different radioimmunoassay systems were used; one recognizes predominantly the intact propeptide showing a lesser affinity to a smaller monomeric peptide (RIAgnost assay), while the other assay detects both forms equally (FAB assay). These results were compared to the growth response [median 5.6 (0.4 to 13.9) cm in 6 months] and to other established growth correlated parameters (somatomedin C, alkaline phosphatase). A relatively better growth response correlated significantly with high pretreatment P-III-NP (RIAgnost assay) values (r = 0.56) and delayed bone age (r = -0.70). A combination of these parameters in multiple regression analysis increased the cumulative prediction value to above 60% (r2 = 0.61). On the other hand, P-III-NP (FAB assay) values proved to be best in monitoring treatment, correlating with the individual growth rate during the first 3 months (r = 0.40; p less than 0.05), during the consecutive 3 months (r = 0.66; p less than 0.001), and during the total 6-month period (r = 0.46; p less than 0.05). All other parameters showed associations to growth only during some treatment periods.(ABSTRACT TRUNCATED AT 250 WORDS)

By inventing the "rooming in", the organisational prerequisites for the undisyurbed early mother--child relationship, which is of fateful relevance for the newborn, are provided. Since part of the responsibility for the child is transferred to the mother already in the hospital, an adequate instruction is necessary. Thus, a change is taking place pertaining to the tasks of the nursing personnel. In an inquiry made on 950 female patients, the social-psychological aspects of the "romming in" were examined and evaluated. The joint accommodation of mother and child ought to be available on request for approximately 50% of the delivered women. During the night the newborns should be taken to the nursery. This meets with the needs of many women for undisturbed rest during the night despite "rooming in" and also with the necessity for control of the newborns by the nursing staff. The general judgment of the patients on a clinic cannot be changed essentially by the invention of "rooming in". This is depending to a great extent on various other factors.