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Mechanical ventilation of mature or premature newborns is supposed to provide pulmonary gas exchange while causing minimal side effects to the respiratory system and circulation of the infants. A certain degree of alveolar ventilation, for example, can be achieved by different ventilator settings with different airway pressures (Fig. 1), and thus the corresponding effects on lung mechanics, barotrauma, and circulation differ. Parameters indicating optimal ventilator settings cannot be measured often enough in routine daily care and sometimes are difficult to interpret because of complex interactivity factors. The aim of the computer program "RespCalc" is to shorten the empirical steps of adapting respirator settings to the status of the ventilated patient by calculating the necessary data and drawing patient-specific nomograms. The computer program "RespCalc" makes use of the mathematical relationships characterizing the determinants of lung mechanics. The following data are necessary for use of the program: patient identification, weight, alveolar ventilation, recent paCO2, compliance, and resistance. By using the time-constant tau, the minimal inspiratory time as well as a maximal possible respirator rate are displayed without inducing inadvertent PEEP at a ratio of 1:1. Afterward, the planned figures of the different respirator rates and corresponding inspiration times must be typed in. The program simultaneously checks whether the previously calculated minimal figures for in- and exhalation time are maintained. If the above-mentioned figures and the typed-in ones differ, an optical and acoustical error message appears, and thus the user is forced to correct the problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of intrapulmonary interstitial emphysema together with other forms of extraalveolar air collections following alveolar rupture was investigated retrospectively in 46 term and preterm newborn infants with respect to gestational age severity of pulmonary disease and mode of ventilatory assistance. Intrapulmonary interstitial emphysema was found in 31 of these 46 infants (67%). Development depended on the severity of pulmonary disease, mode of ventilatory assistance and level of inspiratory pressure. Intrapulmonary interstitial emphysema was found at an average age of 1 day (1-6 days) in 2 out of 23 infants (9%) during unassisted spontaneous breathing, in 8 out of 24 infants (33%) during CPAP and in 21 out of 26 infants (81%) during controlled ventilation. 18 out of these 31 infants (58%) additionally developed other forms of extraalveolar air collections but only in 9 from these interstitial emphysema has been found prior to other forms of extraalveolar air. Mortality rate of infants with intrapulmonary interstitial emphysema alone (10 out of 13; 77%) and infants who additionally developed other forms of extraalveolar air collections (16 out of 18; 89%) did not differ significantly. Development of intrapulmonary interstitial emphysema even in he absence of other forms of extraalveolar air collections has therefore to be judged as a severe complication in infants undergoing different forms of ventilatory assistance.

The role of histamine in physiological and pathological states has not been fully elucidated. In the pathological state histamine release can be induced by several mechanisms. The most frequent events are IgE-mediated release, complement-mediated release and release by chemical agents. During inflammation histamine is set free and contributes to the course of inflammatory processes, either enhancing or inhibiting inflammatory reactions. In order to look for a target in the glomerulum we examined H2 receptor binding to isolated glomerular cells using 3H-cimetidine as ligand. Two binding sites were detected, a low affinity site with a kD = 6.3 µM and a high affinity site exhibiting a kD = 0.18 µM. These findings are comparable to properties of 3H-cimetidine receptor binding to brain membranes.

In 55 newborn infants with respiratory distress syndrome (RDS) we compared chest radiographs and static respiratory compliance to see which of the two methods would best characterize the severity of pulmonary disease. There was a significant correlation between radiological score and compliance (rs = -0.5776, n = 55, p less than 0.001). Healthy newborns, newborns with RDS who did not need artificial ventilation and those newborns who needed respirator treatment had significantly different values of radiological score and compliance. RDS may be differentiated into groups of diagnoses. Newborns with HMD could be separated from those with wet lung syndrome or aspiration pneumonia by analyzing the radiogram or measuring the compliance. When survivors are compared with those newborns who died, the static respiratory compliance alone could predict the final outcome.

Transcutaneous PO2, heart rate, and aortic blood pressure were measured i 10 mechanically-ventilated newborn infants to assess the degree and course of hypoxaemia, and to monitor the cardiovascular and respiratory changes during tracheal toilet. Five infants weighed less than 1250 (mean 994), g and 5 infants weighed greater than 1750 (mean 2216) g. During tracheal suction the TcPO2 fell from 68 +/- 27 (mean +/- SD) to 43 +/- 23 mmHg, and the heart rate from 144 +/- 8 to 123 +/- 25 beats/minute, but the blood pressure increased from 44 to +/- 24 to 49 +/- 24 mmHg. Hypoxaemia (TcPO2 less than 50 mmHg) occurred in 7 of 8 initially well-oxygenated infants when suctioned. The decrease in TcPO2 was similar for both groups of infants. It was greater in infants with controlled ventilation and an F1O2 greater than or equal to 0.8 than in infants with intermittent mandatory ventilation and an F1O2 less than 0.8. The TcPO2 fall correlated well with the TcPO2 during the control period but not during the time that the infants were disconnected from the respirator. A critical re-evaluation of routine tracheal toilet is needed.

An easily applicable score to predict the risk of prematurity (Tab. I) (defined by weight) is examined prospectively (scoring during 6 th month of pregnancy) in 431 and retrospectively (obtained after delivery) in 1183 pregnancies. In the prospective study (Tab. II) 71.4% of all pregnancies resulting in babies below 2501 g exceed the proposed 50 points risk probabilty limit whereas only 18.7% of pregnancies with babies of more than 3000 g do so. Excluding pregnancies with 20 or more risk points and excellent prenatal care (8 or more consultations) - which should change the outcome of risk-pregnancies - the percentages are 77.8% and 12.2% respectively (Tab. III). Pregnancies resulting in babies with birth weight of 2501 g -2750 g exceeded the limit in 38.9% and those with babies of 2751 g-3000 g in 20.7%. If 60 risk points are used as the limit the percentages for more than 3000 g until less than 2501 g would be 8.2%, 6.9%, 33.3% and 66.7%. In the resrospective study (Tab. V) 14.7% of all pregnancies with babies above 3000 g exceeded the 50 risk points limit compared with 57.2 of those with babies below 2501 g. Excluding pregnancies with 20 or more risk points and excellent prental care the percentages are 7.6 and 59.4 respectively. In the retrospective study the influence of the quality of prenatal care by the number of consultations (3-4; 5-7; 8 or more) is clearly demonstrable: Pregnancies with more than 50 risk points resulted in 80.7%, 57.1% and 19.8% depending on the quality of care in babies below 2501 g. Pregnancies with 31-50 risk points did so in 47.2%, 20.4% and 11.8%. In 334 women the score could be applied twice, in the 6th month and at delivery. Comparing both scores it was found that only 1.8% of these women exceeded the 50 risk points limit by events occurring after the 6th month scoring (Tab. IV). The score, simple enough to be applied by nurses and midwives, seems to be able to select 77.8% of pregnancies resulting in babies below 2501 g already during the 6th month of pregnancy, i.e. early enough for preventive measures to be taken that decrease the frequency of underweight births by three quarters.

It has been suggested previously that non-enzymatic glycosylation of certain enzymes results in decreased enzymatic activity. In order to examine the role of high blood glucose concentrations (BG) on serum alkaline phosphatase (AP) activity, we determined BG and serum AP in 32 healthy children during an oral glucose tolerance test (OGTT) and in 10 type I diabetic children at 30-min intervals for at least 150 min. A significant negative correlation was noted for BG and AP during the oral glucose load (r = -0.57, p less than 0.01). In diabetics, however, only children with marked BG fluctuations showed this inverse relationship between BG and AP. These observations could be explained by the formation of a Schiff base as the initial step of non-enzymatic glycosylation of AP. This assumption was further confirmed by in vitro experiments, in which AP was incubated with glucose resulting in decreased enzymatic activity. The dialyzable aldimine formed initially is subsequently stabilized as ketoamine after long-term incubation.

The compliance of the respiratory system was determined at an average of 2.89 h (range 45 min - 8 h) after birth in 82 newborns who were retrospectively divided into group 1: healthy newborns (mean gestational age 37.1 weeks, range 30 - 41 weeks); group 2: newborns with respiratory distress (RD) needing no ventilatory support (mean gestational age 37.3 weeks, range 35--40 weeks); group 3: newborns with RD needing ventilatory support and surviving (mean gestational age 34.3 weeks, range 30--39 weeks), and group 4: newborns with RD who needed ventilatory support and died (mean gestational age 30.8 weeks, range 28--37 weeks). Respiratory compliance was measured by the airway occlusion technique in spontaneously breathing babies and by injecting a known volume of gas into the closed airway system and measuring airway pressure in intubated babies. The difference in postnatal compliance was statistically significant (p less than 0.01) in those four groups and was correlated with the severity of the disease in groups 2 and 3. In infants with RD, compliance was highly predictive for the need for ventilatory support (93% correct and 7% erroneous) and in infants with ventilatory support, for the mortality (83% correct and 17% erroneous). We conclude that postnatal compliance measurements are very useful to predict the course and outcome as well as to classify the severity of RD.

A specific and sensitive method for the quantitative determination of the stable, reduced glucose-lysine adduct, glucitollysine (GL), in plasma protein samples is described. The method uses standard amino acid ion exchange chromatography followed by reverse phase high performance liquid chromatography after derivatisation of GL to a fluorescent product. Moreover, GL was characterised and identified in plasma samples by means of mass spectroscopy. GL measured in plasma samples of eleven type I diabetics and two healthy controls showed a significant linear correlation to concomitantly determined haemoglobin A 1 and glucosylated plasma proteins, but did not correlate with plasma glucose levels. This method allows the estimation of non-enzymatic glucosylation in biological samples with a high degree of specificity and sensitivity down to the low nanogram range.

Loss of bowel gas was observed in 18 out of 49 neonates on mechanical ventilation (37%). Its occurrence was correlated to the outcome and to the use of sedative or neuromuscular paralysing drugs. None of the babies had gastrointestinal disorders requiring surgical intervention. A gasless abdomen was found in 6 out of 26 surviving neonates (23%) and in 12 out of 23 neonates (52%) not surviving the respiratory illness. Absence of intestinal gas in unsedated or unparalysed babies (23%) as well as in Alodan® treated babies (19%) was found with nearly equal frequency whereas its occurrence after neuromuscular paralysation with Alloferin® was significantly higher (91%). Disappearance of intestinal gas pattern despite, normal gastrointestinal patency, occurring in mechanically ventilated neonates severely affected by respiratory distress of varying origin or after neuromuscular drug paralysation should be recognized.

Bronchopulmonary dysplasia, first described by Northway in 1967 as a separate entity, was graded into four stages. Basing on thoracic x-ray films of 14 newborn and prematurely born infants an attempt has been made to analyse the x-ray patterns of signs characterising bronchopulmonary dysplasia and to establish a relation between the x-ray signs and the four stages. With few exceptions the various radiologic signs were seen in all stages, although with varying incidence. It follows that x-ray visualisation of the thorax yields limited pointers only to the actual stage of the disease. Roentgenography is the method of choice (in connection with the pattern of clinical signs) for diagnosing bronchopulmonary dysplasia and should be also employed for controlling the course of the disease and for the identification of eventual complications.

The effect of the airway-occlusion-technique (AOT) on the cardiac- and respiratory frequency, respiratory compliance and pO2 was studied in 5 healthy and 7 cardio-respiratory ill newborns. During a mean study duration of 10.8 minutes (11 occlusions) none of the variables mentioned changed significantly. We conclude that the non-invasive AOT, which informs about lung mechanics and respiratory control, carries no risk for the newborn infant.

Recent investigations point to the nonenzymatic glycosylation as a cause of long-term complications in diabetes mellitus. We describe an enzymatic activity that cleaves glucose from the glomerular basement membrane (GBM), present in lysosomal preparations of diabetic lymphocytes. The GBM, nonenzymatically glycosylated or obtained from rats with diabetes, were incubated with enzyme preparations, separated on Sephadex G-25 and applied for glucose measurement on gas chromatography and mass spectroscopy. The lysosomal preparation of diabetic lymphocytes cleaved from rat GBM, which were nonenzymatically glycosylated 300-500 ng glucose/mg GBM protein, from diabetic rat GBM 300 ng glucose/mg GBM protein. A lysosomal preparation of normal lymphocytes failed to do so, indicating enzyme induction in the diabetic state. Control studies with the glycosylated hemoglobin AIc confirmed this finding and showed the specificity of the enzyme, as alpha-glucosidase and beta-glucosidase failed to cleave the N-glycosidic bond between glucose and the protein. The enzymatic activity can be described formally as a N-l-deoxyfructofuranosyl-glucohydrolase, which could be responsible for a potential reversibility of diabetic GBM changes.

Hour-glass bladder was detected by X-ray investigation in a newborn female infant with delayed postpartum micturition. No signs of difficulty in micturition or urinary tract infection were subsequently detected. Control X-ray investigation at the age of 5 1/2 months showed a completely normal-shaped urinary bladder. This finding contrasts with the general opinion that hour-glass bladder is caused by a congenital malformation.

Collagenolytic activity of rat kidneys with streptozotocin diabetes was estimated by means of a biological collagenase assay and compared to healthy controls. Collagenolytic activity was found significantly decreased in rat kidneys with diabetes correlating with blood glucose levels (r = -0.82, p less than 0.001). Elevated blood glucose levels seem to be responsible for the inhibition. This is supported by our experiment of incubating bacterial collagenase with several carbohydrates as glucose, galactose and saccharose: glucose and galactose significantly inhibited the collagenolytic activity, while saccharose failed to inhibit the enzymatic reaction. The interpretation of the results is that glucose is able to bind to the enzyme as Schiff base, which could be shown by tritiated sodium borohydride reduction of the Schiff base formed between collagenase and glucose. Another support of the hypothesis is that blocking of the amino group of lysine at the active site either by glucose or trifluoroacetylation of collagenase is reducing the collagenolytic activity. The biological significance could be the decreased catabolism of collageneous material of the extracellular matrix, as, e.g., the glomerular basement membrane, which was reported in a previous publication.

Two infants were admitted for severe, intractable hypoglycemia. "Fasting" tests lasting 45 and 30 minutes respectively revealed hypoglycemia with inappropriately elevated levels of plasma insulin and plasma C-peptide. Subsequently, somatostatin was infused to test the individual sensitivity of the B-cells. Basal and glucose-induced insulin and C-peptide secretion were significantly reduced. Preoperative treatment with somatostatin was introduced, which controlled the hypoglycemia. In both patients, subtotal pancreatectomy was effective in restoring normal glucose homeostasis.

A 1740 g premature infant being treated by intermittent positive pressure ventilation with PEEP because of respiratory distress syndrome died from massive air embolism occuring in two attacks on the 14th and 16th day of life. The pathogenesis of systemic air embolism in neonates with respiratory distress syndrome is discussed and the difficulties in diagnosis as well as the importance of this complication regarding possible cerebral damage are considered. There is no conclusive information about the incidence of this serious event available at present.

Bronchopulmonary dysplasia, first described by Northway in 1967 as a separate entity, was graded into four stages. Basing on thoracic x-ray films of 14 newborn and prematurely born infants an attempt has been made to analyse the x-ray patterns of signs characterising bronchopulmonary dysplasia and to establish a relation between the x-ray signs and the four stages. With few exceptions the various radiologic signs were seen in all stages, although with varying incidence. It follows that x-ray visualisation of the thorax yields limited pointers only to the actual stage of the disease. Roentgenography is the method of choice (in connection with the pattern of clinical signs) for diagnosing bronchopulmonary dysplasia and should be also employed for controlling the course of the disease and for the identification of eventual complications.

The Roussy-Lévy-Syndrome in a 12 years old girl is described and its relation to other heredofamilial ataxias is discussed. The kindred of our patient was studied as well. Information about 21 family members could be collected; 11 of them also suffered from RLS. Additionally for the first time in literature, dermatoglyphic patterns in these patients have been investigated.

Non-enzymatic glycosylation (NEG) of alkaline phosphatase (AP) was studied after short- and long-term incubation with glucose and other carbohydrates. Glucose and amino sugars clearly inhibited the enzyme activity; this was in contrast to reducing and non-reducing disaccharides, which had an enhancing effect. After AP had been incubated with 18 nmol/l glucose for 180 minutes (short-term incubation), a subsequent extensive dialysis revealed full recovery of the enzymatic activity. This, plus the demonstration of a [3H]sodium borohydride-reducible glucose-protein adduct, indicated that initially a labile aldimine (Schiff base) had been formed. Binding experiments with [14C]glucose and failure of dialysis to achieve a recovery of enzymatic activity after long-term incubation suggested that subsequently a stable ketoamine product had been formed. This was further confirmed by the thiobarbituric acid test, which revealed 0.65 nmol 5-hydroxymethylfurfural/mg protein for glycosylated AP compared to 0.11 for the non-glycosylated control. Preliminary results further suggest that NEG of AP also occurs in vivo. Streptozotocin diabetic rats had significantly lower serum AP activities than did non-diabetic controls (mean +/- SD: 153.7 +/- 28.4 vs. 760.5 +/- 95.7 U/l; p less than 0.001). Blood glucose levels and serum AP activity, which had been determined simultaneously during an oral glucose tolerance test, showed without exception an inverse relationship in each of 32 healthy children studied. The biological significance of these findings remains to be established.

Development of intrapulmonary interstitial emphysema together with other forms of extraalveolar air collections following alveolar rupture was investigated retrospectively in 46 term and preterm newborn infants with respect to gestational age severity of pulmonary disease and mode of ventilatory assistance. Intrapulmonary interstitial emphysema was found in 31 of these 46 infants (67%). Development depended on the severity of pulmonary disease, mode of ventilatory assistance and level of inspiratory pressure. Intrapulmonary interstitial emphysema was found at an average age of 1 day (1-6 days) in 2 out of 23 infants (9%) during unassisted spontaneous breathing, in 8 out of 24 infants (33%) during CPAP and in 21 out of 26 infants (81%) during controlled ventilation. 18 out of these 31 infants (58%) additionally developed other forms of extraalveolar air collections but only in 9 from these interstitial emphysema has been found prior to other forms of extraalveolar air. Mortality rate of infants with intrapulmonary interstitial emphysema alone (10 out of 13; 77%) and infants who additionally developed other forms of extraalveolar air collections (16 out of 18; 89%) did not differ significantly. Development of intrapulmonary interstitial emphysema even in he absence of other forms of extraalveolar air collections has therefore to be judged as a severe complication in infants undergoing different forms of ventilatory assistance.

The case of a newborn infant showing heroin withdrawal syndrome is reported. Symptoms of neonatal drug withdrawal syndrome, together with the complex problem of maternal drug addiction and pregnancy are briefly discussed.

The ultimate goal in the treatment of neonatal Rh-disease is prevention of hyperbilirubinemia and bilirubin encephalopathy syndrome. Therapeutic approaches as exchange transfusion, phototherapy, reduction of enterohepatic circulation and enzyme induction are discussed on the basis of bilirubin metabolism. The impact of endogenous and exogenous factors upon bilirubin-albumin binding is emphasized in more detail. Two main theories for the pathogenesis of bilirubin encephalopathy syndrome are currently under discussion: the cytotoxicity of the free, unbound bilirubin fraction or the transient opening of the blood brain barrier secondary to asphyxia, acidosis and hyperosmolarity.

The most important infectious skin diseases of the newbornperiod are discussed in a short survey. Those skin alterations which can already be observed immediately after birth are especially emphasized. The search for skin infections has to be a routine measure in the care of the newborn, because even the smallest pyoderms can lead to septic complications, and non-infected newborn must be protected through the quarantining and treatment of those newborns with the infection. Frequent occurrence of pyoderms should be taken as a reason for examining the hygienic measures in the delivery room, nursery and maternity ward.

A report is presented of the chemical pathological findings in 14 premature and one full-term infant receiving almost exclusively parenteral nutrition during the first two weeks of life. Six infants developed cholestatic jaundice. The underlying diseases were the idiopathic respiratory distress syndrome in 10, gastroschisis in 3 and renal insufficiency in 1, while one was an otherwise healthy small for dates infant. After parenteral nutrition had been discontinued obstructive jaundice cleared by the third month of life except in one infant. Apart from the higher glucose intake during the second week, jaundiced infants principally differed from non-jaundiced infants by the development of significant hypophosphataemia. An attempt was made to correlate aetiologically the presence of cholestatic jaundice with the finding of hypophosphataemia on the possible basis of a disturbance of energy metabolism.

Immunoelectrophoresis of glomerular basement membrane antigens in the urine of 20 Type 1 (insulin-dependent) diabetic and 10 healthy children was performed. In 10 of the diabetic children, there was altered alpha-1-mobility, while the other diabetic and normal children showed alpha-2-mobility. After incubation with glucose, glomerular basement membrane antigens in the urine of healthy children showed alpha-1-mobility. Isolated human kidney glomerular basement membrane split products obtained by proteolytic degradation (papain, trypsin, chymotrypsin) were also investigated by immunoelectrophoresis. A difference was observed in the immunoelectrophoretic pattern of native and glycosylated glomerular basement membrane split products. A distinct increase of thiobarbituric acid assay positive glomerular basement membrane structures after incubation with glucose provides suggestive evidence for the occurrence of non-enzymatic glycosylation of glomerular basement membrane proteins. Glycosylated glomerular basement membrane proteins may contribute to both functional and morphological changes in diabetic glomerulosclerosis.

The frequency of congenital Toxoplasma infection is strictly correlated with the frequency of Toxoplasma primary infection in child bearing age. The latter corresponds directly to the increase of contamination rate in the normal population between 20 and 40 years of age, if determined with a sensitive method detecting also low antibody concentrations with certainty (Sabin-Feldman-dye test). In four representative studies the relation was 0.52 conversions id est 0.26 congenital infection per 1 000 per 1% contamination increase. Most congenitally infected children seem normal in newborn age. Follow up studies for long enough periods--many years!--have shown that practically all these children develop sequelea, chorioretinitis and/or cerebral defects. Postnatal treatment does not influence this evolution but preventive treatment in pregnant women selected by serological screening uncovering primary infections does prevent fetal infections with their consequences.

In the course of a prospective study the development of Serum bilirubine levels was controlled in 90 neonates. In 30 cases labour had been induced by means of intravenous oxytocin infusion, in a further 30 cases by means of local peri-cervical prostaglandine E2 (PGE2)-application. The control group consisted of 30 children, with spontaneous onset of labour. Anamnesis, duration of gravidity, course of labour and method of delivery were the same in all groups; the neonates were all treated the same. The serum bilirubine was determined fotometrically with the Greiner Selective Analyzer GSA II on the 1st, 3rd and 5th post partum day and the results assessed by the multivariant analysis according to Newman-Keuls. No differences were found between the PGE2- and the control group, the bilirubine values of the oxytocin groups were significantly higher (p less than 0.001). Icteric neonates with serum bilirubine values of greater than 12 mg% were found more than double as often in the oxytocin group than in the PGE2- group (7:3). The results indicate, that for labour induction by pharmaceuticals, local application of PGE2 by means of a portio cap should be favored over intravenous oxytocin administration.

193 determinations of pH, pCO2 and pO2 have been performed simultaneously on arterial and capillary blood samples in 22 mature and premature infants 1 to 2 weeks old. Despite good agreement of arterial and capillary pH and pCO2 values no such results could be found in pO2 values. In cases of oxygen therapy especially if positive endexspiratory pressures are used control of oxygen tension should be done exclusively from arterial and not from capillary blood samples.

Die Auswirkungen des Gestosesyndroms auf die fetale Entwicklung bzw. auf den Zustand der Neugeborenen aus so komplizierten Schwangerschaften konnen, da allgemeingultige atiologische Vorstellungen zur Genese dieser Storung noch fehlen, nur am Schweregrad der mutterlichen Erkrankung [11] oder an einzelnen bei der Schwangeren zu beobachtenden Symptomen gemessen werden.

pH, pCO2, pO2 and where possible DAaO2 determinations were done before, immediately after and 30 minutes after chest physiotherapy in 4 groups (respiratory adaptation disturbance, pneumonia, hyaline membrane disease--controlled ventilation and RDS--nasal-CPAP) of mature and premature infants and in a group of healthy infants. The most striking alterations of the parameters investigated were found in infants treated with nasal-CPAP and controlled ventilation where especially a decrease of pH and increase of pCO2 was observed. After small increases of paO2 immediately after physiotherapy the paO2 values and concomitantly DAaO2 values 30 minutes after chest physiotherapy fell below the levels before physiotherapy. There was no significant change from pretreatment values in any group of infants. A physiotherapist experienced in the care of infants with respiratory diseases is most important for achieving satisfactory results.

Risk of premature birth was evaluated according to the prematurity risk score proposed by Thalhammer 1973 in 610 newborn infants hospitalized during 1974 to 1979 at the Division of Neonatology and Congenital Disorders of the Department of Pediatrics, University of Vienna. 324 infants had a birth weight of less than 2501 grams and 286 infants a birth weight of more than 2500 grams. Prematurity risk was compared with regard to prenatal care to birth weight and gestational age as well as to the duration of hospital stay, the incidence of respiratory distress syndrome, the need of ventilatory support and the mortality rate. Quality of prenatal care was judged from the frequency of medical attendances obtained during pregnancy. Less than 0,5 medical visits for 4 weeks were classified as bad prenatal care, more than 0,8 visits as good prenatal care. At any prematurity risk newborn infants from pregnancies with good prenatal care had a higher gestational age and a higher birth weight. They also had shorter hospital admissions, less frequent a respiratory distress syndrome or the need for ventilatory support and a lower mortality rate. The benefit of good prenatal care was supported further by the finding that important individual risk factors as well as the total prematurity risk score was the same in infants without respiratory distress syndrome but birth weights below 2501 grams as well as in infants with the respiratory distress syndrome in infants with ventilatory support and in infants who died. The mothers on the other hand of the healthy newborn infants weighing below 2501 grams shared significantly more medical attendances during pregnancy.

The finding in the literature that the neonatal small left colon syndrome can be present in newborn infants of diabetic mothers without relevant clinical signs led us to perform contrast enema investigations of the colon in 20 newborn infants of insulin-dependent diabetic mothers. Among these only one infant, with signs of intestinal obstruction, had the small left colon syndrome. During the same period the neonatal small left colon syndrome was diagnosed in 4 out of 10 mature newborn infants of healthy, non-diabetic mothers who underwent contrast enema investigation because of intestinal obstruction. The concepts of the pathogenesis of the neonatal small left colon syndrome and the importance of this form of functional intestinal obstruction in the newborn are discussed together with the presumptive relationship to severe gastrointestinal complications such as e.g. necrotizing enterocolitis, seen with increasing frequency in artificially ventilated newborns.

Eighteen diabetic children aged between 8.5 and 16.5 years (mean 12.5 years) who had been diabetic for 1 to 10 years (mean 4.1 years) were examined for their urinary glomerular basement membrane (GBM) antigen excretion by means of immunoelectrophoresis and for alterations of the retinal vessels by fluorescence angiography. None of these patients showed albuminuria or hypertension. As compared to 40 healthy controls aged between 5 and 17 years, altered GBM antigen mobility (alpha-1) was found in 9 out of these 18 diabetics, whereas the remaining 9 children had normal GBM antigen mobility (alpha-2). Pathological fluorescence angiography findings on the other hand were evident in 7 children with altered GBM mobility, but only in 4 diabetics with normal GBM antigen mobility. This trend reflects the similarity of biochemical and functional characteristics of basement membranes in the retinal and kidney vessels supporting the well established association of vascular changes in both organs in patients with diabetes mellitus. GBM antigen excretion into urine could be useful for detecting early microvascular alterations in the kidneys in juvenile diabetics where diagnosis of early glomerulosclerosis is important.

Assuming adequate technique, determinations of intracellular phenylalanine and tyrosine concentrations in lymphocytes are very reproducible. The concentrations found in this study (1981) in five homozygotes and five obligate heterozygotes for PKU and seven normals, are identical with the corresponding concentrations found in 1979 in 13 homo- and 19 obligate heterozygotes for PKU and 26 normals. The intracellular concentrations in six homo- and five heterozygotes for hyper-Phe, as determined in the present study, are intermediate between the concentrations found in PKUs and normals in the present and the former study. As in PKUs, there is no difference between homo- and heterozygotes for hyper-Phe. The hypothesis of an intracellular threshold concentration for phenylalanine triggering the production of a toxic metabolite, could explain the severe brain damage observed in untreated PKU-homozygotes, the slight damage in well-treated PKU-homozygotes and in PKU-heterozygotes, and the absence of damage in hyper-Phe homozygotes (and heterozygotes). Also the difference in brain function between homozygotes for both conditions (PKU-treated), can be understood in spite of comparably elevated extracellular phenylalanine concentrations in young patients.

A retrospective study was performed in the context of 1,047 cases of internal foetal monitoring, using direct foetal electrocardiography and/or foetal scalp blood sampling. Seven minor foetal complications have been observed, including six cases of infection and one of haemorrhage, representing a rate of 0.66 per cent. The advantages obtainable from internal foetal monitoring appear to outweigh the low risk associated with these methods.

White mice infected intraperitoneally with the RH-strain of Toxoplasma gondii (inoculum size 50,000 to 100,000 free protozoans per mouse) received treatment between the second and eighth day after infection with sulphamethazine-pyrimethamine, sulphamethoxy-diazine-pyrimethamine, trimethoprim-sulphamethoxazole or spiramycin subcutaneously. All untreated controls and all mice of the trimethoprim-sulphamethoxazole and spiramycin-treated groups died during the acute stage (except two mice in the latter group on the 15th day). The mean survival times were 6.5, 7.5 and 7.6 days, respectively. The best results were obtained in the sulphamethazine-pyrimethamine-treated mice; 18 out of 27 survived the 30-day observation period (5 cured), in contrast to only 9 out of 40 sulphamethoxydiazine-pyrimethamine-treated mice. Considering the high pathogenicity of the RH-strain, the differences in immunological defence mechanisms in mice (absence of antibody-activating "accessory factor") and the late commencement of treatment of the infected mice, one can state that the combination of sulphamethoxydiazine-pyrimethamine should also be capable of overcoming acute human toxoplasmosis in pregnancy. Spiramycin, by contrast, should be given only in cases where sulphonamide intolerance exists and must then be given in high doses until delivery. The combination of sulphamethoxazole-trimethoprim cannot be recommended.