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ZusammenfassungDepressive Störungen gehören zu den häufigsten psychischen Störungen im Kindes- und Jugendalter. Sie gehen mit einer starken psychosozialen Beeinträchtigung einher und sind ein Risikofaktor für affektive Störungen im Erwachsenenalter. Sowohl in der Diagnostik als auch in der Behandlung sind bei Kindern und Jugendlichen alters- und entwicklungsspezifische Aspekte zu beachten. Es wird eine selektive Übersicht über die aktuelle Datenlage zur Behandlung depressiver Störungen mit besonderem Augenmerk auf Besonderheiten des Kindes- und Jugendalters gegeben. Mittel der Wahl in der Behandlung depressiver Störungen bei Kindern und Jugendlichen sind psychotherapeutische Verfahren sowie die antidepressive Psychopharmakotherapie mit selektiven Serotoninwiederaufnahmehemmern. Unter den psychotherapeutischen Verfahren existieren die besten Wirksamkeitsnachweise für die kognitive Verhaltenstherapie. Die beste Datenlage zur Wirksamkeit von Antidepressiva existiert für den Wirkstoff Fluoxetin, welcher als einziges Antidepressivum in dieser Altersgruppe zur Behandlung depressiver Störungen zugelassen ist. Da trotz der existierenden wirksamen Behandlungsverfahren ein signifikanter Anteil von Patienten unter der Behandlung nicht remittiert, ist die Entwicklung neuer und verbesserter therapeutischer Verfahren dringend erforderlich.

Ziel: Ziel dieser selektiven Ubersichtsarbeit ist zunachst die Darstellung der aktuell in Deutschland etablierten pra- und postnatalen Vorsorge- bzw. Screeninguntersuchungen im Alter bis 18 Jahren. Eine solche Gesamtdarstellung ist in Anbetracht der in diesem Lebensabschnitt haufigen und populationsumfassenden Untersuchungen sinnvoll, um die beteiligten Facharzte (Gynakologen, Kinder- und Jugendmediziner, Allgemeinmediziner, Kinder- und Jugendpsychiater und -psychotherapeuten, andere Facharzte, die werdende Mutter bzw. Kinder und Jugendliche behandeln) uber die Wertigkeit dieser Untersuchungen zu informieren. Aktueller Stand: Fur das Erwachsenenalter haben intuitive Annahmen bezuglich der Vorteile von Screeninguntersuchungen zur Fruherkennung von Krebserkrankungen einer empirischen Uberprufung mehrfach nicht standgehalten; zudem wurde wiederholt festgestellt, dass der Nutzen nicht eindeutig den Schaden uberwiegt. Insofern muss erst recht fur das Kindes- und Jugendalter eine solide Evidenzbasierung der Vorsorge- und Screeninguntersuchungen gefordert werden. Zukunftige Entwicklungen: Mogliche zukunftige Entwicklungen der pra- und postnatalen Untersuchungen werden einschlieslich ihrer gesellschaftlichen Implikationen aufgezeigt. Die bislang mangelhafte Berucksichtigung von Untersuchungen zur Fruherkennung von Verhaltensauffalligkeiten bzw. psychischen Storungen wird diskutiert. Es wird schlieslich fur die facherubergreifende Kooperation und Forschung geworben, um die Screening- bzw. Vorsorgeuntersuchungen evidenzbasiert zu optimieren und gleichzeitig gesundheitsokonomische und ethische Aspekte mit zu bedenken.

Patients with advanced Parkinson's disease and motor complications undergoing optimized oral therapy can significantly benefit from continuous intrajejunal levodopa/carbidopa infusion applied by means of a medication pump. However, this requires a correctly positioned PEG-J tube and finely adjusted pump settings. Although this method is a routine procedure in specialist centers, no standard procedure has been defined up to now. For this reason, an expert recommendation regarding the practical application has been developed in order to standardize the procedure and facilitate patient access to this treatment option.

Aim: To examine whether regulatory problems in infancy predict later hyperkinetic symptoms in childhood and pre-adolescence. Methods: In a prospective longitudinal study of 319 children at risk of later developmental problems and psychopathology, hyperkinetic behaviour problems were assessed at the ages of 2, 4.5, 8 and 11 y by means of a standardized parent interview. Infant regulatory problems at the age of 3 mo were determined from multiple sources of information. An observational procedure was used to assess the quality of mother-infant interaction. Results: At the age of 3 mo, 17% of the infants (n= 55; 27 boys, 28 girls) suffered from multiple regulatory problems. Compared to a control group (n= 264), these children presented more hyperkinetic symptoms throughout childhood. Negativity in the mother-infant interaction and early family adversity each contributed to later hyperkinetic symptoms. When controlling for family adversity, the association between infant multiple regulatory problems and later hyperkinetic problems was rendered insignificant. Conclusions: These findings suggest that multiple regulatory problems may not be a key variable for later hyperkinetic problems. The impact of early family adversity factors clearly outweighed that of infant psychopathology on later behaviour disorder.

Zur Vermeidung einer Hypothermie bei Notfallpatienten stehen im Rahmen der Erstversorgung Rettungsdecken zur Verfugung. Es handelt sich dabei um eine dunne, reisfeste, wasserdichte Polyesterfolie mit einer Aluminiumbedampfung. Durch eine Lackierung oder Einfarbung der anderen Seite wird eine bessere Sichtbarkeit gewahrleistet. Die silberfarbene Aluminiumbedampfung ist in der Lage, durch Reflexion der Korperwarme zu einer Prophylaxe einer Hypothermie beizutragen. Zusatzlich kann einer Konvektion durch den Aufbau eines Luftpolsters zwischen Korperoberflache und Decke entgegengewirkt werden. Zum Kalteschutz sollte die Silberseite nach innen gerichtet sein und nicht direkt am unbekleideten Korper anliegen.

The relationship between H. pylori and functional dyspepsia is controversial. Hypothesizing that subjects with a more intense immune response to H. pylori (and hence higher antibody titers) would be at greater risk of dyspepsia, we aimed to identify risk factors for the development of dyspeptic symptoms. In all, 491 healthy blood donors with no history of peptic ulceration and 74 consecutive patients with a confirmed diagnosis of functional dyspepsia were studied. Symptoms and potential risk factors [nonsteroidal antiinflammatory drugs (NSAIDs), alcohol, and smoking] were measured by a validated questionnaire. H. pylori status was determined by IgG antibodies using a validated ELISA test with a cutoff titer for a positive serology of 10 units/ml. Logistic regression analysis assessed the association between risk factors and dyspepsia. Among blood donors, 21% (95% CI 17.6–24.8) reported dyspepsia (pain localized to the upper abdomen); 7.7% (95% CI 5.5–10.4) had frequent dyspepsia (>6 times in the prior year). The age-adjusted prevalence of H. pylori was not significantly different in blood donors with (39.5%, 95% CI 24.0–56.6) and without frequent dyspepsia (34.2%, 95% CI 29.8–38.36), but was significantly greater in patients with functional dyspepsia (68.8%, 95% CI 57.3–77.9). In the combined study population of blood donors and patients with functional dyspepsia, logistic regression adjusting for age identified the following independent risk factors for frequent dyspepsia: high serum antibody levels against H. pylori (OR for IgG titer >50 units/ml vs H. pylori titers 11–50 units/ml 4.6, 95% CI 2.7–7.8) and consumption of standard NSAIDs (OR 2.4, 95% CI 1.3–4.5). In contrast, alcohol (OR 0.6, 95% CI 0.3–1.0), smoking (OR 1.5, 95% CI 1.0–2.3) or positive H. pylori serology with titers ≤50 units/ml (OR 1.6, 95% CI 0.8–2.9) were not associated with frequent dyspepsia. In conclusion, in a subgroup of H. pylori-infected subjects who have high antibody titers, H. pylori appears to be associated with functional dyspepsia.

20-Hydroxyecdysone has an inhibitory effect on the proliferation of l(2)mbn cells, causes vacuolization and fragmentation of cells, and promotes a strong phagocytotic activity. From several lines of evidence, it can be concluded that 20-hydroxyecdysone induces apoptosis. Long-term video observations following the fate of individual cells, scanning and transmission electron microscopy reveal the typical characteristics of apoptosis: sequestration of small cellular protuberances or larger parts of the cell with nuclear fragments (apoptotic bodies), chromatin condensation, condensation and vesiculation of cytoplasm, whereas the mitochondria retain their normal appearance. The induction of apoptosis by 20-hydroxyecdysone was confirmed by the TUNEL reaction and quantitatively determined by a method based on this reaction. Onset of apoptosis precedes phagocytotic activity. JH III alone has no clear-cut effect on l(2)mbn cells. In double treatments, the inhibitory effect of 20-hydroxyecdysone on cell proliferation is significantly reduced by the addition of JH III. Whether or not JH III also reduces apoptotic activity is not yet clear. It is shown that the l(2)mbn cell line is an advantageous model system for the exploration of steroid-induced apoptosis.

We derive and discuss formulas for the density and the hazard rate of the empty space function of a germ-grain model Ξ in R d generated by a stationary point process Φ and i.i.d. convex primary grains Ξ n , n∈ N , that are independent of Φ. Our formulas are based on the Palm probability of the germ process and the mean generalized curvature measure of the grain. Particular attention is paid to cluster models, where the grains form a Poisson cluster process. Our discussion of specific Gauss–Poisson models with spherical grains provides some motivation for the use of the failure rate of F to detect clustering effects. In the general case we propose a family of functions comparing the behaviour in the neighbourhood of a typical germ with the neighbourhood of an arbitrary point in space. These characteristics can be used to measure effects of clustering and spatial interactions between the locations of the individual grains.

Since the identification of the new human virus, GB virus C (GBV-C)/hepatitis G-virus (HGV), in 1995/1996, reverse transcription polymerase chain reaction remained the sole available diagnostic tool for GBV-C/HGV infection. Recently, a serologic test based on the detection of antibodies to the putative envelope protein 2 (anti-E2) has been introduced. We used this assay for a seroepidemiological survey including 3,314 healthy individuals from different parts of the world, 123 patients from Germany who were suspected to have an increased risk of acquiring GBV-C/HGV infection, 128 multiple organ donors, and 90 GBV-C/HGV RNA positive persons. In European countries, anti-E2 seropositivity ranged from 10.9% (Germany) to 15.3% (Austria). In South Africa (20.3%) and Brazil (19.5%), even higher anti-E2 prevalence rates were recorded. In Asian countries like Bhutan (3.9%), Malaysia (6.3%), and the Philippines (2.7%), anti-E2 positivity was significantly lower. GBV-C/HGV anti-E2 prevalence in potential "risk groups," i.e., patients on hemodialysis and renal transplant recipients, did not vary significantly from anti-E2 seroprevalence in German blood donors. Anti-E2 and GBV-C/HGV RNA were found to be mutually exclusive, confirming the notion that anti-E2 has to be considered as a marker of past infection.

The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.

Die interdisziplinare Leitlinie der Qualitat S3 zur Diagnose und Therapie des hepatozellularen Karzinoms (HCC) ist ein evidenz- und konsensbasiertes Instrument, um die Diagnostik und Therapie des HCC zu verbessern, da die Diagnostik und Therapie des HCC ein auserst diffiziles Vorgehen erfordert. Es ist die Aufgabe der Leitlinie, dem Patienten (mit Verdacht auf HCC oder nachgewiesenem HCC) angemessene, wissenschaftlich begrundete und aktuelle Verfahren in der Diagnostik, Therapie und Rehabilitation anzubieten. Dies gilt sowohl fur die lokal begrenzte oder lokal fortgeschrittene Erkrankung als auch bei Vorliegen eines Rezidivs oder von Fernmetastasen. Die Leitlinie soll neben dem Beitrag fur eine angemessene Gesundheitsversorgung auch die Basis fur eine individuell zugeschnittene, qualitativ hochwertige Therapie bieten. Mit den erklarenden Hintergrundtexten ist es auch nicht spezialisierten, mitbehandelnden Kollegen moglich, den Patienten uber das Vorgehen der Spezialisten, Nebenwirkungen und Ergebnisse gut zu beraten. Mittel- und langfristig sollen so die Morbiditat und Mortalitat von Patienten mit HCC gesenkt und die Lebensqualitat erhoht werden.

While severe hyponatremia is reported to be more frequent in adults treated with oxcarbazepine (OXC) than with carbamazepine (CBZ), there is not sufficient data about the incidence of hyponatremia in childhood during treatment with OXC. We evaluated changes in serum electrolyte balance in 75 children with epilepsy before and during treatment with OXC and after replacing carbamazepine (CBZ) therapy with OXC therapy. All patients had normal sodium serum levels at the onset of OXC. During treatment with OXC we found hyponatremia (Na +< 135 mmol/l) without clinical symptoms in 26.6 % of the children (n = 20), sodium levels below 125 mmol/l were observed in 2 children (2.6 %). Clinically relevant hyponatremia occurred in one girl only (1.3 %). In a subgroup of 27 children, in whom CBZ was directly replaced with OXC, hyponatremia without symptoms was found in one child under CBZ (3.7 %) and in six children under OXC (22.2 %). Dosage of OXC, serum levels of the active metabolite of OXC, antiepileptic comedication or patients' age and gender were of no predictive value for the development of hyponatremia. Electrolytes should be measured before establishing OXC and if clinically relevant side effects occur.

Background Transforming growth factor-betas (TGF-bs) are pleiotropic growth factors exerting neurotrophic functions upon various neuronal populations of the central nervous system. In contrast, the role of TGF-b isoforms in the enteric nervous system (ENS) is largely unknown. We therefore analyzed the gene expression pattern of the TGF-b system in the human colon and in rat myenteric plexus, and smooth muscle cell cultures and determined the effect of TGF-b isoforms on neuronal differentiation. Methods Human colonic samples as well as cultured rat myenteric plexus, and smooth muscle cells were assessed for mRNA expression levels of the TGF-b system (TGF-b1-3, TbR-1-3) by qPCR. The colonic wall was separated into mucosa and tunica muscularis and enteric ganglia were isolated by laser microdissection (LMD) to allow site-specific gene expression analysis. Effects of TGF-b isoforms on neurite outgrowth and branching pattern of cultured myenteric neurons were monitored. Key Results mRNA expression of the TGF-b system was detected in all compartments of the human colonic wall as well as in LMD-isolated myenteric ganglia. Cultured myenteric neurons and smooth muscle cells of rat intestine also showed mRNA expression of all ligands and receptors. Transforming growth factor-b2 treatment increased neurite length and branching pattern in cultured myenteric neurons. Conclusions & Inferences The TGF-b system is abundantly expressed in the human and rat ENS arguing for an auto-/paracrine function of this system on enteric neurons. Transforming growth factor-b2 promotes neuronal differentiation and plasticity characterizing this molecule as a relevant neurotrophic factor for the ENS.

Exclusion criteria of the DSM-IV-TR and ICD-10 do prevent dual diagnoses of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). However, inattention, impulsivity and hyperactivity are amongst the most frequent associated symptoms of ASD. Psychopathological, neuropsychological, brain imaging and genetic studies suggest possible pathophysiological links between ASD and ADHD. Thus, standard diagnostic procedures for both disorders should assess the presence of potential comorbid symptoms of the other disorder. Treatment strategies for ADHD symptoms in the context of ASD overlap with those for patients with ADHD, but lower dosages and slower titration might be recommendable.

Mit dem Zellseparator A 201 stand ein neuer Prototyp für Thrombozytapheresen zur Verfügung, der bei diskontinuierlichem Spendefluß eine kontinuierliche Sammlung von plättchenreichem Plasma (PRP) durchführte. Aus dem PRP wurde in einem zweiten Arbeitsschritt mit Hilfe des Plasmazell-CTM-Separators ein Thrombozytenkonzentrat (Tk) und ein gerinnungsaktives Frischplasma (GFP) hergestellt. Das Tk enthielt 2,6 ± 0,7 x 1011 Thrombozyten mit einer Leukozytenkontamination von 3,9 ± 3,9 × 108 und einer Erythrozytenverunreinigung von 3,0 ± 3,0 × 108. Das GFP war nahezu zellfrei. Zur Beurteilung der Biokompatibilität untersuchten wir Hämolyse- und Gerinnungsparameter vor, während und nach der Apherese. Es fand sich kein Anhalt für eine Hämolyse, doch die Analyse der Gerinnungs-faktoren und des Thrombin-Antithrombin III-Komplexes (TAT) ergab Hinweise auf eine Gerinnungsaktivierung.

Malnutrition in anorexia nervosa was simulated in an animal starvation study. Female rats aged 11 to 13 weeks received a hypocaloric standard diet or a hypocaloric choline reduced diet. Weight reduction lasted for 12 to 20 weeks and was between 30 % to 40 % of initial weight. Several animals were refed after weight reduction up to 6 to 12 weeks with a standard or a choline enriched diet ad libitum. Serum parameters and membrane fluidity of the CNS were measured after weight reduction or after refeeding. Weight reduction leads to a significant decrease of serum protein, triglycerides (Z = -3.53 resp. -3.42; p0.001) and an increase of membrane fluidity in the CNS (Z = -2.83; p0.001). Long-term diet with marked weight reduction and following refeeding causes a catabole metabolic situation with significant increase of urea/creatinine-ratio. Choline enriched refeeding after diet results in normalization of serum parameters and membrane fluidity of the CNS. Choline enrichment leads to a significant increase of serum protein (Z = -2.03; p0.01). Besides we found a negative correlation between serum protein and urea/creatinine-ratio (r (S) = -0.47; p0.001; n = 64). This is possibly caused by a reduced protein catabolism or an increased protein anabolism. Furthermore membrane fluidity in the CNS correlates with serum protein (r (S) = 0.65; p0.001; n = 41) and with serum creatinine levels (r (S) = 0.58; p0.001; n = 42). We conclude that these serum parameters are potential predictors for cell function in the starved brain and consequently for the course of anorexia nervosa. We furthermore hypothesize that choline enriched nutrition after starvation improves the stabilization of cerebral membranes and the metabolic situation in anorexia nervosa.

Rapid advancements in telecommunications technologies are opening many new opportunities to broaden a service provider's customer base, and offer those customers more choices in order to personalize services. The advent of intelligent network technology design concepts allows rapid service introduction based on customer needs and the flexibility to personalize a service to an individual's needs through the Intelligent Network's Service Creation Environmentl. However, as Southwestern Bell's Personal Communications service design work has shown, the ability to offer robust, flexible, and personalized services is limited by the resulting complexity of the service and the customer's ability to easily understand how the service operates. We are faced with the following dilemma: How can we offer services with enough flexibility to meet a wide range of customers' needs while ensuring that any one customer is not inundated with too many features? This is an important issue since customers will not use - and therefore not pay for - services which they perceive to be too complex. This paper describes Southwestern Bell's first attempt to provide Personal Communications services using the robust capabilities of an intelligent network platforms. We examine how the service design process was conducted (using the axiom that services must be driven by your Marketing organization and not your technology organization), what we learned, and how we will improve our methodology in future endeavors. The implications of using a service prototyping platform are also discussed.

Due to concerns that selective serotonin reuptake inhibitors (SSRI) might be associated with an increased risk of suicidal ideation and suicide attempts in depressive children and adolescents, treatment with these drugs is controversial. All available data from randomised controlled trials on SSRIs treating depression in these age groups were examined regarding efficacy and suicidality. Results suggest that fluoxetine and, less clearly, sertraline are effective in such treatment. A meta-analysis yielded no statistically significant difference between treatment with SSRI and placebo with regard to the occurrence of suicidal behavior. Following evidence-based criteria, the risk:benefit ratio is favourable for fluoxetine and sertraline. Their use in the pharmacotherapy of depressive children and adolescents is indicated.

To examine whether regulatory problems in infancy predict later hyperkinetic symptoms in childhood and pre-adolescence.In a prospective longitudinal study of 319 children at risk of later developmental problems and psychopathology, hyperkinetic behaviour problems were assessed at the ages of 2, 4.5, 8 and 11 y by means of a standardized parent interview. Infant regulatory problems at the age of 3 mo were determined from multiple sources of information. An observational procedure was used to assess the quality of mother-infant interaction.At the age of 3 mo, 17% of the infants (n = 55; 27 boys, 28 girls) suffered from multiple regulatory problems. Compared to a control group (n = 264), these children presented more hyperkinetic symptoms throughout childhood. Negativity in the mother-infant interaction and early family adversity each contributed to later hyperkinetic symptoms. When controlling for family adversity, the association between infant multiple regulatory problems and later hyperkinetic problems was rendered insignificant.These findings suggest that multiple regulatory problems may not be a key variable for later hyperkinetic problems. The impact of early family adversity factors clearly outweighed that of infant psychopathology on later behaviour disorder.

Rolandic epilepsy is the most frequent epileptic syndrome in childhood, electroencephalographically characterized by focal sharp waves, so called rolandic spikes (benign epileptiform discharges of childhood). These discharges occur in about 1.5 to 2.4% of children; only 10% of them suffer from epileptic seizures.This paper reviews genetic, epidemiological, radiological, neurophysiologic, metabolic and neuropsychological findings in children with rolandic discharges.The epileptologic course is favorable, seizures and EEG features usually resolve completely at puberty. In contrast to former assumptions, symptoms range from infrequent seizures to neuropsychological deficits and behavior problems, even in children without overt seizures. The impact of rolandic spikes on the development of affected children and their behavior is unclear. Two models try to elucidate the relation between EEG discharges and neuropsychological disorders. The first regards neuropsychological disturbances as transient cognitive impairment due to epileptiform discharges; the second model strengthens the role of a hereditary impairment of brain maturation.The benefit of pharmacotherapy for treating neuropsychiatric symptoms in children with rolandic spikes but without overt seizures remains to be clarified.

RDP-58, a decapeptide with inhibitory effects on tumor necrosis factor synthesis, is under development by SangStat Medical Corp for the potential treatment of Crohn's disease and ulcerative colitis; phase II trials for both these indications commenced in October 2001. SangStat also initiated a phase I trial in chemotherapy-induced diarrhea in the first quarter of 2003 and anticipates initiating phase I trials in the gastrointestinal complications of HIV by the end of 2003.

We report on a 17-year-old boy who developed a marked increase in serum creatine kinase (CK) (9743 U/l) during treatment with risperidone for catatonic psychosis. Known causes of elevated CK such as delirium, malignant neuroleptic syndrome, infection, cocaine overdose, trauma, and intramuscular injections were ruled out. Vital signs remained always within the normal range. On discontinuation of risperidone, serum CK concentrations returned to 105 U/l within 1 week and remained within normal limits. While a transient moderate increase in CK activity at admission may be related to acute psychosis, risperidone seems to be the causative agent for the later marked elevation. To our knowledge, this is the first reported case of risperidone-associated elevation of serum CK in an adolescent. While discontinuation of risperidone does not seem necessary in patients with a moderate increase of serum CK, withdrawal of neuroleptics is warranted in more severe cases.

The cross-sectional comorbidity of child and adolescent inpatients with obsessive-compulsive disorder (OCD) was assessed.The hospital records of all inpatients treated for OCD since 1976 (31 girls, 46 boys) were compared with data from a prospective epidemiological longitudinal study (90 girls, 84 boys) in two age cohorts (15 years;or = 15 years) with regard to comorbid psychiatric diagnoses. Additionally, psychiatric Axis I diagnoses of patients with a supplementary diagnosis of compulsive symptoms (n = 45) were descriptively assessed in the client population.In the subgroup of OCD patients15 years, boys showed a higher incidence of tic disorders. OCD girlsor = 15 years showed a tendency toward more frequent comorbid affective disorders and a significant result regarding concurrent eating disorders. Eighteen of 27 female patients with supplementary compulsive symptoms requiring clinical intervention had an Axis I diagnosis of eating disorder.Due to different criteria of classification, diverging definitions of comorbidity and different age cohorts and samples, studies on comorbidity in OCD patients are difficult to compare. The frequency of comorbid psychiatric disorders may be over-estimated if the general prevalence of psychiatric disorders in terms of gender and age is not taken into account.

About 250,000 children and adolescents in Germany are dependent upon alcohol or at severe risk of developing an alcohol disorder. Whereas adults who abuse alcohol benefit from a variety of therapy manuals and numerous institutions offering long-term disorder-specific care, the situation with regard to adolescent patients needs to be upgraded.We present the behavioral therapy of an alcohol-dependent 14-year-old boy, focusing on a version of Petry's therapy manual for alcoholism (1996) that has been adapted for the treatment of adolescents. The efficacy of worksheets as a supplement to the usual behavior therapy, or social or family interventions in the treatment of alcohol-dependent adolescents is discussed.

Stenoses are a frequent complication in patients with Crohn's disease and represent a major diagnostic and therapeutic challenge. The proper assessment of the nature of a stenosis as inflammatory or fibrotic is critical for appropriate treatment, since symptomatic fibrotic stenoses require surgical resection. Standard diagnostic procedures to assess the nature of a stenosis include endoscopy, conventional contrast radiography and magnetic resonance tomography. Recent data suggest, that the positron-emission-tomography possesses a high sensitivity and specificity to confirm inflammatory activity in the bowel. The recombinant monoclonal anti-TNF-antibody Infliximab (Remicade) has been approved for the treatment of steroid refractory and steroid dependent Crohn's disease in Germany since 9/2000 and the efficacy of Infliximab is well documented. However, few data exist about the treatment of inflammatory stenoses with Infliximab. We performed a retrospective analysis of our experience with Infliximab in patients with Crohn's disease with special reference to patients with inflammatory stenoses. Among a total of 21 patients treated with Infliximab 11 patients had an inflammatory stenosis. 9 of these patients responded well to Inflimab and became completely asymptomatic for a considerable period of time. Infliximab was tolerated well except for one patient who developed an intrabdominal abscess. The notable clinical response of patients with inflammatory stenoses to Infliximab suggests that treatment with Infliximab might be helpful to postpone or avoid surgical intervention. This finding should be further investigated in a prospective randomized study.

The temporal relationship between substance abuse and symptoms of psychosis in adolescent patients was examined.The hospital records of all adolescent inpatients admitted to the Central Institute of Mental Health in Mannheim during the period from 1976-1997 with a first-time diagnosis of psychosis were examined retrospectively for evidence of co-morbid substance abuse.In 18 of a total of 165 psychotic patients, co-morbid substance abuse was present, whose frequency rose after 1988, with a renewed increase since 1996. Two of the 18 adolescents began taking drugs only after the appearance of the first symptoms of psychosis, in 13 others the abuse was already well established, while for the final three patients the onset of psychotic symptoms and substance abuse was congruent, occurring within the same month. A close temporal correlation between symptoms of psychosis and substance abuse was established for amphetamines (including ecstasy), LSD and excessive abuse of cannabis.Substance abuse constitutes a risk factor for the development of psychoses without, however, necessarily being a direct trigger of psychosis.

Primary glucocorticoid resistance is characterized by decreased sensitivity to cortisol signalling. We have performed genetic analysis of the glucocorticoid receptor (GR) gene in 12 unrelated patients with primary cortisol resistance as defined by a pathological dexamethasone suppression test.Exon specific polymerase chain reaction amplification of the GR gene and sequencing of each exon was carried out. The two mutations were characterized in vitro in terms of glucocorticoid driven reporter gene activity in a transient transfection assay and in a ligand binding assay. Molecular modelling of the R477H mutant was performed based on the X-ray structure of the GR-DNA binding domain.Two novel mutations in the GR gene were found: R477H in the DNA-binding domain which is the first reported mutation in that region of the human GR gene and G679S in the ligand binding domain. The R477H mutation showed no transactivating capacity, whereas the G679S mutation had reduced transactivation capacity compared to the wild-type (wt) GR. When tested for ligand binding capacity, the G679S mutation had 50% binding affinity compared to the wt GR. The effect of the point mutation R477H was deduced by a comparison between the wt structure and the model of the mutant. The wt GR has direct and water mediated contact with the phosphate groups of the glucocorticoid responsive element (GRE) whereas, in the model, the mutation R477H has no contact with the GRE. The G679S mutation is located on the surface of the ligand binding domain, at a distance from the steroid-binding site. A previously reported polymorphism, AAT to AAC at amino acid position 766, was found in four of the patients.In two of 12 patients with clinical glucocorticoid resistance, mutant forms of GR could be found. The glucocorticoid resistance in vivo in these two patients corresponds to impaired function of the two mutated GR forms in two in vitro assays. The relevance of the conservative polymorphism for the glucocorticoid insensitivity noted in these patients remains to be clarified.

The relationship between H. pylori and functional dyspepsia is controversial. Hypothesizing that subjects with a more intense immune response to H. pylori (and hence higher antibody titers) would be at greater risk of dyspepsia, we aimed to identify risk factors for the development of dyspeptic symptoms. In all, 491 healthy blood donors with no history of peptic ulceration and 74 consecutive patients with a confirmed diagnosis of functional dyspepsia were studied. Symptoms and potential risk factors [nonsteroidal antiinflammatory drugs (NSAIDs), alcohol, and smoking] were measured by a validated questionnaire. H. pylori status was determined by IgG antibodies using a validated ELISA test with a cutoff titer for a positive serology of 10 units/ml. Logistic regression analysis assessed the association between risk factors and dyspepsia. Among blood donors, 21% (95% CI 17.6-24.8) reported dyspepsia (pain localized to the upper abdomen); 7.7% (95% CI 5.5-10.4) had frequent dyspepsia (6 times in the prior year). The age-adjusted prevalence of H. pylori was not significantly different in blood donors with (39.5%, 95% CI 24.0-56.6) and without frequent dyspepsia (34.2%, 95% CI 29.8-38.36), but was significantly greater in patients with functional dyspepsia (68.8%, 95% CI 57.3-77.9). In the combined study population of blood donors and patients with functional dyspepsia, logistic regression adjusting for age identified the following independent risk factors for frequent dyspepsia: high serum antibody levels against H. pylori (OR for IgG titer50 units/ml vs H. pylori titers 11-50 units/ml 4.6, 95% CI 2.7-7.8) and consumption of standard NSAIDs (OR 2.4,95% CI 1.3-4.5). In contrast, alcohol (OR 0.6, 95% CI 0.3-1.0), smoking (OR 1.5, 95% CI 1.0-2.3) or positive H. pylori serology with titersor = 50 units/ml (OR 1.6, 95% CI 0.8-2.9) were not associated with frequent dyspepsia. In conclusion, in a subgroup of H. pylori-infected subjects who have high antibody titers, H. pylori appears to be associated with functional dyspepsia.

We report the occurrence of a tic in a boy with Down's syndrome. The movement disorder was induced by carbamazepine (CBZ) and resolved completely after discontinuation of CBZ. The development of tics seems to be a rare, idiosyncratic side effect of CBZ in children.

Since the identification of the new human virus, GB virus C (GBV-C)/hepatitis G-virus (HGV), in 1995/1996, reverse transcription polymerase chain reaction remained the sole available diagnostic tool for GBV-C/HGV infection. Recently, a serologic test based on the detection of antibodies to the putative envelope protein 2 (anti-E2) has been introduced. We used this assay for a seroepidemiological survey including 3,314 healthy individuals from different parts of the world, 123 patients from Germany who were suspected to have an increased risk of acquiring GBV-C/HGV infection, 128 multiple organ donors, and 90 GBV-C/HGV RNA positive persons. In European countries, anti-E2 seropositivity ranged from 10.9% (Germany) to 15.3% (Austria). In South Africa (20.3%) and Brazil (19.5%), even higher anti-E2 prevalence rates were recorded. In Asian countries like Bhutan (3.9%), Malaysia (6.3%), and the Philippines (2.7%), anti-E2 positivity was significantly lower. GBV-C/HGV anti-E2 prevalence in potential "risk groups," i.e., patients on hemodialysis and renal transplant recipients, did not vary significantly from anti-E2 seroprevalence in German blood donors. Anti-E2 and GBV-C/HGV RNA were found to be mutually exclusive, confirming the notion that anti-E2 has to be considered as a marker of past infection.

Summary Field trials have been carried out to examine the suitability of the JHA fenoxycarb in locust control. Laboratory tests have shown that a variety of JHAs, including fenoxycarb, applied to last instar larvae increased mortality, induced morphogenetic defects during metamorphosis, reduced fertility and provoked solitarisation of gregarious hoppers. The phase shift was indicated by green coloration and the acquisition of morphological and behavioural characteristics typical for solitary locusts. The present field experiments should clarify whether or not the effects observed in the laboratory are also observed with hopper bands in their natural habitat and if swarm formation and emigration from the recession areas can be prevented. The results from the topical application (ultra light volume (ULVJ method) of six hopper bands of different sizes and composition (in respect to developmental stage of hoppers and their phase expression) with a broad range of fenoxycarb doses were quite comparable to those obtained in the laboratory. Colour transition started at day 2 after treatment It was obvious that coherence and marching behaviour were strongly disturbed. Even the lowest dose applied, 50 g a.i./ha, caused a whole array of morphogenetic dcfccts impairing jumping and flight. Fitness in general was greatly reduced, making the treated animals more vulnerable to many predators. Although a quantitative evaluation of the field trials, especially concerning mortality, was not possible, it was shown unequivocally that fenoxycarb exhibited the same activity profile as in the laboratory tests at a reasonably low dose. Thus, further field trials with even lower doses and quantitative calculations are of interest.

Whether Helicobacter pylori is causally linked to dyspepsia remains controversial. The aims of this study were to assess in healthy blood donors the prevalence of dyspepsia and dyspepsia subgroups, determine if H. pylori is associated with different categories of dyspeptic symptoms, and evaluate the association between dyspepsia and nicotine, alcohol, and analgesic use. Consecutive blood donors (N = 180) who had no clinical evidence of organic disease were included. Abdominal symptoms were measured by means of a standardized questionnaire that has been previously validated. Subjects with dyspepsia (defined as pain localized to the upper abdomen) were further subdivided into those with ulcer-like, dysmotility-like, reflux-like, or nonspecific dyspepsia. A total of 65 subjects reported abdominal pain or discomfort during the prior 12 months [36.1%, 95% confidence interval (CI) 29.1-43.1]; 44 subjects (24.4%, 95% CI 18.2-30.7) had dyspepsia. Dysmotility-like, reflux-like, and ulcer-like symptoms were reported by 19.4% (95% CI 13.7-25.2), 17.2% (95% CI 11.7-22.7), and 16.7% (95% CI 11.2-22.1) of subjects with dyspepsia, respectively. Fifty-seven subjects (31.7%, 95% CI 24.9-38.5) were H. pylori positive; 26% of subjects with H. pylori and 24% without H. pylori had dyspepsia (P0.50). The seroprevalence of H. pylori was also similar among the different categories of dyspepsia. We conclude that infection with H. pylori is not associated with abdominal complaints in otherwise healthy subjects.