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Juvenile granulosa cell tumor is a rare tumor diagnosed in children, which can present with precocious puberty. We have reported a case of a 6-month-old female patient who presented with precocious puberty. Abdominopelvic imaging revealed a large mixed cystic and solid mass, with internal solid enhancement, and restricted diffusion. At surgery, mass was confirmed to arise from the left ovary, and histopathology confirmed juvenile granulosa cell tumor. We provide a literature review of juvenile granulosa cell tumor and discuss imaging characteristics of this diagnosis.

Ovarian torsion (OT) is an emergency that mandates early detection and surgical detorsion to avoid catastrophic consequences of further adnexal injury. Prompt ultrasound is critical for accurate diagnosis. Traditionally, evaluation of arterial and venous flow was used as a diagnostic tool for OT, but recent radiologic research has indicated that ovarian size and size discrepancy between sides is a better diagnostic criterion. This study seeks to determine whether ovarian size discrepancy or vascular flow to the ovary is more accurate in the diagnosis of OT in the pediatric emergency population and to better describe symptoms that distinguish OT from other abdominal and pelvic pathology.This was a retrospective, cross-sectional study evaluating all female pediatric patients, aged 1 to 18 years, who underwent a pelvic ultrasound to evaluate for OT over a 2-year period in our pediatric emergency department. Patients suitable for inclusion were identified via Nuance mPowerTM, a search engine that provides clinical analytics based on radiology reports generated within our institution.We reviewed the medical records of 193 female patients aged 1 to 18 years, all of whom had a pelvic ultrasound (with or without Doppler) to evaluate for OT during the study period. In comparing ovarian size on ultrasound, patients with OT had a significantly larger magnitude of difference in ovarian volume than patients without torsion (5.57× [interquartile range, 3-12.5] vs 1.56× [interquartile range, 1.24-2.25; P0.001]). Ovarian torsion was associated with a 33-fold increased risk of lack of arterial flow (relative risk, 33.33) and with a 9-fold increased risk of lack of venous flow (relative risk, 9.27), when compared with those patients without OT. Patients with OT were significantly more likely to have emesis and peritoneal signs on examination, as well as previous history of OT (P = 0.01, 0.02, and 0.002, respectively) than those without OT. All patients with OT reported abdominal pain.We found that a large size discrepancy between ovaries is indicative of OT. Our data also suggest that presence of Doppler flow on ultrasound cannot be used to exclude OT but that lack of Doppler flow on ultrasound is a significant diagnostic marker. As previous studies have also found, clinical symptoms of OT are nonspecific and do not offer any certainty in differentiating OT from other pathologies.

Background In hospitalized patients with skin and soft tissue infections (SSTIs), intravenous (IV) empiric antibiotic treatment is initiated. The best time point for switching from IV to oral treatment is unknown. We used an algorithm-based decision tree for the switch from IV to oral antibiotics within 48 hours and aimed to investigate the treatment outcome of this concept. Methods In a nonrandomized trial, we prospectively enrolled 128 patients hospitalized with SSTI from July 2019 to May 2021 at 3 institutions. Clinical and biochemical response data during the first week and at follow-up after 30 days were analyzed. Patients fulfilling criteria for the switch from IV to oral antibiotics were assigned to the intervention group. The primary outcome was a composite definition consisting of the proportion of patients with clinical failure or death of any cause. Results Ninety-seven (75.8%) patients were assigned to the intervention group. All of them showed signs of clinical improvement (ie, absence of fever or reduction of pain) within 48 hours of IV treatment, irrespective of erythema finding or biochemical response. The median total antibiotic treatment duration was 11 (interquartile range [IQR], 9–13) days in the invention group and 15 (IQR, 11–24) days in the nonintervention group (P Conclusions In this pilot trial, the proposed decision algorithm for early switch from IV to oral antibiotics for SSTI treatment was successful in 95% of cases. Clinical Trials Registration. ISRCTN15245496

Fetal imagers are tasked with diagnosing complex fetal anomalies, but maternal abnormalities that may impact the pregnancy are also of utmost importance to recognize and report. Two rare obstetrical complications are uterine incarceration and torsion which can lead to increased maternal/perinatal mortality. Uterine incarceration occurs secondary to a retroverted uterus that becomes retroflexed and entrapped within the pelvis during the first trimester of pregnancy. Uterine torsion is rotation of more than 45° around its long axis. We report a rare case of an incarcerated uterus with presumed spontaneous resolution on follow-up MRI that was ultimately recognized to be uterine torsion at the time of delivery. Knowledge of these entities may help aid in timely detection and diagnosis of complex imaging presentations and avoid downstream complications.

SIDS stands for sudden infant death syndrome and is one of the leading causes for infant deaths in the United States. It is most common for infants in the age range of newborns to 6 months old. The death occurs suddenly with no symptoms and no predictions based on medical history. Detailed autopsies cannot point out the reasoning behind the death either. There is no known causes for SIDS, however infants are at highest risk when they are sleeping. Our senior design project is intended to provide a modern monitoring system for a sleeping infant. We have designed an ankle strap that can monitor an infant's heart rate and body temperature. The vital signs will be taken and recorded periodically while the strap is worn. In the event that an infant's vital signs are read to be outside of their normal range, the device will send a text message to a care giver. An acceptable response time for an infant in distress is about two to five minutes. Anything above five minutes without oxygen will lead to extreme brain damage and possible death. Our device will detect the onset of an infant losing oxygen and this will allow a care giver to monitor and act promptly to any abnormalities. Once the body starts to lose oxygen, the heart will try to pump more blood throughout the body. This causes the heart rate to increase. The device will be able to detect this increase in heart rate and alert, as the increase in heart rate is usually more drastic than subtle. The device is compact and not harmful to an infant. It uses noninvasive measuring techniques in order to obtain vital sign readings. This device is intended to alert someone of the possible onset of SIDS and allow for a quick response time, in order to help reduce infant fatalities.

Focal Dystonia (FD) is a chronic neurological disorder, which causes twisting and repetitive movements and abnormal postures induced by involuntary sustained contractions of agonist and antagonist muscles. Based on the hypothesis that several dystonia-related brain regions, including cerebellum, are implicated in oculomotor disturbances (OCD), a number of studies investigated oculomotor function in patients with dystonia. However, conceptual clarity with respect to the used assessment tools and interpretation of the findings is lacking in the literature. This is the first article to systematically review studies that assessed oculomotor function in patients with FD. In total, 329 publications, published until September 1, 2019, were identified through MEDLINE search. Twenty out of 329 studies, involving 232 subjects in total, met the inclusion criteria. Most of the studies reported oculomotor disturbances in patients with FD. Abnormalities included asymmetry in vestibulo-ocular reflex (VOR), disturbances in saccadic functions, and prolonged latencies of eye motion. Discrepancies in the results could be explained, at least partially, by the long period of time over which the reviewed studies were published, the different methods used for testing the eye movements, and the limited number of patients assessed since the majority of data derived from case reports or small-scale studies. Further prospective studies with larger subject numbers are needed, using advanced tools for the assessment of oculomotor function in focal dystonia.

Focal Dystonia (FD) is a chronic neurological disorder, which causes twisting and repetitive movements and abnormal postures induced by involuntary sustained contractions of agonist and antagonist muscles. Based on the hypothesis that several dystonia-related brain regions, including cerebellum, are implicated in oculomotor disturbances (OCD), a number of studies investigated oculomotor function in patients with dystonia. However, conceptual clarity with respect to the used assessment tools and interpretation of the findings is lacking in the literature. This is the first article to systematically review studies that assessed oculomotor function in patients with FD. In total, 329 publications, published until September 1, 2019, were identified through MEDLINE search. Twenty out of 329 studies, involving 232 subjects in total, met the inclusion criteria. Most of the studies reported oculomotor disturbances in patients with FD. Abnormalities included asymmetry in vestibulo-ocular reflex (VOR), disturbances in saccadic functions, and prolonged latencies of eye motion. Discrepancies in the results could be explained, at least partially, by the long period of time over which the reviewed studies were published, the different methods used for testing the eye movements, and the limited number of patients assessed since the majority of data derived from case reports or small-scale studies. Further prospective studies with larger subject numbers are needed, using advanced tools for the assessment of oculomotor function in focal dystonia.

Although congenital intracranial tumors are very rare, it is important to know the differential diagnosis and distinguishing features of the different disease processes in order to accurately diagnosis and appropriately treat these patients in the neonatal period. We present a case of a rare congenital craniopharyngioma detected in a fetus on prenatal imaging. Teratoma is the most common congenital intracranial tumor. Hence this tumor was initially labelled as a teratoma, which is a pitfall that should be avoided.

Congenital pulmonary artery anomalies are infrequent but given improved prenatal diagnosis and care, and neonatal surgical advances, over the past two decades are not uncommonly encountered by cardiothoracic imagers. An understanding of their etiology, classifications, associated anomalies, and surgical management can be helpful to avoid under or overdiagnosis. Timely diagnosis assisted by familiarity with imaging findings across modalities and recognition of surgical findings allows for medical management and surgical planning for these patients, with more patients reaching adulthood than ever before.

DerTitel dieser Ausfuhrungen ist angesichts der Ge¬ setzesfulle zu Faktoren des Naturhaushaltes reinste Provokation. Durch Provokationen werden Denkund Arbeitsweisen angezweifelt, werden hinter gul¬ tigen Normen Fragezeichen gesetzt. Durch diese Fragezeichen ist es moglich, grundsatzliche Fehler zu erkennen und vielleicht neue Losungsansatze zu entwickeln. In einer Zeit, in der jede Aussage von Experten/-innen zuerst einmal angezweifelt wird, ist eine dauernde und grundsatzliche Auseinander¬ setzung besonders wichtig, hangt doch unsere Glaubwurdigkeit davon ab.

In Switzerland, the shorelands have been put under considerable pressure by exploitation during the last decades. A planning of the shoreland protection is therefore absolutely essential. This confronts us with the difficult problem of formulating the value of protection. We discuss a practicable but integral and yet transparent method.

In Bezug auf praxis-, diskurs- und erzahltheoretische Ansatze zeigt der Beitrag am Beispiel der fur die eidgenossische Initiative „Gegen Masseneinwanderung“ verwendeten Wahlplakate der Schweizerischen Volkspartei (SVP) den Prozess der Sichtbarmachung sozialraumlicher Phanomene. Dabei ist es bedeutsam die diskursiven und visuellen Elemente des Bildes im Hinblick auf ihre konkrete Bildpraxis zu erarbeiten, so dass folgende Frage im Mittelpunkt steht: Wie argumentiert, beweist und erklart ein Bild, so dass Geltung bei den Bildkonsument_innen erzeugt wird? Zudem soll diese Bildpraxis kontextualisiert werden, also einerseits nach den Regeln des Verstehens fragen, die die Durchsetzung der visuellen Bildbotschaft ermoglichen und andererseits die Bildproduzent_innen in den Blick nehmen, um die Bilder in einen politisch-strategischen Kontext setzen zu konnen. Eine solch angelegte Bild¬analyse gibt einen Einblick in die visuelle Wirklichkeitskonstruktion der SVP und verweist auf die Strategien, um dieser Wirklichkeit Akzeptanz zu generieren.

Purpose– There is much scientific interest in the connection between the emergence of gender-based inequalities and key biographical transition points of couples in long-term relationships. Little empirical research is available comparing the evolution of a couple’s respective professional careers over space and time. The purpose of this paper is to contribute to filling this gap by addressing the following questions: what are the critical biographical moments when gender (in)equalities within a relationship begin to arise and consolidate? Which biographical decisions precede and follow such critical moments? How does decision making at critical moments impact the opportunities of both relationship partners in gaining equal access to paid employment?Design/methodology/approach– These questions are addressed from the perspectives of intersectionality and economic citizenship. Biographical interviewing is used to collect the personal and professional narratives of Swiss-, bi-national and migrant couples. The case study of a Swiss-Norwegian couple illustrates typical processes by which many skilled migrant women end up absently or precariously employed.Findings– Analysis reveals that the Scandinavian woman’s migration to Switzerland is a primary and critical moment for emerging inequality, which is then reinforced by relocation (to a small town characterized by conservative gender values) and the subsequent births of their children. It is concluded that factors of traditional gender roles, ethnicity and age intersect to create a hierarchical situation which affords the male Swiss partner more weight in terms of decision making and career advancement.Practical implications– The paper’s findings are highly relevant to the formulation of policies regarding gender inequalities and the implementation of preventive programmes within this context.Originality/value– Little empirical research is available comparing the evolution of a couple’s respective professional careers over space and time. The originality of this paper is to fill this research gap; to include migration as a critical moment for gender inequalities; to use an intersectional and geographical perspective that have been given scant attention in the literature; to use the original concept of economic citizenship; and to examine the case of a bi-national couple, which has so far not been examined by the literature on couple relationships.

In der Kinder- und Jugendpsychiatrie scheinen Depressionssymptome vermehrt diagnostiziert zu werden. Diese Psychopathologie wird durch Symptome der Verwahrlosung negativ verstärkt. Ziel dieser Untersuchung ist es, die historische Entwicklung des kinder- und jugendpsychiatrischen Diskurses zu diesen beiden Phänomenen innerhalb der Schweiz und Deutschland aufzuzeigen. In einer Diskursanalyse werden 20 Artikel zum Thema Verwahrlosung und Depression vor dem Hintergrund medizinischer, psychologischer, sozialwissenschaftlicher und pädagogischer Perspektiven analysiert und diskutiert. Die Untersuchung ergibt, dass in den Schweizer Fachartikeln sowohl in Bezug auf die Verwahrlosung als auch auf die Depression überdurchschnittlich häufig sozialisationstheoretisch argumentiert wird. In den Fachzeitschriften aus Deutschland hingegen wird Verwahrlosung mehr interaktionistisch begriffen. Aus heilpädagogischer Sicht resultiert die Forderung, Verwahrlosung und Depression in Zukunft noch vermehrt aus interaktionistischer Perspektive zu diskutieren.

We investigated the influences of odor exposure on performance and on breathing measures. The task was composed of tracking, short-term memory, and peripheral reaction parts. During rest or while performing the task, 12 participants were exposed to 4 different odors in 2 intensities. The higher intensity of the malodors induced a short-term decrement in mean inspiration flow (Vi/Ti) after stimulus onset and impaired performance in the short-term memory task, as compared with control trials; no effect was found for the positively judged odors. The study suggests that a distractor as simple as a bad smell may pull a person off task, however briefly, and may result in a detriment to performance. Actual or potential applications of this research involve designing or securing tasks in such a way that a brief withdrawal of attention does not have fatal consequences.

Background: The microbiological basis of diaper dermatitis is not clearly elucidated, although a better knowledge of microbial colonisation can be of importance with regard to an adequate treatment. Objective: To investigate the relevance of Candida sp. and Staphylococcus aureus colonisation in diaper dermatitis and to determine the correlation between the extent of colonisation and the severity of disease. Methods: Growth of Candida sp. and S. aureus in the perianal, inguinal and oral regions was determined by positive/negative and semi-quantitative analysis in an open, multi-centre (n = 3) study. Forty-eight children with healthy skin and 28 with diaper dermatitis were analysed. The severity of diaper dermatitis was assessed using a total symptoms score. Results: Colonisation by Candida sp. was significantly more frequent in children with diaper dermatitis as compared to those with healthy skin (perianal 75 vs. 19%; inguinal 50 vs. 10%; oral 68 vs. 25%, p < 0.0003), whereas colonisation by S. aureus at the 3 swab locations was not different (p > 0.34). There was a highly significant, positive correlation between severity of disease and extent of Candida sp. colonisation at all swab locations. Conclusions: Limited microbial colonisation in diaper dermatitis is of questionable relevance, but extensive colonisation seems to aggravate the symptoms; therefore, we suggest that semi-quantitative evaluation should be preferred to the positive/negative assessment for a differential diagnosis.

This chapter looks at the specific challenges, expectations and opportunities small medium-sized enterprises in emerging countries face regarding enterprise sustainability in today’s worldwide economy characterized by the strong interconnection of supply chains. In its experience with small enterprises development in emerging countries, the International Labour Organization (ILO) has recognized that quality human resource management (HRM) and good workplace practices are a key determinant of enterprise performance and productivity, as well as in practice at the community, national or even international level. Based on the ILO’s Decent Work Agenda (ILO, Decent work, report of the ILO Director-General, 87th session of the International Labour Conference. ILO, Geneva, 1999), the Declaration on Fundamental Principles and Rights at Work (Declaration on Fundamental Principles and Rights at Work. ILO, Geneva, 1998) and the technical cooperation experience of ILO’s Job Creation and Enterprise Development Department, the HRM practices described here are intended to improve enterprise sustainability, understood in its economic, social, and environmental dimensions. Practical examples from the ILO’s practice demonstrate the implementation of labour rights in SMEs in emerging countries.

The interest in having architects utilize building simulation software to better inform conceptual design decisions has been present in the design industry for more than a decade, yet the adoption of simulation by architects in practice has been slow. Past research into the barriers of adoption has often looked through the lens of particular software, with conclusions aimed at improving the tools' interface and applicability to the architects' process. While software has made great advancement, we hear more often today of the engineer stepping forward to apply simulation to the conceptual design process rather than the architect learning to use simulation. In a survey of ten North American firms, diverse in offering design and/or engineering services, individual practices for incorporating simulation into conceptual design were compared. The more common presence of the engineer in conceptual design modeling promises a new collaborative approach to the sustainable design process, overcoming a significant barrier to the architects own adoption while highlighting a need for greater efficiencies in communication between software and analysis time.

Gross cystic disease of the breast may sometimes indicate an increased risk of breast cancer. Biochemical analysis of the cyst fluid could suggest which cysts are associated with breast cancer risk, as well as providing insights into the pathophysiology of this condition. The Na+/K+ ratio appears to be associated with the histological classification of the cyst. Sulfoconjugated estrogens and androgens, especially DHEA-S, are often found at high levels. A number of gross cystic disease fluid proteins (GCDFPs) have been described, and several polypeptide growth factors including EGF and IGF-I are frequently found. It is hoped that biochemical analysis of these components of breast cyst fluids will shed further light on the role of gross cysts in relation to breast cancer.

Respiratory syncytial virus (RSV) was isolated from liver tissue in a 7-month-old infant with extrahepatic biliary atresia. To our knowledge this is the first report of RSV isolation from human liver tissue.

Anal sphincter dysplasia (ASDP) was first described by Upadhyaya [1]. He published his intraoperative observations of the malformation of the superficial anal sphincter in seven children with an anterior perineal anus. Preceding Upadhyaya, Hendren [2] and Leap and Ramenofsky [3] had published their work on the relationship between childhood constipation and the anterior position of the anus.

Anal sphincter dysplasia is a congenital, often familial malformation of the anal canal. In the literature, the anomaly is poorly represented and usually referred to as anteriorly or ventrally displaced anus. The range of symptoms includes chronic constipation, severe straining at defecation, encopresis and chronic paradoxical diarrhea with fecal incontinence. One usually finds dysplasia and absent (type I) or incomplete (type II) fixation of the sphincter complex to the coccyx. Both are demonstrable by computerized tomography (CT) as well as by intraoperative dissection of the sphincter muscles. There ist also shortening of the ectodermal segment of the anal canal which is obviously responsible for the disturbed stool sensation. Posterior butterfly anoplasty combined with fixation of the sphincter complex to the coccyx usually leads to immediate improvement of defecation disorders. A genetic study on 42 patients (age 1-52 years) operated on for anal sphincter dysplasia revealed autosomal dominant inheritance with variable expression and probably incomplete penetrance of the mutated gene.

We describe a boy with asymmetrical hydrocephalus in whom a marked hemiparesis of recent origin resolved completely following insertion of a shunt. In 2 children with shunted obstructive hydrocephalus due to a midline tumour a newly developed hemiparesis improved markedly in one and resolved in the other case subsequent to revision of a blocked shunt. A hemiparesis should therefore not necessarily be attributed to assumed progression of an underlying disease. Other unusual symptoms of hydrocephalus or shunt dysfunction reported in childhood as well as possible causes of hemiparesis in shunted patients are listed.

An off‐line optimization method is described which allows the determination of “optimal” control strategies in a behavioural systems analysis. The method is based on the theory of learning systems, using a phenomenalistic model of the behavioural process for control experiments. There are no restrictions concerning the degree or order of this model. An outline of an investigation in social psychology demonstrates an application of the proposed method. The analysed data are the same as those used in a report on “System identification in behavioural science” previously published in this journal. This allows comparison of two different approaches to behavioural systems analysis by means of a phenomenalistic model.

The majority of shunt dysfunctions can be easily diagnosed by puncturing the Rickham reservoir with a fine needle and estimating the intracranial pressure. Experience has, however, shown that definite shunt dysfunctions can be missed by this method. These limitations of the technique are better understood by constructing a model which enables us to simulate the pressure and flow situation in a ventricular drainage system. This experimental model has shown that in cases of partial proximal or distal blockage, the flow through the shunt system is significantly diminished but not totally stopped, and the pressure reading may thus be normal. In these cases, the shunt should be revised on the basis of clinical evidence of dysfunction.

Between 1982 and 1987 27 Nissen's fundoplications were carried out in our institution. Postoperatively 7 infants showed a typical dumping syndrome. The symptoms were irritability, pallor, sweating, tachycardia, lethargy, diarrhoea and vomiting. In all cases an absolute refusal of feeding was observed. The diagnosis was confirmed by a typical early postprandial hyperglycaemia with hyperinsulinaemia leading to a reactive hypoglycaemia. Additionally, we were able to demonstrate an increased HbA1c as an expression of recurrent hyperglycaemias in 3 infants. In 6 infants the dumping syndrome was of short duration and the symptoms disappeared after application of a so-called dumping diet. In this diet the easily resorbable carbohydrates are replaced by uncooked starch. But in one case we were forced to use continuous enteral nutrition because of persistence of the symptoms 1 year after the Nissen fundoplication. Complete refusal of feeding is an early symptom of the dumping syndrome. If this symptom is observed after a Nissen's fundoplication, a dumping syndrome must be excluded.

An identification method is described which allows the approximation of experimental observations by means of a phenomenalistic model. The method is theoretically based on system theory and is adapted to the needs of behavioural science. Special emphasis will be laid on a system representation, which is transferable to a large group of dynamic systems as well as on an exact formulation of the assumptions connected with the proposed method. A short summary of results determined by a behaviour analysis in the field of social psychology will give a practical view of the possibilities and limits of the described identification method.

We describe two families with pedigrees over three and two generations with nine members affected with anorectal malformations. Both pedigrees are compatible with autosomal dominant inheritance with variable penetrance and expression or with multifactorial inheritance with a high genetic load. The recurrence risk is thought to be in the range of 10% to 20% for first degree relatives of affected members.

During the last two years eight children aged 3 months to 7 years were treated successfully for contaminated small bowel syndrome (CSBS). All patients had a history of a laparotomy in the neonatal period and showed bile stained vomiting and diarrhoea. On examination, a painful distended abdomen with hyperactive bowel sounds was found. Plain abdominal x-rays showed signs of mechanical intestinal obstruction. The diagnosis of CSBS was made by positive gram stain and cultures of samples taken via a nasogastric tube. After antibiotic treatment the symptoms disappeared within a few days. We therefore believe that CSBS should always be considered in the differential diagnosis of abdominal emergencies. Our views agree with those of other authors in so far as we feel that antibiotic therapy may help to avoid unnecessary laparotomies in such cases.

Intestinal obstruction is always accompanied by intestinal hypersecretion. This phenomenon explains the initial symptoms like bilious vomiting and abdominal distension as well as the later clinical signs of hypovolaemia and shock. The proximal hypersecretion in intestinal obstruction is incompletely understood and in the surgical literature on ileus only little attention has been paid to this crucial observation. In analogy to secretory diarrhea and because of own clinical observations we conclude that bowel contamination caused by intestinal stasis is mainly responsible for the increased intestinal secretion in bowel obstruction.

Our series of 17 children with laryngotracheal clefts is reported. In three of four cases with a complicated postoperative course, gastroesophageal reflux (GER) has been found. Three breakdowns of the surgical repair opposed to be due to GER. Only one child with a cleft type III died, although a mortality rate of 93% is reported in the literature. GER has to be excluded before tracheoesophageal cleft surgery is undertaken.

Pulled elbow is a common injury in infancy and childhood. The history and clinical findings are usually classical, but one should never forget that the classical history can always be easily reconstructed by the examining physician. It can be estimated that in 93% of all cases a dramatic response to therapy can be observed. In the remaining 7% the most common cause for failure to treatment is an incomplete or recurrent subluxation of the radial head and distortions or fractures of the elbow. But in approx. 1% the examining physician must suspect a hidden osteomyelitis or osteoarthritis of the elbow. With adequate antibiotic therapy the prognosis is generally good. To avoid this diagnostic pitfall, it is essential to re-examine carefully all cases which do not respond to therapy in order to exclude an osteomyelitis.

Pulled elbow is a common injury in infancy and childhood. The history and clinical findings are usually classical, but one should never forget that the classical history can always be easily reconstructed by the examining physician. It can be estimated that in 93% of all cases a dramatic response to therapy can be observed. In the remaining 7% the most common cause for failure to treatment is an incomplete or recurrent subluxation of the radial head and distortions or fractures of the elbow. But in approx. 1% the examining physician must suspect a hidden osteomyelitis or osteoarthritis of the elbow. With adequate antibiotic therapy the prognosis is generally good. To avoid this diagnostic pitfall, it is essential to re-examine carefully all cases which do not respond to therapy in order to exclude an osteomyelitis.

The main function of the colon is fluid and sodium conservation. In ileostomy patients these colonic functions are lacking. The consequence is excessive loss of fluid and sodium, failure to thrive, and skin excoriation around the ileostomy. Patients with ileostomies require 6-10 mmol/kg sodium per day. With ordinary feeds, infants receive 2-4 mmol/kg sodium; therefore the sodium deficit may be estimated at 4-6 mmol/kg per day. Monitoring of adequate sodium substitution is best carried out by measuring the concentration of sodium in spot urine. Levels higher than 10 mmol/1 sodium signify an adequate oral sodium intake. During the initial period of oral feeding, glucose excretion in the ileostomy fluid must be monitored, as glucose-positive ileostomy effluence necessitates additional sodium substitution in order to activate the sodium and glucose cotransport. Thirty neonates with ileostomies were followed-up retrospectively. All patients received a sodium substitution of at least 4-6 mmol/kg orally per day. The 30 patients had a total of 4769 ileostomy-days. All patients were successfully fed orally and most of them nursed at homeuntil closure of the ileostomy.

Die Entwicklung eines dynamischen Prozessmodells basiert auf einer speziell fur diesen Zweck ausgelegten Versuchsreihe, womit sich die “Allgemeingultigkeit” des Modells auf die im Versuchskonzept vorgesehenen Aenderungen der Einflussgrossen beschrankt. Es kann somit nicht von einem Modell des Konformitatsverhaltens gemeinhin gesprochen werden, sondern nur von einem in Bezug auf eine Versuchsanordnung umfassenden Prozessmodell. Eine exakte Beschreibung der Versuchskonzeption verfolgt damit zwei Ziele: 1. Die Kenntnis der Versuchsbedingungen erlaubt eine richtige Einschatzung der Versuchsergebnisse und einen objektiven Vergleich mit den Erkenntnissen fruherer Untersuchungen zum Anpassungsverhalten. 2 Die Versuchsreihe kann jederzeit unter gleichen Bedingungen wiederholt oder erweitert werden. In diesem Kapitel werden alle verwendeten Hilfsmittel wie auch der Versuchsablauf ausfuhrlich beschrieben und die im Experiment beobachteten Daten schematisch dargestellt und diskutiert werden.

Aus den im Experiment beobachteten Versuchsdaten wird in diesem Kapitel das dynamische Prozessmodell zur Nachahmung des Konformitatsverhaltens empirisch ermittelt. An Hand dieses Modelles konnen sowohl die Zeitabhangigkeit des Anpassungsprozesses nachgewiesen als auch einige Resultate der fruheren Untersuchungen von S.E. Asch, B. P. Cohen und H. D. Schmidt verifiziert resp. widerlegt werden.

We describe a boy with asymmetrical hydrocephalus in whom a marked hemiparesis of recent origin resolved completely following insertion of a shunt. In 2 children with shunted obstructive hydrocephalus due to a midline tumour a newly developed hemiparesis improved markedly in one and resolved in the other case subsequent to revision of a blocked shunt. A hemiparesis should therefore not necessarily be attributed to assumed progression of an underlying disease. Other unusual symptoms of hydrocephalus or shunt dysfunction reported in childhood as well as possible causes of hemiparesis in shunted patients are listed.

Mit der vorliegenden Arbeit zur ‘Exemplarischen Untersuchung des Konformitatsverhaltens anhand eines systemtheoretischen Ansatzes’ wurden zwei Ziele verfolgt: 1. Aus verschiedenen Ansatzen der Systemtheorie war eine Untersuchungsmethode zu entwickeln, die sich auf Probleme der Verhaltensforschung ubertragen liess. Als konkretes Beispiel wurde das ‘Konformitatsverhalten’ analy siert. 2. Von einer umfassenden Untersuchung des Anpassungsverhaltens mit einem dynamischen, nichtlinearen Prozessmodell erhoffte man sich sowohl die Klarung der in der Literatur umstrittenen Fragen als auch einige grundsatzliche Erkenntnisse uber die Dynamik und die Einflussgrossen des Konformitatsprozesses.

We present 4 cases in which atraumatic reduction of an intussusception was achieved only after intraoperative intravenous administration of Glucagon. Because of this observation all our cases of the past 10 years with intussusceptions where bowel resection was necessary, were reviewed. Intraoperative macroscopic and histological findings revealed that bowel resections were not only necessary because of necrosis but also because of bowel wall lesions caused by traumatic reduction or the impossibility to reduce the intussusception. This aspect and the successful use of Glucagon during operation demonstrate that Glucagon should be administered wherever atraumatic surgical reduction of intussusception is not possible. This procedure may contribute to avoid unnecessary bowel resections.

Altered motility of the intestine after laparotomy, adynamic bowel segments, blind bowel loops following bypass operations, or diverticula may cause pathological growth of intestinal microflora and thus lead to contaminated small bowel syndrome (CSBS). As a result of malabsorption in the jejunum and ileum, loss of weight, growth arrest, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia may occur. In addition to these, the acute symptoms of small bowel contamination, intestinal obstruction and secretory diarrhea, are less well known.

Altered motility of the intestine after laparotomy, adynamic bowel segments, blind bowel loops following bypass operations, or diverticula may cause pathological growth of intestinal microflora and thus lead to contaminated small bowel syndrome (CSBS). As a result of malabsorption in the jejunum and ileum, loss of weight, growth arrest, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia may occur. In addition to these, the acute symptoms of small bowel contamination, intestinal obstruction and secretory diarrhea, are less well known. A stenosis in the terminal ileum was experimentally created in Göttingen minipigs and the bacterial flora of the small bowel assessed by quantitative cultures. After 3 months the number of aerobic and anaerobic bacteria in the pre- and poststenotic region had increased by a factor of 10(2)-10(5). The acute form of CSBS was diagnosed by microbiological examination of gastric samples in 14 children. After the children were treated with orally and intravenously administered antibiotics, the symptoms disappeared within 12-36 h. Reoperations for small bowel obstruction can be avoided by conservative treatment of CSBS with antibiotics.