Long hospitalization is the most important risk factor for early weaning from breast milk in premature babies

AIM

To identify certain variables related to the infants' course that might have an impact on the mothers' decision to breastfeed.

PATIENTS AND METHOD

Retrospective survey including all patients <1500 g birth weight (BW) treated between January 1, 2000 and December 31, 2005 at the Neonatal Intensive Care Unit of the Medical University of Vienna who were not transferred to another hospital. Multiple regression analysis of the following variables was carried out: gestational age (GA), BW, length of stay (LOS), parity, singleton or multiple gestation, sex and severe morbidity.

RESULTS

Of the 239 patients included, 142 (60%) were fed breast milk at the time of final discharge, 97 (40%) were fed formula. LOS was significantly correlated with the probability of being breastfed: the shorter it was, the higher was the probability of being breastfed at the time of final discharge (p = 0.0064 for singletons, p = 0.001 for multiples). Lower GA also increased the probability of being breastfed, but this was only statistically significant for multiples (p = 0.001).

CONCLUSION

This study shows clearly that the most important influencing factor on the mothers' decision to continue breastfeeding is the LOS. Thus more emphasis should be put on encouraging mothers to continue lactation throughout their babies' hospital stay.

Rapid recurrence of IBD-associated anemia and iron deficiency after intravenous iron sucrose and erythropoietin treatment

OBJECTIVES

Anemia is a common complication of inflammatory bowel disease (IBD) and iron deficiency (ID) is its predominant cause. Therefore, oral and intravenous iron replacements are widely used. This study was performed to evaluate the frequency and timing of anemia and ID recurrence after a successful treatment cycle.

METHODS

Medical records of patients who had received iron sucrose with or without erythropoietin (EPO) in one of three prospective clinical trials that had been conducted at our center (Ann Intern Med 1997, Digestion 1999, and Am J Gastroenterol 2001) were analyzed for a 5-year follow-up period. The risk for recurrence of anemia (hemoglobin (Hb)<12/13 g per 100 ml) and ID (ferritin <30 microg/l) was evaluated by Kaplan-Meier analysis using the log-rank test.

RESULTS

Eighty-eight patients were available for analysis. Patients had received a mean iron dose of 2,500 mg (range 600-3,600 mg); 33 (37.1%) patients had also received EPO. Anemia recurred in a median of 10 months (95% confidence interval (CI) 8-12) and ID recurred within 19 months (95% CI 11-28). The iron dose had no influence on recurrence of ID or anemia. ID (but not anemia) recurred faster in patients with a post-treatment ferritin level <100 microg/l (median 4 months, 95% CI 1-7) than in patients with ferritin level between 100 and 400 microg/l (median 11 months, 95% CI 6-16) and >400 microg/l (median 49 months, 95% CI 32-66; P<0.001).

CONCLUSIONS

IBD-associated ID and anemia recur surprisingly fast, indicating that maintenance treatment may be needed in a portion of the patient population. Recurrence of ID (but not anemia) can be delayed by aiming for high post-treatment ferritin levels.

Expression of the high-affinity IgG receptor FcRI (CD64) in patients with inflammatory bowel disease: a new biomarker for gastroenterologic diagnostics

OBJECTIVES

We sought to determine the quantitative expression of the high-affinity Fc receptor (CD64) on polymorphonuclear neutrophils (PMNs) in inflammatory and functional conditions of the intestine and investigated its correlation with clinical and biological parameters of inflammation.

METHODS

The quantitative expression of CD64 was determined by fluorescence-activated cell sorting analysis in patients with active or inactive inflammatory bowel disease (IBD, n=76), infectious enterocolitis, lactose and/or fructose intolerance, and healthy subjects.

RESULTS

The quantitative expression of CD64 in patients with active IBD (3,398+/-3,589 molecules per PMN, n=27) was significantly higher than in healthy subjects (607+/-265, n=28, P<0.001) or in patients with lactose/fructose intolerance (531+/-150, n=32, P<0.001). The expression of CD64 correlated significantly with C-reactive protein (CRP, 0.65, P<0.0001), Crohn's disease activity index (CDAI, 0.53, P<0.0001), and colitis activity index (CAI, 0.63, P<0.0001) in patients with IBD. With a cutoff point of 800, CD64 had a sensitivity of 88% and a specificity of 93% in discriminating between lactose/fructose intolerance and active IBD. The quantitative expression of CD64 in patients with infectious enterocolitis (19,190+/-8,920, n=22) was significantly higher than in patients with active IBD (P<0.001). With a cutoff point of 10,000, CD64 showed a sensitivity of 96% and a specificity of 97% in discriminating between infectious enterocolitis and active IBD.

CONCLUSIONS

CD64 could serve as a valuable tool to discriminate between IBD, infectious enterocolitis, and functional intestinal disorders.

Time trends of the prevalence of asthma and allergic disease in Austrian children

After a substantial increase in the prevalence of atopic disease in Europe, recent studies indicate that a plateau has been reached. However, variation across countries and age groups exists. We studied the prevalence and time trends of asthma and allergic disease among schoolchildren in Austria, a country with traditionally low rates of asthma, hay fever, and eczema. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), symptoms and physician diagnoses of asthma and allergic disease of 13,399 Austrian children aged 6-7 yr and 1516 children aged 12-14 yr were surveyed between 1995 and 1997. A similar survey was conducted between 2001 and 2003. Among children aged 6-7 yr, significant increases were seen in the prevalence of physician-diagnosed asthma (+16%; p = 0.013), hay fever (+22%; p < 0.001), and eczema (+37%; p < 0.001) between 1995 and 2003. These changes were paralleled by an increase in the prevalence of symptoms typical for hay fever (itchy eyes and runny nose), but not by an increase in wheeze. Among children aged 12-14 yr, the lifetime prevalence of diagnosed asthma increased by 32%, of hay fever by 19%, and of eczema by 28% (all, p < 0.001). These changes were paralleled by increases in the prevalence of wheezing as documented by both questions before and after a video showing wheezing children but not by symptoms typical for hay fever such as itchy eyes and runny nose. In conclusion, in Austria, contrary to other European countries, the prevalence of asthma and allergic disease increased among schoolchildren. Additional studies are needed to continue monitoring the dynamics of the prevalence of asthma and allergic disease in Austria and to explore trends in their risk factors.

Recent trend in overweight and obesity in male adolescents in Austria: a population-based study

OBJECTIVE

The aim of the study was to provide current estimates of the prevalence of overweight and obesity in young Austrian men and to determine both the trend over the study period and regional differences.

METHOD

Data extracted from the database containing the nation-wide compulsory conscription health examinations were analysed. Four cohorts of 18-year-old males (1986-1990: n=252,799; 1991-1995: n=209,266; 1996-2000: n=208,427; 2001-2005: n=209,168) were investigated. Measurements of height and weight were taken and, and body mass index (BMI) was calculated. Overweight was defined as a BMI >or=25.00 kg//m2 and obesity as a BMI >or=30.00 kg//m2. Information on place of residence of the young men was also collected. The t-test and Cochran-Armitage test were used for statistical analysis.

RESULTS

During the study period, the prevalence of overweight among the study population increased from 12.9 to 15.5%, while that of obesity increased from 2.5 to 5.8%. A significant regional trend was found, with the highest proportion of overweight and obesity occurring among young male residents of the eastern part of Austria (p<0.001). Mean BMI was 22.38+/-3.05 kg/m2 in 1986-1990, increasing significantly (p<0.001) during the study period to 22.89+/-3.88 kg/m2. Overweight and obesity increased remarkably in young males in Austria between 1986 and 2005. The prevalence of obesity doubled during the whole study period.

CONCLUSION

Even in a small country as Austria, significant regional differences with respect to overweight and obesity can be found. Although limited to just one gender and a single age group, data from the nation-wide compulsory conscription health examinations could be a useful tool for public health monitoring.

Resistance to activated protein C is a risk factor for fibrostenosis in Crohn’s disease

AIM: To evaluate the effect of resistance to activated protein C (aPCR), the most common known inherited thrombophilic disorder, on the risk of intestinal operation of fibrostenosis in patients with Crohn’s disease (CD).

METHODS: In a previous study, we assessed the prevalence of aPCR in CD. In a retrospective case-controlled study, 8 of these CD patients with aPCR were now compared with 24 CD patients without aPCR, matched by gender, age at diagnosis and duration of disease in a 1:3 fashion. The primary end point was the occurrence of an intestinal CD-related operation with evidence of fibrostenosis in the bowel resection specimen.

RESULTS: The Kaplan-Meier analysis revealed that patients with aPCR had a lower probability of remaining free of operation with fibrostenosis than patients without aPCR (P = 0.0372; exact log-rank test) resulting in a significantly shorter median time interval from diagnosis of CD to the first operation with fibrostenosis (32 vs 160 mo). At 10 years, the likelihood of remaining free of operation with fibrostenosis was 25% for patients with aPCR and 57.8% for patients without aPCR.

CONCLUSION: CD patients with aPCR are at higher risk to undergo intestinal operation of fibrostenosis than those without aPCR. This supports our hypothesis of aPCR being a possible risk factor for fibrostenosis in CD.

Comparison between three-dimensional placental volume at 12 weeks and uterine artery impedance/notching at 22 weeks in screening for pregnancy-induced hypertension, pre-eclampsia and fetal growth restriction in a low-risk population

OBJECTIVES

To compare the value of three-dimensional placental volume at 12 weeks and uterine artery Doppler at 22 weeks for predicting pregnancy-induced hypertension (PIH), pre-eclampsia and fetal growth restriction in a low-risk population.

METHODS

Over a 20-month period we calculated the placental quotient (PQ = placental volume/crown-rump length) at 11-13 weeks' gestation in all women with singleton pregnancies who booked for delivery in our hospital. At 22 weeks, in the same population, we calculated the mean pulsatility index (PI) of both uterine arteries and the presence of an early diastolic notch was noted. Logistic regression models, the PQ and Doppler parameters were used to compare the two screening methods for subgroups of pregnancy outcome.

RESULTS

Complete outcome data were obtained in 2489 consecutive singleton pregnancies. Logistic regression models for the detection of pre-eclampsia had a sensitivity of 38.5% (PQ) vs. 44.8% (Doppler); for the detection of small-for-gestational age (SGA) the sensitivity was 27.1% (PQ) vs. 28.1% (Doppler) at a specificity of 90%. Taking a PQ of <or= 10th centile, a mean uterine PI of >or= 90th centile and a bilateral notch, the sensitivity for detection of SGA was 25.0%, 20.2% and 22.0%, respectively; for PIH it was 9.5%, 4.8% and 4.8%; for pre-eclampsia without SGA it was 20.0%, 28%, 12%; for PIH/pre-eclampsia with SGA it was 30.8%, 46.1% and 69.2%. In the group with the most severe complications, in which delivery took place before 34 weeks, the sensitivity was 50.0%, 50.0% and 38.9%, respectively.

CONCLUSIONS

PQ at 12 weeks and uterine artery Doppler at 22 weeks have similar sensitivities for predicting pre-eclampsia and fetal growth restriction, although uterine artery Doppler is marginally more sensitive for the prediction of pre-eclampsia. While both methods are insufficient for screening in a low-risk population, the PQ method has the potential advantage of being performed in the first trimester.

Constant decline in sperm concentration in infertile males in an urban population: experience over 18 years

OBJECTIVE

To investigate semen quality in infertile men from an urban population over an 18-year period.

DESIGN

Retrospective study.

SETTING

Andrology clinic at a city university hospital.

PATIENTS

A total of 9,327 men were referred to the clinic for infertility investigation. After excluding those with azoospermia, 7,780 samples were evaluated.

INTERVENTION(S)

Semen samples were analyzed within half an hour of production using computer-automated semen analysis and phase microscopy.

MAIN OUTCOME MEASURE(S)

Sperm concentration, morphology, and motility; semen pH and leukocyte concentration; and patient age.

RESULT(S)

The median patient age over the study period was 31.6 years, with an increase from 30.8 years in 1986 to 34.4 years in 2003. The median sperm concentration was 10.25 million/mL for the entire period, with a decline from 27.75 million/mL in 1986 to 4.60 million/mL in 2003. The median proportion of normally shaped spermatozoa was 15%, and the proportion of motile spermatozoa was 21%. The pH increased from 7.4 in 1986 to 7.9 in 2003, and the median leukocyte concentration was 1.50 million/mL.

CONCLUSION(S)

A constant decline in median sperm concentration was found in the infertile men. The reason for this remains unclear, although the high pH and leukocyte concentration indicates the involvement of infection.

Trends in infant mortality in Austria between 1984 and 2002

Infant mortality rate is an important medical indicator and is often used for comparing countries with respect to welfare and public health. Among other factors, effective medical technology, better access to pre- and postnatal care for all socioeconomic groups and better nutrition have decreased infant mortality in Austria from about 200 deaths per 1000 live births at the beginning of the 20th century to about 5 deaths per 1000 live births at the end. In this study we present the trends in infant mortality, based on 1,654,519 individual birth records, in Austria since 1984. The infant mortality rate dropped rapidly from about 12 per 1000 live births in 1985 to 4.6 per 1000 live births during the last two years of our study (2001/02). Infant mortality rates stratified by cause of death show somewhat differing trends. In particular, the number of deaths due to peripartal problems decreased as the result of improvements in obstetrics and neonatology, but in 1995 a change in the definition of live birth led to a rise of about 20% in the stillbirth rate. At present, Austria has one of the lowest infant mortality rates of all European countries; however, between 1999 and 2002 the mortality rate has been fairly static. A further reduction in mortality clearly cannot be achieved by advances in medicine alone. It remains a challenge for health politicians, physicians and society at large to reduce the prevalence of well-known risk factors such as alcohol abuse, heavy overweight and smoking during pregnancy.

Prostate cancer and prostate-specific antigen (PSA) screening in Austria

The possible effect of prostate-specific antigen (PSA) testing on prostate cancer mortality has remained controversial, despite the test's widespread application. We examined age-specific mortality trends for prostate cancer in Austria before and after the introduction of (opportunistic) PSA testing, to ask whether PSA screening reduces prostate cancer mortality in a uniform cohort of men with equal access to health care. Prostate cancer mortality data covering all 9 federal states of Austria were analysed from 1970 to 2002. PSA testing became widely available in Austria not before 1989. Tyrol, one of the nine federal states of Austria, independently launched a mass prostate cancer prevention project in 1993. We applied join-point regression models to identify changes in the slope of age-specific mortality trends in selected age groups (50-59, 60-69, 70-79, and 80-89 years) and calculated the annual percent change (APC) in mortality between 1970 and 2002 for Tyrol and the rest of Austria separately. After 12 years of follow-up, we were not able to observe a significant reduction in prostate cancer mortality since the introduction of the PSA test in the age groups of 50-59, 60-69, and 80-89 years. A significant decrease was found in the age group of 70-79 (Austria without Tyrol 1989 through 2002: APC, -2.36; 95% CI, -3.38 to -1.34; Tyrol 1991 through 2002: APC, -6.42; 95% CI, -8.92 to -3.86). In this age group the join points 1989 and 1991 cannot be related to PSA testing. PSA screening does not appear to reduce prostate cancer mortality in a uniform cohort of men with equal access to health care. However, given the long lead-time for prostate cancer, even longer follow-up may still be needed to detect any important trends.

Screening detected celiac disease in children with type 1 diabetes mellitus: effect on the clinical course (a case control study)

OBJECTIVE

To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study.

CASES

98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent biopsy.

CONTROLS

two controls in the same center were chosen, (stratified by age and age-at-diabetes onset) who were negative for endomysial antibodies (n = 195). Height, weight, HbA1c, insulin dosage and acute complications were documented for at least 1 year of follow up.

RESULTS

Mean age of diabetes manifestation was 6.5 +/- 4.1 years and diagnosis of celiac disease was made at 10.0 +/- 5.4 years. Biopsy showed total or subtotal mucosal atrophy in 74 patients. The mean observation period after the diagnosis of celiac disease was 3.3 +/- 1.9 years. Mean HbA1c levels were similar between cases and controls (8.63% +/- 1.45% versus 8.50% +/- 1.39%; P = 0.35). There was also no difference in the frequency of severe hypoglycemia, ketoacidosis and the applied insulin dosage (P = 0.45). Body mass index-standard deviation score at celiac disease diagnosis (0.57 +/- 1.24 versus 0.52 +/- 1.07) and height-standard deviation score (0.14 +/- 1.13 versus 0.30 +/- 0.95) did not differ between cases and controls. After diagnosis of celiac disease, weight gain was diminished in boys with celiac disease compared with their controls (P < 0.05). Female cases also had a lower body mass index than female controls (P = 0.067).

CONCLUSION

In a cohort of diabetic children, silent celiac disease had no obvious effect on metabolic control but negatively influenced weight gain.

Careful use of pseudoR-squared measures in epidemiological studies

Many epidemiological research problems deal with large numbers of exposed subjects of whom only a small number actually suffers the adverse event of interest. Such rare events data can be analysed by employing an approximate Poisson model. The objective of this study is to challenge the interpretability of the corresponding Poisson pseudo R-squared measure. It will lack sensible interpretation whenever the approximate Poisson outcome is generated by counting the number of events within covariate patterns formed by cross-tabulating categorical covariates. The failure is caused by the immanent arbitrariness in the definition of the covariate patterns, that is, independent Bernoulli events, B(1,pi), are arbitrarily combined into binomially distributed ones, B(n,pi), which are then approximated by the Poisson model.

Regional and social differences in body mass index, and the prevalence of overweight and obesity among 18 year old men in Austria between the years 1985 and 2000

The BMI data of four birth cohorts of totally 180,716 male 18 year old Austrian conscripts were documented in 5 year intervals starting 1985 and ending 2000 in order to analyze regional and social variety and a time trend of stature, body weight and BMI as well as the prevalence rates of overweight (defined as a BMI > 25.00) and obesity (BMI > 30.00). At first a marked time trend in BMI and overweight/obesity prevalence rates was found. Over the 15 years of investigation BMI increased significantly and the variation of BMI distribution increased too. The impact of educational level on BMI and the prevalence of overweight and obesity was also statistically significant. With increasing educational level BMI and the prevalence rates of overweight and obesity decreased significantly. Furthermore a significant regional variety in BMI and the prevalence rates of overweight and obesity were found. BMI and the prevalence rates of obesity and overweight decreased significantly from the Eastern part of Austria to the Western part. Both observations, e.g. the social and regional variety of obesity and overweight prevalence, were true of all 4 birth cohorts. From these results we can conclude that obesity and overweight represent an increasing health problem among young Austrian males. This is especially true of young men of low social status living in the eastern part of Austria.

Increase in 6-hydroxymelatonin excretion in humans during ascent to high altitudes

Melatonin (MLT), the pineal gland hormone involved in the regulation of circadian rhythms, shows characteristic diurnal variation. Its physiological role in humans is not clear. Exposure to high altitudes may disrupt the circadian rhythm and lead to various endocrine changes. MLT in humans has not been studied under these conditions. Urinary 6-hydroxy-MLT sulfate (aMT6s) excretion was analyzed during the day (0700-2200 h) and night (2200-0700 h) phases. A cohort of 33 healthy volunteers, aged 19-65 yr, was studied during an ascent to a high altitude in the Himalayas on three occasions (at a lower altitude, at 3400 m, and after reaching maximal altitudes of 5600-6100 m). aMT6s excretion during the daytime remained unchanged during exposure to high altitudes. As expected, nocturnal values were higher than diurnal values at each point in time. However, there was a significant increase in nocturnal MLT excretion after the ascent to high altitudes. Ascent to high altitudes is associated with increased nocturnal excretion of aMT6s. The mechanism and physiological significance of this MLT increase are unclear.

Prevalence of overweight and obesity in male adolescents in Austria between 1985 and 2000. A population based study

OBJECTIVE

To analyse the prevalence of overweight and obesity in young Austrian men, to describe a possible time trend during the observation period 1985-2000 and to define regional differences within the country.

DESIGN

Epidemiological population based investigation (conscript health investigation) comparing aggregated data of four cross-sectional studies.

SUBJECTS

Four cohorts of 18 year-old males (1985: n = 50,475, 1990: n = 47,463, 1995: n 39,275, 2000: n = 43,503), in total n = 180,716.

METHODS

Measurements of height and weight were performed during the nationwide conscript health investigation. BMI was calculated and overweight was defined as BMI > or = 25.00 kg/m2 and obesity as BMI > or = 30.00 kg/m2. Besides height and weight data, information on place of residence of the young men was used for the study. Chi-squared and Student's t-test were calculated to test group differences with respect to their statistical significance.

RESULTS

The prevalence of overweight increased from 10.9% to 15.5% and of obesity from 1.8% to 4.9% during the observation period. A significant regional trend was found with the highest prevalence of overweight and obesity in the Eastern part of Austria (p < 0.001). BMI was 22.12 +/- 0.34 kg/m2 (mean +/- SD) in 1985 and showed a significant increase (p < 0.001) during the study period to 22.71 +/- 0.25 kg/m2.

CONCLUSION

Overweight and obesity increased remarkably in young males in Austria between the years 1985 and 2000. The steepest increase was found in the prevalence of obesity and in the Western part of Austria. A significant regional difference could be documented during the whole study period.

Type 2 diabetes mellitus is rare but not absent in children under 15 years of age in Austria

Until recently, most children with diabetes mellitus had type 1 diabetes (T1DM). The prevalence of type 2 diabetes (T2DM) is on the rise in North America, especially in risk populations such as the American Indians. Few epidemiological data on the incidence of the disease exist in Europe. In a prospective population-based epidemiological study, all newly diagnosed cases of diabetes mellitus in patients under 15 years of age were registered nation-wide in Austria between 1999 and 2001. Differential diagnosis (according to the American Diabetes Association diagnostic criteria) was based on clinical case definition. During the 3 years of the study period, 529 cases of DM <15 years were documented, of which 510 were clinically assigned to T1DM (271 boys, 239 girls) resulting in an incidence rate of 12.4/100,000. In the same network, eight cases were diagnosed as T2DM (one boy, seven girls) and two cases with an atypical form of T2DM (two girls). The age of onset of T2DM was 12-15 years and all patients were overweight (body mass index >90th percentile). The calculated incidence for T2DM <15 years in Austria was 0.25/100,000.

CONCLUSION

at present, type 2 diabetes mellitus is rare but exists in children aged under 15 years in Austria. Follow-up of this registration will help to describe the secular trend.

Regional distribution of risk for childhood diabetes in Austria and possible association with body mass index

This study was performed to investigate whether the body mass index (BMI) of diabetic children at manifestation is related to the non-random risk distribution in Austria and whether there is an association with the BMI of the background population. All newly diagnosed cases aged <15 years (n=1644) from 1989 to 2000 were allocated to districts using the postal code. BMI at the time of diagnosis was derived from the Austrian incidence data sheet in 99.3% of the registered cases. Data on BMI of the whole population >14 years of age for the year 1991 and birth weight for the years 1989-1999 were derived from Statistics Austria. Linear regression as well as ecological regression (Poisson) models with correction for non-linearity were used. BMI at diabetes manifestation was positively associated with year of diagnosis (P<0.05) and the age at diagnosis (P<0.01). An increase in BMI when moving from West to East (P<0.01) and a higher BMI at diagnosis in boys than girls (P<0.01) was observed. The ecological regression model showed a positive significant association of BMI in newborns and a positive trend of BMI in the background population with incidence rates.

CONCLUSION

our data support the hypothesis that obesity may be a risk factor not only for type 2 but for type 1 in children acting as an accelerator for the clinical manifestation.

Incidence of Type I diabetes mellitus in children and young adults in the province of Upper Austria, 1994-1996

AIM/HYPOTHESIS

The aim of our study was to determine the incidence rate of Type I (insulin-dependent) diabetes mellitus in the 15-30 years age group in a well-defined province in Austria and to compare this with the incidence rate of childhood-onset diabetes mellitus in the age group 0-15 over a 3-year period.

METHODS

Incident cases of Type I diabetes were reported by the local departments of medicine and paediatrics prospectively to the Austrian Diabetes incidence registry. Completeness of ascertainment was calculated by the capture-recapture method.

RESULTS

The incidence rates per 100,000 person-years for Type I diabetes in the Austrian province of Upper Austria were 8.99 (7.02-11.4, 95%-CI) for the 0-15 years age group and 7.1 (5.5-9.0, 95%-CI) for the 15-30 years age group. The estimated completeness of ascertainment was 93 % (89.0-97.1%, 95%-CI) for children and 87% (84.1-89.9%, 95%-CI) for young adults. Sex differences were evident in young adults, with a 1.6-fold increased risk in males older than 15 years and 2.2-fold increased risk in men over 20 years of age.

CONCLUSION/INTERPRETATION

Our study shows that the incidence rate of Type I diabetes in Austria after the age of 15 years is similar to the incidence rate in childhood. An unexplained male predominance in patients older than 20 years could be observed as in sevc ral other countries.

Extracorporeal photochemotherapy in patients with steroid-dependent Crohn's disease: a prospective pilot study

BACKGROUND

Extracorporeal photochemotherapy has been proven effective in selected T-cell mediated diseases.

AIM

To evaluate the safety and efficacy of extracorporeal photochemotherapy in patients with steroid-dependent Crohn's disease by an open, monocentric trial in three phases of 24 weeks each.

METHODS

In phase 1 standardized steroid tapering was initiated in patients with a history of steroid-dependent Crohn's disease. Those with a prospectively evaluated maintenance dose of at least 10 mg/day prednisolone continued steroid-withdrawal under the application of extracorporeal photochemotherapy in phase 2. The duration of remission or response was followed during phase 3. Colonic tissue bioptically obtained before and after extracorporeal photochemotherapy was studied by immunofluorescence microscopy for the presence of photoadduct positive cells.

RESULTS

Out of 24 patients included in phase 1, 10 entered phase 2 for extracorporeal photochemotherapy. Four subjects achieved remission and four others response. Significant reductions in serum C-reactive protein levels and intestinal permeability were measured, as well as increases in quality of life and plasma adrenocorticotropic hormone levels. No major side-effects were observed. Remission remained stable in three out of four patients during phase 3. In three patients, positive nuclear stainings of photoadducts were detected in colonic mononuclear cells after extracorporeal photochemotherapy.

CONCLUSIONS

Extracorporeal photochemotherapy represents a safe steroid-sparing approach in patients with Crohn's disease and is associated with intestinal homing of photopheresed cells.

[Frequency of cesarean sections in Austria]

OBJECTIVE

While there exist detailed reports on the frequency of cesarean sections in many European countries, there are only selective data of single centers available in Austria. Thus this study aims at evaluating the present frequency of cesarean sections in Austria.

METHODS

To achieve this aim, we analyzed all births during the years 1996 (n = 89,208), 1997 (n = 84,408) and 1998 (n = 81,568). Along with the general mean rate of sections, we also describe the influences of the duration of pregnancy, of the birth weight, and of the number of paturitions. The data were statistically evaluated by chi-square test.

RESULTS

During the study period, the frequence of sections rose from 13.08% (1996) to 14.0% (1997) and to 14.55% (1998). This rise proved to be statistically significant (p = 0.0001). 47% of premature births (< or = 35th week of gestation) are delivered by cesarean section. This rate drops to only 13.24% after the 35th week of gestation. Yet, more than half of pregnancies with dystrophic children (<2,000 g) are delivered by cesarean section even after the 35th week of gestation. Primigravidae have to expect section in 17% of the cases (1998); the section rate diminishes continuously, however, with increasing number of pregnancies.

CONCLUSIONS

Following the general trend, the frequency of cesarean sections is continuously rising in Austria too. The present study can serve as a basis for international comparisons as well as for measures of intradepartmental quality control.