Vaccine Mandates and Cultural Safety

The issues and problems of mandatory vaccination policy and roll out in First Nations communities are unique and do not concern the safety and effectiveness of vaccines. These issues are also independent of more specific arguments of mandatory vaccination of healthcare workers as a condition of employment. As important as these issues are, they do not consider the complex politics of ongoing settler colonialism and First Nations community relations. In this paper, we also set aside the very real problems of disinformation, hesitancy, scientific and health illiteracy, and other concerns that drive vaccine hesitancy and refusal. These affect all communities, including First Nations communities. We, instead describe the dominant arguments in favour of mandatory vaccination and critique them in terms of the disputed legitimacy of Settler-Colonial decision-making as it impacts First Nations communities. We contend cultural responsiveness and safety-not state compulsion-must remain the first principles of any engagement-including vaccination-with First Nations Peoples, families, and communities.

Kinetic, dynamic, and pathway studies of glycerol metabolism by Klebsiella pneumoniae in anaerobic continuous culture: I. The phenomena and characterization of oscillation and hysteresis

Oscillation and hysteresis phenomena are observed in the anaerobic continuous fermentation of glycerol by Klebsiella pneumoniae in long-term cultivations under a variety of conditions. In this work, the conditions for the occurrence of these phenomena are reported and the patterns of cell growth and metabolism under oscillation are characterized. During an oscillation period, the formation rates of CO(2), H(2), and formate and the consumption rate of alkali periodically pass values of maxima and minima, the latter being close to zero. The formation of biomass and fermentation products such as 1,3-propanediol, acetate, and ethanol also undergo periodic changes which shift maxima and minima. Sustained oscillation occurs only under conditions of substrate excess within a distinct regime. At pH 7.0, it is only found at dilution rates above 0.15 h(-1) under the experimental conditions. At lower pH values, oscillations are more likely to happen, even at a relatively low dilution rate and low substrate excess. Whereas the amplitude of oscillations at pH 7.0 depends on both the dilution rate and the residual glycerol concentration (C(Glyc)) the interval of oscillations appears to be only a function of C(Glyc). An increase of C(Glyc) in culture damps the oscillation and leads to its disappearance at C(Glyc) = 1100 to 1200 mmol/L (pH 7.0). The operation mode was also found to be an important parameter in determining the stability and actual state of the culture, resulting in hysteresis under certain conditions, particularly at low pH values. Generally, a large perturbation of cultivation conditions tends to cause oscillation and hysteresis. The results unambiguously demonstrate that the oscillation and hysteresis phenomena shown in this work are bound to genuine metabolic fluctuations of the microorganism. They reveal several differences and new features compared with those reported in the literature and cannot be readily explained by the mechanisms known so far.

NAT1 genotypes do not predict response to mesalamine in patients with ulcerative colitis

BACKGROUND

5- Aminosalicylic acid (5-ASA) is metabolised in colonic mucosa by N-acetyltransferase 1 (NAT1). Common genetic polymorphisms in this enzyme result in rapid or slow acetylation. 5-ASA treatment causes side effects in up to 10 % of patients with ulcerative colitis (UC). We therefore determined genetic variations of NAT1 in patients with UC and looked for a possible association with the clinical response to 5-ASA.

METHODS

DNA was obtained from 78 patients with UC. 77 % of the patients were in remission during 5-ASA treatment, whereas 23 % suffered from active disease. NAT1 genotyping was performed for 23 known alleles using RFLP and sequence analysis. Clinical response to 5-ASA was determined by medical record review and associated with NAT1 genotypes.

RESULTS

Utilising PCR we amplified a 570-bp coding region of the human NAT1 gene in addition to 240 bp in the 3'-untranslated region (UTR). 4 NAT1 alleles previously known as NAT1*3, *4, *10 and *11 were recovered. 31 % of the patients were heterozygous and 4 % homozygous for the NAT1*10 allele. 6 % were heterozygous for the NAT1*3 allele. 6 % were heterozygous for the NAT1*11 allele. No association was found between NAT1 genotype and clinical response as well as side effects to 5-ASA in patients with UC.

CONCLUSIONS

NAT1 genotypes do not predict response or side effects to mesalamine in patients with UC. Variations caused by non-genomic effects may be associated with the clinical response to 5-ASA.

(GT)N dinucleotide repeat polymorphism of haem oxygenase-1 promotor region is not associated with inflammatory bowel disease risk or disease course

Haem oxygenase-1 (HO-1) up-regulation was suggested to reduce mucosal tissue damage in inflammatory bowel disease (IBD) and an up-regulation of HO-1 expression in patients with Crohn's disease (CD) and ulcerative colitis (UC) was demonstrated. A HO-1 gene promoter microsatellite (GT)(n) dinucleotide repeat polymorphism was associated with regulation of HO-1 in response to inflammatory stimuli. We therefore hypothesized that IBD patients might segregate into phenotypes with high or low HO-1 inducibility. Ethylenediamine tetraacetic acid blood samples were obtained from 179 CD patients, 110 UC patients and 56 control patients without inflammation. Genomic DNA was purified and the 5'-flanking region of the HO-1 gene containing the (GT)(n) dinucleotide repeat was amplified. Polymerase chain reaction (PCR) products were purified and the length of the PCR fragments was analysed. The number of (GT)(n) repeats in the population studied ranged from 13 to 42. The distribution of the allele frequencies was comparable in patients and controls for both the short and the long alleles. The frequencies of short-, middle- and long-sized alleles were not changed among the groups studied. No correlation was found between IBD and microsatellite instability detected in five individals. Our data indicate that (GT)(n) dinucleotide repeats of the HO-1 promotor region have no significance for the pathophysiology and disease course of IBD.

In vivo treatment with the herbal phenylethanoid acteoside ameliorates intestinal inflammation in dextran sulphate sodium-induced colitis

Recently we demonstrated that in inflammatory bowel disease (IBD) macrophage-oxidative burst activity is increased and NADPH oxidase mRNA is induced. The herbal phenylethanoid acteoside isolated from Plantago lanceolata L. was shown to exhibit anti-oxidative potential. Using the dextran sulphate sodium (DSS)-induced colitis model, in this study we have assessed whether systemic application of acteoside affects colitis. Colitis was induced by DSS in Balb/c mice. Treatment with acteoside (120, 600 microg/mouse/day) was performed intraperitoneally. The colon lengths were determined. Colonic tissue was scored histologically (max. score 8) by a blinded investigator. T cells isolated from mesenteric lymph nodes (MLN) were stimulated with anti-CD3 antibody in the presence of interleukin (IL)-2 (final concentration 10 U/ml). After incubation for 24 h, IL-1beta, IL-6, IL-12 tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma levels in supernatants were analysed by the beadlyte cytokine detection system. Histological scoring of colonic tissue revealed that application of acteoside was followed by a significantly improved histological score. In acute colitis the histological score was 3.2 with acteoside versus 5.2 with phosphate-buffered saline (PBS) (P < 0.02). In chronic colitis both 120 microg (3.3 versus 5.2) or 600 microg acteoside (3.0 versus 5.2) significantly ameliorated colitis (both P < 0.02). Stimulated MLN from mice with chronic DSS-induced colitis treated with acteoside showed a significant down-regulation of IFN-gamma secretion (195 pg/ml with 600 microg acteoside versus 612 pg/ml with PBS, P < 0.02). Inhibition of oxidative burst activity with acteoside reduced mucosal tissue damage in DSS colitis and could be a therapeutic alternative for IBD treatment. Further studies of this agent are warranted.

Cathepsins B, L and D in inflammatory bowel disease macrophages and potential therapeutic effects of cathepsin inhibition in vivo

The cathepsins D (CTSD), B (CTSB) and L (CTSL) are important for the intracellular degradation of proteins. Increased cathepsin expression is associated with inflammatory diseases. We have shown previously an induction of CTSD expression in intestinal macrophages (IMAC) in inflamed mucosa of patients with inflammatory bowel disease (IBD). Here we investigated the regulation of CTSB and CTSL in IMAC during IBD and effects of CTSD and CTSB/CTSL inhibition in vivo. Human IMAC were isolated from normal and inflamed mucosa. Reverse transcription-polymerase chain reaction (RT-PCR) was performed for CTSB and CTSL mRNA. Immunostaining was used to confirm PCR results. Cathepsin inhibition was investigated in the dextran-sulphate-sodium (DSS) colitis model in mice with application of pepstatin A (CTSD inhibitor), CA-074 (CTSB inhibitor) and Z-Phe-Tyr-aldehyde (CTSL inhibitor). CTSL mRNA was significantly up-regulated in IMAC isolated from IBD mucosa. Up-regulated protein expression was found mainly in areas of mucosal damage by immunostaining. Inhibition of CTSD in mouse DSS colitis was followed by an amelioration of the disease. Inhibitor-treated mice showed a significant lower histological score (HS) and less colon reduction in comparison to controls. Similarly, simultaneous inhibition of CTSB/CTSL was followed by a significant amelioration of colitis. Expression of tissue-degrading cathepsins is increased in IMAC in IBD. Inhibition of CTSD as well as CTSB/CTSL is followed by an amelioration of experimental colitis. The prevention of mucosal damage by cathepsin inhibition could represent a new approach for the therapy of IBD.

[Positron emission tomography with (18)F-fluoro-2-deoxyglucose in cardiological diagnosis]

This clinically oriented review presents main principles of metabolism of cardiac muscle, pathophysiology of myocardial hibernation and stunning, as well as methodological principles of positron emission tomography (PET) of the heart with (18)F-fluoro-2-deoxyglucose ((18)F-FDG). Diagnostic and prognostic value of (18)F-FDG PET and scintigraphic sings of disturbed myocardial viability, contractility and metabolism are also described. Efficacy of (18)F-FDG PET is compared with other imaging methods such as radionuclide, ultrasound and radiological. Literature data and clinical cases demonstrate importance of preoperative diagnosis of hibernating myocardium in patients with ischemic heart disease. (18)F-FDG PET is a basic method of detection of potentially reversible pathological states of the heart (hibernation and stunning); it has high sensitivity and specificity as well as predictive power in relation to forthcoming course of ischemic heart disease. This noninvasive method of investigation provides unique information on severity of ischemic heart disease for stratification of patients in risk groups and selection of candidates for coronary artery bypass surgery or cardiac transplantation.

Crossover behavior in micellar solutions with lower critical demixing point: broadband ultrasonic spectrometry of the isobutoxyethanol-water system

The aggregation kinetics of isobutoxyethanol-water mixtures with lower critical demixing point has been investigated. Two types of kinetics have been observed, a diffusion-controlled formation of micellar species and the formation of a microheterogeneous liquid structure, governed by fluctuations in the local concentration. Ultrasonic attenuation spectra of isobutoxyethanol-water mixtures have been measured between 100 kHz and 2 GHz at 25 degrees C and at several concentrations, covering the complete composition range. With the mixture of critical composition measurements have been performed at some temperatures near the critical temperature (T(c)=299.51 K). In addition to the asymptotic high frequency background contribution, the broadband spectra reveal a Bhattacharjee-Ferrell relaxation term due to critical concentration fluctuations, a restricted Hill term reflecting the monomer exchange between micelles and the suspending phase, and two Debye-type relaxation terms that are assigned to chemical relaxations. The relaxation rates of the Bhattacharjee-Ferrell term exceed those from static and dynamic light scattering (amplitude Gamma(0)=5.3 x 10(9) s(-1)), likely due to the effect of a second parallel pathway of relaxation in the ultrasonic field. The adiabatic coupling constant following from the amplitude in the ultrasonic spectrum agrees with that from a thermodynamic relation (g=1.3). The restricted Hill term displays the features of an extended Teubner-Kahlweit-Aniansson-Wall model of the micelle formation and decay kinetics in surfactant solutions with high critical micelle concentration (C=0.6 mol/l). The idea of a fluctuation controlled monomer exchange in aqueous solutions of poly(ethylene glycol) monoalkyl ether-water mixtures near the critical point is briefly discussed.

Microbial production of 1,3-propanediol

1,3-Propanediol (1,3-PD) production by fermentation of glycerol was described in 1881 but little attention was paid to this microbial route for over a century. Glycerol conversion to 1,3-PD can be carried out by Clostridia as well as Enterobacteriaceae. The main intermediate of the oxidative pathway is pyruvate, the further utilization of which produces CO2, H2, acetate, butyrate, ethanol, butanol and 2,3-butanediol. In addition, lactate and succinate are generated. The yield of 1,3-PD per glycerol is determined by the availability of NADH2, which is mainly affected by the product distribution (of the oxidative pathway) and depends first of all on the microorganism used but also on the process conditions (type of fermentation, substrate excess, various inhibitions). In the past decade, research to produce 1,3-PD microbially was considerably expanded as the diol can be used for various polycondensates. In particular, polyesters with useful properties can be manufactured. A prerequisite for making a "green" polyester is a most cost-effective production of 1,3-PD, which, in practical terms, can only be achieved by using an alternative substrate, such as glucose instead of glycerol. Therefore, great efforts are now being made to combine the pathway from glucose to glycerol successfully with the bacterial route from glycerol to 1,3-PD. Thus, 1,3-PD may become the first bulk chemical produced by a genetically engineered microorganism.

Kinetic, dynamic, and pathway studies of glycerol metabolism by Klebsiella pneumoniae in anaerobic continuous culture: IV. Enzymes and fluxes of pyruvate metabolism

The activities of pyruvate kinase (PK), pyruvate: formate-lyase (PFL), pyruvate dehydrogenase (PDH), and citrate synthase (CS) involved in the anaerobic glycerol conversion by Klebsiella pneumoniae were studied in continuous culture under conditions of steady states and sustained oscillations. Both the in vitro and in vivo activities of PK, PFL, and PDH are strongly affected by the substrate concentration and its uptake rate, as is the in vitro activity of CS. The flux from phosphoenolpyruvate to pyruvate is found to be mainly regulated on a genetic level by the synthesis rate of PK, particularly at low substrate concentration and low growth rate. In contrast, the conversion of pyruvate to acetyl-CoA is mainly regulated on a metabolic level by the in vivo activities of PFL and PDH. The ratio of in vitro to in vivo activities is in the range of 1 to 1.5 for PK, 5 to 17 for PFL and 5 to 80 for PDH under the experimental conditions. The regulation of in vivo activity and synthesis of these enzymes is sensitive to fluctuations of culture conditions, leading to oscillations of both the in vitro and in vivo activities. In particular, PFL is strongly affected during oscillations; its average in vitro activity is only about half of its corresponding steady-state value under similar environmental conditions. The average in vitro activities of PDH and PK under oscillations are close to their corresponding steady-state values. In contrast to all other enzymes measured for the glycerol metabolism by K. pneumoniae PFL and PDH are more effectively in vivo utilized under oscillations than under steady state, underlining the peculiar role of pyruvate metabolism in the dynamic responses of the culture.

Kinetic, dynamic, and pathway studies of glycerol metabolism by Klebsiella pneumoniae in anaerobic continuous culture: III. Enzymes and fluxes of glycerol dissimilation and 1,3-propanediol formation

The initial steps of glycerol dissimilation and 1,3-propanediol (1, 3-PD) formation by Klebsiella pneumoniae anaerobically grown on glycerol were studied by quantifying the in vitro and in vivo activities of enzymes in continuous culture under conditions of steady state and oscillation and during transient phases. The enzymes studied included glycerol dehydrogenase (GDH), glycerol dehydratase (GDHt), and 1,3-propanediol oxidoreductase (PDOR). Three conclusions can be drawn from the steady-state results. First, glycerol concentration in the culture is a key parameter that inversely affects the in vitro activities (concentrations) of all three enzymes, but has a positive effect on their in vivo activities. Growth rate significantly affects the ratio of in vitro and in vivo enzyme activities under low glycerol concentrations, but not under glycerol excess. Second, whereas the flux through the oxidative pathway of glycerol dissimilation is governed mainly by the regulation of in vivo enzyme activity on a metabolic level, the flux through the reductive pathway is largely controlled by the synthesis of enzymes. Third, GDHt is a major rate-liming enzyme for the consumption of glycerol and the formation of 1,3-PD in K. pneumoniae at high glycerol concentrations. Results from oscillating cultures revealed that both in vitro and in vivo activities of the enzymes oscillated. The average values of the in vitro activities during an oscillation cycle agreed well with their corresponding values for nonoscillating cultures under similar environmental conditions. Experiments with step changes in the feed concentration of glycerol demonstrated that growth and product formation are very sensitive to changes of substrate concentration in the culture. This sensitivity is due to the dynamic responses of the genetic and metabolic networks. They should be considered when modeling the dynamics of the culture and attempting to improve the formation of 1,3-PD.

Fermentation of glycerol to 1,3-propanediol and 2,3-butanediol by Klebsiella pneumoniae

Klebsiella pneumoniae was shown to convert glycerol to 1,3-propanediol, 2,3-butanediol and ethanol under conditions of uncontrolled pH. Formation of 2,3-butanediol starts with some hours' delay and is accompanied by a reuse of the acetate that was formed in the first period. The fermentation was demonstrated in the type strain of K. pneumoniae, but growth was better with the more acid-tolerant strain GT1, which was isolated from nature. In continuous cultures in which the pH was lowered stepwise from 7.3 to 5.4, 2,3-butanediol formation started at pH 6.6 and reached a maximum yield at pH 5.5, whereas formation of acetate and ethanol declined in this p range 2,3-Butanediol and acetoin were also found among the products in chemostat cultures grown at pH 7 under conditions of glycerol excess but only with low yields. At any of the pH values tested, excess glycerol in the culture enhanced the butanediol yield. Both effects are seen as a consequence of product inhibition, the undissociated acid being a stronger trigger than the less toxic diols and acid anions. The possibilities for using the fermentation type described to produce 1,3-propanediol and 2,3-butanediol almost without by-products are discussed.

Enzymatic evidence for an involvement of pyruvate dehydrogenase in the anaerobic glycerol metabolism of Klebsiella pneumoniae

Stoichiometric analysis of pathways involved in anaerobic bioconversion of glycerol by Klebsiella pneumoniae revealed that enzyme(s) in addition to pyruvate formate-lyase (PFL) must be involved in pyruvate decarboxylation. In this work, enzymatic evidence is presented that confirmed a simultaneous involvement of pyruvate dehydrogenase complex (PDH) and excluded the presence of pyruvate:ferredoxin oxidoreductase in this anaerobic bioprocess. The in vitro PDH activity of cell extract from continuous culture was found to be strongly affected by the substrate (glycerol) concentration in medium and cell growth rate (dilution rate). It increases with increasing glycerol concentration and correlates well with the specific substrate uptake rate at different dilution rates in a kind of saturation function. At a similar substrate uptake rate, it decreases with cell growth rate. The in vitro activity of PDH is much higher than its in vivo activity calculated from the pathway stoichiometry but comparable to the calculated in vivo activity of PFL.

[Current problems in pediatric intensive care from the pathophysiologic viewpoint. I. Changes in body composition and fluid compartments in relation to age]

A sufficient intensive therapy for children requires an age related knowledge of the bodies composition and the connection between each individual part. A summary of the questions of body composition in relation to age and internal comparison size, especially in connection with the bodies surface will be given.

[Studies on manifestations of Rh-related hemolytic disease of the newborn in the years 1974-1989 in the Erfurt district]

In the course of 13 years (1977-1989) 223 of 223,121 liveborn infants in the district of Erfurt suffered from haemolytic disease due to Rh-isoimmunization, 0.1 per cent died. An initial drop of morbidity from 1.6 to 0.6 of 1000 newborns was followed by stagnation and further increase during the last years. More than 50% of the affected babies were delivered by women who had to be protected from sensibilization by immune prophylaxis. The cause for the immunization were deliveries (75%), miscarriages and interruptions (23%). The most important reason for the insufficient decrease of the Rh-morbidity is the failure of immune prophylaxis in the case of ABO-incongruence between mother and child. Our results support the demands for a general immune prophylaxis without taking into consideration the main blood groups and the number and result of the pregnancy. The quantity of severe erythroblastosis (7 stillborn and 5 hydropic liveborn) demonstrates the necessity to improve the prenatal management of these babies.

High cell density fermentation of recombinant Escherichia coli expressing human interferon alpha 1

A defined medium was developed which, by means of a specific fed-batch mode, allows growth of the recombinant Escherichia coli strain TG1 (pBB210) up to a cell density of 60 g dry weight/l. Apart from glucose and aqueous ammonia fed as carbon and nitrogen sources, it was necessary to supply other nutrients or O2-enriched air. Aqueous ammonia also served for pH control. The pO2 level was kept at 20% saturation via closed-loop controls operating the two output variables of stirrer speed and glucose feeding rate. This fed-batch method prevented significant accumulation of acetate and other metabolic by-products. The recombinant E. coli expressed interferon alpha 1 more efficiently at a lower specific growth rate (muPr approximately 0.15 h-1) than at the maximum specific growth rate (mu max = 0.45 h-1). Therefore, fermentation in the batch phase at mu max was only allowed to continue up to a medium cell density. In the succeeding fed-batch phase, the specific growth rate was reduced to muPr by increasing the stirrer speed according to an empirically developed time scale.

[Hygiene regimen in neonatology]

Prophylaxis of contamination, disinfection, sterilization of needed materials and sterile handling are essential suppositions for a successful struggle against hospital infections during the neonatal period. Proposals are presented to the hygienic management at delivery stations, delivery-rooms and neonatal intensive care units.

[Clinical aspects, diagnosis and therapy of nesidioblastosis]

Hyperinsulinemia due to an excessive secretion of insulin independent on normal regulation is the most frequent cause of persistent neonatal hypoglycemia. We report on clinical course, diagnostic procedures and treatment of nesidioblastosis in three patients. Main symptoms observed in newborn period were hypoglycemia, respiratory embarrassment, cyanosis and convulsions. Primary treatment was started by continuous infusion of glucose, administration of diazoxide and prednisolone or glucagon. Most important investigations were performed simultaneously. In all three children subtotal resection of pancreas was necessary, because there was no constant blood glucose level. Histological specimens confirmed diagnosis. In two of three patients pancreatectomy followed. One suffers from diabetes mellitus, the other one fed normally, has stable blood glucose level possibly due to existence of extrapancreatic insulin producing cells.

[Immunologic findings in the newborn infant. II. Studies of humoral immunity, reference values of immunologic studies in the newborn infant]

After dealing with cellular immune aspects in the first part of the paper the authors describe in the second part the state of humoral immunity in healthy full-term newborns aged one to three days. The number of complementreceptor lymphocytes was 17.0 +/- 8.9% or 0.75 +/- 0.51 (mean +/- S.D.) respectively, with the EAC-rosette method. The percentage value equalled that of adults but the absolute count is higher. Using the immunodiffusion method IgA was detectable in 4 out of 132 newborns only 8.86 +/- 2.52 g/l (mean +/- S.D.) was measured as an average IgG concentration. With regard to the IgM content the values often exceeded 0.30 g/l in newborns of mothers who had been suffering from pre-eclampsia. Their mean value of 0.35 +/- 0.21 g/l, too, was significantly higher than 0.13 +/- 0.08 in the resting infants. Raised IgM values frequently coincided with high spontaneous transformation activities in lymphocyte cultures. The possible causes are discussed. Complement C3-component was measured on average with 0.78 +/- 0.18 g/l and C4-component with 0.34 +/- 0.11 g/l. When calculating reference values for newborns the results of infants with maternal pre-eclampsia have been omitted.

[Immunologic findings in the newborn infant. I. Studies of cellular immunity]

Based on investigations of 133 healthy full-term newborns in the first 3 days of life parameters of cellular immunity are described. The lymphocyte count of 28.5 +/- 10.9% (mean +/- S.D.) or 4.45 +/- 1.99 Gpt/l respectively coincides with literature values. Estimation of T-lymphocytes (E-rosette method) yields a percentage of 67.5 +/- 10%, which is not different from adults, whereas the absolute number 2.99 +/- 1.42 Gpt/l is markedly higher. Measuring phytohemagglutinin induced lymphocyte transformation one often finds a high spontaneous activity in unstimulated controls. The transformation rate, then, is low. 14 of 129 samples had unstimulated control activities higher than with phytohemagglutinin so that stimulation indices could not be calculated. Fairly good lymphocyte transformation was found in more than a half of all newborns. There is no correlation between the absolute value of stimulation index and the phytohemagglutinin-concentration.

[Sonography in the diagnosis of Hodgkin's disease in childhood and adolescence]

We are reporting about the results of the staging by ultrasound in 11 children with Hodgkin's disease. Sonography stands the test as a method that reliably predicts abdominal involvement in patients with Hodgkin lymphoma. Only in a few cases an indication for an additional computerized tomography is given. A demonstration of typical ultrasonic findings takes place.

[Prospective aspects of pediatric care and pediatric research in East Germany in the coming years]

Based on common characteristics and differences in the concept of paediatrics in the Cssr and GDR the author tries to outline tasks of the discipline for the development of child care and research up to the year 2000.

[Comparison of O2-exposed premature infants with and without vitamin E substitution from the ophthalmologic viewpoint]

The present paper deals with the efficiency of vitamin E in the prevention of progress of ROP. 80 premature infants with oxygen therapy and vitamin E all from the year 1986 are compared with 80 premature infants with oxygen therapy without vitamin E from the years 1984 and 1985. The group with protection by vitamin E shows a smaller rate of the higher stages of ROP. The stages II-V could be prevented in the studied group. The two groups of infants are too inhomogenous for an exact statistical analysis because some other factors are meaningful.

[Differential acetonemic vomiting diagnosis--recurrent Addison crises as an early sign of adrenoleukodystrophy]

After 5 years of cyclic vomiting an 8 year old boy was presented with coma and hyponatremia. ACTH and renin plasma concentrations were elevated, cortisol concentrations did not rise after ACTH-stimulation. Behavioural abnormalities including secondary enuresis and dysarthria drew attention to the possibility of an association of adrenal insufficiency with leucodystrophy. NMR tomography of the brain showed symmetrical demyelinated areas in the parieto-occipital regions. Very long chain fatty acids were elevated. The mother showed discrete neurological symptoms and elevated long chain fatty acids. Cyclic vomiting might suggest adrenoleukodystrophy.