From 1953 through 1955 a total of 2364 individuals between o and 18 years were discharged from the Stockholm Child Guidance Clinics. Among these patients 125 (68 boys, 57 girls) were under the age of 3 years. A follow-up study was conducted 30 years later on this sample using records from psychiatric clinics and data from official registers of problematic behaviours. The majority of the infants when seen at the Child Guidance Clinics were judged to be mentally healthy or to have shown mild environmental reactions. However sixty per cent of these patients were identified in at least one of the registers during the follow-up period. Thus the initial evaluation was not prognostic of the future development. Boys developed mainly social maladjustment, whereas girls more often applied for psychiatric care during the follow-up. Significant prognostic factors in the 1950s were gender and parental psychiatric diagnosis.
To achieve the best possible late results in valve treatment we think the following procedure would be mandatory: 1. Immediate transfer to a specialised hospital. 2. Acute diagnostics with correction of the water and electrolytes balance. 3. Suprapubic procedure is preferable over the transurethral approach if the catheter is expected to remain indwelling for a length of time. 4. The obstructing urethral valve is the primary object. 5. Resection is done only in 12 o'clock position in dorsosacral (lithotomy) position. 6. In rare cases with a severely constricted neck of the bladder it may be necessary to perform resection after Turner-Warwick. 7. In most cases it is possible to avoid surgical intervention at the upper urinary tract. 8. Regular follow-up checks are urgently recommended (sonography, x-ray, endoscopy, urodynamics).
Between 1888 and 1892, Mikulicz as well as Fuchs observed each a case of oculo-salivary glandular syndrome. Ten years later, Heerfordt described uveitis complicated by swelling of the lacrimal and salivary glands. Within 100 years, the interpretation of this disease changed repeatedly and considerably: infection of particularly exposed organs--non-avirulent tuberculosis--salivotropic virus--Boeck's disease--allergic-hyperergic reaction--diencephalic and nervous dystrophy with segmental projection--(auto)immune disease--oculo-salivary complex including Sjøgren's syndrome--all these were discussed as possible aetiologies. Short biographies of Johannes von Mikulicz-Radecki, surgeon at Austrian and Prussian universities; Ernst Fuchs, ophthalmologist of Vienna; Christian Frederik Heerfordt, a Danish ophthalmologist particularly fond of publicity.
The phenomenon of patient homicides committed by health service employees has, in the previous years, repeatedly aroused much attention. The cases made known in Germany, the USA, Holland, Norway, and Austria appear to provide evidence to the effect that we are not only dealing with unique incidents. The scientific investigation of this especially sensitive taboo-topic is, to date, missing. The judicial trials carried out emphatically indicate that culprit motives, colleague behavior, but also to a large extent decisions made by superiors remain unclear. It remains controversial, what effect working conditions, strain of employees, their level of education and personal viewpoints over such criminal acts they possess. Finally, the long latency period between the first internal suspicions and the responsible parties' appropriate reactions requires duplicatable explanation. The following paper presents a German single-case study of patient homicide by a female nurse. The focus on causality rests on the presentation of developments up to the point where the long-fermenting suspicion could no longer be dismissed, and appropriate consequences took place. The account largely avoids the "definite" findings required during the judicial process. It concerns rather above all an open, uncertain, and possibly without external influence course of development which in stages each colleague in the health professions can trace, to the point where the uncertain and horrifying suspicion became a certainty. With this single-case study in hand it is made understandable in which ways personal circumstances and professional conditions at the worksituation can intertwine in such a way that the original motivation to help turns into its abysmal opposite. It is the author's intention to make preventive learning possible through this single case study. Every employee in the health professions should proceed on the assumption that such occurrences could also in his own field of work come to pass. In this respect, it is of considerable importance to differentiate between hasty and untenable incriminations and original increasing early-warning signs.
All 291 fatal accidents (510 persons on board, 318 drowned) in water traffic in Finland in 1986-1988 were investigated by specific teams. Only some data of this extensive investigation are presented in this study. Staggering and falling in boat because of drunkenness, falling over and sinking of boat were the main causes of getting into water of the people aboard. Only 3.5% of the drowned had used life jackets and 9.7% of them could not swim. The reduced ability to swim because of alcohol and the exhaustion were in about half of the drowned the actual cause and the cold water in one third the background factor for drowning. The results indicate that fatal accidents in water traffic are a major problem of males (95.9%) and give important information for countermeasures.
Acellular pertussis vaccines contain antigen components of B. pertussis, usually lymphocytosis promoting factor (LPF) which is also called pertussis-toxin (PT) or pertussigen, filamentous hemagglutinin (FH) and, eventually, agglutinogens 2 and 3. Acellular vaccines are being used in Japan since 1981. Several Phase II studies have been performed and showed a better tolerability than whole cell vaccines and antibody responses of at least equal magnitude. In some of these studies good protection rates were observed. The latter were not satisfactory in a Phase III study in Sweden. This study, however, might cause some criticism in as much as only 2 vaccine doses were given and a control group with whole cell vaccine was missing. Moreover, the significance of bacterial infections in vaccinated children is doubtful, similar observations have not been made in other trials nor in Japan since introduction of the vaccine in 1981. Preliminary results of our own study with a newly developed acellular vaccine which has been permitted by the Austrian Drug Commission have shown good tolerability.