Fragenbogen (englische Version)

      Fragenbogen (englische Version)

      QUESTIONNAIRE FOR THE PHHI DATA BASE (english Version)
      -> please copy this content into a mail and send it to Irene by mail or via PN

      Parents' names:

      Child's name:

      Home (state or town, country):

      Date of birth (year, month, day):

      Birth Weight:

      Gestation length (weeks):

      Agpar:

      Age first symptoms:

      Age when diagnosed & method of diagnosis:

      Pancreatectomy:

      % pancreatectomy:

      Age at each pancreatectomy:

      Histopathological results (pancreatic tissue analysis: focal, diffuse):

      Preoperative exams (Portal venous sampling, Calcium test, Petscan):

      Complications from prolonged hypoglycemia:

      Medication (type, dose, method of administration):

      Other medications that failed:

      Age treatment stopped (if that is the case):

      Tube feeding:

      Feeding problems:

      Special diet:

      Genetic testing (results if performed):

      Ethnicity or racial origin (Caucasian, Latino, African, African-American, Jewish (Ashkenazi), Asian, Native):

      Siblings:

      Acute insulin response to glucose, amino acids, calcium or sulfonylureas?:

      Has a fasting test been performed (if so results):

      Did you have a glucose tolerance test during pregnancy? If so, what were the results at 1 hour, 2 hours, and 3 hours?:

      Other remarks (type of PHHI, other pathologies):

      Contact (Email, address or phone number if you want people to be able to contact you directly):

      Drs name and hospital: