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Transposition of intestinal segments into the urinary tract predisposes to urinary tract infections. We characterized bacterial infections in these patients and examined the virulence genotype and persistence of Escherichia coli isolates.

Zusammenfassung: Von den chronischen Virushepatitiden in Deutschland sind 60–70% durch das Hepatitis-C-Virus (HCV) bedingt. Das Virus kommt auf “leisen Sohlen”, d. h. die frische Infektion führt nur in 40% der Fälle zu einer Erhöhung der Transaminasen und in 20% zu einer Erhöhung des Bilirubins. Aber ca. 90% der Infektionen nehmen einen chronischen Verlauf, und in 20% kommt es bereits nach 20 Jahren zur Zirrhose. Die HCV-Durchseuchung ist bei Medizinalpersonen nicht signifikant höher als bei der Normalbevölkerung. Die Übertragung des HCV von Patienten auf medizinisches Personal, z. B. durch Nadelstichverletzungen, ist sehr selten; das Infektionsrisiko liegt unter 1%. Noch viel seltener ist die Übertragung des HCV in umgekehrter Richtung von medizinischen Mitarbeitern auf Patienten. Eine aktive oder passive Immunprophylaxe ist nicht möglich. Eine Schutzimpfung ist derzeit nicht in Sicht. Es hat in jüngerer Vergangenheit Fortschritte bei der Chemotherapie der Hepatitis C gegeben. Der derzeitige Therapiestandard ist pegyliertes Interferon-a in Kombination mit Ribavirin. Die Erfolgschance ist bei den HCV-Genotypen 2 und 3 mit ca. 70–80% deutlich höher als bei den Genotypen 1 und 4 mit ca. 40%. Beide Substanzen haben signifikante Nebenwirkungen, aber bessere Medikamente lassen noch auf sich warten.

Toxin-specific genes are often located on mobile genetic elements such as phages, plasmids and pathogenicity islands (PAIs). The uropathogenic E. colistrain 536 carries two α-hemolysin gene clusters, which are part of the pathogenicity islands I536and II536, respectively. Using different genetic techniques, two additional PAIs were identified in the genome of the E. colistrain 536, and it is likely that further PAIs are located on the genome of this strain. Pathogenicity islands are often associated with tRNA genes. In the case of the E. colistrain 536, the PAI-associated tRNA gene leuX, which encodes a minor leucyl-tRNA, affects the expression of various virulence traits including α-hemolysin production. The exact mode of action of the tRNA5Leu-dependent gene expression has to be identified in the future.

Summary A significant decrease of heparin-inducible LPL was observed in rabbits during the 24-hour post-traumatic phase following experimental fracture of the femur. Simultaneously the increase of serum glycerides was higher than in control animals.

Summary The antithrombin III (AT III) activity and the AT III concentration were investigated in 62 consecutive patients with acute myocardial infarction (AMI). To identify the reactant pattern of AT III in postaggressive situations, we also determined labile and acute phase proteins. Firstly, 29 patients were nourished orally and then 33 patients were fed by i.v. hyperalimentation (additional caloric intake of approximately 1,000 cal). AT III activities and concentrations as well as prealbumin and retinol-binding protein decreased concomittantly and significantly whereas haptoglobin, C-reactive protein and fibrinogen increased significantly after AMI. The changes cannot be interpreted as being alterations of the haematocrit. The alterations of AT III correlated significantly with the changes of labile proteins but not with the acute phase reactant proteins. The AT III decrease in the postinfarctional phase may promote a prethrombotic state. In addition it can be concluded from our results that AT III reacts as (nutritive-dependent) labile protein, which is lowered in postaggressive situation and does not increase as an acute phase reactant. This is in accordance with results from recent animal experiments.

Summary Chlamydia trachomatis was isolated from ten of 188 biopsies (5.3%) obtained from different parts of the lower digestive tract. Patients (mean age 37.0 years) presented with ulcerative proctitis, Crohn's disease, mild colitis or ulcerative colitis. Seven rectal biopsies, two biopsies from the sigmoid flexure and one caecal biopsy were positive for chlamydial isolation whereas all biopsies taken from the colon ascendens, transversum or descendens and from the terminal ileum were negative. We conclude that isolation ofC. trachomatis is most effective from rectal and sigmoidal biopsies and is a rare event from other sites of the lower digestive tract.

Summary Heparin is indicated in pulmonary embolism suspicion, in minor and a part of submassive embolism. The dose is 15,000–20,000 U (acute) and 40,000 U/day subsequently. Fibrinolytic therapy with streptokinase or urokinase is indicated in massive embolism. Submassive embolism is treated by fibrinolysis if no contraindications against fibrinolysis are to be registered.

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Summary Alterations of blood lipids were investigated in 11 cases of pancreatitis. In 6 of these hyperlipoproteinaemia was present, which was classified as type V in four, and as type IV in two patients on account of the pattern of lipoprotein electrophoresis. Plasma lipoprotein lipase activity was reduced in 9 patients, the average being 152 mU/ml plasma as compared to 335 mU/ml plasma in 10 healthy individuals.