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Acquired hemophilia is a rare but severe bleeding disorder caused by autoantibodies mostly against factor VIII. Clinically it mostly presents with soft tissue and muscular bleeding. Diagnostics include a prolonged aPTT, antibodies against FVIII and a reduced FVIII titre. Acute bleeding is controlled with recombinant factor VIIa (NovoSeven(®)) or activated prothrombin complex (FEIBA(®)), as both bypass FVIII in the coagulation pathway. Treatment to reduce the inhibitor consists of immunosuppression with corticosteroids, cyclophosphamid and can be extended with rituximab.

Chlamydia pneumoniae is a common cause of acute infections within the upper respiratory tract. It is less well known that chlamydia pneumoniae, just like chlamydia trachomatis, may also trigger reactive arthritis. We describe three patients with arthritis possibly triggered by chlamydia pneumoniae. The patients showed the typical symptoms of reactive arthritis like asymmetric oligo- or polyarthritis, dactylitis, enthesiopathies and tendovaginitis. The course of the disease was quite different. The first patient developed persistent polyarthritis which required longterm treatment with a rheumatic disease modifying drug; the second patient improved after several weeks and the third patient experienced a full remission within a few days.

Nutritional recommendations for diabetics are nowadays more flexible and better adapted to the individual patient. They resemble those offered to the public at large. Caloric intake is determined by body size and weight as well as physical activity. Approximately 60% of the energy should be consumed in the form of carbohydrates and monounsaturated fatty acids. The proportion of fatty acids and carbohydrates is fixed according to the individual nutritional habits. The intake of saturated and polyunsaturated fatty acids should be restricted. Meals and carbohydrates should be distributed over the day as three main meals with two to three snacks in between. Recommendations should always be adapted to the practical possibilities of the individual and to his particular metabolic situation.

In this article recommendations for dyslipidemias are illustrated by practical dietary recommendations for an individual patient with combined hyperlipidemia. Recommendations in hypercholesterolemia above all consist in the replacement of saturated by unsaturated forty acids thus reducing automatically cholesterol, too. In hypertriglyceridemias reduction of body weight should often be combined with quantitative control of alcohol and simple carbohydrates. A list of foods to be chosen or to be avoided is provided.