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The goal of this study was to examine the effectiveness of endoscopic retrograde choledocho-pancreatography (ERCP) at the Unfallkrankenhaus Berlin in the setting of pre-operative suspicion of choledocholithiasis. The predictive value of various pathologic findings with regard to choledocholithiasis was to be determined in this patient population.All patients treated operatively for symptomatic cholecystolithiasis between August 2000 and August 2001 were evaluated retrospectively for the following variables: age, gender, operative strategy, intra-operative cholangiography, sonographic findings, occurrence of choledocholithiasis. In 21.4 % of 196 patients who underwent cholecystectomy (n = 42) a pre-operative ERCP was performed. In 19 of these 42 patients, no pathology was found on ERCP. The percentage of therapeutic pre-operative investigations was 47.6 % (n = 20). In 3 patients, a juxtapapillary diverticulum was seen.69.9 % of the operations (n = 137) were performed laparoscopically. 167 patients (85.2 %) underwent intra-operative cholangiography. In 4 patients, the ERCP was performed post-operatively. The indication for 3 of those 4 examinations was an abnormal intra-operative cholangiogram. Complications occurred in 4 of the 46 patients who underwent ERCP (8.7 %). Choledocholithiasis was found in 12.2 % (n = 24) of all 196 patients. The pathologic finding with the highest positive predictive value for the diagnosis of choledocholithiasis was the finding of a dilated common bile duct to more than 8 mm diameter (PPV 75 %). Among laboratory variables investigated in this study, the elevation of serum bilirubin level exhibited the highest positive predictive value (PPV 39.2 %).

A 38-year-old white female with primary hypertrophic pyloric stenosis is presented. The patient was admitted to our service with a history of upper digestive tract pain and postprandial vomiting since her 17th year of life. Diagnosis of benign pyloric stenosis was made preoperatively and the patient was successfully treated by Finney pyloroplasty. Primary hypertrophic pyloric stenosis in adults is a rare condition of unknown etiology. Only about 200 cases of primary hypertrophic pyloric stenosis in adults have been reported in the literature.

Tolerance and adaptation to heavy metals of Desulfovibrio- and Desulfotomaculum-strains of different origin have been investigated in enrichment cultures under different conditions of sulphate supply. Three groups of low, medium, and high toxicity were found with As, V, and Mo in the first, Ni, Sb, Co, and Hg in the second, and Cd, Zn, U, and Cu in the third group. If the SO"4-supply was restricted to heavy metal sulphates with a relation of 1:1 of heavy metal- and SO"4 -ions (2:3 with Sb2(SO4)3) the tolerance was somewhat lowered. Adaptation to higher concentrations of heavy metals was possible, if the strains had not yet been exposed and adapted to higher concentration levels at their natural habitats. The tolerance range of desulfurizers has been compared with the tolerance range of different biochemical types of microorganisms.

Besides leaching of sulfide ores with thiobacilli, a second way of microbial leaching is tested with carbon-heterotrophic fungi and bacteria for those types of ores, where thiobacilli fail to work. The active agents are metabolic products, f. i. organic acids, which are released into the medium producing water soluble compounds with heavy metals. A screening method is described for recognizing active strains in samples of soil, metal-containing sites, mining heaps and other biocoenoses, using the dilution method in plates with different media. The critical signs of supposed leaching activity are halo formations around growing colonies in turbid agar media with suspended particles of Ca carbonate or Ca phosphates of low solubility, and in a second group of experiments with insoluble compounds of heavy metals, f. i. oxides. The leaching activity was tested with metal compounds suspended in liquid media and inoculated with active strains of the screening program. First results were reached with oxides of copper (CuO), uranium (U3O8) and an uranium-containing phosphorite.