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Die arthroskopische partielle Meniskektomie ist eine der am häufigsten indizierten und durchgeführten Eingriffe des Kniegelenks. Bei subjektiv zufriedenstellenden Ergebnissen und niedriger Komplikationsrate wurden Indikation und Therapie lange als unkritisch angesehen. Neuere prospektiv randomisierte Studien stellen jedoch die Wirksamkeit und damit die Sinnhaftigkeit infrage. Der vorliegende Beitrag bietet eine Analyse der Studienlage unter besonderer Berücksichtigung der Relevanz in Hinblick auf Indikationsstellung zur partiellen Meniskektomie im klinischen Alltag.

Background Helicobacter pylori infection is predominantly acquired in early childhood. Therefore, childhood nutrition may be related to acquisition of infection. However, there are few current data from developed countries to elucidate this association. We investigated the relation between history of breastfeeding and H. pylori infection in a large population-based sample.
Methods Study subjects were all pre-school children in the city of Ulm, located in southern Germany and two nearby communities who were screened for school fitness between January and July 1997. The infection status of the children and of the accompanying mother was determined by the ¹³C-urea breath test. The parents provided additional information through a standardized questionnaire.
Results In all, 946 children (mean age 5.9 years) and their mothers were included in the final analysis (response in study population 80.2%). Overall, H. pylori prevalence was 9.8% in children and 34.7% in their mothers; there was a strong association between children's and mother's infection. Of the children, 82.5% had ever been breastfed. Prevalence of H. pylori infection was higher in children breastfed compared to never breastfed children (10.1% versus 8.4%) and showed a positive relationship with duration of breastfeeding. After controlling for covariates, including mother's H. pylori status, by means of multivariable analysis, the odds ratio (OR) for children's H. pylori infection was 1.56 (95% CI: 0.79-3.11) for any versus never breastfeeding and 2.57 (95% CI: 1.19-5.55) given the child was breastfed ≥6 months.
Conclusions These data suggest that breastfeeding in infancy does not protect against H. pylori infection among pre-school children in industrialized countries.

This work examines the reaction kinetics of the synthesis of 1‐phenoxyoctane from 1‐bromooctane and sodium phenoxide in microemulsions with excess phases. It can be shown that an interfacial reaction model proposed in a previous paper which describes the kinetics of the same reaction in a single‐phased microemulsion can also be applied to two‐phase systems.

AimTo establish a competitive PCR (cPCR) assay for quantitation of H pylori organisms in dental plaque samples.MethodsThe cPCR coamplified target H pylori DNA and a known amount of internal standard template in the same tube with the same primers directed to 0.86 kb DNA of H pylori. The internal standard was a synthesised DNA bearing the same primer recognition sites at two ends and a non-homologous core sequence as the target DNA fragment. Quantitation was based on determination of the relative, not absolute, amounts of the differently sized and [³²P]-dCTP labelled products derived from H pylori DNA and the competitive internal standard after gel electrophoresis separation.ResultsA significant correlation between known amounts of H pylori added to dental plaque samples and the results of the cPCR was found, and a standard line was developed which allowed quantitation of H pylori in the plaque samples. cPCR was performed on supragingival plaque samples from 10 adult patients with H pylori infection in the stomach, and from five adults and six children without H pylori infection in the stomach. The ranges of H pylori numbers were 1-213 (median 25), 6-76 (10), and 4-94 (14) cells/mg of dental plaque in the three groups, respectively.ConclusionscPCR is useful for quantitation of H pylori in supragingival dental plaque samples; however, the number of the organisms in dental plaque samples seems very low.

Background & Aims: A positive family history is associated with an increased risk of stomach cancer. We compared the prevalence of Helicobacter pylori infection, a known risk factor for stomach cancer, between subjects with and without parental history of stomach cancer to evaluate a potential role of H. pylori infection in familial aggregation of stomach cancer. Methods: A total of 1351 men and women aged 30-74 years who participated in the German Health and Nutrition Survey conducted in the western part of Germany in 1987-1988 were included in the study. Detailed information on sociodemographic factors, nutritional factors, and parental history of cancer was obtained by standardized interviews. Serum samples were analyzed for immunoglobulin G antibodies against H. pylori by enzyme-linked immunosorbent assay. Results: The prevalence of H. pylori infection was much higher (69%) among subjects with a parental history of stomach cancer than among other subjects (44%). This association persisted after control for potential confounders by multiple logistic regression (adjusted odds ratio, 2.7;95% confidence interval, 1.3-5.9), and was particularly strong among subjects below age 55 (adjusted odds ratio, 5.1;95% confidence interval, 1.6-16.1). Conclusions: These results suggest that familial aggregation of stomach cancer may be explained at least partly by familial clustering of H. pylori infection. GASTROENTEROLOGY 2000;118:31-35

The mode of spread of Helicobacter pylori infection is subject to ongoing debate. Recent studies among patients with gastrointestinal disorders suggest a potential role of conjugal transmission. In this study, the clustering of H. pylori infection was assessed among 110 employees of a health insurance company and their partners. Active infection with H. pylori was measured by the 13C-urea breath test. Information on potential confounders was collected by a standardized questionnaire. Overall, 16 employees (14·5%) and 24 partners (21·8%) were infected. While only 7% (6/86) of employees with an uninfected partner were infected, this applied to 42% (10/24) of employees with an infected partner. A very strong relation between partners' infection status persisted after control for age and other potential confounders (adjusted odds ratio, 7·0; 95% confidence interval, 1·8–26·7). Furthermore, the risk of infection increased with the number of years lived with an infected partner. These results support the hypothesis of a major role of spouse-to-spouse transmission of H. pylori infection.

Summary To evaluate and further characterize duodenal ulcer healing macroscopical, histological, and ultrastructural criteria were examined in 24 patients with active duodenal ulcer disease under two different treatment schedules. After the endoscopic confirmation of an active duodenal ulcer patients were randomly assigned to treatment with either an antacid (group A) or with an H2 blocker (group B). Tissue specimen were taken during endoscopy from the margin and 1 cm from the ulcer before therapy and from the ulcer scar or the previous ulcerated region after a 4 week treatment. A macroscopic ulcer healing by endoscopic criteria was confirmed in 83% of the patients in group A and in 83% of group B. The prominent histological feature of duodenal ulcer healing was a significant increase of PAS positive epithelial cells. Ultrastructural changes of the duodenal mucosa were still present at the end of the treatment, even in the presence of complete macroscopic healing. The ultrastructural healing process shows constant patterns independent from the type of treatment. The characteristic morphological feature by electron microscopy of the healing duodenal ulcer is the appearance of a metaplastic mucus secreting cell of the antrum-type. The devastated mucous structure during the ulcerative phase regains the normal net-like structure after 4 weeks therapy.

The purpose of this paper is to define the criteria for the differential diagnosis of trauma following resuscitation and road accidents. To this end, 311 cases of thoracic and epigastric trauma were selected from the 2893 medico-legal autopsies carried out between 1979 and 1982 at the Institute of Forensic Medicine of the University of Heidelberg. Cardiopulmonary resuscitation had to be considered as the cause of trauma in 140 of these, but 45 of this group were excluded from further evaluation as they had been the victims of blunt trauma and no clear-cut distinction was possible between trauma resulting from an accident and trauma resulting from resuscitation. Thus, we were left with 95 cases of internal injury that presented as emergencies and in whom death followed resuscitation, as a group for comparison with 171 road accident victims who had not received cardiopulmonary resuscitation. Rib fractures, predominantly on the left side, were established in half the cases resuscitated, sternal fractures also being found in one-third of these victims. Bleeding at various sites, including hematothorax, was rare, with an incidence of 15%, thus making it highly unlikely that serious traumas caused by resuscitation were a major factor in the cause of death. This paper encompasses an extensive discussion on serious injuries, such as aortic and gastric ruptures, in this connection.

Case report about a myocardial infarction following stab wound of the left atrium including a complete severance of the left coronary artery: An athletic 35-year-old man suffered a latero-medial stab wound of the thorax. The knife had penetrated the left lung and the atrium of the hypertrophic left heart. Postoperatively, the patient developed a heart infarction; 40h after trauma he died. The postmortem revealed traumatic necrosis of the left atrium, an intraoperatively undiscovered complete severance of the ramus circumflexus arteriae coronariae sinistrae and an antero-lateral ischemic cardionecrosis of the left ventricle. The location of the infarction could be explained by an extreme right preponderance of the coronary blood supply. Traumatic and ischemic myocardial necrosis differed distinctly in the amount of contraction bands. Other causes for such morphological changes like catecholamine-cardiomyopathy (so-called epinephrine myocarditis) or heart operations are discussed. Läsionen der Coronararterien werden bei Stichverletzungen des Herzens nur selten beobachtet. Ein 35jähriger Mann war 40h nach penetrierender Verletzung in den linken Vorhof trotz operativer Versorgung der Herzstichwunde im cardiogenen Schock verstorben. Die Obduktion erbrachte eine komplette Durchtrennung des Ramus circumflexus der linken Kranzarterie bei ausgeprägtem Rechtsversorgungstyp. Histologische Untersuchungen zeigten einen antero-lateralen Infarkt mit typischen Kontraktionsbändern, diese waren besonders deutlich im Bereich der traumatisch bedingten Nekrose des Atriums ausgebildet. Die pathomorphologischen Veränderungen werden auch im Rahmen einer Catecholamin-Cardiomyopathie (sog. Epinephrin-Myocarditis) diskutiert.

Summary The influence of hypnotics (barbital und carbromal) on the development of the early wound reactions in mechanically injured skin of guinea pigs was investigated:

Summary The early phase of wound repair after liver incisions was investigated by histological, enzyme-histochemical, and biochemical methods in guinea pigs. There are considerable differences in cellular and histochemical reactions in comparison to incisions of the skin:

Summary 1) The influence of acids and bases on the development of the early wound reactions in the intact and the mechanically injured skin of guinea pigs was investigated. The cellular and the enzymohistochemical reactions showed to be different: the tissue leucocytosis after mechanical trauma is less restrained by chemical effects than the reactive increase of enzymic activity in the border of wounds, which proved to be affected by acids more than by bases. Changes in activity of structure bound enzymes could not be demonstrated in the skin after mere action of acids and bases, but only after mechanical trauma. The cellular reaction is in the border of the base necrosis more compact, in case of the acid necrosis broader and more diffuse. Characteristic changes in the nucleus were preferentially found after basic reaction.

The influence of loss of blood and alcohol intoxication on wound reactions in the first 12 hours after incisions into the skin of the back of guinea pigs was examined. As the most important result we found differences in the cellular and zymohistochemical reactions: while begin and progression of the dermal leucocytosis were not influenced, the parallel running activation of different structure bound enzymes was significantly delayed and decreased.

The study objective was to investigate prevalence and determinants of current Helicobacter pylori infection in an asymptomatic population of middle-aged to elderly people. A cross-sectional study was conducted among 337 participants of a general education programme of the University of Ulm aged 50–85 years. Prevalence of infection as determined by means of the [13C]urea breath test was 34·8% (95% CI 29·6–40·3%) ; overall, 33·8% (95% CI 23·0–46·0) in the age group 50–59 years, 32·4% (95% CI 25·4–39·9) in the age group 60–69 years and 41·0% (95% CI 30·0–52·7) in the age group 70–85 years. Duration of school education of the father, sharing a bed with parents or siblings during childhood, and the area in which participants had grown up were independent determinants of current infection status in a multivariable analysis. We conclude that the prevalence of current H. pylori infection in healthy elderly subjects may not be as high as seroprevalence studies have suggested. Socioeconomic characteristics of childhood living conditions appear to be important determinants of infection status even at older age.

A situation of maximal triglyceride (TG) hydrolysis was generated in normals and patients with type III hyperlipoproteinemia by a large oral fat load and subsequent heparin administration one hour after the fat meal. Lipoprotein fractions [chylomicrons, very low density lipoproteins (VLDL), low density lipoproteins (LDL1 d 1.006-1.019, LDL2 d 1.019-1.063), and high density lipoproteins (HDL2 d 1.063-1.125, HDL, d 1.125-1.25)| were obtained by zonal or preparative ultracentrifugation and subsequent chromatography on 2% agarose. Electron microscopy was performed on full plasma and lipoprotein fractions by using the techniques of negative staining, freeze etching, shadowing and scanning electron microscopy (SEM). The lipoprotein morphology thus obtained was compared with that of type I hyperlipoproteinemia and of Zieve's syndrome. All conditions investigated had some abnormal lipoprotein structures in com mon: 1) Liposome-like particles (500-4000 Å) in the intermediate molecular weight (IMW) fraction of d 1.006-1.063.2) Disc-shaped structures (150-1000 Å) tending to aggregate in stacks and rouleaux upon concentration in LDL2 and HDL2. 3) Flattened, translucent and mostly round structures (200-3500 Å), some with a small globular area of electron dense lipid (all density classes). 4) Sword-like structures (1000- > 10000 Å) representing macrocrystalline free cholesterol (FC) in large molecular weight (LMW) subfractions of d < 1.019.5). Small, edgy and rod-like particles (150-500 Å), probably consisting of microcrystalline cholesterol in fractions of d < 1.063. All structures observed represent different physical-chemical arrangements of excess surface lipid. The appearance of large amounts of crystalline structures, 4) and 5), seems to depend on the presence of phospholipase and/or cholesterol ester hydrolase activity (Zieve's syndrome) which generates an excess of FC over phospholipid (PL), while particles described under 3) and 2) predominate when roughly equimolar amounts of FC and PL accumulate, as is the case in 'pure' LCAT-deficiency.

There is now substantial evidence that Campylobacter pylori (Cp) is able to colonize the gastroduodenal mucosa and is responsible for active chronic gastritis, its role in duodenitis, gastric ulceration and duodenal ulceration is still under debate. Cp has a lot of characteristics which are prerequisites for a pathogen: the typical S-shape, the corkscrew-like movement and the powerful urease and protease enzymes. These features allow a rapid movement through the mucous layer to permit access to the apical membranes of the surface mucous cells. There they adhere directly to the membranes and induce several ultrastructural alterations: degeneration of microvilli, depletion of mucous granules and an increase in sialic-acid rich glycoproteins in the apical part of the cytoplasma. Cp weakens the tight-junction complex and is found between the cells and sometimes intracellularly. Cp is phagocytized by invading polymorphonuclear leukocytes and causes an intense inflammatory response. These observations clearly demonstrate pathological alterations which in the cellular level induced by Cp with the result of a disrupted mucosal barrier of the stomach and the duodenum.

37 patients with epigastric pain and chronic erosive gastritis underwent an open controlled therapeutic trial with bismuthsubsalicylate (BS). Group A (21 patients) was treated with BS, liquid, 4 × 314 mg for three weeks, group B (16 patients) with BS tablets, 3 × 300 mg for two weeks. A significant reduction of symptoms (p < 0.001) and endoscopically assessed chronic erosions (p < 0.001) was achieved in both groups. Campylobacter pylori was detected in 89% of the patients before treatment, but was absent in 78% of the patients after treatment. The histological grading of antral mucosa showed a significant reduction (p < 0.001) of polymorphonuclear cell (PML) infiltration after two and three weeks treatment respectively. While in group A PML cells had disappeared from gastric mucosa in all but two patients, in group B 50% of the patients had some degree of PML cell infiltration left in the antral mucosa. This study confirms the beneficial effect of BS in the treatment of C. pylori associated active chronic gastritis and reemphasizes the pathogenetic role of C. pylori in this disease.

A situation of maximal triglyceride (TG) hydrolysis was generated in normals and patients with type III hyperlipoproteinemia by a large oral fat load and subsequent heparin administration one hour after the fat meal. Lipoprotein fractions [chylomicrons, very low density lipoproteins (VLDL), low density lipoproteins (LDL1d 1.006-1.019, LDL2d 1.019-1.063), and high density lipoproteins (HDL2d 1.063-1.125, HDL, d 1.125-1.25)| were obtained by zonal or preparative ultracentrifugation and subsequent chromatography on 2% agarose. Electron microscopy was performed on full plasma and lipoprotein fractions by using the techniques of negative staining, freeze etching, shadowing and scanning electron microscopy (SEM). The lipoprotein morphology thus obtained was compared with that of type I hyperlipoproteinemia and of Zieve's syndrome. All conditions investigated had some abnormal lipoprotein structures in com mon: 1) Liposome-like particles (500-4000 ÅÅ) in the intermediate molecular weight (IMW) fraction of d 1.006-1.063.2) Disc-shaped structures (150-1000 ÅÅ) tending to aggregate in stacks and rouleaux upon concentration in LDL2and HDL2. 3) Flattened, translucent and mostly round structures (200-3500 ÅÅ), some with a small globular area of electron dense lipid (all density classes). 4) Sword-like structures (1000- > 10000 ÅÅ) representing macrocrystalline free cholesterol (FC) in large molecular weight (LMW) subfractions of d < 1.019.5). Small, edgy and rod-like particles (150-500 ÅÅ), probably consisting of microcrystalline cholesterol in fractions of d < 1.063. All structures observed represent different physical-chemical arrangements of excess surface lipid. The appearance of large amounts of crystalline structures, 4) and 5), seems to depend on the presence of phospholipase and/or cholesterol ester hydrolase activity (Zieve's syndrome) which generates an excess of FC over phospholipid (PL), while particles described under 3) and 2) predominate when roughly equimolar amounts of FC and PL accumulate, as is the case in 'pure' LCAT-deficiency.

Helicobacter pylori urease was characterized by means of an enzyme histochemical electron microscopic technique. Ultrastructural analysis revealed no urease activity in one strain; in sevenH. pylori strains (43.75%), urease activity was associated with the cell membrane. Eight strains (50.0%) showed reaction product located within the cytoplasm. Urease activity showed no correlation with localization of activity. Our results demonstrate thatH. pylori urease is not uniform in allH. pylori strains, and differences in activity and localization of urease activity may account for different virulence activities.

Background: The aim of the study was to investigate the association of the use of commonly prescribed antibiotics with prevalence of Helicobacter pylori infection in a population of adult outpatients. Methods: All patients aged 15-79 years who visited the practice of a general practitioner (GP) between June and September 1996 in a suburban community near Ulm, a city in southern Germany, were asked to participate in the study. Infection status was determined with a l3C-urea breath test. In addition, the patients were asked to fill out a self-administered questionnaire. Results: Overall, 475 outpatients were included in the study (response, 94.1%). A total of 266 patients (56.0%) reported a history of antibiotic treatment within the past 5 years, whereas 147 patients (30.9%) did not (62 patients (13.1%) did not know). Prevalence of infection in patients with a history of antibiotic medication during the past 5 years was 23.3%, whereas the prevalence of infection was 20.4% in subjects without antibiotic treatment (P = 0.283 after stratification for age). Control for other potential confounders by multivariable analysis did not materially alter the results. Conclusion: Coincidental antibiotic treatment is not associated with H. pylori prevalence in adults.

Helicobacter pylori is among the most common infections in humans and has been recognized as major cause of various gastroduodenal diseases. There is limited knowledge, however, on the prevalence and determinants of this infection in children. We addressed these issues in a population-based cross-sectional study in Southern Germany.

Summary: Bismuth salts are currently used as monotherapy or in combination with antibiotics for the treatment ofHelicobacter pylori-associated peptic ulcer disease. Besides encouraging clinical results with colloidal bismuth subcitrate (CBS), there is an ongoing fear of organ toxicity with the use of bismuth salts. To study potential toxic effects of CBS under short-term exposure, we tested the influence of CBS on amylase secretion from isolated rat pancreatic acinar cells under basal conditions and following carbachol (CCh) and ceruletide (CRT) stimulation. Basal secretion was reduced by 8.99.6% (n=10) (meanSEM) (P<0.05), 5.29.2% (P<0.05), 9.46.4% (P<0.01), and 6.212.2% (P<0.05) with 0.001, 0.01, 0.1, and 1 μg/ml CBS, respectively. With 10 μg/ml and 100 μg/ml CBS, basal amylase secretion was increased in a dose-dependent manner, by 13.711.7% (P<0.05) and 24.512.8% (P<0.01). CCh (10−5 M)-and CRT (310−10 M)-stimulated secretory responses were not altered significantly by any of the CBS doses used. In concentrations above 1 μg/ml, CBS increased pancreatic amylase secretion. Amylase secretion in response to secretagogues was not affected by CBS. These findings are unlikely to be associated with a toxic effect of CBS on exocrine pancreatic acinar cell function.

Summary The effect of long-term treatment over 40 weeks with Bezafibrate on lipids and lipoproteins was investigated in 27 patients with primary hyperlipoproteinemias (hlp) (12 patients with hlp type IV, 7 patients with type IIb, 3 patients with type IIa, 4 patients with type V and 1 patient with type III). Bezafibrate reduced total cholesterol by 16%, whereas HDL-cholesterol increased by 28% and 36% (p<0.05). Serumtriglycerides decreased by 59% (450 mg Bezafibrate daily) and by 66% (600 mg Bezafibrate daily) statistically significant (p<0.05). In hyperlipidemias type IV, IIb, IIa and V increases of HDL-cholesterol could be observed. The course of LDL-cholesterol was different in the various types of hlp. The postheparin-lipoprotein-lipase (PHLA) was activated by treatment with Bezafibrate from 10.5±0.7 to 14.7±0.7 and 15.5±0.8 µmol FFA/ml/h or by 30% (p<0.05). Only few side-effects during treatment with Bezafibrate could be ascertained.

ABSTRACTThe prevalence of Helicobacter pyloriinfection in a population-based sample of 477 children (mean age ± standard deviation, 5.8 ± 0.5 years) determined by the [13C]urea breath test ([13C]UBT) was 10.7% (95% confidence interval [CI], 8.1 to 13.8%), and that determined by salivary enzyme-linked immunosorbent assay (ELISA) was 11.9% (95% CI, 9.2 to 15.2%). Compared to the [13C]UBT, the sensitivity and specificity of the salivary ELISA were 80.9% (95% CI, 66.3 to 90.4%) and 95.3% (95% CI, 92.7 to 97.1%), respectively.

Summary The ultrastructure of campylobacter-like organisms found within duodenal biopsy specimens from 7 of 24 patients (28%) with active duodenal ulcer is described. Their curved shape and variable size are similar to what has previously been reported in descriptions of light microscopies. The organisms were found at the edge of active duodenal ulcers exclusively near neutral-mucous producing antral cells, to which they can adhere. The presence of these bacteria within cells and in the intercellular fluid implies that they can penetrate through the cell membrane or through tight intercellular junctions. The occurrence of these bacteria as well as numerous polymorphonuclear leukocytes in the afflicted regions suggests that the bacteria originally described by Warren and Marshall are indeed pathogenic and that their influence on ulcer healing should be included in designing treatment protocols.