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Three weeks after commencing oral contraception for the first time, a 26-year-old woman with a history of rheumatic carditis and chorea minor presented with sudden recurrence of hyperkinesis. Withdrawal of the contraceptive agent was followed by rapid remission of the hyperkinesis, which suggests a casual relationship between the contraceptive and this condition and an analogy between this case and so-called chorea gravidarum. A young non-pregnant woman presenting with chorea minor should be specifically questioned by ingestion of oral contraceptives. If there is a past history of rheumatic fever with or without chorea, oral contraceptives are contraindicated.

Although we are all carriers of fungi, an infection is rare. Therefore, the following questions are discussed: Why do these actually saprophytic germs become pathogenic at all? Why have opportunistic fungus infections increased? The diagnosis of a fungus infection due to saprophytic pathogens is difficult, as the demonstration of a fungus does not necessarily imply disease. The case history with relevant predisposing factors is an essential clue to the diagnosis. As a matter of principle, the diagnosis of a systemic mycosis should only be established by exclusion.

Following drug-induced agranulocytosis and antibiotic and steroid treatment, sepsis due to candida albicans together with bilateral fungal coxitis developed in a 41-year-old female patient. Satisfactory eradication of the inflammatory process was achieved with combined treatment with amphotericin B and 5-fluorocytosine, so that mobilisation was possible after surgical fitting of bilateral total endoprothesis.

An 85-year-old female diabetic was admitted in coma, having been on antidiabetic treatment with the biguanide derivative "Silubin retard", 600 mg/d, for one-and-a-half months. The anion deficiency was 57 mmol/l, pH 6.9, suggesting the diagnosis of lactic acidosis in the absence of other causes of metabolic acidosis. Blood lactic acid levels of more than 16.65 mmol/l (150 mg/100 ml) confirmed the diagnosis. Administration of 875 mmol sodium bicarbonate over 12 hours corrected the deficiency. On admission to hospital there had been slight pre-renal failure. Myocardial infarction developed as a result of tissue hypoxia but did not prove clinically important. On the second day there were signs of a compensated disseminated intravascular coagulopathy with upper gastro intestinal haemorrhage. The woman died suddenly 18 days later of pulmonary embolism.

Four primarily healthy patients with granulomatous hepatitis during acute cytomegalovirus infection are described. Granulomatous hepatitis associated with cytomegalovirus infection has been described previously in only 7 patients. As the authors have observed 4 such cases within a period of one year, this disease pattern may occur more frequently than was formerly assumed.

The clinical picture of pulmonary mycoses is described and discussed. The diagnosis of tropical pulmonary mycoses is--in contrast to the native mycoses--relatively simple with respective serological tests and intracutaneous reactions. For the diagnosis the differentiation of fungi or molds is of utmost importance.

The case is presented of a 48-year-old woman who, in association with repeated septic temperatures, developed abscesses in the region of the right shoulder and in the right ankly. Histological examination from excisates revealed caseous tuberculoid granulomas. Mycobacterium fortuitum was isolated from the pus of both abscesses. Although the Mycobacterium fortuitum was resistant to nine commonly used tuberculostatics, it was found to be sensitive to ethionamide and capreomycine. The use of these two drugs in combination with local measures proved successful.

In the differential diagnosis of gastrointestinal disturbances the possibility of laxative abuse is considered either too late or not at all. The sequel is a protracted course of illness with a series of expensive and fruitless investigations. On the basis of three recently observed cases of laxative-induced diarrhea the problems of diagnosis and management are discussed. Methods of securing early diagnosis are mentioned. The overall prognosis must be considered unfavorable. The importance is stressed of long-term follow-up of these patients at community level, to ensure timely intervention should complications arise and to prevent further unnecessary investigations.

alpha-Fetoprotein (AFP) has been shown to suppress a variety of immune responses in vitro. The immunosuppressive properties of AFP can be partly attributed to the ability of this protein to decrease the cell surface expression of Ia antigens on macrophages. The experiments described in this report define more precisely the regulatory effects of AFP on Ia expression. Using the "dendritic-like" cell line P388 AD2 and bone marrow-derived macrophages we have shown that AFP can suppress the constitutive expression of cell surface Ia antigens. This decrease is detectable on the cell surface 24 hr after the addition of AFP. In further experiments we also examined the effect of AFP on lymphokine-induced Ia expression. Our results show that AFP has no suppressive influence on the inductive phase of lymphokine-induced Ia antigen expression but can decrease elevated levels of Ia antigen subsequent to their induction.

A diphtheria epidemic in the eastern part of Switzerland in 1974 and the measures which were taken for its management and eradication are described. In particular it is pointed out that at present diphtheria displays atypical clinical symptoms in Europe, a fact that renders the diagnosis very difficult in many cases. Therefore, it is important to perform a throat swab in every patient with suspected diphtheria; it is also necessary to explicitly require a search for C. diphtheriae. The early recognition and early treatment of diphtheria with penicillin or erythromycin is of the utmost importance in order to avoid neurological and cardiac complications. With regard to the management and eradication of a diphtheria epidemic, the most important measures are rapid antibiotic protection of all contacts and a widespread immunization of the population. Vaccination of adults with a DiTe vaccine containing a reduced amount of Di-toxoid is recommanded.

Since therapy of an overt attack of rabies fails, we are completely dependent on prophylaxis. This must be carried out with extreme care. A careful detailed history is the most important, the fundamental question being: was this a provoked or unprovoked attack by the animal? In addition some knowledge of the behavior of different animals towards man is essential. Before every treatment, the question whether it is really necessary must be settled. The help of a veterinary colleague should be called upon in taking the history. A rapid diagnosis can be obtained by fluorescence serology of the dead animal.