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Congenital heart defects (CHD) occur in 8 per 1000 live births. If they remain untreated, 70-80% of these patients die in early childhood. With modern diagnostic and treatment procedures, 90% of these patients reach adulthood. Within 8 years following reunification of Germany, it was possible to improve treatment for CHD in former East Germany to West German standards. Based on the experience gained in this process, a plan for improvement of care of Estonian patients with CHD was developed and implemented in the German-Estonian project, "Partnership for the Heart". The main elements of the project were (1) the training of Estonian physicians in Germany, (2) training courses conducted by German and Estonian specialists in Estonia and (3) use of telemedicine for consultation on a continuous basis. During the project 15 Estonian patients underwent cardiac surgery and/or catheter interventions performed by a joint team of German and Estonian specialists. The infant mortality due to CHD in Estonia fell by 28% during the project period. Key techniques of cardiac surgery are now being employed in Estonia without outside support, indicating the success of the training program and the long-term improvements to cardiac health care in Estonia. The total project costs were 314,252 Euro (euro), which is 50% lower than the estimated cost of treating the 15 patients abroad in Western Europe. The structure of "Partnership for the Heart" and the modified self-sufficiency model of medical care have not only produced results for Estonia but can be taken as a template for future bilateral health projects with other transition countries and for other fields of medical specialisation, and thus might aid a European health policy.

Output of bacterial metabolites reflects not only the number but the metabolic activity of certain microorganisms. In case of excess of a substrate one can observe the increased output of metabolite(s) without the overgrowth of intestinal bacteria. This matter is used for detection of malabsorption of some carbohydrates (lactose, glucose) by increased excretion of hydrogen in expired air. Another group of so-called breath tests (14C-cholylglycine, 14C-xylose) is designed to detect the bacterial overgrowth in the small intestine by measuring the rise of the concentration of 14CO2 in alveolar air. All the tests basing on the decomposition of the test substance by intestinal bacteria, have some limitations. Little is known about the microorganisms decomposing the different test substances. Significant correlations between the urinary phenols (p-cresol, phenol) and certain groups of mucosal flora (staphylococci, bacteroides) of the small intestine of rats could be found. Therefore one suggests that elucidating the origin of a bacterial metabolite is still possible in some instances, although very complicated. In conclusion, the authors refer to several reasons for failure to obtain correlations between the output of the metabolite(s) and data of bacteriological investigation.