Yersinia arthritis (author's transl)

Yersinia arthritis is an acute oligo- or, more rarely, polyarthritis. It occurs after pyrexic diarrhoea of several days, often associated with right-sided lower abdominal pain. The disease is caused by Yersinia enterocolitica and four such cases, confirmed serologically in three, are described. In one case fluid from the knee-joint was antibody-positive. It was not possible to culture the causative organism, probably because all patients had previously been treated with an antibiotic. Rheumatic fever and Reiter's disease must be considered in the differential diagnosis. Because pharyngitis, transitory ECG changes and conjunctivitis may occur in the early stages of Yersinia arthritis, the diagnosis may be missed. Prognosis of Yersinia arthritis is good, with complete cure within weeks or months. Demonstration of HLA-B 27 in all four cases points to a genetic disposition.     

Pathogenesis of osteopathy caused by anticonvulsives (author's transl)

After a short survey of the recent suggestions of the pathogenesis of osteopathy caused by therapy with anticonvulsives it is demonstrated in the light of 3 case reports that 1. A vitamin D-sensible rickets, which is only due to abnormal living conditions, can develop in severely cerebral-damaged persons if there is no specific vitamin D administration. 2. An "antiepileptic rickets" is spontaneously reversible if the anticonvulsive therapy is stopped. 3. An enzymatic induction due to anticonvulsives is also detectable in the light of morphologic hepatic changes (biopsy, electron microscopy). Hence it follows that there are demands for a specific control of all patients treated with anticonvulsives. It is recommended to carry out a rickets prevention for a selected patient group.     

Experimental infection of axenic mice by "Yersinia enterocolitica" (author's transl)

Although most of Yersinia enterocolitica strains isolated from man have no pathogenicity for laboratory animals, it has been demonstrated that some strains are pathogenic for conventional mice and that most of the strains are probably pathogenic for Nude mice. The authors report the results of the infection of germ-free mice with a strain of Y. enterocolitica which is non pathogenic for holoxenic mice. It appears that C3H/He mice are sensitive to the infection by gavage or aerogenic and peritoneal routes. They all die within 8 to 12 days after injection of an inoculum of 5.10(5) viable cells. Germ-free NCS mice were also sensitive to the oral and aerogenic infection but not to the peritoneal infection; the difference between C3H/He and NCS sensitivity to this way of infection could be explained by a higher bactericidal activity of the peritoneal phagocytes of the latter. The C3H/He and NCS holoxenic control mice infected with the same inoculum of the same strain, did not show any symptoms and all attempts to isolate Y. enterocolitica failed three months after the challenge. Germ-free mice killed by the infection showed histopathological findings, i.e. abscesses involving intestinal wall. liver and spleen; they were similar to those described in experiments with pathogenic strains for conventional mice (holoxenic) and to those observed in infection of athymic Nude mice with strains non pathogenic for conventional mice. This infectious disease model is discussed in regards to the natural human infection.     

Visceral larva migrans infections caused by toxocara species (author's transl)

A total of 4656 serum samples from suspect persons were investigated for Toxocara antibodies over the last 10 years. Using the Ouchterlony technique antibodies were demonstrated in 707 cases, and in 409 cases with the help of the microprecipitation test using secondary larvae. It was shown that the living larva test is highly specific and very sensitive so that a positive reaction can be taken as definite evidence of infection. Clinical symptoms were characterised by high eosinophilia, ophthalmologic changes, lung involvement, central nervous affection and increase of gamma-globulins. A history of contact with dogs or cats was an additional indicator. Treatment of larva migrans syndrome has to date remained unsatisfactory as no effective and well tolerated drug is known.     

Hemorrhage caused by thrombocytopathies: new aspect of treatment (author's transl)

Hemorrhage due to thrombocytopathies can in most cases be stopped by application of the homologous coagulation-active phospholipide complex Fibraccel, as shown in a study in which 78 patients suffering from various thrombocytopathies were checked. This effect is especially important in patients with immunothrombocytopathies which do not permit any thrombocyte substitution. Recalcification time and thromboelastogram should be normalised during Fibraccel treatment. In existing extravascular coagulation Fibraccel treatment is contraindicated, especially in cases of inadequate protection by heparin.     

Bilateral fracture of the scapulae caused by a convulsive seizure (author's transl)

The authors report a case of bilateral communicated fractures of the scapulae caused by a seizure of unknown etiology. The differential diagnostic problems and the mechanism of inquiry are being discussed.     

Dumping-prophylaxis (author's transl)

The dumping syndrome is due to a vigorous reflex distension of the jejunum, caused by the stomach violently evacuating its contents. The aim of treatment is to overcome the drastic evacuation by restoring the rhythmic peristalsis of the stomach (eukinetics). This can be achieved by a special diet. Every meal should begin with well chewed solids (pulp) and avoid all fluids. With a well organised medical staff a complete success can be achieved. Surgical measures in Dumping can be avoided.     

Respiratory disturbances caused by vascular tracheal compression after repair of oesophageal atresia (author's transl)

Interference with respiration, caused by stenosis of the trachea after an operation for oesophageal atresia, is described. The narrowing of the tracheal lumen through blood vessels is particularly mentioned. Tracheal stenoses through the truncus brachiocephalicus, which cause serious symptoms following operation on oesophageal atresia, have a particular part to play. The causes of this are discussed, the clinical picture and steps in diagnosis are laid out. One case of atypical oesophageal atresia with an extremely hypoplastic left lung showed, after union of the oesophagus segments, the classic picture of serious tracheal compression through the truncus brachiocephalicus. This was caused by displacement of the mediastinum, pushing the heart backwards and to the left. It was cured by fixing the aortic arch to the sternum at the level of origin of the truncus. More than 1 1/2 years after the operation, the child is still symptom-free.