[MRI-based diagnosis of giant cell arteritis]. / Differentialdiagnose eines un- spezifischen Beschwerdebildes: Riesenzellarteriitis (Morbus Horton).

The giant cell arteritis and its symptoms are usually non-specific and accompanied with symptoms of polymyalgia rheumatica. As complications of the giant cell arteritis ischemia, infarction or rupture of the damaged vessel can occur. We report on a 56-year-old female patient, who suffered for one year about weight loss, tiredness and intolerance as well as symptoms of polymyalgia rheumatica. Gastroscopy and colonoscopy showed normal findings. In the context of the malignancy search we made a computer tomography and magnet resonance tomography. The data showed an enlargement and an enhancement of the aorta, which led us to the suspicion of a giant cell arteritis. We started immediately with a medical treatment. The biopsy of the arteries temporales supported histological the diagnosis.

[Sulfasalazine-induced pulmonary infiltrates and Legionella pneumonia]. / Salazopyrin-induzierte Lungeninfiltrate und Legionellenpneumonie.

After 2 weeks' treatment with sulfasalazine (SASP) and mesalazine enema, a 32-year-old female with recently diagnosed ulcerative colitis developed bilateral pulmonary infiltrates with peripheral eosinophilia. Both drugs were discontinued. In view of a high-positive antibody titre (1:4096) against Legionella pneumophila serogroups 1-5, legionnaires' disease was assumed and empirical antilegionella therapy with macrolid antibiotic was started. The patient's condition improved within days. Three months later SASP was given again in view of exacerbation of the inflammatory bowel disease. Three days after initiation of therapy acute pulmonary symptoms again developed with bilateral, confluent opacities and blood eosinophilia. The abnormalities resolved completely after the drug was discontinued and prophylactic antibiotic therapy was given. Peripheral lung infiltrates with blood eosinophilia are a rare side effect of SASP therapy. The prognosis of the illness after the drug has been discontinued is generally good, usually with complete recovery of pulmonary function. The risk factors for sulfasalazine pulmonary toxicity are not well known. We describe the first case of SASP-induced hypersensitivity lung disease with simultaneous Legionella pneumophila infection.

[Spontaneous bacterial peritonitis with Streptococcus constellatus in an HIV positive patient]. / Spontane bakterielle Peritonitis mit Streptococcus constellatus bei einem HIV-positiven Patienten.

Liver diseases are an important cause of high morbidity and mortality in HIV-infected patients, and liver cirrhosis is the commonest cause of ascites in this population. We describe the case of a 38-year-old HIV-positive male (CDC stage B3, CD4 cell count 199/mm3) with a history of hepatitis C-associated liver cirrhosis. Following pneumonia he developed spontaneous bacterial peritonitis due to Streptococcus constellatus. Clinically noticeable was the gradually worsening course with few symptoms, despite the initially high ascitic fluid leucocyte count of over 11,000/microliter, but a favourable response to betalactam antibiotics.

[Rhabdomyolysis and cholestatic hepatitis under treatment with simvastatin and chlorzoxazone]. / Rhabdomyolyse und cholestatische Hepatitis unter der Behandlung mit Simvastatin und Chlorzoxazon.

Acute rhabdomyolysis under treatment with HMG-CoA reductase inhibitors ("statins") is a group-specific if rare side effect. Muscle toxicity of statins can be potentiated by medication influencing their metabolism. Here drug interactions on the level of the microsomal cytochrome P450 enzymes play an important role. We report the first case of marked rhabdomyolysis with cholestatic hepatitis in a 73-year-old woman treated with simvastatin and chlorzoxazone. Withdrawal of the causal medication and conservative therapy with volume substitution and forced diuresis was followed by almost complete resolution of the symptoms with normalisation of the blood tests. Possible mechanisms involved in the drug interactions are discussed. Thorough knowledge of the enzyme systems involved in drug metabolism helps to predict possible adverse drug interactions and prevent toxic effects.

[Segmental small intestine lesions after taking non-steroidal antirheumatic drugs]. / Segmentale Dünndarmläsionen nach Einnahme nicht-steroidaler antirheumatika.

Over a period of 7 months a 51-year-old diabetic took mefenamine acid (up to 500mg 20 times daily), diclofenac and, more rarely, paracetamol for lumbosacral pain. In addition, dexamethasone (4 mg three times daily) was prescribed later. For 4 weeks he had colicky abdominal pain which then started acutely to radiate into the flanks. Pressure and rebound pain in the left epi- and mesogastrium, as well as the results of biochemical tests, suggested an acute abdomen. Abdominal X-rays, selective contrast examination of the small intestine and computed tomography demonstrated changes within some segments of the jejunum (thickened wall, irregular wall surface). Laparoscopy showed brown discoloration of the loops of the small intestine. In consequence of these findings a 10 cm long segment of the jejunum was resected. Histological examination showed extensive ulcers at the tip of the rugae with granulating inflammation and bifringent foreign bodies with giant-cells. The villi were extensively atrophied, the blood vessel were congested and the submucosa fibrosed. The patient was discharged after 9 days and, no longer taking NSAIDs, has been free of abdominal symptoms.

[Acute erosion of the esophagus, stomach and duodenum]. / Akute Verätzungen von Osophagus, Magen und Duodenum.

Acute burns of the oesophago-gastro-duodenal tract require an immediate diagnostic and therapeutic approach. Early endoscopy has been shown to assist greatly in determining the further treatment of corrosive injury. The main task of radiology is to detect perforations. While first degree burns cause hardly any therapeutic problems, second and third degree burns require intensive care right from the start. Later, possible stricture formation warrants chief attention. Early corticosteroid treatment seems to be effective in preventing stricture development in second degree burns.

[Side effects of non-steroidal antirheumatic agents in the lower intestinal tract]. / Nebenwirkungen nichtsteroidaler Antirheumatika (NSAR) im unteren Intestinaltrakt.

Side effects of non-steroid anti-inflammatory drugs (NSAIDs) on the lower intestinal tract are reviewed. NSAID use may exacerbate or reactivate quiescent inflammatory bowel disease. There are distinct types of NSAID-induced enterocolitis: ulcerative colitis, Crohn's disease, and necrotizing enterocolitis in premature infants. It is also suggested that NSAIDs may play an etiological role in collagenous colitis. Furthermore, NSAIDs may induce ulcerations, perforations and strictures in the small as well as large bowel. Occult and severe blood loss from lower intestinal tract under treatment with NSAIDs should be kept in mind.

[Septic syndrome with a pulmonary focus]. / Sepsissyndrom mit Lungenherd.

After acute pharyngitis a 21 year old patient developed signs of severe bacteremia with a well demarcated infiltrate in the left lung. The typical course and a prompt response to antibiotic therapy with Imipenem (Tienam) led to the diagnosis of Lemierre's syndrome (post-anginal sepsis)--in spite of negative blood cultures. The patient recovered quickly, a chest radiogram after two weeks showing but pleural scarring and restitution ad integrum after four weeks.

[Mechanisms of accumulation of neutral lipids in the liver]. / Mechanizm akumulacji tluszczu obojetnego w watrobie.

The process of triacylglycerol (TG) synthesis in the liver is described. Some factors influencing the biosynthetic pathways and the removal of TG from the liver are discussed. Clinical considerations regarding the problem of fatty liver are presented.

The effect of pancreatitis associated ascitic fluid on some functions of rat liver mitochondria. A possible mechanism of the damage to the liver in acute pancreatitis.

The damage to the liver during acute pancreatitis (AP) could be partly dependent on depressive action of pancreatitis associated ascitic fluid (PAAF) on the energy metabolism of hepatocytes. The aim of the study was to assess the effect of PAAF from dogs with acute experimental pancreatitis (AEP) and from humans with AP on the respiratory function of isolated rat liver mitochondria (RLM). The mitochondrial oxygen consumption rate in state 3 respiration (with ADP) and in state 4 (without ADP) using sodium succinate as substrate and oxygen Clark's electrode was estimated. Respiratory control ratio (RCR) and P/O ratio were calculated. PAAF was collected after 6 h of AEP induced by Elliott's method in 8 dogs, and from 4 patients with AP, intraoperatively. Both animal and human PAAFs increase the oxygen consumption rate by RLM in state 4 dose dependently (by 65% with 50 microL to 150% with 200 microL of canine PAAF). This uncoupling effect of human PAAF was twice more potent than the canine. Dialysis of PAAF reduced this effect almost completely. The mitochondrial ATPase activity in RLM treated with PAAF was stimulated and this effect was also reduced by dialysis. The conclusion was that the damage to the liver in AEP could be partly dependent on the toxicity of dializable component(s) of PAAF on the energy metabolism of mitochondria. These findings may partly explain the beneficial effects of peritoneal lavage in acute pancreatitis.

Effect of exhaustive exercise on liver mitochondrial function in the rat.

The oxidative and phosphorylative function of rat liver mitochondria after exhaustive exercise was investigated. The stimulation of state 4 respiration (without ADP) with NADH and FADH2 dependent substrates was demonstrated. The reduction in RCR ratio (the rate of oxidation in state 3/the rate of oxidation in state 4) and enhanced activity of oligomycin sensitive ATP-ase was also found. The results suggest an inhibition of liver mitochondrial phosphorylative activity in rats exercised till exhaustion.