[The frequency of demonstration of Campylobacter pylori]. / Zur Häufigkeit des Nachweises von Campylobacter pylori.

In 376 patients who underwent gastroscopy the presence of Campylobacter pylori by microscopy, bacterial culture and urea test was studied. Additionally, the histological examination of the antral mucosa was performed. The organisms were detected in 47.9% of the biopsy specimens (37.2% in normal endoscopic findings and 70% in duodenal ulcers). Dependence on sex was not found and also no significant difference of Campylobacter pylori detection in patients younger than 45 years compared with those who are older. However there was a strong correlation between the presence of Campylobacter pylori and the histological results (p less than 0.05). In comparison with international literature we found a distinctly lower percentage of positive Campylobacter pylori rate in patients with peptic ulcer; the association between the presence of Campylobacter pylori and the degree of gastritis was confirmed.

[Detection of Campylobacter pylori in gastric mucosa--relation to gastroscopy findings and degree of gastritis]. / Nachweis von Campylobacter pylori in der Magenschleimhaut-Beziehungen zu gastroskopischen Befunden und zum Gastritisgrad.

In 862 unselected gastroscopies we could confirm the high percentage of campylobacter pylori infection in the antral gastric mucosa strongly associated with chronic superficial gastritis and active inflammatory signs. Significant correlation with age concerned the normal findings only. In patients with duodenal ulcers we found in 91% gastritis and in 88% campylobacter pylori in antral mucosa. A small group with duodenal ulcers was campylobacter pylori-negative as well as without gastritis signs. Comparing the antrum and corpus gastric mucosa (250 pat.) the antral mucosa was representative for the whole stomach in view of gastritis and campylobacter pylori test, sufficiently for practical use. Between the test methods (culture, urease, microscopy) we favoured the microscopic test.

[Combination of glandular and foveolar hyperplasia of the gastric mucosa--a rare mixed type]. / Kombination von glandulärer und foveolärer Hyperplasie der Magenschleimhaut--eine seltene Mischform.

In a 28 year-old man with epigastric pain endoscopy detected giant gastric folds and multiple superficial erosions. Histologically a mixed form of glandular and foveolar hyper plasia of the gastric mucosa was suggested (Ming's type III). Basal and pentagastrin stimulated secretion volume and acid output were moderately elevated, hypersecretion of protein was not found. Serum levels of calcium and gastrin were normal, also after secretin stimulation. The mucosa of the corpus was extensively infested with Campylobacter pylori. Therapy with cimetidine, antacids, pirenzepine and metronidazol resulted in relief of symptoms but not of histological findings. Bismuth (JatroxR) was successful in eradicating Campylobacter pylori and decreasing inflammation of the mucosa. Cause and prognosis of this mixed hyperplasia are not known.

[Experiences with a diet-training program in patients with obesity associated diseases including follow-up]. / Erfahrungen mit einem Diät-Trainingsprogramm an Patienten mit adipositasassoziierten Krankheiten einschliesslich Nachkontrollen.

In 158 inpatients (61 m., 97 f.) with obesity-associated diseases were performed a diet-training-programme for about four weeks. We used a PSMF (protein sparing modified fasting) as a 350 kcal diabetic mixed diet, adequate to 4 carbohydrate units (40g carbohydrate, 30g protein, 5g fat) with weekly tea-vegetable-days, additionally wheat brain. The training programme was adapted individually. Reexamination were made by questionnaires and diabetic control cards concerning the body weight. The favourable influence of blood pressure and metabolism was registered. The diet schedule consist natural foodstuffs, fibers, minerals and vitamins. It can be varied, is very effective especially in combination with exercise. The middle term results are rather good more for women than men. Our diet-training-programme can be recommended for outpatients as well as for cures.

[Treatment of newly diagnosed type II diabetic patients with special reference to prescribing glibenclamide in low doses]. / Die Behandlung neuerfasster Typ-II-Diabetiker unter besonderer Berücksichtigung der Verordnung von Glibenclamid in niedriger Dosierung.

In the period of 15 months 90% of all newly registered type II diabetics of a district area (70 males, 122 females) were prospectively thoroughly examined above all in hospital, standardizedly stabilized and have been followed up for 1 year with regard to their therapy behaviour. From the features obtained (age, body weight, heredity, symptomatology, blood glucose and insulin concentrations basally and after 75 g oGTT) subgroupings were worked out relevant for the therapy. 64% of the newly registered type II diabetics could be stabilized purely dietetically (males 70%, females 60.7%). Female type II diabetics revealed the worse course of therapy. Younger age, overweight, genetic load and higher insulin concentrations are markers of the importance of the insulin resistance and a domain of the basis therapy. Older age, normal weight in connection with higher blood glucose and lower insulin concentrations as an expression of the insulin deficit of higher degree render in most cases possible a treatment with SH-preparations. Small doses of glibenclamide proved to be very favourable both in not purely dietetically manageable younger patients and in older patients. 68% of all SH-cases did with a dosage of 1-3 mg glibenclamide a day, 28% with 1 mg a day. The pathophysiologic and pharmacologic mechanisms are discussed.

[Lipid parameters in newly detected type II diabetic patients and relations to coronary heart disease]. / Lipidparameter bei neuerfassten Typ-II-Diabetikern und Beziehungen zur koronaren Herzkrankheit.

In a prospective study 192 new manifested type 2 (noninsulin dependent) diabetics were checked in view of prevalence of coronary heart disease (CHD) and hypertension in relation to concentration of lipids in serum. CHD was found in 49%, hypertension in 53% dominating females. Increased triglycerides (1.98 mmol/l) and decreased HDL-cholesterol i.s. (1.28 mmol/l) were characteristically, cholesterol (6.6 mmol/l) were within references, the lipoprotein-screening test was pathologically. Prevalence of CHD was associated with age, sex, hypertension, partly with triglycerides and weight and inverse with HDL-cholesterol i.s. but not with the concentration of blood glucose and insulin i.s. basal as well as stimulated (75 g oGTT). In conformity with other studies the differences in lipids alone would'nt be allowed to explain the high prevalence of CHD in new manifested type 2 diabetics.

[Type 2 diabetes--etiopathogenetic aspects]. / Typ-II-Diabetes--ätiopathogenetische Gesichtspunkte.

Prevalence of diabetes and increasing incidence mainly concern the type II diabetes, the etiopathogenesis of which is finally still unclarified. While the behaviour of the insulin secretion of type II diabetes is clarified as far as possible, research of the last years concentrates to disturbances of the insulin binding at the receptor, of the insulin efficiency after receptor binding as well as to the complicated interrelations between insulin secretion and peripheral effectiveness. On the one hand, metabolic sequels of malnutrition and obesity as well as decreasing muscle activity and muscle mass, on the other hand the genetic disposition plays an important role. Recently, insights into disturbed intracellular biochemical courses could be obtained and newer approaches for therapy could be found out. Significant could be the separation into perhaps still reversible findings in the manifestation of the irreversible late findings at the level of postreceptors after longer course of diabetes at least for the type IIb (adipose type). The diversity of etiopathogenetic factors demands substandardizations which would give only beginnings for prevention and optimized differential therapy. It cannot be denied that type II diabetes and arteriosclerosis partly have common genetic and exogenic causes.

[Management of diabetes during operative procedures]. / Diabetesführung bei operativen Eingriffen.

The described basic scheme for the peroperative care of patients with diabetes mellitus which was for many years successfully used proved to be very efficient and improves the interdisciplinary care. On the basis of a standardized infusion programme in which the carbohydrates are given in combination as glucose and sorbite in many type II diabetics administrations of insulin and tolbutmide may be avoided. Modern anaesthesia techniques have a sedative effect on the postaggression syndrome. The change to oral fluid and food supply takes place as early as possible with adequate good results and advantages also after abdominal interventions. The diabetic and postoperative metabolism have both a common disturbed utilization of glucose which lead to catabolism with increased gluconeogenesis and lipolysis and additionally evoke complications. The necessary therapeutic measures may also be used in other non-postoperative postaggression syndromes without presence of diabetes mellitus. It is particularly referred to the dangers of a too schematic approach.

[Fracture of the collum of femur as a consequence of disturbed function in patients with resected stomach (Billroth II) (author's transl)]. / Schenkelhalsfraktur als Folge von Störungen am operierten Magen - ein Beitrag zur Differentialdiagnose der Osteoporose.

Disturbed metabolism of bones like osteoporosis are not completely physiological in elder persons. In all cases it is needed to search for the origin. Under the intestinal factors is a slight calcium deficiency with food of a great importance for genesis of osteoporosis stimulating a occult secondary hyperparathyroidism. If vitamin D-deficiency is added a osteomalacic component is following called "Osteoporomalacia". This mixed form is typical for intestinals. Especially elder patients are endangered because the supplying of calcium and vitamin D also the calcium absorption are decreasing with getting elder. The calcium absorption is also smaller in patients with resected stomach (Billroth II). When the function in resected stomach is disturbed like in our case of afferent-loop-syndrome a osteoporosis with osteomalacic component and pathological fractures can develop. In such cases teamwork is worthwhile.

[Diagnostic value of renal urate excretion]. / Diagnostische Wertigkeit der renalen Uratausscheidung.

After a short survey of the purine metabolism, excretion of uric acid, theories of gout and urate nephropathy methodical references are given for the estimation of excretion of uric acid, a normal region on test persons was established and compared with other authors. The quantities of excretion and concentrations of uric acid from the 24 hours urine found on patients with asymptomatic hyperuricemia and manifest gout are the basis of the discussion of the diagnostic and therapeutic value of these examinations. In patients with gout and asymptomatic hyperuricemia the excretions of uric acid are a little higher than in healthy persons. A treatment with uricosuric remedies might not reduce the factor of risk hyperuricemia, since this does not lead to a prevention of the gout nephrophathy, on the contrary it furthers it.