[Leptospirosis after refurbishment of old buildings]. / Leptospirose nach Altbausanierung.

UNLABELLED: HISTORY AND DIAGNOSIS: A 30-year-old patient was hospitalised with fever and jaundice. No long-term medication was taken. The patient worked as a plumber in refurbishment projects. He presented with headaches, myalgia and arthralgia of varying location and a fever of 38.9 °C. Skin and sclerae were visibly jaundiced. His cardiovascular system was normal. Further routine examination did not reveal any additional signs. INVESTIGATIONS: Having ruled out an acute gallbladder infection or mechanical obstruction of the bile ducts by abdominal ultrasound, an infectious etiology appeared likely, alongside possible toxicological and immunological reasons. Clinical history and diagnosis led to an urgent suspicion of leptospirosis which was confirmed by IgM titer rise within five days in ELISA. TREATMENT AND COURSE: The patient was treated immediately with ceftriaxone. During his stay in the hospital, his fever, jaundice and subjective symptoms subsided. Initial pathological markers also showed a significant trend towards reversion to normal levels. The patient was discharged from the hospital without any symptoms after 16 days. CONCLUSION: Leptospirosis is a significant differential diagnosis in patients with fever, jaundice, headaches and myalgia. Clinical history can provide vital clues for diagnosing this illness. Individuals that are prone to be exposed to water contaminated with rodent urine are at heightened risk of developing the disease. Climatic conditions such as heavy rainfalls or flooding also appear to increase the risk of infection.

[Ulcerating tumor of the esophagus as a primary manifestation of extrapulmonary tuberculosis]. / Ulzeröser Tumor der Speiseröhre als Erstmanifestation einer extrapulmonalen Tuberkulose.

HISTORY AND ADMISSION FINDINGS: The patient, a 36-year-old man from Somalia, who had moved to Germany a year before, was referred for a diagnostic work-up of an ulcerating tumour. He suffered from thoracic tightness for the last weeks albeit without any further symptoms. There were no pre-existing illnesses. No further pathological signs were found during a preliminary physical examination. INVESTIGATIONS: After ruling out any malignancies by means of an analysis of biopsy samples, further differential diagnostic measures were undertaken. Besides mechanical and chemical factors, an infectious genesis of the esophageal lesion was considered and investigated further through histological, immunohistochemical, laboratory and microbiological tests. DIAGNOSIS, TREATMENT AND COURSE: Mycobacterium tuberculosis was detected in cultures sampled from biopsy material. This strain turned out to be responsive to medical treatment. Further diagnostics regarding a potential primary pulmonary tuberculosis were negative. Histological analysis of a liver biopsy confirmed noncaseating epithelioid cellular granuloma as typically seen in granulomatous hepatitis without any direct evidence of mycobacteria. Thus, tuberculosis of the liver appeared most likely considering the differential diagnosis of a granulomatous hepatitis. The patient underwent standard treatment using antituberculous drugs over six months. Endoscopic control after two months showed a significant reduction of the ulcerating lesion. CONCLUSION: Ulcerating tumors of the esophagus are primarily classified as potential malignancies. Crohn's disease is an important differential diagnosis. Apart from mechanical and chemical causes, infectious diseases should be taken into consideration. However, tuberculosis is one of the most relevant differential diagnoses, particularly in patients immigrating from TB-prone countries, pre-existing immune deficiency or environmentally induced elevated infection risk.

[Normal values for spirometry lung function values and peak flow for 7-18-year-old probands]. / Normwerte für spirometrische Lungenfunktionsgrössen und den Peak-flow für 7-bis 18jährige.

A prospective cohort study, designed to examine the long-term effects of air pollution on respiratory health, was conducted during the years 1977, 1979 and 1985 in Southwest Germany. In order to derive prediction equations, we analyzed the functional relationship of pulmonary function and anthropometric measures by graphical tools and regression analysis. Results are based on 10.605 spirometric measurements from 6625 individuals aged 7 to 18 years. Asthmatics, extremely overweighted persons, and smokers were excluded. Regression equations for the logarithmic transformation of FVC, FEV0.75 FEV1.0 MMEF and peak-flow are obtained separately for boys and girls, using the logarithms of standing height, weight and age as linear predictors. A comparison between equations from the present study and other available reference data shows that our prediction values for the volume parameters are at the upper end of the range given by other studies whereas for the flow parameters they lie in the middle of the range.

[Icteric cholestasis as an early symptom in Hodgkin's disease]. / Ikterische Cholestase als Frühsymptom bei Morbus Hodgkin.

Initial symptoms in a hitherto healthy 23-year-old man were jaundice (bilirubin 21.7 mg/dl) and pruritus, but extensive radiological, endoscopical, microbiological and laboratory investigations failed to reveal the cause. Stool culture positive for Salmonella agona suggested intrahepatic cholestasis resulting from a Salmonella cholangitis. However, antibiotic treatment was not successful. As he was in generally good health the patient declined further investigations. He returned two years later because of fatigue, lack of appetite and weight loss. Further tests now revealed lymphogranulomatosis in stage IVb of the nodular sclerosing type. The case demonstrates that cholestasis as an isolated early symptom of Hodgkin's disease can precede by years any further signs of the disease.