[Miliary tuberculosis of the liver as a cause of septic shock with multi-organ failure]. / Miliare Tuberkulose der Leber als Ursache eines septischen Schocks mit Multiorganversagen.

A woman aged 63 presented with septic fever, followed by hepatocellular jaundice. Viral hepatitis was ruled out by serologic tests, but no definite diagnosis could be made. Due to severe disturbance of the plasmatic coagulatory system and a serum bilirubin level above 4 mg/dl, a liver biopsy was not performed. The patient had a persistent septicemia refractory to Imipenem. In spite of intensive care measures, the patient died of disseminated intravascular coagulation and multiorgan failure caused by septic shock. The correct diagnosis of miliary tuberculosis was made only post mortem by histopathological examination of liver specimens and confirmed by detection of Mycobacterium tuberculosis DNA in the patient's liver by polymerase chain reaction.

[Glucose determination by means of NMR spectrometry]. / Glukosebestimmung mittels NMR-Spektrometrie.

NMR spectroscopy could be a method for non-invasive determination of glucose concentration in the future. In this connection, 13C-NMR spectroscopy is of special interest. In vitro investigation of blood serum samples in 13C-NMR revealed significant changes in signal intensities reflecting the different glucose concentrations in these samples. The further development of noninvasive in vivo glucose determination by means of NMR spectroscopy is closely associated with technological progress.

Synthesis of disubstituted tetrahydrocarbazoles with potential antidepressive activity.

A new series of disubstituted tetrahydrocarbazoles were synthesized. They are tested for antidepressive activity by the Porsolt's forced swimming test (one of the acute stress methods) and by the prevention of reserpine induced hypothermia and ptosis in mice. 3-Morpholino-1-[N-(6-methoxy-1,2,3,4- tetrahydrocarbozolyl)2-propanol, fumarate (XI) was demonstrated to be the most promising compound of this series. Besides, this series did not present the most common adverse effects of the conventional tricyclic-antidepressants (loss of locomotor coordination, ataxia and anticholinergic activity).

[Cyclosporin A as a diabetogenic cofactor]. / Cyclosporin A als diabetogener Kofaktor.

Two kidney transplanted patients are reported, who developed an insulin dependent diabetes mellitus after crossing therapeutic Cyclosporine A levels. After stabilisation of the Cyclosporine A levels the insulin dependent diabetes mellitus was completely reversible. The results are indicating Cyclosporine A as the insulin dependent diabetes mellitus initiator.

[Value of the oral glucose tolerance test]. / Stellenwert der oralen Glukosebelastung.

Although there has been repeated criticism regarding the Oral Glucose Tolerance Test (OGTT), we still do not know an alternative procedure with a better evaluability than the OGTT which can be carried out as easily as that. Radioimmunological tests to determine insulin as well as C peptides will not be able to give a definite distinction between a marginal "diabetic" and an "eumetabolic", nor will the OGTT. Considering certain criteria when carrying out and analyzing the OGTT, however, it might as well be possible to restrict the area of "disturbed glucose tolerances".

[Pathogenesis and therapy of hepatic coma]. / Zur Pathogenese und Therapie des Coma hepaticum.

Even today, there is a markedly high rate of lethality resulting from an acute or chronic failure of the liver function. The reason of this seems to be the still unknown pathogenesis of the hepatic coma. In general, therapeutical measures will involve medical treatment of single symptoms on the basis of empirically made experience. However, any success will primarily depend on an early recognition of the approaching lethal breakdown and on the corresponding therapeutical measures taken before the final stage has been reached. Studies on its pathogenesis have to focus mainly on changes affecting the structure of the amino acid in the serum, in particular as regards the differences of the molecular ratio between aromatic and ramified-chain amino acids. The increased amount of serum ammonia does not seem to have major influence on the genesis of hepatic encephalopathy as has previously been assumed for a long time. Any treatment has to set in early, preferably in the General Department, as approximately 60% of cerebral malfunctions can already be registered in a zero coma state. Measures will involve detoxification, parental nutrition as well as substitution of such liver-generated substances as are not sufficiently produced at that stage. Any worked-out therapeutical scheme ought to be handled in a most flexible way in order to allow for an immediate response to the sometimes fast-changing clinical symptoms.

[Comparative studies of the personality structure of the diabetic patient and the patient with chronic liver disease]. / Vergleichende Untersuchungen über die Persönlichkeitsstruktur des Diabetikers und des chronisch Leberkranken.

Not only does the psychological pressure of suffering from a chronic and in most cases incurable disease have a major impact on the patient's mind; it has also to be assumed that it is rather the mental predisposition which contributes to the manifestation of an organic disease and its becoming chronic. Studies of insulin-depending diabetics have shown that with two thirds of the patients there had been a mental conflict which they were unable to cope with prior to the manifestation proper of this metabolic disorder. With type-II diabetics it is an unsurmounted feeling of anxiety and guilt which makes patients break off their interhuman relations and leads, in most cases, to obesity and, eventually, to the manifestation of the disease. Adolescent diabetics who accept the disease as part of their lives once they have overcome their initial feelings of inferiority and recovered a certain mental equilibrium, develop an optimistic and predominantly life-affirming character and tend to restore the self-confidence they had lost. The situation is different with type-II diabetics who, even if the disease has been completely integrated into their lives, will show a basically depressive mood with a distinct lack of open-mindedness and self-criticism. Patients who suffer from a chronic hepatic disease can be characterised by a pronounced hypochondriac and anxious mood which is apparent even before the outbreak of an acute hepatocellular disorder or, at least, before this disease becomes chronic. From the psychological point of view, these persons reveal a marked depressive personality with a neurotic element in it which shows in the course of the disease and even after it has been cured or stopped. As a result, these patients often retire prematurely from their jobs. On the other hand, diabetics will not give up their professional activities unless they are forced to do so because of organic complications or delayed diabetic effects.

[Pollution of drinking water by tetrachloroethylene]. / Trinkwasserverunreinigung durch Tetrachlorethylen.

At the end of the year 1983 and at the beginning of 1984, groundwater contamination with tetrachloroethylene was discovered south of Graz. Many wells showed an elevated concentration of tetrachloroethylene. 1210 persons living in this area were examined. As tetrachloroethylene may cause liver damage, screening tests were carried out in order to detect pathological liver function tests (LFT), such as gamma-GT elevation. In most cases, initially elevated LFT could be attributed to alcohol abuse. After thorough medical examinations, two cases remained unclear; later on, however, the initially elevated LFT could no longer be detected. This is a certain indication that there was some type of stress on the liver shortly before the blood sample was taken. In all other cases of liver disease, the causes could be determined. The pollution of drinking water was not the cause of pathological LFT. Nevertheless, the inhabitants of this region will receive drinking water from the public water supply for safety reasons. However, one thing that needs to be stated very clearly is that these findings which fortunately show no detrimental effect due to the pollution of drinking water, do not allow any conclusions concerning the possibility of injury to health, i.e. they do not preclude possible impairment of health as a consequence of prolonged consumption of the polluted drinking water.

[Experience in dietary counseling of diabetics with a new multifunctional learning aid]. / Erfahrungen bei der Diätberatung von Diabetikern mittels eines neuen multifunktionellen Lehrmittelbehelfes.

The improvement of the effectivity of dietary lessons was investigated in a heterogenous diabetic patient material by using a newly developed multifunctional dietary learning-aid. There was a significantly improved dietary knowledge with respect to the quantitation of both carbohydrates and fat after a single lesson. Furthermore, the results justify the application of the dietary aid in elderly patients and in cases of long duration of the diabetes mellitus.

[Comparative studies between median blood sugar, hemoglobin A, triglycerides and C-peptide in normal-weight insulin and non-insulin dependent diabetics]. / Vergleichende Untersuchungen zwischen mitttlerem Blutzucker, Hämoglobin A1, Triglyzeriden und C-Peptid bei normalgewichtigen insulin- und nichtinsulinpflichtigen Diabetikern.

In our study the glycosylated haemoglobin was positively correlated with the mean bloodglucose concentration and the levels of serum triglycerides and proved to be a valuable parameter, which completes the hitherto existing possibilities of diabetes control. The difference of the levels of serum triglycerides and C-peptide between non-insulin-dependent and insulin-dependent diabetics, with the same quality of the levels of HbA 1 and mean bloodglucose, give us a help to decide, which therapeutic way would be the best in the introduction respectively correction of the treatment of the elderly diabetic patients.