[Imported Anopheles: in the luggage or from the airplane? A case of severe autochthonous malaria tropica near an airport]. / Importierte Anopheles: im Gepäck oder aus dem Flugzeug? Ein Fall von schwerer autochthoner Malaria tropica in Flughafennähe.

HISTORY AND ADMISSION FINDINGS: A 67-year-old woman was admitted with pyrexia of unknown cause preceded by transitory peripheral pareses. She had not been to any malaria-infested regions. Within 4 days a "sepsis syndrome" developed with acute respiratory and renal failure. INVESTIGATIONS: Initially there were no pointers to organ involvement, either clinically or by ultrasound, in the electrocardiogram, radiographically or by computed tomography. Haematological and other laboratory tests indicated a bacterial infection. But 6 days after starting intensive treatment a blood smear revealed Plasmodium falciparum. TREATMENT AND COURSE: Administration of mefloquine and quinine quickly reduced the parasite count (from 10% to 1%), no parasite being found in the blood smear on the 5th day. But severe complications developed: perforation of a duodenal ulcer, exudative pancreatitis, cholangitis, diffuse bleeding into the large intestine and a chronic capillary leakage syndrome. But the patient was finally cured and discharged to a convalescent home after 160 days in hospital, 135 of them in intensive care. CONCLUSION: The source of the malaria could not be identified. "Baggage malaria" is more likely than the bite of a mosquito expelled from the "plane's undercarriage" well as it approached Frankfurt airport (the patient lived under one of the approach sectors, 30 km from the airport). As there are no screening procedures, imported malaria should be thought of in case of fever of unknown cause without history of foreign travel; a blood smear should be done.

[Autologous hemotherapy in heart transplantation: a case report]. / Autologe Hämotherpie bei Herztransplantation: Ein Fallbericht.

The use of autologous blood in patients with organ transplantations is feasible only when the blood is stored in the frozen state, since the timing of the operation is not predictable. A 53 year-old patient with dilatative cardiomyopathy was selected for transplantation. By preoperative donation, four erythrocyte concentrates were prepared and frozen by high-glycerol low-temperature technique. The frozen blood was thawed, manually washed and made available for transfusion as required. The increment of hemoglobin after transfusion was 0.9 g/dl per unit. Quality control of the prepared erythrocyte concentrates was performed: Resistance to osmotic fragility of the erythrocytes was in the normal range, beginning hemolysis was found at 0.40 +/- 0.02% NaCl, complete hemolysis was found at 0.30 +/- 0.02% NaCl. The osmolarity of the supernatant fluid of the final washing was 0.314 +/- 0.116 mosmol/l. This case report stresses the feasibility to prepare and store autologous blood even if the time when the blood is needed cannot be determined.

Tissue fibrinolytic activity in different types of varicose veins.

The fibrinolytic activity of the venous wall was investigated by using Todd's technique in 92 patients with different types of varicosis. A control group consisted of 19 patients with apparently normal superficial veins who had had a saphenectomy prior to an aortocoronary bypass operation. Fibrinolytic activity was mainly localized in the adventitia of varicose and normal veins. It significantly decreased in the distal regions of all types of varicosis. The highest fibrinolytic activity was detected in the proximal part of the varicose vena saphena magna and the lowest values were observed in the perforating and side branch veins of the calf. Fibrinolytic activity is higher (p less than 0.077) in the normal vena saphena magna than in the varicose vena saphena of the calf. Older patients show a loss of fibrinolytic activity in their vena saphena magna. Obese patients have less fibrinolytic activity in varicose calf veins than patients with normal weight do.