[Clostridium difficile and antibiotic-associated colitis in risk patients: 2-month epidemiologic study in an intensive care unit]. / Clostridium difficile und Antibiotika-assoziierte Colitis bei Risikopatienten: Zweimonatige epidemiologische Studie auf einer Intensiveinheit.

A toxin produced by Clostridium difficile has been implicated in the pathogenesis of antibiotic-associated colitis. It is not known how often the microorganism is encountered in Germany particularly in high risk patients. Therefore, following a lethal case of colitis, stool samples of 90 patients and 30 staff members of an intensive care unit were screened routinely for C. difficile over 2 months. The organism was found in 6 of 41 patients treated with antibiotics (14.6%); four of them apparently acquired C. difficile while in hospital whereas in 2 a pre-existing carrier state could not be excluded. Colitis developed in 3 of the 6 patients as judged from endoscopy or a positive cytotoxin assay; in 2 patients (not subjected to endoscopy) colitis was suspected on clinical grounds, and 1 patient became an asymptomatic carrier. C. difficile was not found in 49 patients without antibiotic medication, in the health personal and in 12 patients of a general ward. Patients harbouring C. difficile were clustered in certain bed sites of the unit. Environmental studies recovered the microorganism from bed pan washing machines of bedridden and from toilets of ambulant patients but not from other sites like the hands of the personal. These results suggest that chronic carriers of C. difficile, as far as they are identified by current bacteriological methods, are rare in Germany (not more than 2 out of 132 persons investigated, i.e. 1.5%). The frequent finding of C. difficile in patients treated in certain bed sites supports the view that the infection may be acquired from exogenous sources. Antibiotic-associated colitis should be considered more often when intensive care patients are treated with antibiotics.

Case report and study of collagen metabolism in Marfan's syndrome.

The case report on a 33 year old woman with prominent features of Marfan's syndrome is presented. Characteristic signs were seen in the bones, the eyes, the cardiovascular system, and the lungs. Due to regurgitation of both the aortic and mitral valves and an aneurysm of the ascending aorta a double valve replacement was made, including a prosthesis of the aorta. The problems of early diagnosis and therapy of the life-threatening cardiovascular complications are discussed. Tissue specimens from the aorta were analysed histochemically and biochemically. Histology showed a typical necrosis of the media with cyst formation. Biochemical analysis by in vitro labeling of collagen in tissue explants and by electron microscopical evaluation showed proportions of type I and type III collagen which were significantly different from controls. In both the media and the adventitia the amount of type I collagen was drastically reduced as shown by quantitation of collagen and procollagen. Fibroblasts derived from the skin of the patient showed a normal content of type I and type III collagen. It is conceivable that the reduced content of type I collagen in the aortic wall is responsible for the weakness of the vessel wall causing formation of aneurysm and its sequelae.

[The insulin test]. / Insulintest.

Since its introduction through Hollander 30 years ago the interpretation of the value of the insulin test following vagotomy have been discussed. For the individual patient no correlation between the incidence of ulcer recurrence and the result of the insulin test has been found. In addition, the risk of hypoglycemia seems to be too high for diagnostic purposes. Therefore, to evaluate the outcome after vagotomy basal acid output, pentagastrin stimulated acid secretion and endoscopy are emphasized as reliable methods.

[Measurement of the conduction time within the fascicles of the His-Purkinje-system using endocardial detection (author's transl)]. / Messung der Leitungszeit in den Faszikeln des His-Purkinje-Systems mittels endokardialer Detektion.

The conduction time in the 3 fascicles of the His-Purkinje system can be measured by recording the local excitation in the peripheral His-Purkinje system of the right bundle and the anterior and posterior fascicle of the left bundle, in combination with His-bundle recordings. This technique allows a detailed study of the subjunctional conduction and gives information on the conduction pathways in ventricular arrhythmias.