[Carnitine deficiency myopathy (author's transl)]. / Carnitin-Mangel-Myopathie. Episodische belastungsabhängige Myalgien und Schwäche.

Carnitine is a carrier for the transport of long-chain fatty acids from the cytoplasmic to the mitochondrial space. So far 18 cases of carnitine deficiency myopathy have been recognized, generally occurring as progressive or relapsing myopathy. In contrast episodic exercise-induced myalgia and paresis was found in a 46-year-old patient with carnitine deficiency myopathy which was quickly reversible at rest. As a consequence of this observation carnitine deficiency myopathy must be added to the differential diagnosis of the McArdle syndrome (muscular phosphorylase deficiency) and other "exercise myopathies".

[Drug induced agranulocytosis. Improved prognosis due to better supportive care]. / Medikamentöse Agranulozytose. Verbesserte Prognose dank besserer "supportive care"?

A retrospective study of 61 episodes of agranulocytosis observed in 56 patients between 1958 and 1977 is reported. The diagnosis was based on peripheral granulocyte counts below 500/mm3 and further documented by bone marrow analysis. The aim of this study was to determine whether the new guidelines for supportive care introduced in January 1973 led to an improvement in overall prognosis in this disease. Therefore, the patients were divided into two groups: the first group included 39 episodes of agranulocytosis observed between 1958-1972 and the second group 22 episodes observed between 1973-1977. Standard supportive care administered in the latter group included reverse isolation (hand-disinfection and gown-change before patient contact, conventional hospital single room), the immediate initiation of an appropriate combination of antibiotics in infectious states and additional granulocyte transfusions in selected cases. The two groups compared were similar as to the extent of neutropenia and the frequency of severe infectious complications. On the other hand, patients of the first group showed more advanced recovery of myelopoiesis as compared to the second group at the time of hospital admission. Death due to infection was observed in 36% of episodes in the first group, but only in 9% in the second group. The supportive care introduced in 1973 thus appears to improve the prognosis of agranulocytosis to a substantial extent.

[Chlamydia peritonitis: a disease of young females]. / Die Chlamydienperitonitis: eine Erkrankung junger Frauen.

Serological evidence of recent infection with Chlamydia trachomatis was found in 9 of 11 young women with acute peritonitis or perihepatitis proved by laparoscopy. High antibody titres to chlamydiae without laboratory evidence of gonococcal infection were present in 5 of these 9 patients, while the other 4 had evidence of simultaneous gonococcal infection. C. trachomatis may play an important part in peritoneal inflammation previously attributed only to gonococci.

Ruptured pancreatic pseudocysts: diagnosis by endoscopy. Report of 3 cases.

Report on 3 cases of spontaneous perforation of a pancreatic pseudocyst into the stomach; presenting symptom was in each case an acute upper GI-bleeding. The pseudocyst was endoscopically seen as a well delineated, hemorrhagic protrusion into the stomach. After full perforation the spontaneous ostium had the appearance of a surgical anastomosis. High amylase concentration in the aspirate ave further diagnostic evidence. All 3 patients survived, 2 of them without surgery.

[Acute kidney failure as a complication of fasting therapy]. / Akutes Nierenversagen als Komplikation von Fastenkuren.

Acute urate nephropathy during starvation for weight reduction has been observed in 2 patients. Under these conditions ketoacidosis causes impaired renal uric acid excretion and hyperuricemia. Uricosuric agents or sudden intake of normal calorie diet induces massive uricosuria and kidney damage. Uricosuric agents should be avoided and steps taken to promote abundant diuresis, while allopurinol should be prescribed.

The Mallory-Weiss-syndrome: a clinical study of 20 cases.

This is an account of 20 cases of MWS, representing 8% of a series of 247 consecutive upper GI-bleedings. Men above 40 years and persons with severe concomitant disease are specially at risk. The prognosis is rather good, mortality from bleeding being 10%. Surgery should not be undertaken unless all conservative measures, including vasopressin infusion and even Sengstaken-Blakemore tube have been applied. The typical history, a hiatal hernia and alcohol intake are frequently missing. Neither studies of gastric acid secretion nor esophageal manometry disclosed new pathogenic aspects.