Therapy of aseptic nonunions with parathyroid hormone.

The absence of osseous consolidation of a fracture for 9 or more months with no potential to heal is defined as nonunion. Both for the patient and from a socioeconomic point of view, nonunions represent a major problem. Hypertrophic, vital nonunions are distinguished from atrophic avital ones. Risk factors for a delayed fracture healing are insufficient immobilisation, poor adaptation of the fracture surfaces or residual instability, interposition of soft tissue within the fracture gap, as well as circulation disturbances and infections. The incidence of nonunions after fractures of the long bones lies between 2.6 and 16% depending on the surgical technique used. In human and animal studies, a positive effect of parathyroid hormone (PTH) on fracture healing has been shown. PTH has a direct stimulatory effect on osteoblasts and osteoclasts. In addition, it appears to influence the effect of osseous growth factors. In this prospective study, 32 patients with nonunions were treated with teriparatide to investigate the effects of PTH on fracture healing. Definitive healing of the nonunions following PTH treatment could be observed in 95% of the cases.

[Autochthonous hepatitis E-virus infection as cause of acute hepatitis in Germany - a case report]. / Autochthone Hepatitis-E-Virus-Infektion als Ursache der akuten Hepatitis in Deutschland - eine Kasuistik.

There is an increasing body of evidence that hepatitis E virus (HEV) triggers acute hepatitis not only in tropical and subtropical regions of Asia, Africa, and America with low sanitary standards but also in highly industrialized countries. We here report on two patients from Thuringia (Germany) with a HEV infection without a recent stay abroad. All other common causes of hepatitis were excluded. Transaminases were significantly increased in both cases, while icterus could be proven in one patient, only. Both patients fully recovered in the long-term course. Epidemiological and phylogenetic data from viral analyses suggest that HEV infection has to be considered as a zoonosis. It is likely that viral transmission from animals to humans occurs through insufficiently cooked meat or entrails, e. g., from pigs or wild animals. In summary, HEV infection is a relevant differential diagnosis in acute non-A/B/C viral hepatitis. Further studies are required for the identification of other transmission pathways, pathogen reservoirs as well as novel concepts for prophylaxis, especially for patients at risk for hepatic diseases.

Accreditation of post-basic nephrology courses within the EDTNA/ERCA.

This paper will outline the development of the EDTNA/ERCA accreditation programme for post-basic courses in nephrology. It will discuss results of the pilot project and relate the experiences of one school that has successfully gone through the accreditation process. The article will conclude with a discussion on more recent developments and evaluate the project in light of the original concepts.

Preparation of genomic DNA from plant tissue.

This unit describes two methods for preparing genomic DNA from plant tissue. In the first method, plant cells are lysed with ionic detergent, treated with protease, and subsequently purified by cesium chloride (CsCl) density gradient centrifugation. The second method is based upon a series of treatments with the nonionic detergent cetyltrimethylammonium bromide (CTAB) to lyse cells and purify nucleic acid. Nucleic acid is recovered from the final CTAB solution by isopropanol or ethanol precipitation. The first method, although somewhat more lengthy, results in highly purified nucleic acid. The second method requires fewer manipulations, results in very high yields (approximately 10-fold higher per gram fresh tissue depending on species and condition of starting material), and produces DNA that is less pure but nonetheless suitable in quality for use in many molecular biology manipulations.

[Von Recklinghausen type I neurofibromatosis and neuroendocrine tumor (somatostatinoma) in a 50-year-old woman]. / Neurofibromatose von Recklinghausen Typ I und neuroendokriner Tumor (Somatostatinom) bei einer 50jährigen Frau.

HISTORY AND CLINICAL FINDINGS: A 50-year-old woman has had diffuse abdominal symptoms for approximately 2 weeks. For 30 years a von Recklinghausen's neurofibromatosis has been known. INVESTIGATIONS: Clinically and chemically there was a cholestasis (alkaline phosphatase 244 U/l, gamma GT 83 U/l) with uneventful values for transaminases and bilirubin. The hepatitis serology (A, B, C) as well as the AMA were negative. Somatostatin with 73 ng/l was slightly increased. Ultrasonography revealed a low-grade intrahepatic cholestasis, the ductus pancreaticus was extended to 9 mm, while endoscopic retrograde cholangiopancreatography showed an extended pancreatic duct without inflamed changes as well as an extended intra- and extrahepatic gall duct system without detecting a stone. The oesophagogastroduodenoscopy showed a polypoid tumor 3 cm above the Papilla Vateri which is part of a neuroendocrine tumor of the carcinoid type, immunoreactive towards somatostatin. TREATMENT AND COURSE: In the framework of the surgical intervention carried out by extirpation of the polypoid tumor above the Papilla Vateri by segment excision with a duodeno-duodenostomy. Within a period of 15 months, the patient was free from a tumor relapse or metastasis. CONCLUSION: Carcinoid tumors should always be considered in patients who have von Recklinghausen's neurofibromatosis in combination with abdominal pain in the duodenal area, especially if cholestasis parameters and bilirubin are high or if gastrointestinal bleeding occurs.

[Prognostic criteria for initial success in PTA and catheter thrombolysis]. / Prognostische Kriterien für die initiale Erfolgsrate bei PTA und Katheterthrombolyse.

The preliminary results of 1063 percutaneous dilatations (PTA) of iliac or femoropopliteal arteries were evaluated in order to establish pre-existing clinical or morphological criteria with possible influence on the early success rate. Early failure was defined as the impossibility to eliminate the arterial occlusion or re-occlusion within 48 hours. Regarding the clinical criteria the combination of long duration and advanced stage of the disease unfavourably influenced the primary success rate (failure rate of 40%). Morphological factors such as length of occlusion over 10 cm, poor run-off or existence of large arterio-venous shunts had an even worse influence on the early success rate (failure rate of 50-60%).

The value of specific antibody detection and culture in the diagnosis of reactive arthritis.

Joint inflammation, predominantly of the lower limbs, occurring some weeks after urogenital or gastrointestinal infection is classified as reactive arthritis (ReA) but there is no general agreement on diagnostic criteria, especially if the preceding infections are asymptomatic. The same is true for Lyme disease (LD) which is caused by Borrelia burgdorferi (BB). Determination of antibody titre or culture of urethral swabs and stools are often used as diagnostic tools. We examined 4 groups of patients: one with undifferentiated arthritis (Group I, n = 55), one with well-defined rheumatic diseases other than ReA (n = 43, Group II), one group without joint disease (n = 50, Group III) and one with ReA or LD (n = 7). Specific antibacterial antibody titres in serum were measured in all patients; stool and urethral cultures were performed in all groups except the last. A calculation of positive predictive value (PPV) was done for each test. Evidence of present or previous infection with the microbes Chlamydia trachomatis (CT), Mycoplasma urethritidis (MU), Yersinia enterocolitica (YE) and BB were found in all groups. In Group I, Group II and Group III respectively, positive serological results were found for CT IgA (20%, 31%, 16%) and IgG (49%, 51%, 34%), YE (7%, 6%, 0%) and BB (17%, 2%, 10%). Positive cultures were found in Group I and Group II respectively for CT (28%, 29%) and MU (14%, 17%). Therefore no test had a significant positive predictive value for ReA in the general population and even in the rheumatology clinic the PPV for most tests was low. We conclude that these methods are of little value in the diagnosis of reactive arthritis when the preceding infection is asymptomatic.