[Acute gastrointestinal bleeding caused by distinct small intestinal diverticulosis]. / Akute Gastrointestinalblutung bei ausgeprägter Dünndarmdivertikulose.

HISTORY AND CLINICAL FINDINGS: A 58-year-old man was admitted to our hospital after an acute onset of rectal bleeding. He was known to have had recurrent duodenal ulcerative disease, once with upper gastrointestinal haemorrhage. Clinical examination was remarkable only for rectal bleeding. INVESTIGATIONS: After application of a nasogastric tube cherry-red blood was evacuated. Upper endoscopy showed only very small mucosal erosion in the stomach and coloscopy demonstrated several non-bleeding diverticula. Small bowel enteroclysis showed severe diverticulosis of the duodenum and jejunum. DIAGNOSIS, TREATMENT AND COURSE: We assumed that the extensive duodenojejunal diverticulosis was the most probable cause of this episode of gastrointestinal bleeding because of simultaneous signs of upper and lower gastrointestinal haemorrhage. Because this was the first such episode we preferred a conservative approach. At nineteen months follow-up there was no recurrence of bleeding. CONCLUSION: Gastrointestinal hemorrhage is a common cause of hospitalization. After exclusion of the more common bleeding sources small bowel diverticula should be considered as a possible rare cause. Surgical resection of the bleeding bowel part is the procedure of choice, but one of the major problems in such cases is to locate exactly the bleeding site. If the location is uncertain, a more conservative approach may be preferable, especially in haemodynamically stable patients with first-time diverticular bleeding.

Pyridinium cross-links in multiple myeloma: correlation with clinical parameters and use for monitoring of intravenous clodronate therapy--a pilot study of the German Myeloma Treatment Group (GMTG).

The relevance of quantitative determinations of urinary deoxypyridinolines (DPY) and pyridinolines (PY), and of serum type I collagen carboxyterminal cross-linked telopeptides (ICTP), has been evaluated for patient monitoring in multiple myeloma (MM). In 178 untreated MM patients, a clear correlation was found between ICTP concentrations, bone destructions and serum calcium levels. Furthermore, serum ICTP, urinary DPY and PY concentrations were estimated before and during treatment in a further 33 MM patients randomly allocated to four groups receiving intravenous melphalan/prednisone (MivP) chemotherapy alone, or MivP in combination with three different doses of i.v. clodronate. 1800 mg of i.v. clodronate combined monthly with MivP induced a rapid and sustained reduction in bone resorption parameters to the normal range, a result not obtained with either MivP alone, or with a lower clodronate dose. While confirming the relevance of determining pyridinium cross-links for estimating bone resorption in MM, our data indicate that measurements of these parameters could be useful for dose finding and monitoring of bisphosphonate therapy.

[Plasma levels of rifampicin and isoniazid and serum levels of aminotransferases in combined tuberculostatic treatment (author's transl)]. / Rifampicin und Isoniazid-Plasmaspiegel sowie Aminotransferasen im Serum bei tuberkulostatischer Kombinatsionstherapie.

During treatment of active pulmonary tuberculosis with isoniazid, rifampicin and ethambutol in 15 patients transaminase activity increased in seven to levels of 60-340 U/l (group I). In the other eight the laboratory values remained within normal limits (group II). Rifampicin levels in group I were significantly raised at 2 and 5 hours after administration of 10 mg/kg body weight on proven fasting. There was no significant difference between the two groups for isoniazid. Estimated half-life of rifampicin was significantly longer in the first than the second group. If there is evidence of chronic liver disease (by history or by chemical tests) the rifampicin dose should be decreased to less than 10 mg/kg body weight.

[HB's-antigen and anti-HBs in hospital staff (author's transl)]. / HBs-Antigen und Anti-HBs bei Krankenhauspersonal.

In 826 employees from six hospitals and three theoretical clinical institutes of Düsseldorf University HBs-antigen and anti-HBs were determined. HBs-antigen was not significantly more frequent than in a control group. On the other hand anti-HBs was much more common in hospital staff. In probands with histories of liver disease and blood transfusions there was a significantly higher incidence of anti-HBs. Different occupations within the hospitals showed different anti-HBs frequencies.

[The effectiveness of antibiotic treatment for Salmonella enteritis and Salmonella excretors]. / Die Bedeutung der antibiotischen Therapie bei der Salmonellen-Enteritis und bei Salmonellen-Ausscheidern.

The role of antibiotic treatment was evaluated in 190 hospitalized patients with Salmonella enteritis and 80 with asymptomatic Salmonella infection (without typhoid or paratyphoid). The results indicate that antibiotic treatment does not shorten the duration of excretion (compared with non-treated patients). Because of the danger of prolonged bacterial excretion under antibiotic treatment in complication-free Salmonella enteritis as well as the possible development of resistant Salmonella strains, antibiotic treatment of Salmonella infections (other than typhoid or paratyphoid) should be limited to systemic forms. Treatment of complication-free Salmonella enteritis and Salmonella excretors should be limited to intestine-cleansing measures.

[Tuberculosis of peripheral lymph nodes (author's transl)]. / Zur peripheren Lymphknotentuberkulose

The diagnosis and therapy of tuberculosis involving peripheral lymph nodes is discussed in a series of thirthy patients. Diagnosis is best made by both bacteriological and histologic study. Therapy is best effected by combining medical tuberculostatics with operative intervention. Epithelioid cell or proliferative forms of lymph node tuberculosis best respond to medical management.