[Aorto-enteric fistula: an interdisciplinary practical approach]. / Ein praktischer Ansatz zur interdisziplinären Therapie der aorto-enteralen Fistel.

Aorto-enteric fistulas (AEF) are a rare but often -fatal complication. The primary diagnosis of AEF remains difficult. Computed tomography and FDG-PET / CT (fluorodeoxyglucose positron emission computed tomography) are the diagnostic tools of choice. Therapy consists of an urgent individual interdisciplinary surgical approach with primary axillo-femoral bypass and secondary prosthesis explantation or in situ replacement and consecutive bowel resection. Endovascular aortic repair (EVAR) is reserved for primary -aorto-enteric fistulas in patients without signs of infection or in emergency cases as a bridging meth-od. A systematic review of the literature from 1990 to 2009 was performed by medline -research (pubmed) to analyse diagnostic and treatment strategies for aorto-enteric fistulas. A practical, interdisciplinary diagnostic and therapeutic algorithm was created in accordance with the analysed results.

Optimizing BM harvesting from normal adult donors.

The experience at a single institution of BM harvesting (BMH) in general anesthetic for allogeneic transplantation from 49 healthy adult donors since March 2002 is presented in detail, together with an analysis of all the donor complications. In this study, we analyzed the advantages through the change from an aspiration needle with one hole (group A, n=18) to a system with additional five side holes (group B, n=31) in April 2005 for faster aspiration of large volumes of BM. In group B, the operation time was reduced by 50%, which is 12 min to date (1006 ml BM). Furthermore, the collection rate (volume BM/time) was significantly increased, namely to 81.9 ml/min in group B. The yields of total nucleated cells and CD34+ cells are nearly identical and adequate in both systems. The proportion of donors treated as day cases--that is, able to be discharged on the same day as the procedure--was 56% in group A and 81% in group B. There was no significant operative site morbidity. BMH accomplished by trained personal is a safe procedure for healthy adult donors on an outpatient basis as standard in our collection center.

Long-term effects of azathioprine in rheumatoid arthritis.

Efficacy and safety of azathioprine in 'high' and 'low' dose regimens in rheumatoid arthritis (RA), both in short-term studies and in follow-up over 40 months, have previously been shown. In the present report, 36 patients with RA treated with azathioprine (group I) and 49 age-matched patients with RA (group II), were studied to detect potential early markers of malignancy. Chest x-rays were similar to both groups. One patient in group I had a positive PAP smear and was subsequently found to have uterine carcinoma. Alpha-fetoprotein was positive in one patient in group I and none in group II. CEA was negative in all patients in group I, but positive in seven in group II. On chromosomal analysis group I showed a greater frequency of breakage. Group I showed lower serum folates and a highly significant number of megaloblastic features in marrow aspirates. In group I seven tumours, three being malignant, occurred while taking azathioprine, and in group II six tumours, one malignant, were identified (p = 0.17). The apparent increased risk of malignancy previously suggested by others warrants further studies with larger populations and over a continuous longer period.

Growth of Cryptococcus neoformans on uric acid agar.

Effect of certain low molecular nitrogen substances, namely uric acid, eura and creatinine as sole source of nitrogen was studied on 31 strains of Cryptococcus neoformans as well as on a rough looking isolate recovered from the brain of a mouse inoculated with a mucoid strain of C. neoformans. Uric acid as a nitrogen source caused striking alterations in the morphology of C. neoformans. In view of the facts that uric acid is a common end-product of human and animal metabolism, it is abundantly present in the avian faecal matter and is capable of inducing mucoid growth and capsule formation in dry growing non-encapsulated strains or in an otherwise rough looking hypha forming isolate, its role in studying the phylogenesis of C. neoformans and its pathogenicity seems to be an important proposition.