Combined stool-based multiplex PCR and microscopy for enhanced pathogen detection in patients with persistent diarrhoea and asymptomatic controls from Côte d'Ivoire.

Infectious diarrhoea ranks among the leading causes of morbidity worldwide. Although most acute diarrhoeal episodes are self-limiting, the diagnosis and treatment of persistent diarrhoea (≥2 weeks) are cumbersome and require laboratory identification of the causative pathogen. Stool-based PCR assays have greatly improved the previously disappointing pathogen detection rates in high-income countries, but there is a paucity of quality data from tropical settings. We performed a case-control study to elucidate the spectrum of intestinal pathogens in patients with persistent diarrhoea and asymptomatic controls in southern Côte d'Ivoire. Stool samples from 68 patients and 68 controls were obtained and subjected to molecular multiplex testing with the Luminex(®) Gastrointestinal Pathogen Panel (GPP), microscopy and rapid antigen detection tests for the diagnosis of diarrhoeagenic pathogens. Overall, 20 different bacteria, parasites and viruses were detected by the suite of diagnostic methods employed. At least one pathogen was observed in 84% of the participants, and co-infections were observed in >50% of the participants. Enterotoxigenic Escherichia coli (32%), Giardia intestinalis (29%) and Shigella species (20%) were the predominant pathogens, and Strongyloides stercoralis (10%) was the most prevalent helminth. Pathogen frequencies and numbers of co-infections were similar in patients and controls. Although the Luminex(®) GPP detects a broad range of pathogens, microscopy for helminths and intestinal protozoa remains necessary to cover the full aetiological spectrum in tropical settings. We conclude that highly sensitive multiplex PCR assays constitute a useful screening tool, but that positive results might need to be confirmed by independent methods to discriminate active infection from asymptomatic faecal shedding of nucleic acids.

[Fine needle puncture of the prostate: results and complications]. / Geinnadelpunktion der Prostate: Resultate und Komplikationen.

The transrectal aspiration biopsy of the prostate is a very accurate method in the diagnostic of prostatic diseases. Results and complications of more than 1200 cases are reported and discussed.

Consequences to the upper urinary tract after ureteric torsion.

The effects of ureteric torsion on the upper urinary tract were studied in 8 pigs. With 5 pigs the distal ureter was mobilised, torted 1 to 5 times and reimplanted into the bladder. With three pigs the proximal ureter was torted 1 to 3 times and re-anastomosed to the renal pelvis. It was shown that a torsion of 1 or 2 times in the distal ureter does not result in ureteral obstruction. However, as little as 360 degrees torsion in the proximal ureter may lead to dysfunction secondary to mechanical obstruction. Histological examination of the ureter showed ischaemic changes only after multiple torsions.

[The accuracy of lymphography in patients with malignant testicular tumours (author's transl)]. / Die diagnostische Zuverlässigkeit der Lymphographie bei Patienten mit malignen Hodentumoren

In 33 patients with malignant teratoid testicular tumours, the retro-peritoneal lymph nodes were surgically removed after lymphograms had been carried out. Histological examination of the lymph nodes showed retroperitoneal metastases in 42% (14 out of 33). In 25 of the 33 patients, there was agreement between lymphography and histology; diagnostic accuracy of lymphography was about 76%. In the presence of positive findings, accuracy was 87%.5%, for negative findings it was 72%. The more frequent false negative findings are due to anatomically determined failure of contrast filling of aortic lymph nodes; the less common false positive findings are produced by involution of lymph nodes.