[Probiotic therapy of pseudomembranous colitis. Combination of intestinal lavage and oral administration of Escherichia coli]. / Probiotische Therapie einer pseudomembranösen Kolitis. Kombination aus intestinaler Lavage und oraler Gabe von Escherichia coli.

HISTORY AND FINDINGS: An 82-year-old woman was admitted because of acute left heart failure with pulmonary oedema. There was a right basal pneumonia with congestion which was treated with amoxycillin and clavulanic acid. Severe watery diarrhoea with more than 10 stools daily occurred. Clostridium difficile was not isolated. INVESTIGATIONS: Coloscopy as far as the right flexure revealed proximally increasing whitish coatings, like those in severe pseudomembranous colitis (PMC), revealed as acute erosive colitis histologically. The plate-like incomplete erosions contained fibrin and granulocyte deposits so typical of PMC. Clostridium difficile could again not be demonstrated. TREATMENT AND COURSE: As intestinal lavage, already undertaken in preparation of the coloscopy, markedly improved the symptoms it was repeated for therapeutic purposes. This brought about further improvement and a fall in granulocyte count from 29,500 G/l to 10,700 G/l. Subsequently live E. coli bacteria (nissle 1917 strain) were administered. After 5 days stool frequency had fallen to one or two daily, each soft or partly formed. Stools were normal after a further week. Coloscopy 3 weeks after onset of treatment showed almost complete healing of the PMC. CONCLUSION: The successful treatment of PMC with intestinal lavage and physiological E. coli administration agrees with the results of animal experiments and clinical experience. Whether it is an effective alternative to primary standard treatment with vancomycin or metronidazole remains to be tested by further experience, preferably properly controlled therapeutic trials.

Dysembryoplastic neuroepithelial tumour of the cerebellum.

A case of dysembryoplastic neuroepithelial tumour of the cerebellum occurring in a 28-year-old woman is presented. The lesion extended from the cortex of the inferior vermis upwards into the white matter. Histologically, it exhibited areas of microcystic cerebellar astrocytoma and glial regions with hamartomatous blood vessels as well as areas with oligodendrocyte-like cells (OLC) with a delicate, fibrillary stroma lying in a mucinous, often microcystic matrix. The OLC showed prominent rosette formation and immunohistochemical features suggesting neuronal, i.e. granule cell, differentiation.