[Pathological diagnosis--costs and benefit]. / Die pathologische Diagnostik--Kosten und Nutzen.

The autopsy rate in Germany has drastically diminished in the last decades and is below 10% nowadays. Possible reasons for this development are discussed. Pressure of cost is a quoted cause, although it is not so high. There is a large discrepancy between the clinically supposed cause of death and the by autopsy confirmed diagnosis (40-60%). This especially applies to mycoses. Every year in Germany 1200 crimes of causing death and 11.000 non-natural deaths are not found because of missing autopsy. Another important aspect for a sufficient number of autopsies is their value for the quality assurance in diagnosis and therapy and also in education and further training of physicians and students.

[What distinctions do Candida biofilms have to offer?]. / Was bieten Candida-Biofilme Besonderes?

In a miniature continuous flow cell system we investigated the influence of voriconazole (VCZ) (27 trials) or anidulafungin (ANID) (five trials) on the antimycotic resistance of C. albicans (type strain SC5314 and three strains from blood cultures). The duration of the trials was up to 10 d. After continuous addition of VCZ or ANID to the media, biomass decreased and glucose levels and pH values increased. After exposure to VCZ, the dry weight of biofilm dropped by 90%. There was no evidence of resistance. No resistance also developed against ANID after 1 day or 3 days of exposure. No viable cells were detected in the biofilm after 5 days of exposure to ANID. Therefore, VCZ and ANID effectively inhibited biofilm formation of different C.albicans strains. Our experiments show that biofilm production is not necessarily associated with development of resistance.

Effects of levels of cigarette smoke exposure on symptom-limited spiroergometry.

Previous investigations demonstrated reduced exposure to selected cigarette smoke constituents in adult smokers switching from conventional cigarettes (CC) to an electrically heated cigarette smoking system (EHCSS). This study investigated whether reduced exposure and no smoking (NS) would improve exercise performance. In a 3-period crossover study, 18 male adult smokers (age, 43.6+/-5.3 years) of CC were randomized to smoke CC (tar, 11 mg; nicotine, 0.8 mg; carbon monoxide, 11 mg), to use EHCSS (tar, 3 mg; nicotine, 0.2 mg; carbon monoxide, 0.4 mg [Federal Trade Commission method]), or to NS for 3 days before performing symptom-limited spiroergometry. NS and EHCSS vs CC resulted in less severe dyspnea (NS, 44.4% [P<.01 vs CC;] EHCSS, 50% [P=.03 vs CC;] CC, 88.9%), higher working capacity (NS, 2.92+/-0.4 W/kg [P=.06 vs CC;] ECHSS, 2.92+/-0.4 W/kg [P=.04 vs CC;] CC, 2.86+/-0.5 W/kg), higher peak oxygen uptake (NS, 2694+/-466 mL O(2)/min [P=.08 vs CC;] EHCSS, 2830+/-606 mL O(2)/min [P=.03 vs CC;] CC, 2682+/-492 mL O(2)/min), higher anaerobic threshold (NS, 1324+/-306 mL O(2)/min; EHCSS, 1396+/-312 mL O(2)/min [P=.03 vs CC;] CC, 1315+/-290 mL O(2)/min), and higher maximum rate-pressure product (NS, 30.1+/-2.7 x 10(3) mm Hg/min; EHCSS, 2.8 x 10(3) mm Hg/min [P<.01 vs CC;] CC, 30.7+/-29.2+/-3.6 x 10(3) mm Hg/min) indicating that reduced exposure from tobacco smoke and NS for 3 days may improve cardiovascular function as detected by symptom-limited spiroergometry.

Quantitative determination endogenous acid phosphatase activity in vaginal washings.

Vaginal washings obtained in 98 patients were analyzed for acid phosphatase activity. A history of recent sexual intercourse was also obtained. Acid phosphatase values of less than 50 IU (obtained by the alpha naphthol phosphate method) correlated with abstinence from sexual intercourse for more than 30 hours, whereas values greater than 50 IU correlated with sexual intercourse in a period up to and including 30 hours (P less than 0.05). The presence or absence of sperm was found to correlate poorly with the time since intercourse.

[Difficulties of fungus detection in corneal culture medium]. / Schwierigkeiten beim Pilznachweis in Hornhautkulturmedium.

UNLABELLED: It is not always possible to prevent the growth of microorganisms in organ culture for cornea preservation, despite many prophylactic measures. It is especially difficult to prove the presence of fungi in the cultural medium. MATERIALS AND METHODS: A culture medium was examined for sterility after 8 days' storage of cornea in organ culture. To prove the presence of fungi a culture of Sabouraud 2% glucose-agar was prepared and its growth examined by light microscopy. RESULTS: After 8 days of preservation we noticed a color change in the cultural medium and suspected contamination with fungi. Coagulase-negative Staphylococci could be cultivated from the conjunctival smear obtained before preparation of the cornea only. Routine screening of microbiological contamination did not show any results. We were able to identify an Aspergillus species only after preparing a special culture. The conjunctival smear as well as the cultural medium of the other eye of the same donor showed no contamination. CONCLUSIONS: In spite of the fact that microbiological contamination can be seen macroscopically, it is difficult to prove the presence of a specific microorganism and even more so when dealing with fungus. Especially in these cases the incubation of the cornea in media might have an advantage because contamination can be suspected by just looking at the medium. By excluding these preparations from transplantation we can possibly prevent infections, even when routine examinations show negative results.

[Fungi in the intestine--normal flora or pathogens?]. / Pilze im Darm--Normalflora oder Erreger?

Candida spp. und C. albicans are common within the microbial ecosystem of the human orointestinal tract. Candida in low quantities is found at various sites in healthy subjects. In patients with typical risk factors, mainly in immunocompromised hosts, an increased growth of Candida occurs. In cases with multiple sites colonised there will be an increased risk of severe Candida infections. The metabolic activity of Candida in the gut is very low under anaerobic condition and limitation of nutrients.

Mycological aspects of gastrointestinal microflora.

There are two aspects about the presence of Candida in the human orointestinal tract: (i) it is a part of normal human flora and (ii) it is a risk factor for immunocompromised patients. The orointestinal tract can be considered a reservoir for Candida species, several of which are from the oral cavity, stomach, duodenal juice and faeces. Their germ counts in normal small and large bowel do not exceed 10(4) cfu/ml resp.g. The input of Candida to a well-developed faecal flora system under continuous flow culture conditions did not lead to a multiplication of the yeast. The take in of faecal flora into a Candida continuous flow culture diminish Candida germ counts. If, however, the faecal flora was destroyed, e.g. by antibiotics, we found the yeasts multiplying, with the formation of germ tubes and mycelial structures. Colonization by Candida has to be seen as a starting-point of the development of subsequent candidosis in immunosuppressed or intensive care patients. The best protection against Candida colonization in the gut is the existence of a normal bacterial flora. Lactulose, which promotes the Gram-positive potential of faecal flora, may protect indirectly by supporting the indigenous flora.

["Never useful even for the most primitive accomplishments". Murder of handicapped and sick children 1939 to 1945 in the Ueckermünde district hospital]. / "Niemals auch nur zu den primitivsten Arbeitsleistungen zu gebrauchen". Die Tötung behinderter und kranker Kinder 1939 bis 1945 in der Landesheilanstalt Ueckermünde.

During the Nazi era "euthanasia" of the disabled and sick was introduced with the founding of the "Reich's Commission for the Scientific Assessment of Hereditary and Genetically Determined Serious Suffering" August 1939 on 18th. The task of this commission was to organize the killing of physically and mentally disabled children in so-called "Specialized Children's Departments". In the existing literature on the killing of sick children and adolescents, reports of the "official child-euthanasia", organized by the Reich's Commission, predominate. However, independently from the Reich's Commission, many children and adolescents were murdered in the programme of adult "euthanasia". This paper will focus on the latter neglected group of victims, taking the example of the psychiatric sanatorium "Ueckermünde". A large number of participants shared responsibility, during the time of National Socialism, for the murder of disabled and sick children. Various medical specialties such as paediatrics, genetics, gynaecology, administration, general practice, psychiatry and child and adolescent psychiatry were involved.

Evaluation of neutron sources for ISAGE-in-situ-NAA for a future lunar mission.

For a future Moon landing, a concept for an in-situ NAA involving age determination using the (40)Ar-(39)Ar method is developed. A neutron source (252)Cf is chosen for sample irradiation on the Moon. A special sample-in-source irradiation geometry is designed to provide a homogeneous distribution of neutron flux at the irradiation position. Using reflector, the neutron flux is likely to increase by almost 200%. Sample age of 1Ga could be determined. Elemental analysis using INAA is discussed.

The first description of an oesophageal candidosis by Bernhard von Langenbeck in 1839.

In November 1839 the young university lecturer Bernhard (von) Langenbeck (1810-1887) published the first description of a fungus as aetiological agent of an oro-pharyngeal and oesophageal candidosis. We present his in English translated paper entitled 'Finding of fungi on the mucous membrane of the gullet of a typhoid fever corpse' (Germ.) in 'Neue Notizen aus dem Gebiete der Natur- und Heilkunde' (Froriep). There are interesting particulars in Langenbeck's description and discussion. The publication happened at the same time as that by Johann Lukas Schoenlein about fungi as the cause of the favus lesions. In this time Langenbeck lived at Göttingen. Later he went to Kiel and Berlin and became one of the most prominent surgeons of the 19th century. He sponsored the founding of the German Surgical Society, the Berlin Medical Society and the 'Archiv für Klinische Chirurgie'. In 1864 he was ennobled. Some of his assistants were Th. Billroth, R.U. Kroenlein, F. von Esmarch, and F. Trendelenburg.

Candidosis and aspergillosis as autopsy findings from 1994 to 2003.

We analysed the autopsy records of the Greifswald University Institute of Pathology (located in Eastern Germany) in respect of findings of candidosis and aspergillosis from 1994 to 2003. We also present eight immature aborted fetuses and premature infants with a mycosis. In a total of 2027 autopsies we found 164 cases of invasive candidosis and aspergillosis (8.1%) including a combination of both on four occasions. Other authors cited between 0.7 and 7.3%. In these 10 years in our material mycoses and in particular candidosis increased in spite of slightly decreased numbers of autopsies. The differences comparing the 5-years periods (1994-98 and 1999-2003) are highly significant for both mycoses and candidosis. They are not significant for aspergillosis. A similar relationship was observed in the distribution of mycotic organs and causative origin for candidosis alone. In the last 5 years the gastrointestinal and respiratory tracts, including the peritoneum, were more frequently infected by Candida. Non-haematological neoplasia and pneumonia as basic diseases more often appeared in cases of candidosis. All eight immature aborted fetuses and premature infants suffered from candidosis. The survey confirms the importance of autopsy as a tool for education and quality control in medical diagnostic and therapeutic activity in the field of mycoses, too.

[Microecological regulative principles of human gastrointestinal flora]. / Mikroökologische Regulationsprinzipien der menschlichen Gastrointestinalflora.

In the course of coevolution of man and microorganisms the macroorganism must have developed mechanisms which allow a qualitative and quantitative regulation in his microbial colonization. On the several places, microbial growth is limited by various factors. Adherence ability of microorganisms belongs to the special colonization events. An uninhibited colonization begins if regulative factors are omitted. Factors of the host are only partially able to kill the microorganisms. Microbes possess signal receptors managing adaptation to environmental changes. If a strategy of growth and multiplication is not realizable such factors change to a strategy of survival. Very likely, these common microbiological principles are valid to the gastrointestinal tract, too.

[Candida in the ecological system of the orointestinal tract]. / Candida im Okosystem des Orointestinaltraktes.

Within the microbial ecosystem of the orointestinal tract Candida spp. are common but not always detectable organisms. Therefore they belong to the transient flora. Candida spp. are found at various sites in healthy subjects in quantities between 10(2)-10(4)/ml or g. In different diseases an increased growth of Candida can occur depending on the presence of typical risk factors. In any case the yeasts only account for a minimal part of the bacterial flora. In this regard the contribution to the formation of metabolic products-in particular carbon dioxide, hydrogen and alcohols-is very small. Growth and development of Candida are dependent on nutrient and oxygen supply. In the colon under anaerobic conditions the flora competes for limited nutrients and fermentation is the dominant metabolic pathway in Candida. There is only minimal growth. Under aerobic conditions as can be demonstrated in experimental settings a marked growth with the formation of mycelium takes place. The generation time in vivo is much longer than under laboratory conditions and takes several hours. The detection of Candida in stool specimens can be interpreted in the first line only as a colonization. This is not equivalent with an infection, which, unfortunately, often is wrongly suggested in positive stool specimens.