Insight into the Pathology of a COL1A1 Signal Peptide Heterozygous Mutation Leading to Severe Osteogenesis Imperfecta

Osteogenesis imperfecta or "brittle bone disease" is a congenital disorder of connective tissue causing the bone to break easily. Around 85-90% of cases are due to autosomal dominant mutations in the genes encoding type I collagen, the major organic component of bone. Genotype-phenotype correlations have shown that quantitative defects of collagen type I lead to mild OI, whereas structural defects show a wide clinical range from mild to perinatal lethal. This may partially be explained by the type of amino acid substitution and the relative location in the domain structure. To fully understand the variability of the clinical manifestation and the underlying pathomechanisms, further investigations are required. Here we provide the first biochemical characterization of a mutation at the signal peptide cleavage site of COL1A1, a domain not yet characterized. By steady-state analysis, we observed reduced production of collagen type I. Furthermore, by pulse-chase analysis we detected delayed secretion and partial intracellular retention of collagen I. In the cellular fraction, the electrophoretic migration was abnormal; however, secreted type I collagen showed a normal migration pattern. The intracellular retention of collagen I was confirmed by immunofluorescent staining. Moreover, transmission electron microscopy of cultured fibroblasts revealed enlargement of ER cisternae. These results further support the hypothesis that mechanisms interfering with ER integrity play an important role in the pathology of severe OI.

Cardiac disease in children and young adults with various lysosomal storage diseases: Comparison of echocardiographic and ECG changes among clinical groups

BACKGROUND

Lysosomal storage disease (LSD) is a rare inherited disease group. Consecutively there are few data on cardiac changes in mucopolysaccharidosis (MPS), Anderson Fabry disease (AFD), and other LSD (oLSD) including Pompe disease (PD) and Danon disease (DD), I-cell disease ICD and mucolipidosis III (ML III).

METHODS

Between 1994 and 2011, we identified 39 patients with LSD: 25 with MPS, 8 with AFD, and 6 with oLSD including PD (1), ML III (2), DD (1), and ICD (2) at our institution fulfilling the inclusion criteria of at least one echocardiogram and ECG.

RESULTS

Median age was 11.4 years (range: 2-27), 22 were females (56%). Normal echocardiograms were present in 12 patients (31%): 4 with MPS (16%), 7 AFD (88%), and 1 oLSD (17%). Valvular heart disease was present in 23 patients (59%) occurring more often in MPS (76%) and oLSD (67%) than in AFD (0%) (p < 0.001). The most common ECG abnormality was a short PR interval in 10 of 35 patients (29%) occurring in all LSD groups. Median follow-up was 5.8 (0.2-22.2) years showing diminished 5-year survival compared to an age-matched group. However, no patient died due to a cardiac cause and no cardiovascular intervention was necessary.

CONCLUSION

Echocardiographically detectable cardiovascular involvement in children with LSD is mostly confined to MPS and oLSD. Valve thickening in echo and a short PR interval in the ECG are the most frequent abnormalities. Routine repeat assessment is recommended in LSD. However, significant cardiac disease necessitating cardiac intervention is rare during a short follow-up.

Positive effect of a simplified diet on blood phenylalanine control in different phenylketonuria variants, characterized by newborn BH4 loading test and PAH analysis

Until today, the mainstay of phenylketonuria (PKU) treatment is a phenylalanine (Phe)-restricted diet. Strict dietary treatment decreases flexibility and autonomy and still has a major impact on patients and their families. Compliance is often poor, particularly in adolescence. The aim of this study was to investigate the effect of the intake of fruits and vegetables containing Phe less than 100 mg/100g ('simplified diet'), as recommended by WHO for all individuals, instead of classical totally restricted diet on the course and treatment control of the disease in a well-characterized PKU cohort (n=80). All individual blood Phe measurements of each patient (1992-2009) were statistically analyzed before and after diet switch. Epidemiological data, age at diagnosis, PAH mutations, BH(4) responsiveness, as well as Phe control measurements and detailed diet information were tabulated in a local database. 62.5% had BH4 loading test and 40% had PAH analysis; 50/80 switched from classical to simplified diet, including 26 classical PKU, 13 moderate PKU, 7 mild PKU and 4 mild hyperphenylalaninemia (HPA). Median Phe levels on a simplified diet did not differ significantly to the median Phe levels on classical diet in all disease groups. Our results indicate that a simplified diet has no negative effect on blood Phe control in patients with hyperphenylalaninemia, independent of severity of the phenotype or the age at diet switch, over the period of 3 years. Thus, a simpler approach to dietary treatment of PKU available to all HPA patients is more likely to be accepted and adhered by patients and might also increase quality of life.

[Dopamine receptors of the corneal epithelium and endothelium]

BACKGROUND

Dopamine is a major neurotransmitter and its two receptor subgroups, termed D1-like and D2-like receptors, are found both in the central and peripheral nervous systems. D1-like receptors signal through increases, D2-like receptors through decreases in cAMP production. Reports about the presence of dopamine receptors in the cornea are rare and inconsistant. The aim of this study was to examine if native bovine corneal epithelial and endothelial cells express dopamine receptors and whether these receptors belong to the D1-like or D2-like group.

MATERIALS AND METHODS

Dopamine receptors were studied using polyclonal antibodies. The cAMP concentration after receptor stimulation with dopamine was determined by means of an enzyme immunoassay.

RESULTS

In bovine corneal epithelium and endothelium immunohistochemical staining was positive for D1-like receptors but not for D2-like receptors. Stimulation of corneal D1-like receptors with dopamine revealed a dose-dependent increase of the intracellular cAMP concentration which was blocked by SCH23 390 (a selective D1-like antagonist).

CONCLUSION

Our data demonstrate that bovine corneal epithelium and endothelium express a functional D1-like receptor positively coupled to adenylyl cyclase and cAMP production. However, at the present time the physiological role of this receptor remains a matter of speculation.

[A rare toxicological emergency case: snakebite of the Saharan horned viper]

We report on the snakebite injury of a 27-year-old male patient by a Saharan horned viper in his left middle finger. General symptoms (thrombocytopenia, fibrinolysis and rhabdomyolysis) were leading and required observation at close intervals on intensive care unit and the application of a specific antiserum. At the finger a local necrectomy for the haemorrhagic necrosis was needed, followed by split-skin grafting for tissue coverage.

Natural history of Niemann-Pick disease type C in a multicentre observational retrospective cohort study

Niemann-Pick disease type C (NP-C) is a devastating genetic disorder characterised by progressive neurological deterioration. However, data on the progression of neurological manifestations, particularly across different patient age-of-disease onsets, are limited. This is an observational retrospective cohort study designed to assess the progression of neurological disease in patients with NP-C. Physicians were asked to retrospectively complete a web-based questionnaire for each patient, at diagnosis and at up to three follow-up visits. An NP-C-specific disability scale was used to measure disease progression. The scale comprised four key parameters of neurological disease progression; ambulation, manipulation, language and swallowing. Disease progression was evaluated based on the annual rate of change in each parameter and the composite score using a linear mixed model analysis, and by classifying patients according to the number of worsened parameters during the observation period. Data were collected from 57 patients. The rate of deterioration was similar across the four individual parameters of the disability scale. The mean (95% CI) annual disease progression was +0.12 (0.09, 0.15) units. Among patients with a time interval of at least 1 year between diagnosis and last visit (n=49), 42 (86%) patients had progressed disease and 7 (14%) patients had stable disease. Disease progression was consistently more rapid in patients diagnosed in early childhood, compared with those diagnosed in late childhood, or with juvenile or adult presentation. In conclusion, our findings showed a progression in all four parameters of the disability scale, representing a continuous, unbroken progression of neurological manifestations.

Miglustat in patients with Niemann-Pick disease Type C (NP-C): a multicenter observational retrospective cohort study

Miglustat has been shown to stabilize disease progression in children, juveniles and adults with Niemann-Pick disease type C (NP-C), a rare genetic disorder characterized by progressive neurological deterioration. We report findings from a retrospective observational cohort study assessing the effects of miglustat on neurological disease progression in patients treated in the clinical practice setting. Data from all NP-C patients prescribed miglustat at 25 expert centers were evaluated using a disease disability scale. The scale analyzed four key parameters of neurological disease progression in NP-C (ambulation, manipulation, language, swallowing). Mean individual parameter scores and a composite score were calculated at baseline (time of diagnosis) and up to 4 follow-up visits. Overall, 66 patients were included (mean [SD] age at diagnosis, 9.7 [7.6] years, and at treatment start, 12.8 [9.5] years). The median (range) miglustat exposure was 1.46 (0.05-4.51) years. Mean annual progression was +0.11 score units/year from diagnosis to treatment start, indicating disease progression prior to therapy, and decreasing to -0.01 score units/year from treatment start to last clinic visit, indicating stabilization. Stabilization of neurological disease on miglustat was observed in all age groups, but the magnitude of the effect was greater in patients diagnosed in late childhood and in juveniles and adults. Stabilization of neurological disease was also observed in a subset of 19 patients with extended pre-treatment information. Overall, these data support previous clinical trial findings indicating clinically relevant beneficial effects of miglustat on neurological disease progression in patients with NP-C.

Prenatal diagnosis of fetal exencephaly associated with amniotic band sequence at 17 weeks of gestation by fetal magnetic resonance imaging

We report a fetus with exencephaly diagnosed by fetal magnetic resonance imaging (MRI) at 17 weeks of gestation. Fetal ultrasound performed at 13 and 17 weeks of gestation suggested occipital encephalocele. However, the fetal MRI done at 17 weeks of gestation showed exencephaly and suggested amniotic bands as the cause. By providing early and precise information regarding the abnormality and the possible etiology, the fetal MRI enabled us to provide the couple and their families with accurate information regarding the low recurrence risk of this condition.

A new therapeutic approach to treat psoriasis by inhibition of fatty acid oxidation by Etomoxir

BACKGROUND

The dogma in psoriasis is that due to pathogen-induced inflammatory responses, an autoreactive immune response is induced that leads to tissue destruction. However, this model might be too simplistic. Literature data suggest that the expression of enzymes crucial for fatty acid oxidation is upregulated in the skin of patients with psoriasis compared with healthy individuals.

OBJECTIVES

To examine the influence of fatty acid oxidation on psoriasis with regard to expression and activity of the key enzyme in fatty acid oxidation, carnitine palmitoyltransferase-1 (CPT-1) and the effect of the CPT-1 inhibitor, Etomoxir.

METHODS

Experiments were performed with homogenates of lesional and healthy skin, fibroblast cultures and a model of human psoriatic skin transplanted on immune-deficient BNX mice.

RESULTS

CPT-1 was highly active in lesional skin. Etomoxir was able to block CPT-1 activity in skin, implying that this antagonist may have the potential to suppress psoriasis when administered topically. In the mouse model, Etomoxir had an antipsoriatic effect that was at least as good as that of betamethasone, as evidenced by reduction of epidermal thickness, keratinocyte proliferation and differentiation.

CONCLUSIONS

We conclude that fatty acid metabolism and in particular CPT-1 may be an excellent target for treatment of psoriasis.

Traumatische Glaukome - Eine Übersicht*

Traumatic glaucomas represent a very heterogeneous group of entities due to a variety of pathomechanisms which increase the intraocular pressure in the early or late phase after traumatic injury (blunt or penetrating injury, acid or alkali burn). Little is known about the real prevalence of traumatic glaucoma. Angle recession, hyphema-associated and lens-associated mechanisms are the most common causes of traumatic glaucoma after blunt ocular trauma. Secondary angle closure due to peripheral anterior synechiae is the most common pathomechanism leading to glaucoma in patients with penetrating eye injury or acid or alkali burn. Early anti-inflammatory therapy for eye injuries is the most important step in the prevention of traumatic glaucoma. Although no general recommendations exist, topical potent corticosteroids significantly decrease the risk of glaucoma development. Medical and surgical treatment of traumatic glaucoma has often been disappointing. Therefore the visual prognosis of these eyes is often restricted. Antiglaucomatous drugs that reduce the secretion of aqueous humor (e. g., beta-blockers) should be preferred. Mitomycin-augmented trabeculectomy is the surgical method of first choice in patients with open angle traumatic glaucoma. Transscleral cyclophotocoagulation represents the method of first choice in secondary angle closure glaucoma due to anterior peripheral synechiae. New surgical techniques will increase the possibilities of an effective reduction of the intraocular pressure in secondary angle closure glaucoma. These new procedures are endoscopic cyclophotocoagulation, retinectomy, and the implantation of drainage devices via the pars plana. Further evaluation and modifications of these surgical techniques should markedly improve the visual prognosis of eyes with secondary angle closure glaucoma. For a few types of traumatic glaucoma (e. g., after epithelial ingrowth) no effective treatment modality is available at present.

[Epidural abscess following delivery with peridural analgesia. The question of prevention]

A 35-year-old healthy gravida 2 para 2 developed a spinal epidural abscess after uneventful obstetric epidural analgesia. The diagnosis was confirmed by gadolinium-enhanced MRI; immediate surgical drainage combined with long-term antibiotic treatment led to complete recovery. The symptoms and possible contributing factors (e.g. immunological impairment of the patient, duration of the catheterization, violation of hygienic standards, type of disinfectant and dressing) are discussed. Vigilance is essential to avoid complications in patients with epidural catheters, even after it has been removed, in order to introduce appropriate diagnostic and therapeutic measures without delay. Immediate treatment is decisive for long term prognosis which should be introduced before neurological dysfunction appears.

Screening of the Fc epsilon RI-beta-gene in a Swiss population of asthmatic children: no association with E237G and identification of new sequence variations

BACKGROUND

The gene of the beta subunit of the high affinity receptor for IgE (Fc epsilon RI-beta) encoded on chromosome 11q13 has recently been identified as a candidate gene for asthma and atopy. Two coding variations, E237G and I181L have been described as being associated with asthma and atopy. Our aim was to investigate a Swiss population of atopic and asthmatic children for variations in this gene.

METHODS

We screened all 7 exons of the Fc epsilon RI-beta-gene in 224 atopic/asthmatic, 68 relatives and 159 control subjects using exon amplification by PCR and single strand conformation polymorphism (SSCP) analysis followed by fluorescence based DNA sequencing.

RESULTS

The sequence variant E237G was found in 3.7% in atopics and in 2.6% in the control population. None of the samples carried the I181L mutation. In addition, we characterised nine novel mutations (1 nonsense mutation, 2 missense mutations, mutation, 2 silent mutations, 4 intronic mutations).

CONCLUSIONS

Our results suggest that the E237G does not have a primary effect on the development of atopy and asthma, and thus excludes the Fc epsilon RI-beta locus from being a candidate gene directly involved in these diseases.

[An analysis of 148 outpatient treated occupational accidents]

BACKGROUND

The most common eye injuries are non-perforating. Eye injuries in the workplace are a major cause of socioeconomical damage, morbidity and disability, despite well publicised standards for industrial eye protection. This study investigates the epidemiological and clinical aspects of 148 occupational cases.

PATIENTS

At the University Eye Clinic of Tübingen, 709 non-perforating eye injuries were registered as occupational accidents between 1995 and 1996. Of these cases, 148 were analysed retrospectively per random.

RESULTS

The 5 most common injuries of 148 patients (m/f = 138/10; mean age 33.4 +/- 12 years) were related to corneal foreign body injuries (35%), chemical burns (15.5%), sub-conjunctival foreign bodies (12%), thermal/ultraviolet injuries (11%) and contusions (7.4%). Of these patients, 22.3% were employed as construction workers and 16.2% as metal workers. At the time of examination the visual acuity of the traumatic eye was 0.9 +/- 0.3. The interval between the beginning of work and accident was 6.2 +/- 6.4 hours in average (0.5-13.5 h). Of all accidents, 8.5% were caused during the first hour of work; in contrast 45.5% of all accidents were caused after 6 hours of work. Another 12.4 +/- 14.5 hours (5min.-72 h; median 7 h) passed by until the patients arrived for eye examination at the Eye Clinic of Tübingen. Only 6% of all patients arrived within the first hour, and 29.7% after 12 hours. Of all cases, 30.4% received first-aid treatment in their company by the factory doctor or by the eye doctor before examination at the Eye Clinic. Only 6.8% of all patients had protective spectacles during work. Incapacity was seen in 30.4%; the average in total was 5.5 +/- 10 days.

CONCLUSION

Despite the late examination at the Eye Clinic the functional loss was mostly little except after chemical burns. Nevertheless, most occupational accidents can be avoided with better protective devices in order to reduce the incidence of injuries and socioeconomical damage. Therefore an intense campaign about protective devices at the place of employment should be required. We conclude that education about safety glasses in the workplace by tradespeople and trades assistants during tasks for which goggles are recommended could considerably reduce the rate of occupational eye traumata. The data of the University Eye Clinic of Tübingen are useful to identify strategies to prevent eye injuries such as wider and better use of safety glasses and improvement in engineering controls.

[Premedication in retrobulbar anesthesia. A blood gas analysis comparison of sublingual flunitrazepam and intravenous midazolam]

Benzodiazepines for sedation may decrease the PaO2, the arterial O2 saturation (SaO2), and the CO2 response more in the elderly than in the young. The purpose of this study was to assess changes in blood gases due to i.v. midazolam or sublingual flunitrazepam given as premedication in elderly patients for unilateral cataract surgery. METHODS. Fifty patients over 65 years of age with treated arterial hypertension and other co-existing diseases (ASA III-IV) were randomly assigned to have: (1) i.v. midazolam titrated until they became drowsy (17 patients; 2.85 +/- 0.84 mg [mean +/- SD]); (2) sublingual flunitrazepam (16 patients; 0.005 mg/kg); or (3) no sedation (17 patients; controls). On entering the operating theatre, the radial artery was cannulated and the first blood gas analysis was obtained. The premedication was then given. At 5, 10, 20, and 30 min after premedication, before and 10 min after retrobulbar block, before operation, 5 and 15 min after the beginning of the operation, 10 and 20 min after administration of 500 mg acetazolamide i.v. during the operation, and 10 and 20 min after the operation additional arterial blood samples were analysed (a total of 15 measuring points). Pulse oximetry, invasive blood pressure, and ECG were continuously monitored. All patients received oxygen 3 l/min during the operation by nasal cannula. Differences between the three groups were analysed by Student's t-test or U-test and a P value < 0.05 was considered significant. RESULTS. The patient demography, including duration of anaesthesia and operation, was similar in the three groups (Table 1). No significant differences were seen in heart rate, mean arterial pressure, PaO2, pulse-oximetric oxygen saturation (SpO2), base excess, or serum bicarbonate levels. The PaCO2 increased in patients after midazolam (P < 0.01) and flunitrazepam (P < 0.05) until the beginning of the operation compared with the control group (Fig. 3); 20 min after the operation there was still a significant difference between the midazolam group and the controls. SaO2 was significantly (P < 0.05) lower in the midazolam group 10 and 20 min after administration of premedication compared with the control group, but was within physiological limits (Fig. 5). Despite titration, 2 patients had severe respiratory insufficiency 3 min after midazolam: the SpO2 decreased below 85% and the paO2 below 55 mmHg. The paCO2 was higher (P < 0.05) in the midazolam group 10 min after acetazolamide compared with the controls. CONCLUSIONS. The results of the study show the potential hazards of i.v. midazolam in the elderly. If sedation is required for cataract surgery under local anaesthesia, we recommend sublingual flunitrazepam or the use of benzodiazepines with lower hypnogenic effects in the elderly. A thorough preoperative discussion of anaesthesia and the operation might be an adequate substitute for any premedication in high-risk patients; the best blood gas analysis results were obtained in the control group.

[General anesthesia vs. retrobulbar anesthesia in cataract surgery. A randomized comparison of patients at risk]

Several studies comparing retrobulbar block (RB) and general anaesthesia (GA) for cataract surgery in the elderly have been published. Most of them were retrospective. Our prospective study was designed in order to determine the benefits or disadvantages using RB or GA. Arterial blood gases (ABG) and cardiovascular stability were explored in high-risk patients undergoing elective unilateral cataract extraction. METHODS. Forty patients over 65 years of age and with other co-existing diseases (ASA III-IV) were allocated randomly to receive either GA or RB. No premedication was given to either group of patients. On arrival in the anaesthetic room, a radial artery was cannulated for collection of blood samples and direct monitoring of the blood pressure. Pulse oximetry and ECG were continuously monitored in all patients, the end-expiratory CO2 (F(eexCO2)) only in the GA group. GA was induced with vecuronium 0.1 mg/kg and thiopentone 5 mg/kg; the lungs were ventilated with 100% oxygen. After intubation of the trachea controlled mechanical ventilation was continued with N2O/O2 (55:45) and enflurane 1%-2%. Only enflurane concentrations were varied to correct changes in mean arterial pressure (MAP) if these exceeded +/- 20%. Respiratory frequency and tidal volume were kept constant until completion of surgery. The patients were extubated when they were able to ventilate more than 5 1/min (pressure support 10 cmH2O; PEEP 5 cmH2O). After extubation no O2 was given. In the RB group neural block was undertaken with prilocaine 2% (3 ml) as a retrobulbar injection and prilocaine 1% (5 ml) to block the facial innervation of the orbicularis muscle (Van Lint, O'Brien). Oxygen 3 1/min was administered by nasal tube during the operation. Nine arterial samples for blood gas analysis were collected: (1) control; (2) before operation; (3) 5 min after beginning the operation; (4) 15 min after beginning the operation and before i.v. administration of 500 mg acetazolamide over 5 min; (5) after acetazolamide; (6 and 7) 10 and 20 min after acetazolamide; and (8 and 9) 15 and 30 min after operation (RB) or extubation (GA). RESULTS. The patient demography, including duration of anaesthesia and operation, was similar in both groups (Table 1). Four patients in the GA group (2 needed O2 after extubation because of hypoxaemia) and 2 in the RB group were excluded. No significant differences were seen in base excess (BE) and standard bicarbonate (SHCO3). Arterial O2 tension, arterial O2 saturation, and pulse-oximetric O2 saturation were higher in the RB group intra- and postoperatively (Figs. 1, 3, 4). Arterial CO2 tension (PaCO2) was significantly higher in the GA group during the pre- and postoperative period (Fig. 2), but not during the operation. The PaCO2- F(eexCO2) gradient ranged between 5 and 9 mmHg. Administration of acetazolamide did not influence this gradient by regressive analysis. The postoperative outcome of the patients was comparable in both groups. Nausea or vomiting did not occur. MAP was significantly higher in the RB group during the operation. No significant differences were seen in the pre- and postoperative period. Heart rate in the GA group was higher only after extubation, but was within physiological limits. DISCUSSION. Despite the differing results between the two groups, our study showed no important advantage related to either RB or GA. Changes in ABG, MAP, and heart rate during the investigation period were within physiological limits in elderly patients. Intravenous acetazolamide did not influence ABG in a significant manner. With regard to the preference of each patient, we recommend both RB and GA for cataract surgery in high-risk patients on the assumption of sufficient preoperative treatment of co-existing diseases. In conclusion, cardiovascular and ABG stability were maintained during both anaesthetic techniques.

[Which are the most frequent enteropathogenic parasites found in clinical practice?]

Infectious diarrhea is seen with increasing frequency in general practice. The main reason is growing tourism in countries with conditions of public health different from ours, where the incidence of enteropathogenic parasites is higher. To obtain an overview of these parasites, the results of 23,276 stool samples from patients in general practice throughout Switzerland were analyzed. Protozoa were found in 32% of samples (4.6% pathogenic protozoa, 24% facultative pathogenic protozoa and 3.4% apathogenic protozoa). Helminths were demonstrated in 2.9% of stool samples. The helminth spectrum covered 15 types, with Trichuris trichiuria predominating (one third). 8% of the Swiss population travel every year to areas with a higher diarrhea incidence. A proportion of these subjects constitute a health risk on their return to Switzerland. They chiefly consist of people working in, or living with someone working in, the food industry. Specific parasitologic diagnosis of diarrhea contributes significantly to reducing this risk.

Irradiation of choroidal melanomas before enucleation?

The eyes of 26 patients with choroidal melanomas were irradiated before enucleation at the University Eye Clinic in Tübingen. Preoperative external beam radiation therapy (PERT) was administered between July 1980 and July 1986. Follow-up ranged from 25 months to 8 years, 4 months with a mean follow-up of 53 months. The average diameter of the tumor base was 15 mm and the height 10 mm. Before enucleation vertical stationary electron beam irradiation (10-12 meV) was applied to the tumor-containing eye and the orbit. The dose was increased during the course of the study from 12 to 40 Gy. Enucleation was performed by a technique that cauterized the vasculature before severing it and avoided maneuvers that would cause changes in intraocular pressure. The patients were reexamined between August and November 1988. Nine (34.6%) had died of metastases of melanoma, six of them during the second postoperative year; one patient was alive with metastases. Subsequent death occurred in all patients who had melanomas of epithelioid cell type (3 of 3) and in no patients who had melanomas of spindle A cell type (0 of 3). In this small series PERT had no apparent beneficial effect on the patient's life expectancy.

[Which are the most frequently occurring enteropathogenic bacteria in clinical practice?]

Diarrhea is an increasingly frequent clinical finding in Swiss medical practice. One reason is the volume of tourism in countries with different climatic and social circumstances. To obtain an overview of the enteropathogenic bacteria spectrum as a cause of diarrhea, we analyzed 11,163 stool specimens from a representative group of patients throughout Switzerland. Enteropathogenic bacteria were found in 15.2% of all specimens; 50% were Campylobacter jejuni/coli, 35% Salmonella spp., 8% Aeromonas hydrophila group, 4% Shigella spp. and 3% Yersinia enterocolitica. This distribution is taken for all age groups and for both sexes. In the infant age there was a maximum evidence of enteropathogenic bacteria of the female sex. In childhood this maximum concerned to the male sex. Patients older than fifty had no positive stool specimens. As expected the most frequent positive stool specimens were in summer.

[Chlamydia diagnosis in clinical practice. Chlamydia trachomatis EIA and direct immunofluorescence (MikroTak) in comparison with cell culture]

The correct obtaining of material is decisive for microbiological diagnosis. The new immunologic methods, enzyme immunoassay (Chlamydiazyme) and the direct immunofluorescence with monoclonal antibodies (MikroTrak) for the detection of Chlamydia trachomatis have several advantages over cell culture. In 457 tests of urethral smears from men with all 3 methods, sensitivity and specificity were compared with cell cultures as method of reference. Tests with Chlamydiazyme yielded a concordance of 87.1%, a sensitivity of 81.5% and an specificity of 87.8%. Tests with MikroTrak were almost identical with a concordance of 86.9%, a sensitivity of 81.3% and a specificity of 87.5%. With both methods, the positive predictive value with 43.8% and 43.3% respectively is low. Frequent positive results with the immunological methods, which could not be verified by cell cultures, must be interpreted as failure of the culture method under practice conditions. The correlation of results with the clinical course supports this assumption.

Gibt es beim menschlichen Embryo ein Kloakenfenster?

Three- and four-day-old chicken embryos show normally a defect in the epithelium of the cloacal wall. This defect is not seen in human embryos at a similar developmental stage. Its signification is unknown.

Quantitative analysis of 'plaque material' between ciliary muscle tips in normal- and glaucomatous eyes

Between the anterior ciliary muscle tips in normal and glaucomatous eyes, different forms of plaque material were found within the intermuscular connective tissue. These plaques derive from either the sheaths of the elastic-like fibers or the elastic tendons of the anterior ciliary muscle tips. In addition, there are plaques which have the characteristics of the hyalinized basement membranes of the trabecular beams. The quantitative evaluation of all three types of ciliary muscle (c.m.) plaques showed that in normal eyes the amount of c.m. plaques increases with age and correlates with the amount of plaques in the inner wall of Schlemm's canal. In cases of chronic simple glaucoma the amount of c.m. plaques did not significantly correlate with age, but the absolute amount of this material was significantly higher than in normal eyes. No correlation between inner wall and c.m. plaques was found, indicating that in glaucoma additional factors besides age contribute to plaque formation.

Quantitative analysis of 'plaque material' in the inner- and outer wall of Schlemm's canal in normal- and glaucomatous eyes

The amount of plaque material derived from the sheaths of the elastic-like fibers in the cribriform layer of the trabecular meshwork (sheath-derived or SD plaques) was quantitatively evaluated in normal eyes and in trabeculectomy specimens of chronic simple, intermittent angle closure, and pseudoexfoliation glaucoma. The amount of SD plaque material increases with age but no correlation between age and SD plaques was found in any of the glaucomas evaluated. In comparison to normal eyes, the amount of SD plaque material was significantly greater in cases of chronic simple glaucoma and in cases of intermittent narrow angle glaucoma, but not in pseudoexfoliation glaucoma. In the latter, number and distribution of SD plaques resembled those of normal eyes. SD plaques were also found in the outer wall of Schlemm's canal. In normal eyes there was a correlation between outer-wall plaques and age as well as between inner- and outer-wall plaques. These correlations were not found in the different types of glaucoma. Our findings indicate that in addition to the age-related increase in plaque material, there is in glaucomatous eyes some plaque material which is distributed unevenly in the inner- and outer-wall of Schlemm's canal. This additional material was not found in pseudoexfoliation glaucoma, indicating that elevated intraocular pressure alone can not be responsible for plaque formation.

[Clinical evaluation of the Gonozyme enzyme immunoassay in comparison with the modified Thayer-Martin medium and the Jembec transport medium]

A solid phase enzyme immunoassay (GC-EIA, Gonozyme Abbott) for detection of Neisseria gonorrhoeae was tested in 185 male patients with urethritis purulenta sive serosa, and compared with the results obtained by bacterial culture. In 69 men gonorrhoea was confirmed by bacterial culture as method of reference. In 60 patients detection of Neisseria gonorrhoeae was carried out by means of direct inoculation on to Thayer Martin selective medium and immediate incubation, as well as on Jembec transport medium, which was mailed once a day to the respective laboratory. In 8 cases, N.go. was diagnosed with the Thayer-Martin medium only, in 1 case with the Jembec medium only. In 68 out of the 69 patients (sensitivity 98.6%) diagnosis was established with Gonozyme. An additional 8 positive results were obtained with this test, which could not be confirmed by bacterial culture (specificity 93.1%). 2 of these so-called false positive results can with great probability be assessed as true positive results on the basis of the case history. The positive predictive value with the Gonozyme method was 81.5% and the negative predictive value was 99.1%. The advantages, disadvantages and indication for this method are discussed and compared with the experience of other authors to date.