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Tuberculosis is extremely rare in Germany today. Diagnosis of extrapulmonary tuberculosis has proved to be particularly difficult and a correct diagnosis can take months. The danger of fatality is high. In the case of a 29 year old male paraplegic patient suffering from enteral tuberculosis, diagnosis was possible only after several weeks of onward observation, extreme physical degeneration and finally, a laparotomy.

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Following a short summary of the historical development of the terminology, the nosological separation between peptic ulcer disease and secondary ulcers including the gastroduodenal stress erosions and ulcers - is stressed. The differing and in the last 20 years decreasing frequency of the different causes as well as the pathogenesis - mainly disturbances of the mucosal defense mechanisms (blood supply, mucus secretion and epithelial renewal) - are discussed, partly referring to results of own investigation. The diagnosis implies - depending on the state of the patient - an emergency esophagogastroduodenocopy after the treatment of shock. The different outcome of bleeding in common peptic ulcer and in stress lesions is analyzed in detail as well as the limiting risk factors. The decrease of the incidence and the improvement of prognosis under a modern interdisciplinary intensive care of acutely ill patients, especially due to a strict shock therapy are stressed. The interventional-local therapy of stress-induced gastric or duodenal bleeding is not practicable, debatable, if performed with drugs, and surgically not possible; however, this dilemma is as mentioned above due to the less frequent occurrence of such a situation considerably diminished. The major effort of prophylaxis of gastroduodenal stress lesions is clearly directed towards an influence of causes and risks; several drugs - mainly H2 blocking agents, sucralfate and antacids demonstrate a comparable efficacy. The potential risk of a nosocomial pneumonia is differently seen; undebatable trials demonstrating a clear superiority of either prophylactically applied drugs do not exist.

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A 44-year-old German fell ill in Libya, where he had been living for 10 years, with high fever, rigor and a nonitching centrifugally spreading macular rash, which had spared the head, hands and soles. In addition, a systolic cardiac murmur was heard. The Weil-Felix reaction had a titre rising within 3 days from 1:160 to 1:640, confirming the diagnosis of rickettsial disease, the total clinical picture indicating typhus. On treatment with chloramphenicol (1 g three times daily i.v.) the fever subsided within 5 days. On the ninth day treatment was changed to oral doxycyclin, 200 mg daily for 3 weeks. Echocardiography surprisingly revealed a floating thrombus, about 4 x 8 cm, attached to the hypo- and even akinetic apex of the left ventricle. In addition there was single-vessel coronary disease. Since the segmental contraction abnormality persisted after the typhus had been cured, a causal connection with the rickettsial disease is unlikely. The thrombus was removed at the time of a aortocoronary bypass operation: his course has been unremarkable since then.

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Colonoscopy preparation with lavage is a clinically accepted procedure. After having shown that its results can be improved by the additional intake of Senna this randomized prospective trial was designed to evaluate the effects of different laxatives in a combined preparation regimen. The day before endoscopy either Bisacodyl or extractum Sennae was given to 120 patients. Immediately before examination all patients underwent whole gut irrigation with Golytely solution. Patient acceptance and effectiveness of the two procedures were excellent and no relevant intolerance was observed. Satisfactory cleansing results were achieved with Bisacodyl as well as with Senna (98.3 vs. 95%). There was no significant difference between the laxatives used. We conclude that both regimens are safe, generally well tolerated and effective ways of preparation for colonoscopy.

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We report on six cases of sepsis caused by Serratia marcescens in patients with neutropenia. Four cases showed an additional involvement of the upper respiratory and digestive tract with oral and pharyngeal mucositis, haemorrhagic laryngo-tracheo-bronchitis, and oedematous swelling of the face. One patient showed a Serratia marcescens carrier state in the pharynx over a period of months without neutropenia. The isolated strains showed a broad spectrum of resistance against antibiotics; only aztreonam and amikacin were effective in vitro against all isolates.

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The clinical course of a 50-year-old woman with oral lichen ruber planus (Irp) and prolonged dysphagia is described. The swallowing problems of this patient were related to an inflammatory lesion of the middle third of the esophagus, leading to stenosis. Distal to this area, the esophagus was covered with mucosa of the cardia type, as seen in endobrachyesophagus. Apart from reflux disease, the Irp may have accounted for the stenosis of the mid-esophagus. The mucosal lesions disappeared after administration of etretinate (Tigason). After endoscopic dilatation the patient was able to swallow normally again.

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44 patients with acute hepatitis B virus (HBV) infection were observed until recovery and formation of anti-HBs or in case of development of chronic infection for up to 18 months. With the exception of 3 patients the infection resolved clinically within 3 to 16 weeks, HBs and HBe antigen were eliminated. Anti-HBs and anti-HBe formation could be demonstrated in 39 patients. An accurate prognosis of the course of the disease could be predicted in 42 out of 43 patients by comparison of the serum HBs antigen concentrations at the beginning of clinical symptoms with those after 4 weeks. Inclusion of HBe antigen demonstration enabled predictability in all patients. In 15 patients with acute HBV infection the risk of infection (occupational exposure, transfusion etc.) was known. By investigation of contact persons (family members, sex partners etc.) of the remaining patients HBs antigen und partly HBe antigen in serum could be demonstrated in 11.8% of these persons (11 out of 93). In contrast, in contact persons of patients with known risk of infection HBs antigen could be demonstrated in only one case (1 out of 36). No one of the HBs antigen positive contact persons was aware of the possibility of infectiousness. They did not perceive any connection between their own chronic infection and acute HBV infection occurring around them.

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ERCP was performed in 57 patients who had undergone Billroth II resection. Cannulation of the papilla of Vater was successfully accomplished in 31 cases (55%). The success rate of ERCP was clearly dependent on the type of Billroth II resection presenting.

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Resorption of hydrocyanic acid after ingestion of linseed was investigated in 20 healthy volunteers and 5 patients. The persons investigated took a single dose of 30 g or of 100 g of linseed or they received throughout several weeks 15 g. t.i.d. One volunteer also took for purposes of comparison bitter almonds or potassium cyanide. Before, during and after the periods of ingestion plasma levels of hydrocyanic acid and of thiocyanate were normal. During long-term trials urinary excretion of thiocyanate was monitored regularly. Intake of linseed even in extremely high dosages never caused significant rises of plasma thiocyanate levels; this, however, was the case after intake of bitter almonds or potassium cyanide. Thus, it can be excluded, that intoxication by hydrocyanic acid can be caused by linseed. Long-term intake of linseed however, raised plasma levels of thiocyanate significantly; at the same time urinary excretion of thiocyanate increased.

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A synthesis of many experimental works performed during the last ten years regarding the nonspecific response of the pituitary gland during some immune and neoplastic processes is presented. Different modalities of the response of pituitary gland cell that vary depending on the antigen type were observed. The TAB vaccine inducing a humoral immune response determined an increased secretory activity of STH and FSH cells which are involved by their secretions in the activation of protein synthesis also including antibodies. The tumoral antigens also representing a stressing factor brought about a more intense activity besides the FSH cells, the ACTH and TSH cells.

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1. If endoscopy leads to the suspicion of an exulcerated and/or polypous carcinoma of the colon, surgical intervention is the primary therapy. Histological classification of the tumour should be effected by means of endoscopic biopsy. 2. (Familial) adenomatosis of the colon requires colectomy. 3. Broad-based polypi resembling a lawn where a large wound area must be expected by electrocoagulation (risk of perforation), and pediculate polypi of the (rare) size of 3 cm and more (risk of haemorrhage) should not be resected via endoscopy but by surgery. 4. Solitary or multiple polypi of the colon not covered by points 1 to 3 above, are primarily for reasons of diagnosis an indication for endoscopic polypectomy. Biospy in the case of adenomas to clarify the histological structure and to obtain qualitative and quantitative information regarding malignant degeration, must be discouraged (""partial diagnosis''.) 5. Basing on the current state of knowledge it is assumed that effective prohylaxis of cancer is achieved by the endoscopic removal of benign adenomas of the colon. 6. It is also assumed that effective cancer therapy can be realised by the endoscopic removal of adenomas which have already undergone malignant degeration (adenoma with severe cellular atypia, invasive differntiated adenocarcinoma in the head of the adenoma.)

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