[Candida and the gastrointestinal tract. A medical-research evaluation]
Nolting S. Stanescu-Siegmund A. Schwantes PA.
Klinik und Poliklinik fur Hautkrankheiten-Allgemeine Dermatologie und Venerologie, Universitat Munster/Westfalen.
In immunocompetent persons, Candida species are members of the normal flora of the gastrointestinal tract. Budding yeasts, in particular Candida albicans, can, however, in patients with a corresponding disposition, spread topically and systemically, that is, they may become pathogenic. In hematological/oncological patients with severe immunodeficiency, for example, the mycelium may infiltrate the muscularis mucosae, with involvement also of the vascular system. The relationships between recurrent diarrhea and Candida are still discussed controversial; various data do, however, suggest that massive colonization with Candida might well represent a(n additional) diarrhea-provoking factor. Similar considerations may also be assumed to apply to diarrhea induced by antibiotic therapy. For immunocompetent persons, guidelines exist for the yeast cell count in the stools. The interpretation of quantitative findings must, however, always be made on an individual basis and against the background of clinical symptoms and/or any particular predisposition of the patient. Reliable treatment of superficial candidasis can be achieved with oral polyene antifungal antibiotics (nystatin, amphotericin B).
[Viral genesis and autoimmunity of chronic hepatitis. Suggestion for a dynamically descriptive nomenclature without verification of etiology]
Today, viruses and autoimmunity phenomena are at the focus of interest in chronic hepatitis, not least with respect to the differing treatments, e.g. with interferon and immunosuppressants. Unfortunately, the last international nomenclature fails to take adequate account of the various forms of chronic hepatitis, of the fact that autoimmunity phenomena are predominantly physiological and also occur in the case of viral hepatitides, and also that the cause of autoimmune hepatitis is not clear. If we wish to avoid errors, we should employ a descriptive dynamic classification and not forget that the reclassification may be needed during the natural history of the disease. The indication for treatment should be critically and carefully weighed, and not established too hastily. During treatment--in particular with interferon--the autoimmunity phenomena should be monitored.
[Severe osteomalacia in endemic sprue. An important differential diagnosis in osteoporosis]
Dorst AJ. Ringe JD.
Medizinische Klinik 4, Klinikum Leverkusen, Universitat zu Koln.
A 67-year-old woman has a 20-year history of recurrent abdominal pain, diarrhea and diffuse bone pain. During the course of numerous hospitalisations the diagnoses "iron deficiency anemia", "iron absorption disorder", "osteoporosis" and "hyperparathyroidism" had been made. Despite treatment with vitamin D3, calcium, fluorides and iron, the patient's condition deteriorated to such a degree that she became in need of constant care. After 20 years of illness, nontropical sprue (celiac disease) with secondary intestinal osteopathy was identified. High-dose parenteral treatment with vitamin D3, oral calcium supplementation and a gluten-free diet resulted in an improvement of the patient's condition within three months, and the patient can now largely look after herself again.
[Diverticulosis and diverticulitis in the elderly]
Lux G. Langer M. Stabenow-Lohbauer U. Orth KH. Bozkurt T. Meyer MJ.
Stadtisches Klinikum Solingen.
Diverticulosis of the colon is a disease that mainly affects the elderly, presenting in 10 to 20% of this age group. The most common complication--painful diverticular disease, is usually treated conservatively with a high-fiber diet, intermittent use of antispasmodics and possibly regulation of the stools. Diagnostic differentiation is best performed using ultrasonography of the bowel wall, supplemented where necessary by computer tomography and colonoscopy (sigmoidoscopy) or, where this latter is not possible, barium enema using Gastrografin. Conservative treatment of diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for three to ten days. In the absence of a response to this treatment, frequent recurrence, immunosuppression or complications (perforation, peritonitis, enterovesicular fistula), surgery is indicated.
[Acute appendicitis in advanced age]
Zachert HR. Meyer HJ.
Klinik fur Allgemein- und Visceralchirugie am Stadtischen Krankenhaus Solingen.
In the elderly, both the diagnosis and treatment of acute appendicitis require particular attention. The diagnosis is often made very late with 40% to 80% of the cases already having perforated. Reasons for the delayed hospitalisation include atypical course, reduction in sensitivity to pain in old age, and an inadequate ability to communicate. The prognosis of uncomplicated appendicitis is just as good in the old as in the young patient, but perforation and concomitant diseases worsen the situation appreciably. Early operation is therefore desirable. The preference of the author is for open, rather than laparoscopic, appendectomy.