Biomedical subjects
Publications and source records attributed to J Barnert.
A 51-year-old, ketoacidotic diabetic with the rare neurological complications of rhinocerebral mucormycosis is reported. The clinical presentation was characterized by initial severe frontal headache, rapid visual loss with complete external ophthalmoplegia and intracranial spread by invasive fungal growth. Its course and fungostatic therapy with amphotericin B and ketoconazole are described and the literature reviewed.
During the six-year period from 1978-1983 968 so-called "enteritis Salmonellae" were isolated in our laboratory. 50 of them (= 5,2%) were primary isolations from extraintestinal specimens, first of all from blood, abscess smear and urine. The greater part of the patients with an atypical course of enteritis salmonellosis showed clinical signs of septicemia (44%) or local suppuration (24%). In atypical salmonellosis advanced age and sex distinctly prevailed compared to the distribution of age and sex of patients suffering from typical Salmonellae enteritis. 80% of the patients with atypical salmonellosis had mostly resistance lowering basic diseases, first of all diabetes mellitus, or were treated with immunosuppressive therapy. The spectrum of "enteritis Salmonellae" isolated only from feces during the same period differed significantly (p = 0,01) from the spectrum of Salmonellae types found in extraintestinal specimens. An atypical course was relatively often caused by S. enteritidis, S. panama and S. virchow.
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A case report is given of a patient, who harbored a gastric adenomyoma; this is a special form of heterotopic pancreatic tissue including excessive formation of smooth muscle tissue. Size and localization of the tumor were unusual in our case. The case presented is discussed taking into account the literature available.
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A 51-year-old male patient with diabetes mellitus complicated by ketoacidotic imbalance developed a rhinocerebral mucor mycosis that advanced despite early amphotericin B therapy and extensive surgical intervention. The MIC of amphotericin B for the isolated mucor species was 64 mg/l, meaning that in vitro resistance also existed. Only long-term treatment with ketoconazole (600 mg/day, perorally) was successful in curing the disease.
We investigated the state of humoral and cellular immunity of 16 patients (eight women, eight men, aged 16 to 80 years), who had suffered from extraintestinal manifestations of infections with enteritis salmonellae. Four patients were examined during the acute state of the disease, the others one to three years thereafter. These patients were in good clinical condition. In all cases we could exclude an antibody deficiency syndrome. In the peripheral blood of 11 patients, we found a diminished number of T-helper lymphocytes, mostly together with a decrease in total T lymphocytes. Because the microbicidal activity of macrophages may be impaired by a general or localized decrease in T-helper cells, we suggest that the phagocytized enteritis salmonellae survive in this way and cause the atypical course of the infection in these patients.
Incontinence is a very stigmatizing symptom in our society. About 1% of the adult population is affected by fecal incontinence. In the evaluation anorectal manometry and defecography play a major role. Therapy often is still disappointing. In recent years simple retaining or biofeedback therapy have been reported to improve about 70% of incontinent patients. Within one year we treated 19 patients. Success was achieved in 69%. Biofeedback training, therefore, should be attempted prior to considering surgery.
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We report the case of a 20-year-old woman with functional vomiting who presented with symptoms of anorexia nervosa. Antroduodenal and upper jejunal perfusion manometry was performed using an eight-lumen catheter. The investigation revealed a hitherto unknown motility pattern consisting of continuous simultaneous contractions at high frequency from the antrum down to the upper jejunum. The observation suggests that this disorder was related to the patients symptomatology.