[Acute headache with meningism and xanthochromic cerebrospinal fluid.An unusual manifestation of cervical epidural abscess]

We report on a 70-year-old female with acute onset of headache, meningism, xanthochromic cerebrospinal fluid, and developing laboratory parameters indicating a systemic infection. Initially, a subarachnoidal hemorrhage was assumed. However, magnetic resonance imaging showed upper cervical osteomyelitis and extending spinal epidural abscess. After application of broad systemic antibiotics, secluded abscess formation was achieved and successful neurosurgical debridement performed. The unusual cranial concentration of the complaints is probably due to the involvement of the craniocervical transition. Cervical epidural spinal abscess represents a potentially dangerous bacterial infection of the upper spine. Inadequate treatment can lead to irreversible neurological deficits. Cervical magnetic resonance imaging is an effective tool for diagnosis, since early diagnosis is important for good prognosis.

Identification of cellular proteins involved in nikkomycin production in Streptomyces tendae Tü901

Expression of genes involved in nikkomycin production in Streptomyces tendae was investigated by two-dimensional gel electrophoresis of cellular proteins. Ten gene products (P1-P10) were identified that were synthesized when nikkomycin was produced; these proteins were not detected in non-producing mutants. N-terminal sequences of six of the 10 proteins were obtained by microsequencing of protein spots excised from preparative two-dimensional gels. Protein P8 was identified as L-histidine amino-transferase (HisAT), which has been previously correlated with nikkomycin production. By using oligonucleotide probes deduced from the N-terminal sequences of protein P2 and P6, we isolated an 8 kb BamHI fragment and a 6.5 kb PvuII fragment, respectively, from the genome of Streptomyces tendae Tü901. Restriction analyses revealed that both fragments overlapped within a region of 1.5 kb. Mapping of the oligonucleotide probe hybridizing sites indicated that the genes encoding protein P2 and P6 are closely spaced on the 8 kb BamHI fragment, and the latter is located on the overlapping region. DNA sequence analysis revealed that proteins P1 and P2 are encoded by a single gene, orfP1, that is translated at two initiation codons. The orfP1 gene was interrupted by homologous recombination using the integrating vector pWHM3. The gene-disrupted transformants did not produce nikkomycin, indicating that proteins P1 and P2 are essential for nikkomycin production. The data presented show that reverse genetics was successfully used to isolate genes involved in nikkomycin production.

[Juxtapapillary intraduodenal lipoma as a rare cause of jaundice and acute pancreatitis]

A 52-year-old man was admitted to hospital with acute pancreatitis and jaundice. The patient's medical history showed a case of hospitalization due to acute pancreatitis about three years before. Diagnostic examinations (abdomen sonography, CT, contrast medium radiography of the small intestine, ERCP) revealed a juxtapapillary lipoma, approximately 1 by 6 cm, obstructing the papilla Vateri. After the examinations had been completed and the pancreatitis had largely eased off, the lipoma was removed by transduodenal surgery. There were no postoperative complications.

Investigation in healthy volunteers to evaluate serum concentrations and urinary excretions of aluminium, magnesium, calcium and phosphate after multiple administration of hydrotalcit (Talcid) suspension

The aim of this study was to evaluate the extent of aluminium absorption after repeated administration of Talcid suspension. Therefore, the serum concentrations of aluminium and the amount of urinary excreted aluminium were determined. Furthermore, the influence of repeated Talcid administration on serum concentrations and urinary excretion of magnesium, calcium and phosphate was studied. The trial was carried out as a randomized, double-blind, parallel-group, placebo-controlled investigation in 17 healthy male volunteers and 1 female volunteer, aged between 18-34 years.

Histidine aminotransferase activity in Streptomyces tendae and its correlation with nikkomycin production

Streptomyces tendae Tü901 produces nikkomycins belonging to the nucleoside peptide antibiotics. Mutants defective in histidine catabolism were isolated and characterized with regard to their histidine ammonium-lyase activity and antibiotic synthesis. In the histidine ammonialyase-negative mutant hut-11 which was unimpaired in nikkomycin production histidine aminotransferase activity was detected as an additional histidine metabolizing enzyme. A protein exhibiting histidine aminotransferase activity could be demonstrated on non-denaturing gels of hut-11 crude extracts. Using optimized assay conditions, histidine aminotransferase activity was investigated in the strain hut-11 during growth in nikkomycin production medium. Maximal activity was reached at the end of exponential growth prior to nikkomycin production. In the presence of bromopyruvate, an effective inhibitor of histidine aminotransferase activity in vitro, production of nikkomycin Z and X was markedly reduced in hut-11.

[Therapeutic experiences with tenoxicam. Results of an observational study of 18,976 patients]

Within the framework of an observational study, 18,976 patients attending 2,086 centers were treated with tenoxicam. This drug was prescribed for rheumatic diseases, the most common diagnoses being activated arthrosis and degenerative disease of the spinal column. After an average period of treatment of 21 days, the following results were noted: 28.9% of the patients were symptom-free, 44.5% greatly improved, 18.1% somewhat improved, 7.6% noted no change, and 0.5% reported a deterioration. Tenoxicam was well tolerated by most patients (93.5%). A total of 1,725 side effects occurred in 1,241 patients (6.5%). The side effects affected three organ systems, the gastrointestinal tract (5.2%), the CNS (1%), the skin (0.6%) and "others" (0.6%; for the most part the side effects were mild. The rare severe side effects corresponded in nature and incidence to the spectrum known to be associated with NSAIDs. Overall, tolerance can be said to be good, with a spectrum of side effects already known from the clinical situation.

Assembly of colicin genes from a few DNA fragments. Nucleotide sequence of colicin D

The nucleotide sequence of a 2.4 kb Dral-EcoRV fragment of pColD-CA23 DNA was determined. The segment of DNA contained the colicin D structural gene (cda) and the colicin D immunity gene (cdi). From the nucleotide sequence it was deduced that colicin D had a molecular weight of 74,683 D and that the immunity protein had a molecular weight of 10,057 D. The amino-terminal portion of colicin D was found to be 96% homologous with the same region of colicin B. Both colicins share the same cell-surface receptor, FepA, and require the TonB protein for uptake. A putative TonB box pentapeptide sequence was identified in the amino terminus of the colicin D protein sequence. Since colicin D inhibits protein synthesis, it was unexpected that no homology was found between the carboxy-terminal part of this colicin and that of the protein synthesis inhibiting colicin E3 and cloacin DF13. This could indicate that colicin D does not function in the same manner as the latter two bacteriocins. The observed homology with colicin B supports the domain structure concept of colicin organization. The structural organization of the colicin operon is discussed. The extensive amino-terminal homology between colicins D and B, and the strong carboxy-terminal homology between colicins B, A, and N suggest an evolutionary assembly of colicin genes from a few DNA fragments which encode the functional domains responsible for colicin activity and uptake.

No dynamic effector responses to fast changes of core temperature at constant skin temperature

Experiments in conscious goats were done to see whether heat production and respiratory evaporative heat loss show dynamic responses to changing core temperature at constant skin temperature. Core temperature was altered by external heat exchangers acting on blood temperature, while skin temperature was maintained constant by immersing the animals up to the neck in a rapidly circulating water bath. Core temperature was altered at various rates up to 0.9 degrees C/min. Step deviations of core temperature from control values were always followed by a positive time derivative of effector response, but never by a negative time derivative during sustained displacement of core temperature. Ramp experiments showed that the slopes at which heat production or heat loss rose with core temperature deviating from its control level grew smaller at higher rates of change of core temperature. It is concluded that neither heat production nor respiratory evaporative heat loss respond to the rate of change of core temperature. At constant skin temperature, thermoregulatory effector responses appear to be proportional to the degree to which core temperature deviates from its set level.

Skin and core temperatures as determinants of heat production and heat loss in the goat

In 82 experiments on 10 goats body core temperature (Tcore) was altered between 35 degrees and 42 degrees C by external heat exchangers acting on blood temperature while skin temperature (Tskin) was maintained constant, by a circulating shower bath, at different levels between 32 degrees and 44 degrees C. At all skin temperatures at least fourfold increases of heat production (M) and respiratory evaporative heat loss (REHL) occurred when Tcore was lowered or raised, respectively. The lower Tskin was, the higher were the thresholds of Tcore, at which M or REHL exceeded resting levels. The lower Tskin was, the higher were the slopes, at which M or REHL changed per unit of Tcore. At a given Tskin, the slopes decreased with increasing M or REHL, and were dependent on the range of Tcore. The higher the range of Tcore, the steeper changed M and REHL with changing Tcore, if all other variables were held constant. The results support the concept that an exponential relationship between Tcore and the rate of core temperature signals is the primary cause of the effects exerted by Tskin on the slopes, at which M or REHL change per unit of Tcore.