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During 1988 to 1992 18 patients with spondylodiscitis and neurological deficits were treated in our clinic. Tuberculous spondylodiscitis was diagnosed in 4 patients and 14 suffered from non specific spondylodiscitis. The mean age was 59 years (range 25-77). 16 (89%) of the patients had risk factors like diabetes mellitus, genitourinary tract infection, respiratory tract infection, rheumatism, intervertebral disc operation and old spine fracture. MR-tomography revealed the most valuable diagnostic method. 14 patients with progressive spinal cord compression, and root lesions because of gross vertebral damage and epidural abscess underwent operative removal of the focus with intercorporal spondylodesis. Postoperative neurological examination revealed improvement in 7 and no changes in the other 7 patients. In 4 patients with non specific spondylodicitis and radicular deficits conservative treatment was performed and spontaneous interbody fusion without persisting neurological complaints occurred.

Firstly, the basic principles of absorption and secretion in the intestine of healthy animals are described. The etiology and the pathophysiologic mechanisms of neonatal diarrhea in the calf due to E. coli and rota-/coronavirus are discussed. Enterotoxins of E. coli stimulate primarily the secretion of chloride (and thereby water) in the small intestine without damaging the intestinal mucosa. The sodium-dependent transport systems for the absorption of glucose and amino acids remain intact. In contrast, infections with rota- or coronavirus lead primarily to a disturbance of absorption processes in the intestine due to villous atrophy. Crypt cells are indirectly affected by inflammation mediators. Intestinal motility is inhibited during most diarrheic episodes; the application of para-sympatholytics in therefore not favourable.

The study deals with an animal model for the problems of surgical intensive care patients. Following repeated applications of E. coli endotoxin WO 111:B4 under standard conditions, specific hemodynamic and biochemical (TNF, TXA2, PGI2, IL-6, PAF) and morphological (endothelium of the lung) alterations were detected. ARDS patterns induced by the sepsis were analyzed by high-frequency measurement of pressure and flow (385 measurements per breathing cycle). The role of the intestine in sepsis was investigated by ion-selective monitoring of surface potassium activity comparing mucosa and serosa. Every injection of endotoxin was followed by a selective increase of the potassium activity revealing relative ischemia induced by the endotoxin. The profile of the potassium levels on the surface correlates both with the cardiac output and with the prostacyclin levels. The continuous narrowing of the difference between mucosa and serosa, potassium during the period of investigation can be regarded as evidence for pathologic change in permeability fostering the septic course.

In an animal model the hemodynamic effects of three infusions of HES during the early stage of a septic syndrome were examined. In nine pigs with a body weight between 29 and 36 kg a septic syndrome was produced by infusion of E. coli endotoxin. 1, 4 and 7 hours after beginning of the endotoxin infusion 250 ml HES 200/0.5 were infused. After the 1st and 3rd infusion an increase of the cardiac output resulted, which was previously lowered, without changes of the CVP. During normal CO the 2nd infusion shows an increase of CVP and MAP. PWP did not change. The reactions of the hemodynamic parameters can be well explained physiologically. A volume supply at a reduced CO increases the latter without influence of the CVP. Normalized CO before the infusion resulted in a CVP-increase. The PWP is not evaluable under the conditions of an elevated pulmonary resistance, as it exists at the septic syndrome.

Comparative examinations of renal function using inulin- and endogenous creatinine-clearance tests in 5 pigs showed nearly identical values of glomerular filtration rate (GFR). Based on this relation 79 healthy pigs, weighting 2 kg to 230 kg were investigated using the creatinine-clearance test for determination of normal values of GFR and urine flow rate (Vu) as well as renal excretion (E), renal clearance (Clr) and fractional excretion (FE) of urea, sodium, potassium, calcium, phosphorus, glucose and lactate. The renal excretion of creatinine (E-Creat) was closely correlated with the body weight. Therefore it is possible to use the body weight for estimation of E-Creat and to calculate GFR and Vu using plasma and urine concentrations of creatinine independent of a timed volumetric urine collection. Subsequently E, Clr and FE of electrolytes or other endogenous substances can be evaluated. Finally the practicability of this procedure for detection of disturbed glomerular filtration or tubular reabsorption was demonstrated in piglets suffering from colidiarrhoea and/or transmissible gastroenteritis.

Broth culture filtrate containing endotoxin, prepared from serotype O 139:K82(?):H1 was given by the intra-enteric route with and without dimethyl sulphoxide, and with or without blockade of the RES by intravenous injection of trypan blue, using about five piglets for each of the four combinations. Clinical signs, blood pressure, ECG, respiration, temperature, haematology and pathological findings were recorded. Coli enterotoxaemia manifested by fatal endotoxin shock developed in all ten piglets given toxin plus dimethyl sulphoxide, and in 4 of 5 similarly treated after RES blockade. The sondrmoe did not develop in piglets given large amounts of toxin without dimethyl sulphoxide, whether the RES was blocked or not. When enteric absorption of toxin was promoted by dimethyl sulphoxide, RES blockade increased the sensitivity of the animal to toxin (shortening of the time till death). The results show that there are two functional barriers to endotoxin: - the intestinal barrier, which normally prevents large amounts of toxin from entering the circulation; and RES, which plays a part in detoxifying and eliminating endotoxin which has been absorbed. Application of these findings to the pathogenesis of coli, enterotoxaemia is discussed.

40 uninephrectomized male Wistar rats with an experimental E.-coli-022-pyelonephritis (PN) were treated twice daily for 9 days with 30 mg trimethoprim and 150 mg sulfamethoxazole (TMP-SMO) i.p. Bacteriologically most of the kidneys became sterile. Histologically a significant reduction of the frequency of severe PN was found in the treated group. The biologic half-life of 131I-hippuran indicated a decrease of excretory function which was reversible. Urine osmolality and osmotic clearance were increased after oral water loading in 10 untreated control animals with PN but not in the treated group. The 9 day treatment had a favourable effect bacteriologically, histologically and also on renal function.

In 1883 Robert Koch isolated and characterized Vibrio comma as the etiological agent of cholera thereby creating a breakthrough in cholera research. Pathogenesis and pathophysiology of diarrheal diseases caused by V. cholerae and enterotoxigenic E. coli are cleared up by the production of enterotoxins and colonizing factors of microorganisms. Plasmids code for antibiotic resistance, distinct enterotoxins, colonization and other virulence factors. Sero-, bio-, phage-, colicino- and plasmid typing are important to epidemiological surveillance.

Toxicity of freeze-dried lysates of the organism for unweaned mice (3-4 days old) increased in the order:smooth-mucoid-rough. The toxicity was neutralized by mixing the toxin with immune serum of group O149. All toxins of the smooth, rough and mucoid variants of the Escherichia coli strain possessed hypersensitivity, skin necrosis, abortion and diarrhoea factors, which could be partly or completely neutralized by binding with homologous immune serum.

Different uterus contracting compounds (methylergonovine, oxytocin and prostaglandin F2 alpha) were evaluated with respect to their effect on the pathophysiology of endotoxin-induced shock. We used the model developed by Beller and Theiss of a continuous endotoxin-infusion in female Sprague-Dawley rats. In each group fibrinogen, plasma hemoglobin, hematocrit and thrombocytes were measured. The body weight of the rats was determined before and after the infusions. After the end of the experiment the intravasal fibrin deposits in the kidneys were evaluated quantitatively. Methylergonovine showed a slight protective effect regarding the clotting system and the shock events. This effect was more pronounced with oxytocin. In contrast prostaglandin F2 alpha enhanced the shock events. Based on our results we feel that the use of prostaglandin F2 alpha under septic conditions can be associated with significant risks.