o. Univ.Prof.Dr. Günter J. Krejs
Medical University of Graz, Austria
Barmherzige Brüder Krankenhaus Graz, Eggenberg Graz, 5. April 2014
Gastroenterologie:
Ein Rückblick und ein Ausblick
Univ.Doz. Dr.
Bernd Eber
Schitag der Med. Univ.Klinik
1991
Univ.Prof. Dr.
Otto Eber
Weihnachtskarte v. Prof. Otto Eber 1990:
Rainer Musterbuch
1215, Kropf und Ketinismus
Pankreaspseudocyste 1976
Pankreaspseudocyste 1976
1986
Gastroskopie von Gerhard Berger, 1994
Zubau I der Univ.Klinik für Innere Medizin
fertiggestellt 1997
Fallbericht
� 36-jähriger Arzt:
� Mehrere Jahre in einer Missions-Station in der Türkei
gearbeitet, Rückkehr in die Heimat wegen einer bereits
seit 5 Jahren fortschreitenden Krankheit
� Hauptsymptome: Arthiritis, chron. Husten,
episodisch subfebrile Temperatur, Gewichtsverlust
und chron. Diarrhoe, Sputum war auf Ziehl-Neelson
negativ
� Spitalsaufnahme
Admission to Johns Hopkins
Hospital in Baltimore, Maryland
on April 12, 1907
Some faculty members at Johns Hopkins. Franklin P. Mall, William
S. Thayer, Lewellys F. Barker, Simon Flexner , R. Smith.
The patient was admitted to the service of Thayer and
Barker.
� Because of weight loss and anemia the patient was
treated by forced feeding: fat 257 g/d, carb 490
g/d, protein 237 g/d, 5,221 kcal/d.
No improvement was noted
� Surgical exploration revealed prominent
mesenteric adenopathy suggesting tuberculosis or
lymphoma
� The patient died shortly after the laparotomy
George Whipple
was assigned to
do the autopsy
George Hoyt Whipple (on right) with his
boss William H. Welch
JejunumH&E stain
Distended villi.
Dilated lymph channels.
Heavy infiltrate with
foamy macrophages
which did not contain
fat by osmic acid stain.
No increase in
lymphocytes or plasma
cells.
PASH&E
H & E
Macrophages stained scarlet (even after diastase); no
other staining of LP. Staining substance believed to be a
mucoprotein.
Note: goblet cells
Black-Schaffer, PAS stain in WD, Proc.
Soc. Exp. Biol. & Med. 72:225, 1949.
Parkland Case: By EM, cytoplasm of a large
macrophage contains numerous phagocytized
bacilliform bodies (B) and remnants (R) of bacilliform
bodies in a vacuolar structure (V).
x 18,000
BV
R
Follow-up on Parkland case # 205819
� Discharged on July 17, 1960 on prednisolone 5 mg four
times a day, and tetracycline 250 mg four times a day.
Discharge weight 135 pounds. In October 1960 he was
free of diarrhea, had gained 10 pounds, and had
returned to work. In December 1960 he was
asymptomatic and weighed 170 pounds.
� Case published in Gastro 41:129, 1961, with thanks to
Donald W. Seldin, George Hilliard, and Joseph Ogle.
Vor Antibiotikum Nach Antibiotikum
Case from the literature.
� 1991 Sequencing of 16S ribosomal DNA (rDNA) showed that the organism is an aerobic nocardioform actinomycete. This group also includes Mycobacteria, Corynebacteria, Nocardia, and Rhodococcus
� 2000 Propagation in co-culture with human fibroblasts; extremely slow growing
� 2003 Full sequencing; reduced genome, suggesting host dependency; different genotypes (strains) have same clinical course
Further studies on the bacterium that
causes W. D. (Tropheryma whipplei)
George Hoyt Whipple, William P. Murphy, and George
Richards Minot receiving the Nobel Prize in 1934
G.H. Whipple: Second from left, first row
31
16S rDNA PCR positive; 291 bp sequence, BLAST identities = 290/290 (100%)
1:
2:
pc pc pa pa nc nc
Tropheryma whipplei specific PCR positive
Medical Tribune, 26. Oktober 2011
Karl Schwarz (Dragutin Schwarz), 1868-1917
„Ohne Säure kein
Ulcus“
1907
Med. Universität Graz
Zusammen-
setzung der
Mikrobiota
von
Centenarians
(green),
Elderly (blue)
und
Young (yellow)
Weltweit Stuhltransplantation
ist booming
Ch. Högenauer P.K. Kump
Medizinische Universität Graz
Stuhltransplantation, Medizinische Universität Graz
Abschiedsvorlesung, 10. Oktober 2013, Graz