Gastroenterologie: Ein Rückblick und ein Ausblick · o. Univ.Prof.Dr. Günter J. Krejs Medical University of Graz, Austria Graz, 5. April 2014 Barmherzige Brüder Krankenhaus Graz,

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