Outer membrane protein A (OmpA) contributes to serum resistance and pathogenicity of Escherichia coli K-1.

We examined whether outer membrane protein A (OmpA) contributes to gram-negative pathogenesis by determining the effect of mutagenesis of ompA in a virulent Escherichia coli K-1 isolate. An OmpA mutant was generated by insertion of the transposon TnphoA, which was genetically modified to increase the efficiency of its delivery by conjugation. The mutant was less virulent than its parent strain in two models of E. coli K-1 infection. Equal inocula of the OmpA+ and OmpA- strains fed to neonatal rats resulted in a sevenfold-greater incidence of bacteremia at 72 h from the OmpA+ strain. The lethal effect of the OmpA- mutant was significantly less than that of the OmpA+ parent strain when inoculated onto the chorioallantoic membrane of 10-day embryonated chick eggs. There was, however, no difference between strains in growth characteristics under physiologic conditions, either in rat serum or in unembryonated chick eggs. In the presence of a 10-day chick embryo, there was a 10-fold increase in the survival and growth of the OmpA+ strain. Correction of the mutation in ompA with an E. coli K-12 ompA gene restored a level of virulence equivalent to that of the parent strain. The ompA mutant was more sensitive to the bactericidal effect of pooled human serum by the classical pathway of complement activation. These results suggest that OmpA contributes to E. coli K-1 pathogenesis by a mechanism which may involve increased serum resistance.     

Intestino-esophageal reflux following gastrectomy. Mechanism of action and effectiveness of esophago-jejunoplication

The influence of the type of reconstruction after gastrectomy upon the postoperative reflux was analyzed in 30 patients. The refluxed material could be directly gained by the long-term reflux aspiration test and, thus, the quality including bile acids could be evaluated. After esophago-jejunoplication and Roux en Y-derivation 5 out of 7 patients were asymptomatic; only one patient suffered from mild esophagitis. Total bile acid concentration was near to the test systems sensitivity. The result in 11 patients after esophago-jejunostomy without Y-en Roux, but with a preserved lower esophageal sphincter (LES) are similar to the former group, whereas in all cases of 12 patients in whom the LES was resected, severe reflux esophagitis and excessively elevated bile acid concentrations were present. These results confirm that a jejunoplication supports the antireflux effect of preserved parts of the LES. If--for oncologic reasons--the LES has to be resected, free intestinal-esophageal reflux is following. In these cases a Roux en Y-derivation is required.     

A leg ulcer as manifestation of metastatic squamous cell vaginal carcinoma

Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg.