The Division for Clinical Medicine of the Bernhard-Nocht-Institute comprises 68 beds including three beds in an intensive care unit and in addition two isolated bed systems for patients with suspected haemorragic fever as Ebola, Lassa etc., an outpatient clinic and diagnostic functions as cardiology, ultrasound, endoscopy, pulmology, X-ray, haematology and parasitology.
Besides the routine work which is dominated by treating patients with internal diseases, tropical and infectious diseases the division concentrates on clinical research on the pathophysiology of P. falciparum Malaria and on the pathophysiology and treatment of HIV-infection and AIDS. Over the years successful scientific research has been performed, documented by publications in well recognized international journals with high impact factor. Also the citation index has been considerably high in both areas (HIV- and Malaria-research). The publication: The Role of Tumor Necrosis Factor in Human P. falciparum Malaria (Am J T Med) has been pronounced in an international scientific report of the Wellcome Foundation as one of the most highly cited papers in Malaria research between 1989 and 1996. International recognition is also documented by the decision of the European AIDS Clinical Society to elect the Head of the Division of Clinical Medicine as Conference Chairman of the Sixth European Conference on Clinical Aspects and Treatment of HIV-Infection to be held in Hamburg in 1997. This conference will attract between 2 and 3 thousand scientists from Europe and Overseas.
Members of the Division of Clinical Medicine have been invited to collaborate in different committees, national and international. The Department serves as a reference centre for Germany in Tropical Medicine and infectious diseases and is quite active in many consultations of physicians and hospitals throughout the country in cases of severe tropical diseases and difficult differential diagnoses.
The care of more than 100 patients with P. falciparum malaria a year in the Division of Clinical Medicine enables us to study the pathophysiology of human P. falciparum malaria in detail and allows to evaluate new therapeutic interventions without the difficult problems which are encountered usually in tropical areas. In fact, only in non-endemic areas malaria can be investigated in detail without interference with other parasitic infections and in patients who have been infected for the first time. Thus, the results of malaria clinical research may differ from the semi-immune status in patients from endemic countries in contrast to the non-immune subjects from non-endemic countries. Furthermore, we define clinical research as a fundamental approach as close as possible to the clinical situation. This includes the thorough observation and examination of our patients but also the use of sophisticated laboratory techniques. As we have shown in the past the interaction between the infection by P. falciparum parasites and the defense mechanism of the patients involving the endothelial cell system seems to be the main pathological event in the course of the disease and the development of severe complications. Therefore, we have been using the human umbilical vein endothelial cell cultures (HUVEC) to simulate the human situation. More recently we have succeeded in studying the interaction of sera from patients with P. falciparum malaria in cultured human brain microvascular endothelial cells (HBMEC). Moreover, we have established successfully a model of endothelial cell culture of human lung tissue in order to analyze the pulmonary complications in Malaria.
Research in HIV pathophysiology, treatment and intervention strategies have been performed in close cooperation with the Divisions of Virology, Pathology and Immunology of the Institute. The division is concentrating on the possible role of autologous retransfusion of lymphocytes in patients with HIV-infection after manipulation to protect T-cells against further HIV-infection, one option being gene therapy. So far, results have shown that lymphocytes can be deep frozen for years without significantly impairing the propagation of T-cells in culture. In fact, numbers achieved after culturing were 50 to 100 fold. This research is in progress, collaboration with the Heinrich-Pette-Institute for Virology in Hamburg is planned.
The collaboration in investigations of lymphnode and other tissue in HIV-infection is still intensive and highly effective with the Division of Pathology (P. Racz und K. Tenner-Racz). The Department collaborates on a national level with GASG (German AIDS Study Group), ENTA (European Network in Treatment of AIDS), EuroSida and other networks and projects on an international level.
 

For additional information please also see Investigators’ Reports.