SUMMARY A 34 year old female long distance runner is reported with bloody diarrhoea. Colonoscopy revealed patchy haemorrhagic mucosal lesions throughout the colon. The most extensive lesions were found in the sigmoid colon. Histologic examination disclosed mucosal haemorrhage, dilated capillaries, patchy fibrosis and superficial erosions. Additional findings in this patient were haemorrhagic gastritis, microscopic haematuria and rhabdomyolysis. The only medication taken by the patient was oral contraceptives. We conclude that ischaemic colitis is one of the possible mechanisms leading to gastrointestinal blood loss in competitive runners.Abdominal discomfort and alteration in gastrointestinal function are common in runners. Twenty five per cent of runners had abdominal cramps or diarrhoea in association with competitive running.' Although occult gastrointestinal bleeding seems to be quite common2" bloody diarrhoea remains a rare event.' The pathophysiology of gastrointestinal bleeding during physical exercise is poorly understood, but bowel ischaemia has been proposed as a possible mechanism.2"' We report on a female long distance runner with a bloody diarrhoea syndrome caused by acute ischaemic colitis.Case report A 34 year old female long distance runner was referred to our hospital because of bloody diarrhoea. She competed in a 15 km mountain race; the altitude ranged between 540 and 870 m and the temperature was 14 to 18°C. At 10 km she experienced generalised severe crampy abdominal pains, forcing her to stop the race. During the next hour she noted bloody red stools, over the next few hours she subsequently vomited and noted small portions of blood. The same day she was referred for clinical evaluation. The patient had been in good health all

Escherichiafergusonii was isolated from a 69-year-old male with pancreatic carcinoma and cholangiosepsis from gallbladder fluid, three blood cultures, feces, and a superficial wound of the abdomen. Biochemical reactions, antimicrobial susceptibility patterns, susceptibility to polyvalent phage 0-1, and rRNA gene restriction analysis suggested that the four strains were of clonal origin. Our data indicate that E. fergusonii possesses a pathogenic potential in humans.

A case of prosthetic valve endocarditis with Propionibacterium acnes is described. The diagnosis was documented by histology and isolation of P. acnes from both blood and anulus tissue. Grinding of the tissue, which was first omitted to avoid contamination, was indispensable for cultivating the agent. The literature for P. acnes endocarditis is reviewed.

There are many complex socio-economic, geographical, legal, cultural and religious factors that contribute to low kidney transplant rates in Indonesia. Although an increase in transplantation rates will require strategies from various agencies, healthcare professionals, including nurses, can play a role in overcoming some barriers. Community education programmes, improving their own education levels and by increasing empowerment in nursing we may contribute to improved kidney transplant rates in Indonesia.

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