[Pulmonary and pleural manifestations of multiple myeloma]. / Pulmonale und pleurale Manifestationen beim Plasmozytom.

Multiple myeloma is a low malignant, non-Hodgkin's lymphoma, which is characterised by infiltration of the bone marrow by clonal prolifaration of atypical plasma cells. Clinical presentation is mostly determined by the sequeles of displacement of normal hemopoiesis, destruction of bones and the immune deficiency. Extramedullary manifestations are relatively rare. Pulmonary and pleural involvement has been described in case reports only. We report on a 75-year-old male patient in whom an IgG-secreting multiple myeloma type lambda, stage III (according to Durie and Salmon) has been diagnosed. Chest X-ray and CT revealed a diffuse confluent nodular pattern in the lungs and a large left-sided pleural effusion. Histology and immunohistochemistry confirmed diffuse infiltration of the lungs as well as the pleura by dysmature plasma cells with deposition of lambda-light chains. Preliminary treatment with vincristine and prednisone followed by polychemotherapy according to the VAD scheme was performed, which led to resolution of the pleuropulmonary changes.

[A rare cause of diffuse pulmonary hemorrhage in a 45 year-old man]. / Seltene Ursache einer diffusen alveolären Hämorrhagie bei einem 45-Jährigen.

Diffuse pulmonary hemorrhage denotes a diffuse bleeding into the alveoli as a result of severe damage of the alveolocapillary membrane. Autoimmune diseases, toxic injury and hemodynamic changes are the most frequent causes. A 45 year old male patient presented with diffuse alveolar hemorrhage. An Immunoglobulin A (IgA) paraprotein secreting myeloma was found to be the underlying cause. Immunohistochemistry revealed dense pericapillary and perivascular deposits of IgA, indicating a paraprotein mediated damage of the alveolocapillary membrane. The predominantly vascular pattern of damage was regarded as the most likely cause of the pulmonary hypertension in this patient. The diffuse pulmonary bleeding stopped after initiation of treatment consisting of vincristine, adriamycine and dexamethasone.

[Differential diagnosis of diffuse pulmonary haemorrhage]. / Differenzialdiagnostik der diffusen alveolären Hämorrhagie.

Diffuse alveolar haemorrhage (DAH) denotes a diffuse intra-alveolar bleeding from small vessels as a result of severe damage of the alveolocapillary membrane of the lungs. These are comparatively rare, but than often life threatening events. The differential diagnosis is broad and comprises immunologic as well as toxic, infectious, hemodynamic, neoplastic and physical causes. DAH may be a manifestation of systemic diseases, as well as a result of an injury restricted to the lungs. The most frequent systemic diseases, that cause DAH are the so-called small vessel vasculititis-microscopic polyangiitis and Wegener's granulomatosis. More rarely Goodpasture's syndrome and systemic lupus erythematosus are causal. Alongside the immunologic processes mainly diseases with increased left-ventricular preload, infections and side effects of drugs have to be kept in mind. This review summarizes the differential diagnostic spectrum and the diagnostic workup of patients with DAH. Because early aggressive treatment can be life-saving, early and aimed diagnostics is essential.

Results of balloon angioplasty in the carotid arteries.

PURPOSE: To report the experiences to date with percutaneous transluminal angioplasty (PTA) of the carotid artery and other supra-aortic vessels. A new coaxial dilatation system for carotid angioplasty with temporary balloon occlusion to avoid cerebral embolization is presented. METHODS: PTA was performed in 220 patients with 245 stenosed or occluded supra-aortic arteries; among these were 74 carotid stenoses in the proximal common (n = 5), distal common (n = 1), internal (n = 65), and external (n = 3) carotid arteries. Duplex and B-mode ultrasonography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, indium 111-labeled platelet scintigraphy, and/or angiography were used before and after PTA. Intravascular ultrasound imaging was also recently added for monitoring angioplasty results. RESULTS: All patients but one with carotid lesions had symptoms of cerebrovascular insufficiency. Angioplasty was successful in 69 of the 74 carotid stenoses: proximal common (n = 5), distal common (n = 1), internal (n = 60), and external (n = 3). There were only 1 major (hemiparesis) and 2 minor complications. During the average 70-month observation period, restenosis has not occurred in any treated carotid artery. In a literature review of > 500 patients undergoing carotid angioplasty, the complication rate appears very low (mortality 0%; morbidity 2.1%) and comparable to that for carotid endarterectomy. CONCLUSIONS: Results of this review suggest that percutaneous transluminal angioplasty of the carotid artery is an effective alternative method to vascular surgery, particularly for patients with comorbidities that elevate the risks of surgery.

[Quality criteria in using percutaneous transluminal angioplasty of supra-aortic arteries]. / Qualitätskriterien beim Einsatz der Perkutanen Transluminalen Angioplastie (PTA) an supraaortalen Arterien.

OBJECTIVE AND METHOD: On the basis of 252 personally performed angioplasties and almost 2000 published results of percutaneous transluminal angioplasties (PTA) in supra-aortic arteries quality criteria for PTA in supra-aortic arteries are to be elaborated with special reference to the carotid artery. RESULTS: To keep the complication rates low the indication must be strictly observed and particular attention paid to the morphological criteria. Experience has shown that PTA should be applied in brachiocephalic arteries only in the presence of symptomatic, high-grade, circular or short stenosis and smoothwalled stenosis without ulceration or severe calcification. In support of the angiography, intravascular ultrasound tomography is recommended for therapy control to ensure the quality. The application of stents is only useful when the result of the angioplasty is suboptimal and dissections and/or intimal flaps can be detected. Occlusion of the subclavian artery should be dilated by primary stent application. Quality can be assured by the use of modern instruments including investigational systems. The proper performance of angioplasty necessitates monitoring by means of EEG and ECG as well as close supervision of the pressure applied for dilatation. The quality and the documentation of the angioplasty results are ensured by post-therapeutic controls using angiography, intravascular ultrasound tomography and cerebral computer tomography. Good long-term success can only be achieved with the aid of post-therapeutic oral anticoagulant therapy. Application of angioplasty in supra-aortal arterial obliteration can result in an average morbidity of 0.9% with no or only minimal lethality if the necessary quality criteria are observed. CONCLUSIONS: Whereas percutaneous transluminal angiography of the subclavian artery and the vertebral artery can be regarded as the therapy of choice, the results of prospective multicentre studies will have to be awaited before it can be assigned a place in carotid angioplasty.

PTA of carotid, vertebral, and subclavian artery stenoses. An alternative to vascular surgery?

The current status of percutaneous transluminal angioplasty (PTA) of the supra-aortic arteries is presented with a survey of the literature and personal experience. PTA was performed in 165 patients presenting occlusive lesions in the supra-aortic arteries. The good result obtained are presented and the conclusion is drawn that PTA is the preferred therapy in these cases.

[Percutaneous transluminal angioplasty of the carotid artery]. / Perkutane transluminale Angioplastie (PTA) der Arteria carotis.

This paper presents personal experience of 169 percutaneous transluminal angioplasties (PTA) and more than 1,000 worldwide published results of angioplasty on supraaortic stenoses especially of the carotid artery. The technique of the angioplastic procedure, essential pretherapeutic diagnostic methods and indications of PTA are described and discussed. Results of published and own experience indicate that PTA is an effective and alternative method to vascular surgery in the treatment of symptomatic carotid artery stenoses. With strict definition of the indication, the complication rate for PTA is not likely to be higher than that for vascular surgical treatment. PTA of carotid artery stenosis should be used exclusively in medical centers in which a cooperation by vascular surgeons, internists, neurologists and interventional radiologists or neuroradiologists comes true.

Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially of the carotid and vertebral artery. An alternative to vascular surgery?

This paper presents personal experience of 174 percutaneous transluminal angioplasties (PTA) and more than 1,000 worldwide published results of angioplasty of supraaortic stenoses especially of the carotid and vertebral artery. The technique of the angioplastic procedure, essential pretherapeutic diagnostic methods and indications of PTA are described and discussed. Results of personal and published experience indicate that PTA is an effective and alternative method to vascular surgery in the treatment of symptomatic carotid artery stenoses. With strict definition of the indication, the complication rate for PTA is not likely to be higher than that for vascular surgical treatment. PTA of carotid artery stenosis should be used exclusively in medical centers in which a cooperation by vascular surgeons, internists, neurologists, and interventional neuroradiologists comes true.

Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially the internal carotid artery.

We present our experience with 105 patients in whom percutaneous transluminal angioplasty was performed in 112 stenosed or occluded supra-aortic arteries. Symptoms of cerebrovascular and/or vertebrobasilar insufficiency were present in 104 of the 105 patients. The angioplasty was successful in 35 stenoses of the internal carotid artery, 2 stenoses of the common carotid artery, 1 stenosis of the external carotid artery, 15 stenoses of the vertebral artery, 3 stenoses of the innominate artery and 44 stenoses of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 transient ischemic attack, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy and treated by thrombendarterectomy before the appearance of neurological symptoms). All patients were symptom free after angioplasty. During the observations period of 3 to 109 months (average 58 months) there were only two cases with re-stenosis after subclavian angioplasty. The results of more than 700 personal and international published percutaneous transluminal angioplasties of supra-aortic arteries are presented. The results suggest that angioplasty of supra-aortic arteries is an effective method. On strict definition of the indications, the complication rate for angioplasty of the supra-aortic arteries is not likely to be higher than that for operative treatment.

[Long-term results of PTA of degenerative supra-aortic arterial changes]. / Langzeitergebnisse der PTA degenerativer supra-aortaler Arterienveränderungen.

We present our experience with 129 patients in whom PTA was performed in 135 stenosed or occluded supra-aortic arteries. Angioplasty was successful in 44 stenoses of the carotid artery, 19 stenoses of the vertebral artery, 5 stenosis of the innominate artery, 53 stenoses of the subclavian artery and 4 occlusions of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 TIA, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy) and 1 major-complication (permanent hemiparesis). During the observations period of 1 to 116 months (average 61 m) there were only two cases with re-stenosis after subclavian angioplasty. The results suggest that angioplasty of supra-aortic arteries is an effective method.

[The results of percutaneous transvascular sclerotherapy of varicoceles]. / Ergebnisse der perkutanen transvasalen Varikozelenverödung.

The indications, techniques, complications and results of percutaneous sclerotherapy or embolization of gonadal veins for varicocele are discussed. Of our 93 patients, sclerotherapy of varicocele was technically possible in 81 cases. Sclerotherapy or embolization can be effected by different materials, such as: Histoacryl and Lipidiol mixed 1:2 to 1:4 and Aethoxysklerol, applied by a coaxial catheter system or end-opened F 6-catheter. Today the percutaneous transluminal sclerotherapy of gonadal veins is the treatment of choice for varicocele.

[Complications in cerebral angiography. A study of 6698 cerebral angiographies]. / Komplikationen bei zerebraler Angiographie. Eine Studie über 6698 zerebrale Angiographien.

The complications of 6,698 cerebral angiographies performed from 1979 to 1985 in 2,503 patients were analysed. In 5.24% of the patients (1.95% of the angiopathies) temporary complications could be observed. Temporary neurologic-psychiatric complications occurred in 1.96% of the patients (0.73% of the angiographies), most of them in middle-aged patients and in the presence in the presence of diffuse cerebrovascular disease. In 0.12% of the patients (0.05% of the angiographies) a permanent damage was recorded.

[Percutaneous transvascular embolization as a palliative measure in bleeding gynecological malignancies of the pelvis]. / Die perkutane transvasale Embolisation als Palliativmassnahme bei blutenden gynäkologischen Malignomen des kleinen Beckens.

Between 1981 and 1983 48 patients with an average age of 54 years have had an arterial embolization of internal iliac artery. In 7 patients this was done preoperatively within a clinical study, in 41 ones because of profuse vaginal bleedings. In 6 patients there was a vital indication. In all cases survival time was 152 days. In two cases a re-embolization was necessary. In these two patients survival time was on average 338 days. The manoeuvre was done with particles of gelatin of different size suspended in contrast medium. One complication could be observed, but was not caused directly by embolization. In cases of profuse or vital bleedings which conservatively cannot be stopped embolization is method of first choice with no contraindication.