[Actinomycosis of the colon as a rare differential diagnosis of colonic carcinoma]. / Die Actinomykose des Colon als seltene Differentialdiagnose des Coloncarcinoms.

INTRODUCTION: Abdominal actinomycosis is an uncommon disease. Nevertheless it should be considered in case of unclear tumor-like abdominal masses. METHODS: We report a case of a 49-year-old patient with an intrauterine device. The patient was submitted with a solid and painful tumor in the upper abdomen. After sonography, computerized tomography, gastroduodenoscopy and colonoscopy the preoperative presumptive diagnosis was a carcinoma of the transvers colon invading the abdominal wall. Pathological examination after a right hemicolectomy surprisingly revealed an actinomycosis. RESULTS: Based on this case diagnostic tools and therapeutic options of actinomycosis of the colon are discussed. CONCLUSIONS: This case illustrates the importance to consider the possibility of actinomycosis when finding an unclear abdominal mass. After a surgical excision an abdominal actinomycosis requires antibiotic therapy.

Percutaneous transhepatic catheterization of the portal vein: A combined CT- and fluoroscopy-guided technique.

Combined CT- and fluoroscopy-guided transhepatic portal vein catheterization was performed in 44 patients selected for pancreatic islet cell transplantation. The method allowed catheterization with a single puncture attempt in 39 patients. In four patients two attempts and in one patient four attempts were necessary. One minor hematoma of the liver capsule occurred that required no further treatment. Compared with other methods the average number of puncture attempts was reduced.

Rational diagnostic steps in acute pyelonephritis with special reference to ultrasonography and computed tomography scan.

Depending on the severity of the clinical syndrome, acute pyelonephritis may require more extensive imaging diagnostics. In the uncomplicated form of the disease, ultrasonography does not appear to be absolutely necessary. In clinically severe cases, however, which fail to respond to antibiotic therapy, ultrasound is the optimal procedure for ruling out urinary tract obstruction. Where there is clinical suspicion of complications proven risk factors, persistent fever and/or continuing pathological inflammation parameters (elevated C-reactive protein levels in serum)-ultrasonography is the primary imaging technique for the exclusion of pyonephrosis, as well as for other complicating factors such as calculi, etc. In cases of insufficient response to antibiotic therapy, we recommend performing a renal computed tomography scan with contrast medium, in order to rule out hypoenhancing zones as hints for severe tissue alterations. This procedure is in accordance with the suggestions of the Society for Uroradiology. In the future, DMSA scintigraphy might constitute an equivalent diagnostic method for the exclusion of these focal inflammatory changes. Above all, DMSA scintigraphy makes it possible to anticipate the development of scars following acute pyelonephritis.

Metastatic RCC arising in a transplant kidney.

We report a case of metastatic renal cell carcinoma arising in a cadaver transplant kidney 6 years after transplantation. Due to molecular analysis of the tumor tissue we could prove that the carcinoma originated from the male donor. After tumor resection and interruption of immunotherapy, the concomitant bone and lymph node metastases resolved with alpha-interferon and interleukin-2-based immunotherapy.

[The diagnostic accuracy and therapeutic relevance of CT arthrography and MR arthrography of the shoulder]. / Diagnostische Sicherheit und therapeutische Relevanz von CT-Arthrographie und MR-Arthrographie der Schulter.

PURPOSE: In glenohumeral instability, CT arthrography and MR arthrography of the shoulder joint were compared to assess accuracy in diagnosis of labral lesions and other internal derangements of the joint, and to evaluate relevance of both imaging methods for therapy. METHODS: 38 patients with symptoms of shoulder instability were examined clinically, arthrographically with CT and MRI, and arthroscopically. Arthrography with CT and MRI was performed in a double-contrast technique after single puncture and simultaneous injection of the contrast agents for both imaging methods. Type and extent of lesions on arthrographic imaging were criteria for planning therapy to a conservative, sole arthroscopic, or open surgical approach. RESULTS: Sensitivity in diagnosis of labral lesion (26 defects) was 85% in CT, 88% in MRI and 100% if both methods were used. Full-thickness tears of the rotator cuff were visualised in CT in 73%, and in MRI in 100%. Diagnostic accuracy increased from partial to complete to total defects. An open surgical approach was correctly predicted on MRI in 90% and on CT in 71%. A sole arthroscopic therapy was correctly foreseen on both arthrographic techniques in only 38% due to difficulties to assess glenohumeral ligaments. CONCLUSIONS: CT arthrography and MR arthrography were excellent for diagnosing labral lesions. MRI is superior to CT in the imaging of all joint structures. Surgical approach can be accurately predicted with both imaging methods but special surgical techniques cannot be effectively planned to replace diagnostic arthroscopy in all cases.

[CT quantification of pleuropulmonary lesions in severe thoracic trauma]. / Computertomographische Quantifizierung pleuropulmonaler Läsionen beim schweren Thoraxtrauma.

PURPOSE: Computed quantification of the extent of pleuropulmonary trauma by CT and comparison with conventional chest x-ray--Impact on therapy and correlation with mechanical ventilation support and clinical outcome. METHOD: In a prospective trial, 50 patients with clinically suspicious blunt chest trauma were evaluated using CT and conventional chest x-ray. The computed quantification of ventilated lung provided by CT volumetry was correlated with the consecutive artificial respiration parameters and the clinical outcome. RESULTS: We found a high correlation between CT volumetry and artificial ventilation concerning maximal pressures and inspiratory oxygen concentration (FiO2, Goris-Score) (r = 0.89, Pearson). The graduation of thoracic trauma correlated highly with the duration of mechanical ventilation (r = 0.98, Pearson). Especially with regard to atelectases and lung contusions CT is superior compared to conventional chest x-ray; only 32% and 43%, respectively, were identified by conventional chest x-ray. CONCLUSION: CT allows rapid classification and quantification of pulmonary lesions after thoracic trauma and provides higher sensitivity and reliability. Because of the great correlation with the extent of artificial respiration in respect of duration and pressure, prognosis of the individual patient, as well as a differential therapy, appear possible.

[Value of arthro-CT in decision for arthroscopic or open stabilization in ventral shoulder instability]. / Wertigkeit der Arthro-CT in der Entscheidung zur arthroskopischen oder offenen Stabilisierung bei ventraler Schulterinstabilität.

A prospective study was performed on 30 patients with anterior instability of the shoulder to assess the diagnostic value of preoperative arthro-CT. One special diagnostic problem was the definition of diagnostic criteria for arthroscopic or open surgery. Arthro-CT of the shoulder was performed with a double-contrast technique. Visualization of labral tears, bony lesions, glenohumeral ligaments and disruption of the rotator cuff was registered. Findings of arthro-CT were verified by diagnostic arthroscopy. Therapy consisted of either arthroscopic or open surgery depending on the lesion pattern found in diagnostic arthroscopy. The most common cause of anterior instability (90% of cases) was damage of the ventro-caudal labral complex, which was diagnosed by arthro-CT with a sensitivity of 93% and a positive predictive value of 93%. Specificity and negative predictive value were reduced to 33%; the overall accuracy was 87%. In all, 16 patients were successfully treated using arthroscopic stabilization because whereas 14 patients required open surgery because diagnostic arthroscopy contraindicated an arthroscopic approach. The preoperative arthro-CT failed to define all criteria mandatory for the decision for arthroscopic or open surgery because pathoanatomy of the joint was not sufficiently demonstrated with the current technique of arthro-CT.

[Tumor dissemination after thoracoscopic resection of malignant pulmonary coin lesions]. / Tumordissemination nach thoracoskopischer Resektion von malignen Lungenrundherden.

We report about two cases of tumor dissemination after thoracoscopic wedge resection of malignant nodules of the lung. In the first case, a metastasis at the extraction site was observed after thoracoscopic resection of a metastasis of the lung. In the second case we diagnosed a pleural carcinosis after thoracoscopic wedge resection (and additional open lobectomy and lymph node dissection) of a pT2 N0 lung cancer. The patient died 12 months after the operation. The indication for thoracoscopic resection of malignant nodules of the lung should be restricted for peripheral tumors smaller than 2 centimetres.

[Clinical experiences with the Gianturco-Z stent in endotracheal and -bronchial stenoses]. / Klinische Erfahrungen mit Gianturco-Z-Stents bei endotrachealen und -bronchialen Stenosen.

We inserted Gianturco-Z stents in 17 patients with tracheobronchial stenoses on 18 occasions. Three patients had benign, all others malignant stenoses due to compression of the tracheobronchial tree by metastasising malignancies. In all cases the stents could be easily positioned and the patients experienced relief of their severe dyspnea. In one case there was fatigue breakage of the stent. The patient was therefore given a silicone tracheal stent.

[The implantation of Hickman catheters. A new function of interventional radiology]. / Die Implantation von Hickman-Kathetern. Eine neue Aufgabe der interventionellen Radiologie.

Hickman catheters are used mainly in patients with hematologic diseases, especially lymphatic and myelotic leukemias, and malignant lymphomas. They facilitate the administration of chemotherapeutics, hyperosmolar solutions and other substances with local toxicity as well as frequent taking of blood samples. Usually Hickman catheters are placed by surgical cut-down on a jugular vein. In lieu of this surgical placement, we recommend the implantation of Hickman catheters by means of interventional radiology techniques. In a period of 13 months 78 Hickman catheters were placed in 67 patients, 37 catheters (= 47%) stayed more than one month, 8 catheters (= 10%) stayed 5 to 8 months in the central venous system, 26, respectively 6, of these catheters are until now in situ. Lethal or life threatening complications did not occur. There were no infections at the introduction site of the catheter. The main complications were: pneumothorax without drainage: 3.2%, pneumothorax with drainage: 3.2%, slipping back of the tip of the catheter: 4.8%, thrombosis of the subclavian vein: 3.2%, fluid in the pleural cavity: 1.6%. In correspondence to the literature the complications of Hickman catheter placement by means of interventional radiology are less serious than by means of surgical cutdown. Further advantages are: general anesthesia can be avoided (less strain on severely ill patients, no problems to wean from assisted ventilation in patients with respiratory insufficiency), the smooth curve of the implanted catheter avoids sharp kinking and occlusion of the lumen, very small skin incisions are sufficient (lesser risk of hematomas in patients with thrombopenia), time and cost are reduced in comparison to surgical placement.

[Primary malignant fibrous histiocytoma of the lung]. / Primäres malignes fibröses Histiozytom der Lunge.

A chance finding of a sheet-like, dorsal opacification in the left lower lung field of a 77-year-old nonsmoking woman was at first misdiagnosed as tuberculosis because mycobacteria were demonstrated in bronchial secretion. Before it was shown that they were atypical mycobacteria, only facultatively pathogenic, tuberculostatic treatment was started. But both radiologically and clinically the patient's condition deteriorated, with fever and enlargement of the pulmonary lesion. The left lower lobe was resected on suspicion of a chronic pneumonia with consolidation and ultimately abscess formation. The preliminary histological diagnosis of the resected lobe was of a small-cell bronchial carcinoma, stage pT3N0Mx. Further immunohistochemical tests, however, revealed a malignant fibrous histiocytoma which is extremely rare in the lung.

The mechanism of fibrin-induced disorganization of cultured human endothelial cell monolayers.

Deposition of polymerizing fibrin on the vascular endothelium is the final event in intravascular coagulation. Exposure of fibrin clots to confluent monolayers of cultured human endothelial cells for 4 to 24 hours resulted in the disappearance of their normal cobblestone morphology and in the formation of endothelial cell aggregates. The present study was designed to evaluate the conditions and structural requirements of the fibrin clot for the induction of disorganization. Even after harsh treatment with denaturing agents or loading with large amounts of fibrinogen antibodies, polymerized fibrin always induced disorganization of the monolayers. In contrast, soluble fibrin that was kept in solution by either fibrinogen, fragment D-cate, or the tetrapeptide Gly-Pro-Arg-Pro did not cause any alteration of the monolayers. The fibrinogen degradation product D-cate (Mr 94,000) itself had no microscopically detectable influence on the monolayer structure. In the absence of fibrin, the effect of thrombin on endothelial cells was found to be distinct from that induced by fibrin; however, the exposure of pieces of glass coverslips caused alterations in morphology indistinguishable from the fibrin-induced disorganization of the monolayer. Experiments using protein-coated polyester films indicated that the ability of the endothelial cells to attach to the overlying material, independent of its chemical structure, is the prerequisite for the induction of disorganization, but not a defined component of the fibrin molecule. Disorganization of vascular endothelium in vivo might be important for the organization and revascularization of an occluding thrombus.