[Coiling vs. clipping: hospital stay and procedure time in intracranial aneurysm treatment]. / Coil vs. Clip: Verweildauer und Behandlungszeit bei der Therapie intrakranieller Aneurysmen.

PURPOSE: Evaluation of hospital resource allocation in intracranial aneurysm treatment in a medium-volume neurovascular center. MATERIALS AND METHODS: Retrospective data analysis included 653 procedures performed on 598 patients with 667 aneurysms (A) from 1990 to 2004. 515 treatments were carried out in ruptured A (clip: n = 370; coil: n = 145) and 138 procedures in non-ruptured A (clip: n = 51, coil: n = 87). Patient management data included procedure time (min), length of stay in the intensive care unit (days), total length of hospital stay (days), and discharge to home ratio. RESULTS: Clinical admission grade (rupt. A: Hunt and Hess grade 1 - 3: clip: 73 % coil: 72 %) and clinical outcome at discharge (good neurological outcome/mortality rate: rupt. A: clip: 51.1/13.8 % coil: 45.5 / 10.3 % non-rupt. A: 88.2/0 % coil: 88.5/1.3 %) were similar for both treatment modes. The coil procedure time was found to be significantly shorter (rupt. A: coil: 145 min; clip: 203 min; p < 0.01; non-rupt. A: coil: 164 min, clip: 200 min; p < 0.01). Coiling reduced the length of stay in the ICU (rupt. A: coil: 5.3 d; clip: 6 d, p < 0.01; non-rupt. A: coil: 1.5 d; clip: 2 d; p = 0.21) and coiling significantly reduced the length of hospital stay (rupt. A: coil: 21.4 d; clip: 26.8 d, p < 0.01; non-rupt. A: coil: 9.2 d; clip: 17.5 d; p = 0.01).The discharge to home ratio did not differ (rupt. A: clip: 31.6 % coil: 29.7 % non-rupt. A: clip: 74.5 % coil: 80.5 %). CONCLUSION: In a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy.

[Rupture of two intact tubal pregnancies]. / Ruptur zweier intakter Tubargraviditäten.

We report on a 24 years old patient with an acute abdominal pain and an unknown intact tubal pregnancy in the 8th gestation week. The sonographic examination confirmed an intact tubal pregnancy. Shortly after the diagnosis, it ruptured with a massive intraabdominal bleeding. Thereafter, the patient collapsed. We carried out a laparoscopy and performed salpingotomy. Because of the persistent bleeding a salpingectomy was performed. We also report on a second patient 34 years old, who was referred to our Department on suspicion of a ruptured ectopic pregnancy with acute abdominal pains and a positive pregnancy test. The transvaginal sonography revealed massive intraabdominal fluid, adnexal tumor and endometriumhyperplasia without a sign of a gestational sac or an embryo.We carried out a laparoscopy, which revealed a ruptured tubal pregnancy with a life, fetus lying in the abdominal cavity. As a result of the massive and persistent intraabdominal bleeding, we carried out laparotomy and performed salpingectomy. Using these two case reports, the etiology, symptoms, clinical course, diagnosis, as well as surgical and drug therapy are discussed.

[Chronic abdominal pains caused by peritoneal tuberculosis - two case reports]. / Peritonealtuberkulosebedingte chronische unklare Unterbauchschmerzen - zwei Fallberichte und Literaturübersicht.

Chronic abdominal pains caused by peritoneal tuberculosis - two case reports. The diagnosis of a peritoneal tuberculosis could be a demanding task for even an experienced Physician, because of the unspecific symptoms. We report on two patients, who as a result of therapy refractory chronic abdominal pains, weight loss and ascites were admitted to our hospital. The excisional biopsy taken from the peritoneum and the omentum major during an exploratory laparotomy resulted in the histopathologic diagnosis of peritoneal tuberculosis being made. Both patients were given tuberculostatic therapy with isoniazid, rifampicin, pyracinamide and streptomycin and both have since recovered. The symptoms, the difficulties encountered in making the diagnosis and the therapy of the peritoneal tuberculosis are discussed using these two case reports.

Photoradiation of perfused placental tissue--a suitable in vitro model for photodynamic therapy?

Our aim was to evaluate the isolated placental lobule as a model to study the cytotoxic effects of photodynamic therapy (PDT) in vitro. Ten human placental lobules were dually perfused with a modified medium 199 for a 4-hour period. Photosan III was added to the fetal perfusate at a dose of 5 mg/kg tissue, and laser light (630 nm wavelength) provided by an argon-pumped dye laser was applied at 50 J/cm2 in the experimental group (n=5). Potassium and lactate dehydrogenase (LDH) release into the perfusate as well as the transplacental creatinine passage from PDT-treated placentas and control placentas (n=5) were compared, and light microscopic examinations of the placental tissue were performed after the experiments. Potassium release into the fetal perfusate was higher in the PDT-treated placental lobules (p<0.05), and weight gain during the artificial perfusion suggests the development of edema only in the photoradiated lobules (p<0.01). The release of the bigger molecules of the LDH however was comparable in the two experimental groups, and transplacental creatinine passage was not affected by photoradiation. Light microscopic examinations demonstrated lesions at the cytotrophoblast, the syncytiotrophoblast and the endothelium of the fetal vessels of the photoradiated placentas, although they were not specific and could also be found in the control tissue. We conclude that the isolated placenta may be used to study cytotoxic effects of photoradiation in vitro, but better specifity and sensitivity might be achieved if a. The perfusion time is prolonged to make the difference between the experimental and the control group clearer and b. Electron microscopic investigations are made to demonstrate intracellular lesions of the mitochondria and the endoplasmic reticulum.

[De novo formation of a cavernoma in association with a preformed venous malformation during immunosuppressive treatment]. / Neuformation eines Cavernoms bei begleitender, vorbestehender venöser Malformation unter immunsuppresiver Behandlung.

We report the clinical course of a 48 year old woman, who underwent a cranial MRI-examination in 1995, which confirmed the diagnosis of encephalomyelitis disseminata, but also showed a left temporal venous malformation without evidence of prior hemorrhage. Three month after immunosuppressive treatment with Methotrexate in 1997 begun, first hemorrhage in the left temporal lobe occurred with de novo formation of a cavernoma in association to the known venous malformation. The lesion was totally removed after stereotactic guided craniotomy without any complication. The pathogenetic relationship of de novo cavernomas and associated venous malformations and the remarkable association with immunosuppressive treatment will be discussed.

Growth factors in cultured human glioma cells: differential effects of FGF, EGF and PDGF.

Primary cell cultures were initiated from surgically obtained specimens from human gliomas. After 4-10 passages in vitro the cells from 18 individual cases were seeded onto cluster dishes and left to attach for 24 h in medium containing fetal calf serum. Thereafter the medium was changed to serumfree, defined conditions and the following growth factors were added: EGF 1.5 x 10-8 M, PDGF 35 ng/ml, FGF 80 pg/ml. The growth factors were added fresh every 2 days. After 9 or 11 days in culture, the cells on one multiwell-plate were counted. In 8 cases another set which was cultured also in a multiwell-plate but on glass cover slides was immunostained for glial fibrillary acidic protein (GFAP), fibronectin (FN), A2B5 and galactocerebroside (galC). The proliferative response pattern in consequence to the growth factor addition varied greatly between different cases. In all cases a pronounced proliferative response was accompanied by marked changes on the culture morphology. Usually the best proliferative response was obtained with PDGF (10 cases) or FGF (8 cases) whereas EGF was most effective only in one case. Two cases showed only minimal response, one of which was an oligodendroglioma D according to Ludwig and another a gliosarcoma which was re-evaluated after 1 year in culture. It could be noted, however, that FGF had a tendency to be less effective in the group of malignant astrocytomas. The staining pattern of the cultures with the afore mentioned markers was not affected by the growth factor treatment. The proliferative response usually resulted in increased staining for fibronectin and never an induction of GFAP. A2B5 staining was positive only in one case of gliosarcoma and galC staining was regularly negative.

Initiation of primary cell cultures from human intracranial tumors on extracellular matrix from bovine corneal endothelial cells.

Tissue specimens from 105 human gliomas and 57 human meningiomas were obtained at surgery, dissociated into single cells and small cell aggregates and then plated onto plain plastic tissue culture dishes and dishes which had been precoated with an extracellular matrix (ECM) derived from bovine corneal endothelium. In 80% of the glioma cases we observed a marked improvement in initial plating efficiency, colony formation and speed of attachment when cells were plated on ECM. In 5 cases cells attached only to the ECM-coated dishes but remained afloat in the untreated dishes. In addition it could be noted that over the first 2 days, those cells which had been initiated on ECM showed more signs of morphological differentiation, i.e., extension of cytoplasmic processes or formation of fiber networks between cell groups. If adaptation occurred and proliferation began in vitro, either immediately or after a several days' lag phase, both the ECM-cultured cells as well as those which slowly had adapted to culture on plastic could be passed on to untreated culture ware and perpetuated thereon. In the case of well-differentiated low-grade gliomas where no growth in culture took place, the cultures on ECM could at least be used for initial experiments in the primary cultures (P0). Meningiomas usually attached well to both, plastic or ECM. In 50% of our cases the plating efficiency was higher on ECM but after successful initial culture, the delay until the cells on plastic reached confluence in comparison with those on ECM was 1 or 2 days. Again there were 2 cases in which the cells would not plate on plastic. Here the cells which after 1 day were still afloat plated to more than 80% within the first 2 h after transfer to ECM. In all cases the cells from plastic and ECM cultures were indistinguishable and could be passed onto untreated dishes henceforth. In later culture stages ECM offers several advantages: It is easier to shift cells to serum-free defined culture conditions, the cells will grow at a faster rate on ECM when in higher passages and the maximal number of passages possible is higher on ECM.