Ultrasound-guided percutaneous ethanol ablation of parathyroid hyperplasia: preliminary experience in patients on chronic dialysis.

OBJECTIVE: We report on a 3-year experience using single-shot, ultrasonography-guided, percutaneous ethanol ablation (PEA) of hyperplastic parathyroid glands in chronic dialysis patients suffering from secondary or tertiary hyperparathyroidism. MATERIALS AND METHODS: Seventeen uraemic patients (mean age 52 +/- 14 years) with hypercalcaemia and elevated serum levels of parathyroid hormone were assessed for ethanol ablation. Ten patients did not fulfil the inclusion criteria and underwent surgical parathyroidectomy. Seven patients were treated using PEA. RESULTS: All patients treated with PEA tolerated the procedure well, and no major complications were observed. Three out of seven patients underwent further ethanol ablation due to recurrent symptomatic hyperparathyroidism. Following the procedures, serum values of total calcium and parathyroid hormone remained within target range with concomitant medical therapy in all patients. CONCLUSION: PEA performed as a single-shot therapy can be used as a minimally invasive and safe supplement to medical therapy in the treatment of secondary or tertiary hyperparathyroidism in selected patients. In case of recurrence, treatment can be repeated without any problems.

Regional cerebral blood flow in patients suffering from post-traumatic stress disorder.

OBJECTIVE: The aim of the study was to determine whether regional cerebral blood flow in survivors of torture suffering from post-traumatic stress disorder (PTSD) differed significantly from that in healthy controls. METHOD: We examined the cerebral regional distribution of 99m-technetium-hexamethylpropyleneamineoxime (HMPAO) using single photon emission computed tomography (SPECT) in 8 patients and in 8 healthy controls. A semi-quantitative analysis was performed in which symmetrical regions of interest (ROI) were drawn in all subjects. RESULTS: Regional blood flow was markedly more heterogeneous in patients suffering from PTSD than in healthy controls. The differences are significant. CONCLUSION: Severe psychological trauma induced by torture can cause neurobiologic alterations that may contribute, even years after the original trauma, to a number of complaints commonly expressed by patients suffering from PTSD.

Scintimammography enhances negative predictive value of non-invasive pre-operative assessment of breast lesions.

AIMS: The aim of this study was to develop a criterion with a high negative predictive value for the evaluation of breast lesions. We aimed to determine the value of combining three non-invasive tests, mammography (MM), ultrasonography (USS) and 99mTc-methoxyisobutylisonitrite (99mTc-MIBI) scintimammography (scinti-MM). METHODS: We included 94 consecutive patients with suspected lesions detected by mammography or on physical examination. MM, USS and scinti-MM were performed no more than 4 weeks prior to excisional biopsy in all patients. We then compared the biopsy results with a score calculated for each patient, derived from the results of the three tests, which we termed 'mamma malignancy index' (MMI). RESULTS: Each of the three exams yielded a score ranging from 0 to 2, with 0 representing an almost certainly benign lesion, 1 an indeterminate finding and 2 a likely malignant lesion, and hence giving a total score ranging from 0 to 6. The biopsy results showed that the lesions in 64 patients were benign. Forty-nine (77%) of these patients had received an MMI score of 0 or 1. The negative predictive value for malignancy in patients with a score less than 2 was 100%. CONCLUSIONS: Since the smallest detected lesion was 9 mm in diameter, we conclude that MMI may be a highly useful diagnostic tool in the delineation of breast lesions > or =1 cm which should not be routinely referred for biopsy but may be followed non-invasively. Although fine needle aspiration has limitations, we would recommend it as a less invasive method to evaluate suspected lesions smaller than 1 cm.

Treatment of advanced colorectal cancer with folinic acid and 5-fluorouracil in combination with cisplatinum.

51 patients with metastatic colorectal cancer (stage Dukes D) were treated with intravenous (i.v.) infusion on days 1, 3, 5, 8 and 16 with folinic acid (200 mg/m2) and 5-fluorouracil (600 mg/m2), and on days 1, 8 and 16 with cisplatinum (25 mg/m2 i.v.); cycles were repeated every 4 weeks. All 51 patients were evaluable for toxicity and response criteria. 26 patients had objective responses (3 complete responses, 5.9%; 23 partial responses, 45.1%), relative risk 51% (95% confidence intervals 36.7-65.0%). Response duration ranged from 4 to 28.0 months (median 16.8). Overall median survival of all patients included was 14.7 months (range 3.0-33.0). Toxicity of WHO grade III, requiring dose reduction, occurred in 9 (18%) patients. The regimen described here appears to be active, safe and well tolerated for treatment of patients with advanced colorectal cancer.

Erythropoietin treatment for chronic anemia of selected hematological malignancies and solid tumors.

BACKGROUND: Neoplasias, especially in their more advanced stages, are often associated with chronic anemia of malignancy which impairs the patient's physical ability and quality of life. PATIENTS AND METHODS: Forty-two patients with chronic anemia associated with hematological malignancies (18 multiple myelomas, 10 myelodysplastic syndromes) or solid tumors (9 breast cancers, 5 colon cancers) were treated with 150-300 units/kg rHuEPO for a median time period of 16 weeks. Response was defined as an increase of the initial hemoglobin level by at least 2 g/dl. RESULTS: The response rates for solid tumors were comparable (44.4% and 40% for breast cancer and colon cancer, respectively), whilst the response in patients with hematological malignancies depended strongly on the disease entity (77.8% for multiple myeloma, 10% for myelodysplastic syndrome). Pretreatment serum levels of endogenous erythropoietin (EPO) were significantly higher in non-responding patients than in responders. During rHuEPO therapy, EPO levels in non-responders increased even further, while they remained basically unchanged in responding patients. In responders, the WHO performance status before the start of rHuEPO therapy was more favorable and showed impressive improvement during the course of treatment. The median survival time of responders was 28.0 months as compared to only 9.2 months for non-responders. Clinical symptoms of anemia subsided or at least considerably improved under successful rHuEPO therapy. With the exception of occasional flu-like symptoms, no undesirable effects of rHuEPO treatment were observed. CONCLUSIONS: In conclusion, rHuEPO treatment corrected anemia of malignancy both in patients with hematologic disease and in those with solid tumors, but responsiveness varied considerably amongst the different disease entities.

[Vitronectin in bronchoalveolar lavage--a parameter of disease activity in sarcoidosis]. / Vitronectin in der bronchoalveolären Lavage--ein Aktivitätsparameter bei Sarkoidose.

Vitronectin is a multifunctional glycoprotein which is involved in several of the processes of inflammation and repair. In previous studies we demonstrated that increased concentrations of vitronectin can be detected in bronchoalveolar lavage fluids (BAL) of patients with interstitial lung disease (e.g. sarcoidosis). The outcome of sarcoidosis is generally favorable, however, some patients progress to pulmonary fibrosis. There is a need for markers indicating early fibrotic changes in the lung in patients with sarcoidosis. The present study was designed to evaluate the potential of BAL-vitronectin measurements for the assessment of disease activity in subjects with sarcoidosis. BAL-vitronectin concentrations were determined in 19 patients with biopsy proven sarcoidosis and sequential analysis of BAL-vitronectin levels were performed in 11 patients before and after therapy. Patients with active sarcoidosis had higher BAL-vitronectin concentrations (1.56 +/- 0.89 microgram/ml) than patients with inactive disease (0.68 +/- 0.33 microgram/ml; p < 0.01). Patients with active sarcoidosis received high-dose glucocorticoid treatment for four weeks followed by low-dose glucocorticoid therapy for eleven months. After high-dose medication BAL-vitronectin concentrations fell significantly (1.08 +/- 0.9 microgram/ml; p < 0.01). A further decrease in vitronectin levels resulted when therapy was continued for a year (0.75 +/- 0.48 micrograms/ml). Clinical deterioration correlated with an increase in BAL-vitronectin concentrations. Thus, measurement of BAL-vitronectin levels might be a useful marker for assessing disease activity and response to therapy in patients with sarcoidosis, but does not provide prognostic information.

[Diagnostic value of secretory products of eosinophils and neutrophils in bronchoalveolar lavage in patients with idiopathic lung fibrosis]. / Aussagekraft der Sekretionsprodukte von Eosinophilen und Neutrophilen in der bronchoalveolären Lavage bei Patienten mit idiopathischer Lungenfibrose.

Idiopathic pulmonary fibrosis (IPF) is characterized by a chronic inflammatory process in the lower respiratory tract of unknown etiology and poor prognosis. There is evidence that cytotoxic mediators released by neutrophils and eosinophils, such as myeloperoxidase (MPO) and eosinophil cationic protein (ECP) play a central role in the pathogenesis of this disease. The aim of this study was to assess disease activity in patients with IPF by measuring MPO and ECP concentrations in bronchoalveolar lavage (BAL). 14 patients with IPF had significantly higher concentrations of BAL-MPO and ECP (median = 117.2 micrograms/l, range: 4-217 micrograms/l and median = 16 micrograms/l, range: 4-34 micrograms/l, respectively) than patients with sarcoidosis (n = 9) (median = 6.5 micrograms/l, range: 4-12 micrograms/l and median = 7.1 micrograms/l, range: 2-13 micrograms/l, respectively) or pneumonia (n = 13) (median = 10.8 micrograms/l, range: 5-14 micrograms/l and median = 7.6 micrograms/l, range: 3-10 micrograms/l, respectively) (p < 0.01). Follow-up of MPO and ECP concentrations in BAL was performed in 8 patients with IPF before and after 4 weeks high-dose and 12 months low-dose corticosteroid therapy. Changes in MPO and ECP levels paralleled the clinical course and successful treatment resulted in a significant decrease of both MPO and ECP concentrations (p < 0.05), while clinical deterioration or treatment failure was associated with an increase of BAL-MPO and ECP levels. Increased MPO and ECP concentrations in BAL seem to reflect ongoing disease activity and may be useful prognostic markers in the management of patients with IPF.

Serum procollagen III peptide levels in subjects with sarcoidosis. A 5-year follow-up study.

In a prospective study, Type III procollagen N-terminal peptide was measured in the sera of 38 subjects with biopsy-proven pulmonary sarcoidosis at 6-month intervals over a period of 5 yr. The subjects were divided into four groups according to their radiologic presentation and clinical course: Group A (n = 10) subjects with sarcoidosis Type I without radiologic progression over 5 yr; Group B (n = 5) subjects with sarcoidosis Type I with radiologic progression to Stage II or III; Group C (n = 9) subjects with sarcoidosis Types II and III without progression over 5 yr; and Group D (n = 14) subjects with sarcoidosis Types II and III with radiologic progression. Lung function tests (FVC, FEV1, and DLCO), chest roentgenograms, and measurements of serum angiotensin converting enzyme (S-ACE) were performed concurrently with the S-PCP-III levels. Significantly higher levels of S-PCP-III were found in group B (Type I, progressive) (18.2 +/- 1.09 ng/ml) and in group D (Type II/III, progressive) (13.9 +/- 1.2 ng/ml) compared with those of Group A (Type I, stable) (9.1 +/- 1.09 ng/ml) and Group C (Type II/III, stable) (7.6 +/- 1.1 ng/ml) or normal volunteers (9.4 +/- 4 ng/ml) (p less than 0.001 for all comparisons). Changes in S-PCP-III levels tended to parallel the clinical course, and steroid treatment resulted in a significant decrease in S-PCP-III concentrations (p less than 0.001). In contrast, serum angiotensin converting enzyme (S-ACE) levels did not correlate with either the clinical course or radiologic changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Laser angioplasty: results of a prospective, multicenter study at 3-year follow-up.

A prospective multicenter trial was initiated to evaluate the efficacy and safety of laser angioplasty. Laser recanalization was performed in 338 patients with arteriosclerotic femoropopliteal artery occlusions (average length, 8.5 cm). Neodymium-yttrium-aluminum-garnet lasers were used in combination with sapphire probe catheters. The initial recanalization rate was 85%. Complications were observed in 14% of the patients. Emergency surgery was required in 1.5%. The cumulative long-term patency rate of the successfully recanalized arteries was 80%, 70%, 62%, and 57% at 6 months, 1 year, and 2 and 3 years, respectively. The patency rates were not affected by the length of the occlusion and the long-term medication (platelet inhibition vs anticoagulation), but patients with a normal runoff had significantly better patency rates than those with reduced runoff (63% vs 52%, P less than .01). The study has shown that laser-assisted angioplasty is safe and at least as effective as conventional angioplasty.

[Clinical and urodynamic results after various ileum neobladder procedures]. / Klinische und urodynamische Ergebnisse nach unterschiedlicher Ileum-Neoblase.

Urinary diversion after cystectomy in 15 male patients suffering from advanced transitional cell carcinoma of the bladder (pT-pT3b) was performed by ileal neobladder in different ways: S type n = 5, U type n = 3, J type n = 3 and W type n = 4. The perioperative mortality was nil, the overall complication rate 60%. The patients were followed up by means of regular urodynamic controls after 3, 6 and 12 months. After a median follow up period of 18 months (12-29) the J type and W type seem to be superior with regard to postoperative continence. All patients with W type neobladder are continent. The capacity of the neobladders varies from 200 to 800 ml; the W pouches have the highest capacity.

[Femoropopliteal laser recanalization--a multicenter study]. / Femoropopliteale Laserrekanalisation--eine Multicenterstudie.

Laser-assisted angioplasty was performed in four different hospital centers, following the same treatment protocol and using an Nd-YAG laser with a sapphire-probe catheter. The initial recanalization rate of 259 femoro-popliteal occlusions with a mean length of 7.5 cm was 84%. Dissections or perforations were observed in 10%. An emergency surgical intervention was required in 1.1%. The long-term patency rate of the successfully recanalized arteries was 74% after 2 years. The cumulative cure rate of all 259 patients was 62%.

[A cerebral air embolism due to a central venous catheter in the computed tomogram]. / Zerebrale Luftembolie bei zentralvenösem Katheter im Computertomogramm.

A case of air embolism to the brain occurred via a disconnected central venous catheter. Computed tomography disclosed a number of small air bubbles in the right hemisphere. If the clinician suspects air embolism a CT scan should be obtained immediately to verify the presence of intracerebral air. On later CT scans only secondary effects like in any embolism will be seen.

[Ultrasound controlled kidney cyst puncture: significance for diagnosis and therapy]. / Ultraschall-gezielte Nierenzystenpunktion: Bedeutung für Diagnostik und Therapie.

Renal cyst puncture under ultrasonic guidance has proved an excellent and safe method in the differential diagnosis of cystic renal masses. The use of ultrasound in the follow-up of patients with renal cyst puncture is mandatory for evaluation of complications and results. The therapeutic success of renal cyst puncture is poor and estimated at about 25%. New percutaneous techniques with resection of the cystic wall lead us to expect much better results than with open surgical management.

Adrenal cortical carcinoma: preoperative demonstration of right atrial extension by sonography and computerized tomography.

We report a case of adrenal cortical carcinoma with tumor thrombus extending to the right atrium. Tumor extension was demonstrated preoperatively with sonography and computerized tomography. We recommend that both modalities be used when evaluating masses in the suprarenal space. The preoperative diagnosis of tumor extension via the adrenal vein into the inferior vena cava was confirmed at operation.

[Changes in the vena cava in kidney tumors: sonography or cavography?]. / Kavaveränderungen bei Nierentumoren: Sonographie oder Kavographie?

In seven out of 45 cases with malignant growths in kidneys and adrenal glands, sonography presented tumor-induced changes in the vena cava. The accuracy of this technique in detecting changes in the vena cava corresponds to that of cavography. Thus, it is no longer necessary to use cavography--except as a supplementary method mainly in cases where with sonography it is difficult to differentiate between an incomplete and a complete occlusion of the vena cava or between a cone-shaped invasion of the neoplastic thrombus into the inferior vena cava and an infiltration of the tumor into the wall of the vena cava.

[Clinical significance of the dilated common bile duct in the sonogram]. / Die klinische Bedeutung des im Sonogramm erweiterten Ductus choledochus.

The data of 34 patients with a sonographically established dilated common bile duct were analysed as to the clinical significance of these findings. Whereas it was possible to diagnose dilated proximal common bile ducts in all of the cases under examination, presentation of the distal section succeeded in only 56% of the patients involved. Thus distal concretions escaped diagnosis in seven out of 24 cases. There is no established relation between the extent of dilatation of the common bile duct and hyperbilirubinemia; quite to the contrary, in three cases without any signs of arrest of bile excretion under chemical analysis, it was not until ultrasonography was performed that some initial indications of an impeded bile outflow due to concretions were discovered. It was possible to obtain a confirmed diagnosis in the case of two pancreas carcinomas, three bile duct carcinomas, a local recurrent carcinoma of the gall bladder and lymph node metastases of a gastric carcinoma in the hepaticoduodenal ligament. In another gall bladder carcinoma nothing but dilated bile ducts presented itself. What was thought to be a hepatoma, turned out to be a carcinoma of the bile duct during autopsy. A cirrhotic carcinoma of the common bile duct was considered to be a case of calculi in the common bile duct without shadow when examined with ultrasound. During their stay in the hospital, four patients passed gallstones, thus relieving distention of the duct. Additional tests were carried out in 16 patients (47%) in order to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Morphological liver diagnosis in radiology]. / Morphologische Leberdiagnostik in der Radiologie.

Based on the experiences incurred in the years 1970 to 1977, this thesis deals with the efficiency of sonography, scintigraphy and angiography as well as such supplementary diagnostic procedures as ERCP, hepatography and computed tomography in circumscribed hepatic processes. Based on the typical clinical findings obtained, recommendations are made on further diagnostic procedures according to the given hospital structure in Austria: 80% of liver metastases and circumscribed space-occupying primary lesions may be diagnosed by sonography in Basic Hospitals (Standardkrankenanstalten) while cystic processes may be excluded. Solitary space-occupying lesions will have to be examined further by scintigraphy and angiography on the next highest level, the General Hospital (Schwerpunktkrankenanstalt). In combined application, diagnostic accuracy increases to 90%. ERCP, hepatography and percutaneous transhepatic cholangiography are used in special clinical cases only. Computed tomography, available in Central Hospitals (University Hospitals), will not replace the other morphological, diagnostic procedures.