[Anemia, subcutaneous bleeding and weight loss. Disseminated metastasizing, mucinous adenocarcinoma of the stomach]. / Anämie, Suffusionen und Gewichtsverlust. Disseminiert metastasierendes, schleimbildendes Adenokarzinom des Magens.

A 69 years old female patient was admitted to the hospital with anemia, loss of appetite and weight since three months. The physical examination showed extended cutaneous bleedings. Laboratory tests revealed a hemolytic anemia with fragmented erythrocytes. The bone marrow examination was characterized by erythroid hyperplasia and an invasion by mucin-producing adenocarcinoma cells. Upper endoscopy detected a small hiatal hernia with mucosal erosions between esophagus and stomach. The histology of the mucosal biopsy identified a poorly differentiated mucin-producing adenocarcinoma with portions of signet-ring cells. X-ray examination revealed osteoplastic bone metastases of the vertebrae and of the pelvis. We diagnosed a disseminated, mucin-producing adenocarcinoma of the stomach, associated with microangiopathic hemolytic anemia. In spite of rapidly begun chemotherapy with adriamycin and daily blood transfusions the woman died after four weeks.

[Münchhausen syndrome in otorhinolaryngology]. / Das Münchhausen-Syndrom in der Hals-Nasen-Ohren-Heilkunde.

The case of a 22-year-old nurse with Münchausen syndrome is described. Faked symptoms included sudden hearing loss and fever. In addition to the definition and classification, clues for diagnosis of faked disease are given. Early diagnosis avoids unnecessary diagnostic and therapeutic procedures. The prognosis of Münchhausen's syndrome depends on the ability to establish an effective doctor-patient relationship, even though the nature of disease renders any treatment difficult.

Effects of a 'common sense diet' on urinary composition and supersaturation in patients with idiopathic calcium urolithiasis.

OBJECTIVES: To test whether dietary advice as the only treatment is able to reduce urinary supersaturation in patients with idiopathic calcium urolithiasis. METHODS: By means of EQUIL 2, we calculated relative supersaturations of calcium oxalate (RS(CaOx)), brushite (RS(Brushite)), apatite (RS(Apatite)) and uric acid (RS(UA)) of 24-hour urine samples of 68 healthy male controls as well as of 47 male idiopathic calcium stone formers (ICSF) before and after individualized dietary advice (DA). Main goals of DA were (1) to keep urine volume > 2,000 ml/day, and (2) to reduce meat protein intake to 1 g/kg body weight per day. Compliance was judged from changes in urine volume and U(Urea)xV. RESULTS: In the whole group of ICSF, DA did not alter supersaturations. Only in those 9 ICSF (19%) with good compliance (increase in volume and decrease in U(Urea)xV), RS(CaOx) and RS(UA) fell by 26 and 49%, respectively. Besides poor compliance, these findings can be explained by positive correlations between changes in volume and U(Urea)xV in ICSF (r = 0. 319, p = 0.037) or U(Na)xV (r = 0.342, p = 0.019). For instance, ICSF with volumes >/= 2,000 ml/day had evidence of elevated protein and salt intake; thus, DA mainly focused on protein and salt intake, but not on volume. This resulted in decreases in U(Urea)xV and U(Na)xV, but also in volume; thus, RS(CaOx) remained unaltered. CONCLUSIONS: DA is able to significantly lower RS(CaOx); however, because intakes of fluid and protein are directly and positively linked to each other, this only can be achieved if high fluid and lower meat protein intake are equally stressed in all ICSF.