Imaging of mesothelioma of tunica vaginalis testis.

OBJECTIVES: To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis. METHODS: We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis. RESULTS: A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection. CONCLUSIONS: A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity. KEY POINTS: Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively. Most common finding is a complex hydrocele with hypervascular parietal vegetations. Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common. Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.

Leiomyosarcoma of the inferior vena cava extending into the right atrium. A rare differential diagnosis of a right atrial tumor with fatal outcome.

A 54-year-old female patient presented with a progressive and deteriorating dyspnea at the slightest exertion in particular during the past few days before presentation. Transthoracic echocardiography revealed a large space-occupying lesion in the right atrium extending into the inferior vena cava (IVC). Abdominal magnetic resonance aortography showed an elongated space-occupying lesion in the IVC with a significant portion of the tumor and almost completely filling the right atrium accompanied by an infiltration of the hepatic and renal veins. A pronounced tumor infiltration of the IVC at the level of the liver was confirmed intraoperatively and immunohistochemical analysis showed a moderate to poorly differentiated leiomyosarcoma. The extended tumor was successfully removed by a complex operation of the thorax and abdomen but the procedure was accompanied by severe bleeding. A few hours following the procedure the patient died due to a further episode of irreversible intra-abdominal hemorrhage.

Spigelian-cryptorchidism syndrome: a case report and discussion of the basic elements in a possibly new congenital syndrome.

Pediatric cases of Spigelian hernias are rare. Only a few reports on this condition, in combination with ipsilateral cryptorchidism and testis in the hernia sac, have been published. We report on Spigelian hernia in a 3-week-old boy containing both the ipsilateral testis, without a gubernaculum and an incarcerated loop of the small intestine. It has been suggested that the combination of Spigelian hernia and ipsilateral cryptorchidism is part of a new syndrome. We discuss whether the lack of a gubernaculum and an inguinal canal reported in other similar cases may be additional elements of this new syndrome. We present a comprehensive overview of pediatric patients with Spigelian-cryptorchidism syndrome reported in the English language literature. In 75% of male infants with Spigelian hernia, there is an associated ipsilateral cryptorchidism, and in 87% of these patients, the testis is found inside the hernia sac. Thus, the surgeon dealing with a congenital Spigelian hernia should look for an undescended testis and be prepared to find it in the hernia sac.

Relation of impaired interorgan communication and parasympathetic activity in chronic heart failure and multiple-organ dysfunction syndrome.

BACKGROUND: We investigated the relationship of impaired autonomic function and severity of illness in chronic heart failure (CHF) and multiple-organ dysfunction syndrome (MODS) as an end stage of CHF. Furthermore, we assessed the link of parasympathetic modulation of the heart rate and inflammatory activation in CHF and MODS. METHODS: Sixty-five patients admitted for worsening of CHF were retrospectively enrolled in this study. In addition, 65 age- and sex-matched patients with pronounced MODS were assigned for comparison of autonomic function and C-reactive protein in patients with CHF or MODS, respectively. Heart rate variability (HRV) parameters of the time and frequency domain as markers of autonomic function were analyzed from 24-hour Holter electrocardiograms. RESULTS: The more pronounced the severity of illness as expressed by the Acute Physiology and Chronic Health Evaluation score, the more the HRV was impaired. This effect was particularly seen for overall variability (SD of RR intervals) and HRV parameters characterizing the parasympathetic modulations of the heart rate (high, very low frequency power). C-reactive protein levels as markers of inflammation were inversely related to high and very low frequencies. CONCLUSION: Our results allow for speculation that autonomic dysfunction in CHF indicates a beginning of uncoupled interorgan communication potentially leading to MODS as characterized by disruption of communication between the organs.

[Balloon dilatation and local thrombolysis in massive pulmonary embolism--initial results of a new therapy concept]. / Ballondilatation und lokale Thrombolyse bei massiver Lungenembolie--erste Ergebnisse eines neuen Therapiekonzeptes.

The high mortality rate among patients suffering from massive pulmonary embolism makes it imperative to act quickly. The first and foremost goal must be to lower the pulmonary pressure rapidly and to relieve the right ventricle. In three patients with massive pulmonary embolism we therefore tried to crush the thrombus by means of a balloon catheter. The diameters of the balloons were adapted to the size of the vessels to be treated; the balloon diameters were between 10 and 20 mm. Recanalisation resulted in a rapid improvement of perfusion and haemodynamic relief of the right ventricle. This was clinically documented by the drop in pulmonary pressure levels and an impressive improvement of general well-being. Dilation was followed by thrombolytic therapy adapted to the relevant situation. This method of thrombus crushing by means of balloon catheters is indicated in case if massive thrombi in the main stem of the a. pulmonalis, with elevated pulmonary pressure levels, and corresponding clinical signs and symptoms. It can follow alternatively as a first possibility of pressure relief directly after diagnostic pulmangiography. The initial clinical results of this new treatment method are most encouraging. Complications have not been observed so far.

[Interaction of digoxin and quinidine]. / Wechselwirkungen zwischen Digoxin und Chinidin.

Plasma digoxin level and digoxin excretion were studied in 5 pat. suffering from cardiovascular diseases who had to be digitalized because of acute states of congestive heart failure. One of the patients took quinidine simultaneously. In the "quinidine" patient digoxin level was elevated to the 2--2.5 fold, as compared with "control" patients. Digoxin excretion of the "quinidine" patient was slightly increased. Following the results, a reduction in digoxin dosage to half of the dose is recommended.

[Report of experiences: frequency and significance of intestinal parasitoses in patients at a hospital in the Ethiopian highlands]. / Erfahrungsbericht: Häufigkeit und Bedeutung von intestinalen Parasitosen bei Kranken eines Krankenhauses im äthiopischen Hochland.

Intestinal parasitoses are of greatest importance in health policy in tropical developing countries. On account of the increasing numbers of travellers into these countries and the increasing number of inhabitants of these regions who stay in the GDR for purpose of study or training, these problems gain significance also for us. A report on experiences from Socialist Ethiopia illustrates the problems connected with intestinal parasitoses. A non-selected number of patients of a province hospital in the Ethiopian Highlands was evaluated. An epidemiologically obligatory evidence is of course not possible, but the actual situation is exactly characterized. The demonstration of the frequency of the individual parasites is followed by a short discussion of the main helminthic and protozoic diseases.

[Exertion-electrocardiographic and hemodynamic studies with oral verapamil in chronic ischemic heart disease]. / Belastungselektrokardiographische und hämodynamische Untersuchungen mit Oral-Verapamil bei chronisch ischämischer Herzkrankheit.

The effect of the Ca++ -antagonist Verapamil on the ECG, the haemodynamic parameters and the systolic time intervals was investigated in the long-term experiment on 12 patients with ascertained chronic ischaemic heart disease at reat and during exercise. The dosage was 3 x 80 mg/die during 4 weeks. The tolerance was not increased. The load-induced decrease of the ST-T-distance in the ECG was improved under load and in the recreation phase. The function of the myocardium, measured on the quotient LVET/ICT, improved under load with simultaneous decrease of the double product and the TTI, the pulmonary pressure, however, remained uninfluenced. Side-effects were not observed.

[Treatment of severe hypertension and hypertensive crises with nitrates]. / Die Behandlung schwerer arterieller Hypertonien und hypertensiver Krisen mit Nitrokörpern.

Taking into consideration the frequent combination of hypertension, ischaemic heart disease and heart insufficiency the effect of blood pressure as well as the influence of pre- and afterload gain increasing importance, when nitrates are used. It is the question, whether the blood pressure reducing effect may be used with a certain aim or not. In own investigations acute haemodynamic experiments with glycerol trinitrate were carried out on 10 patients with arterial hypertension (catheterization, estimation of HMV and so on) in rest and under ergometric load, clinical therapeutic experiments on 10 patients with crisis of hypertension with cerebral and/or cardiac complications as well as long-term experiments with pentaerythrityl tetranitrate on 6 patients with in most cases severe arterial hypertension. The acute effects on the haemodynamics correspond to those in normal blood pressure, in which case the reduction of blood pressure and resistance is more expressed. The favourable effect of glycerol trinitrate in the crisis of hypertension with cardiovascular complications can be regarded as proved. First own experiences with the long-term application of nitrates do not yet result in a clear estimation of effectivity and indications.

[Local streptokinase administration in massive pulmonary embolism]. / Lokale Streptokinaseanwendung bei massiver pulmonaler Embolie.

Five patients with acute massive pulmonary embolism were treated with streptokinase administered via the pulmonary artery as close as possible to the embolus. Streptokinase (Awelysin) was infused at a loading dose of 250,000 IU followed by a maintenance dose of 100,000 IU/hour under haemodynamic and angiographic control. In four of five patients (two patients with cardiogenic shock) the clinical signs, pulmonary artery pressure and the angiographic findings improved or they normalised within 5-12 hours. In one patient with recurrent embolisation over three weeks the clinical condition improved gradually, although the angiographic findings improved only slightly. The results demonstrate that local thrombolysis of acute massive pulmonary embolism is a highly effective form of treatment.

[Severe Klebsiella serogenes infections]. / Schwer verlaufende Infektionen mit Klebsiella aerogenes.

It is reported on 2 cases of Klebsiella-septikaemia with difficult course. Germs of the group Klebsiella aerogenes could be proved microbiologically. On the basis of the peculiarities of the clinical course the author adopts a definite attitude to the development of the infection, the pathogenesis, to the microbiological proof and to the aimed antimicrobial chemotherapy. The antibiotic treatment was successful in the first case with karbenicillin and gentamycin and in the second case with cephalotin and gentamycin during 4 weeks when a penicillin allergy was present and following this with chloramphenicol and streptomycin during 3 weeks.

[Mechanocardiography as a screening method in chronic ischemic heart disease]. / Mechanokardiographie als Screening bei chronisch ischämischer Herzkrankheit

On 121 patients with ischaemic heart disease mechanocardiographic examinations were carried out on conditions of rest and partly under conditions of ergometric load and were compared with a group of healthy persons. It was shown that in the patients with ischaemic heart disease there appeared a significant shortening of the ejection time (LVETk), prolongation of the frequency-corrected preejection time (PEPk) as well as of the isovolometric contraction time (ICT and ICTk), an enlargement of the quotient (see article) and reduction of (see article) in rest. Under load the differences between healthy persons and patients with ischaemic heart disease became more clearly with regard to the quotients (see article) as well as (see article) and proved as favourable for the judgment of the cardiomechanics. With the help of the above mentioned mechanocardiographic parameters in connection with the usual diagnostic methods according to our opinion patients with ischaemic heart disease may be diagnosed for the greatest part.

[Case report of Lyell's syndrome]. / Ein kasuistischer Beitrag zum Lyell-Syndrom.

In Lyell's syndrome a toxic skin erythema is concerned which leads to the epidermal necrolysis and desquamation. An infantile and an adult form are differed; the latter is usually induced by medicaments. Two patients with apparently medicamentously induced Lyell's syndrome are presented. The evoking medicaments were penicillin and thioacetazone. The two patients showed a severe course with an extensive affection of the body surface. The therapy with glucocorticosteroids, electrolyte substitution and local treatment of the skin lesions was successful in the two cases.

[Electrophysiological findings in atrial arrest]. / Elektrophysiologische Befunde bei Vorhofstillstand.

It is reported on intracardiac electrophysiological findings of a 50-year-old patient in whom an atrial arrest could be diagnosed. With the help of the intracardiac mapping electric residual activities could be proved in the area of the sinus node, of the anterior atrial bundle as well as of the left atrium. The electrophysiological mechanism, the causes, the ways of conduction as well as the valency of the diagnostic measures are discussed.

[Endocardial mapping in the differential diagnosis of supraventricular arrhythmias]. / Endokardiales Mapping in der Differentialdiagnostik supraventrikuläer Dysrhythmien.

The surface ECG only in a restricted number allows evidence on the course off conduction in the atria. By introduction of the intracardial electrography into the clinic as well as various stimulation techniques has become possible better to analyse the formation of stimuli and the conduction system in man. The diagnosis of supraventricular arrhythmias renders particular difficulties. By recording of the intracardial potentials in as many as possible and defined points of the atria in relation to the fixed point possibly near to the sinus node (endocardial mapping) a better analysis of the excitation and conduction is possible. Only own examinations on 9 patients with sinus rhythm and supraventricular dysrhythmias by means of atrial mapping showed that origin and course of the conduction of cardial arrhythmias may be clarified better. The method mentioned according to our experiences hitherto made and reports in literature despite several lacks and difficulties in an enrichment of the diagnostic possibilities in supraventricular dysrhythmias.

[Esophageal electrocardiography--new variants in derivation technics]. / Osophaguselektrokardiographie--neue ableitungstechnische Varianten.

Oesophageal electrocardiography provides for an analysis of heart rhythm that must be considered more accurate than the one obtained in a conventional electrocardiogram. Bipolar intraoesophageal and oesophagosternal or oesophagoparasternal leads, using adequate electrode cables, permit recordings, satisfactory from a technical point of view, even when applying the methods of provocations (ergometry).

[Combined use of talinolol and beta adrenergic stimulants in status asthmaticus. Report on 3 patients]. / Kombinierte Anwendung von Talinolol und beta-adrenergen Stimulatoren beim Status asthmaticus. Ein Bericht über 3 Patienten.

Experiences in combined use of beta-adrenergic stimulants and cardioselective beta-receptor blocker Talinolol are reported in 3 patients in Status Asthmaticus. High dose Aminophyllintreatment in these 3 severe cases was insufficient, in 1 case it had to be finished because of toxic side effects respectively. For adrenergic stimulation in two cases Orciprenalin i.v. was given initially, in one case Terbutalinsulfat i.v. By cardioselective adrenergic blockade with low dose Talinolol it became possible to prevent cardiotoxic side effects in preexisting tachycardia and premature ventricular contractions. This combination treatment was continued successfully with Terbutalin and Talinolol p.o.

[Myocardial infarction without coronary artery changes]. / Myokardinfarkt ohne Koronararterienveränderungen.

Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.