[Endoscopic resection of a rare gastric adenoma (pyloric gland adenoma) with transition into a well-differentiated adenocarcinoma]. / Endoskopische Resektion eines seltenen Magenadenoms (Pyloric-gland-Adenom) mit Übergang in ein gut differenziertes Adenokarzinom.

We present the case of a 76-year-old lady in whom the work-up for iron-deficiency anaemia resulted in the finding of a giant gastric polyp. The polyp could be completely removed endoscopically. The final histology showed the rare entity of a pyloric gland adenoma with focal transition into a well-differentiated adenocarcinoma. The patient is well after a follow-up of 12 months. Pyloric gland adenoma was first described in 1990. In spite of its benign histological appearance, a transition into adenocarcinoma has been reported in up to 30 % of the cases. Thus, although relatively rare, the gastroenterologist/endoscopist, as well as the pathologist should be aware of the entity of pyloric gland adenoma.

Genotypic and phenotypic determination of five virulence markers in clinical isolates of Escherichia coli.

The presence of the virulence markers K1 capsule, serum resistance, aerobactin, S and P/PR fimbriae were examined in a total of 395 E. coli strains from different extraintestinal infections and in 81 faecal isolates of healthy volunteers using specific DNA probes and classical phenotypic methods. All markers were more frequently detected when genotypic assays were applied. The simultaneous occurrence of 3-4 virulence determinants was typical for isolates derived from patients with septicaemia or meningitis. Isolates from blood cultures and cerebrospinal fluid were expressing the virulence phenotypes to a greater extent than isolates from urine or faeces. The use of colony hybridization with specific oligonucleotide and polynucleotide probes for the detection of virulence determinants has been proven to be more specific and reliable than phenotypic approaches.

Occurrence of S and F1C/S-related fimbrial determinants and their expression in Escherichia coli strains isolated from extraintestinal infections.

The presence of S and F1C/S-related fimbrial determinants was determined in 462 E. coli strains obtained from different extraintestinal infections and in 162 control isolates of E. coli by using two different DNA probes: an oligonucleotide probe consisting of three oligonucleotides that bind specifically to the S adhesin gene and a polynucleotide probe which is not able to distinguish between S, F1C, and S-related sequences. The expression of S and F1C phenotypes was tested by dot enzyme immunoassay with the corresponding monoclonal antibodies. S fimbriae genotypes were observed more frequently in septic (25%) and urinary (12%) isolates of E. coli than in faecal and water isolates (1%) and often occurred together with O2, O6, O18 and O83 antigens. F1C/S-related fimbrial DNA was detected with a higher frequency in UTI isolates (26%) than in septic (16%) and faecal (10%) isolates and was most frequently associated with O4, O6, and O75 serotypes. Since the production of S and F1C fimbriae was comparatively rare in all clinical and control isolates of E. coli, DNA hybridization assays which allow the sensitive and specific detection of fimbrial determinants even in the absence of their expression are preferable to phenotypic assays.

Toxoplasma gondii infection: analysis of serological response by 2-DE immunoblotting.

Toxoplasma gondii is known to cause a variety of diseases ranging from asymptomatic infections to serious conditions in immunocompromised hosts such as AIDS-patients or transplant recipients. In addition they may cause abortion or fetal abnormalities during pregnancy. Despite the clinical importance, diagnosis, treatment and prevention still remain unsatisfactory. Analysis of the parasitic cell determinants, recognized by specific humoral and cellular immune responses, may have important implications for diagnosis, therapy and vaccination strategies. Two-dimensional electrophoresis (2-DE) was used to resolve and compare protein patterns from Toxoplasma gondii strains RH and BK (mouse virulent strains). Comparison of silver-stained gels showed that 35.2% to 60.3% of the spots had the same position. In a second series of experiments, the reactivity of the spots with human sera was tested. Proteins were transferred to PVDF membranes and were detected with sera from different patient groups. Depending upon the immunoglobulin class (IgG, IgM, IgA or IgE) different epitope patterns were observed. Some of the spots seemed to be recognized in different stages of infection. Sera of two patients with similar serology and comparable stage of infection were compared in order to demonstrate an individual immune response.

Biochemical diagnosis in prenatal uropathy.

Thirty-two fetuses, six with prune-belly syndrome, seven with renal cyst, 19 with obstructive uropathy, underwent intrauterine fluid aspiration during weeks 15-37 of gestation. Fluid samples were analysed for Na, K, creatinine, urea, alpha 1-, and beta 2-microglobulin. Aspirate concentrations of sodium below 130 mmol/L and creatinine above 115 mumol/L indicate an active kidney and exclude a renal cyst. However, aspirates from fetal cysts or fetuses with obstructive uropathy showed analyte concentrations for sodium, potassium, creatinine, and urea corresponding to extracellular fluid (ECF). In conclusion fluid aspirates of fetuses with ultrasonographically detectable cystic cavities in the abdomen should be examined for sodium and creatinine to assess remaining renal function for planning of obstetric management.

Angiomyxoma of the umbilical cord in one twin with cystic degeneration of Wharton's jelly. A case report.

We report the prenatal diagnosis of an angiomyxoma of the umbilical cord in a female fetus of a dizygotic twin pregnancy. The pregnant woman was hospitalized at 18 weeks for exclusion of a suspected exomphalos. Using high-resolution ultrasound and color doppler, the umbilical tumor (8 x 5 x 4 cm) was suspected to be an angiomyxoma without malformations in the fetus. Neither chromosomal aberrations nor elevated alphafetoprotein were found after amniocentesis. Serial examinations showed an increase in the size of the cystic mass without deterioration of the fetal condition. Macroscopical and microscopical examinations of the tumor performed after delivery revealed an angiomyxoma with cystic degeneration of Wharton's jelly. Tumors of the umbilical cord are rare anomalies and should be considered when using prenatal ultrasound for detection of cystic lesions.

Correlation of prenatal ultrasound diagnosis and morphological findings of fetal autopsy.

The findings of prenatal ultrasound diagnosis were compared with the autopsy findings in 183 fetuses (between the 14th and 24th week of gestation), aborted for fetal malformations in the period from 1995 to 1997. In these 183 cases, the primary diagnosis showed 50 central nervous system anomalies, 48 cardiovascular system anomalies, 42 genitourinary system anomalies, 18 respiratory system anomalies, 8 skeleton system anomalies, 6 gastrointestinal system anomalies and 11 other abnormalities. Of the total number of cases, 41% had multiple malformations. In 144 cases (78%), the prenatal diagnosis was confirmed by autopsy, in 36 cases (20%) the prenatal diagnosis was confirmed with additional significant pathology, and in only 3 cases (2%) the prenatally detected malformation was not confirmed by pathological examination. Autopsy remains an important component of the evaluation of fetal losses after induced abortion.

Benign and malignant cells in effusions: diagnostic value of image DNA cytometry in comparison to cytological analysis.

Identifying tumor cells in body cavity fluids reliably is a well-known diagnostic problem. Since cytometric quantitation of nuclear DNA content appears to be a promising new tool in the diagnosis and prognostic evaluation of many solid human tumors, we examined its validity in detecting malignant cells in cytologically positive effusions. For this purpose, image DNA cytometric measurements, including the evaluation of DNA-ploidy and the calculation of the DNA index (DI), were performed in 80 body cavity fluids. The results were correlated with cytology, clinical course and final histological diagnoses. We used aneuploidy, as shown by interactive image DNA cytometry, as a marker for the malignancy of cells that occur in body cavity fluids with a 100% specificity and 94.8% sensitivity. Cytological investigation showed a 92.3% specificity and 95.4% sensitivity. Combining both methods raised the specificity to 100% and the sensitivity to 98.5% and had a positive predictive value of 100% and a negative predictive value of 93.8%. The DNA-index (DI) was significantly higher in malignant effusions than in benign effusions: 1.5 +/- 0.74 (mean +/- SD) versus 1.11 +/- 0.26 (p < 0.05). Along with the difficult cytological evaluation of malignant cells in body cavity fluids, image DNA cytometry can be a helpful additional method for evaluating these cells. Combining the two techniques results in a highly specific and sensitive prediction of malignant cells. We, therefore, suggest using these methods for the reliable identification of tumor cells in effusions.

[Localization of nonpalpable breast lesions in intraoperative rapid-section diagnosis using a new procedure]. / Lokalisation nicht-tastbarer Mammaveränderungen zur intraoperativen Schnellschnittdiagnostik mit einem neuen Verfahren.

The author describes a simplified method for the radiological demonstration of non-palpable breast lesions in operative specimens. The specimen is x-rayed with a wire grid let into the lid of a small plexiglass box. The box with the tissue is then sent to the pathologist. By comparing the radiograph with the specimen, the pathologist is able to orientate himself and to examine the area in question.

Oto-palato-digital syndrome with features of type I and II in brothers.

We report on the oto-palato-digital syndrome (OPD) in two sons of a mother showing minimal signs of the condition. The index patient, a 10-year-old boy, presents typical symptoms of OPD type I together with bowing of the long bones and abnormalities of the thorax and spinal column. During the following pregnancy ultrasonographic studies of the male fetus in the 16th week of gestation revealed severe micrognathia, short and wide thumbs, and big toes, and bowed tibiae. After termination of the pregnancy further features were observed which fulfilled the diagnostic criteria of both OPD I and II. A possible explanation of these findings is that OPD type I and II and the features in the described cases are part of a continuous clinical spectrum of the same underlying mutation, or that several different alleles are involved in the OPD type I, type II, and mixed phenotypes.

[Idiopathic sclerosing mesenteritis. Case report and differential diagnosis of a rare disease picture]. / Idiopathische sklerosierende Mesenteritis. Fallbeschreibung und Differentialdiagnosen eines seltenen Krankheitsbildes.

We report the case of a 78-year-old woman with the endoscopic tentative diagnosis of a malignant tumor of the colon ascendens (biopsy without malignancy) that was removed by right hemicolectomy. Extensive mesenteric infiltration and colonic obstruction seemed to confirm this diagnosis. Surprisingly histology revealed invasion by sclerosing mesenteritis. The differential diagnoses include inflammatory pseudotumor, tumor-like fibromatosis at traumatized sites, idiopathic retroperitoneal fibromatosis, sclerosing malignant lymphoma, liposarcoma and drug-induced sclerosing mesenteritis, as well as mesenteric infiltration and metastases. Though preoperative diagnosis is not possible in most cases, the intraoperative macroscopic appearance and the histopathologic picture are conclusive.

[Testicular metastasis of prostatic carcinoma 3 years after subcapsular orchiectomy. A case report]. / Hodenmetastase eines Prostatakarzinoms drei Jahre nach subkapsulärer Orchiektomie. Ein Fallbericht.

Metastatic cancer to the testis is a rare phenomenon of prostate carcinoma with only 80 cases reported in the literature. Most of these secondary testicular tumors were diagnosed on routine pathohistological examination of testicular tissue after plastic orchiectomy. In none of these cases metachronous development of these metastases has been described. For the first time we report on a 75-year old patient who developed a prostate carcinoma metastatis to the right testicle three years after undergoing subcapsular orchiectomy. This case shows that the urologist has to think about a metastatic cancer when he sees a testicular tumor also after plastic orchiectomy.

[Ultrasound measurements of the diameter of the aorta and pulmonary trunk of the fetus]. / Sonographische Messungen der Durchmesser der Aorta und des Truncus pulmonalis beim Feten.

Fetal cardiac measurements derived in the five-chamber and the short-axis view were performed in uncomplicated pregnancies between the 20th and the 40th week of gestation. Using cine loop and zoom techniques, the diameters of the aortic and pulmonary valve were measured (n = 157) and the pulmonary trunk/aorta ratio calculated. Normal ranges for both parameters were constructed and correlated with gestational age. Both diameters showed a linear increase during gestation (aorta r = 0.87, pulmonary trunk r = 0.91). The mean pulmonary trunk/aorta ratio had a constant value of 1.25 and showed no changes throughout pregnancy. In 128 fetuses the heart width was further measured and the vessel diameters were presented in correlation to the heart width.

[Normal value curves for intrauterine fetal blood gas and acid-base parameters in the 2nd and 3rd trimester]. / Normwertkurven für intrauterine fetale Blutgas- und Säure-Basen-Parameter im 2. und 3. Trimenon.

OBJECTIVE: The aim of the study was to establish reference ranges for fetal blood gases and acid-base balance for the second half of the gestation. METHODS: 155 appropriate-for-gestational-age fetuses between 18 and 39 weeks of gestation underwent a diagnostic cordocentesis. From a specimen obtained from umbilical venous blood the acid-base balance and blood gases were evaluated using an AVL 995 blood gas analyzer. In detail, pH, oxygen partial pressure, and carbon dioxide partial pressure were measured and oxygen saturation, bicarbonate concentration and base excess calculated. Thereafter, a linear regression for gestational age was calculated and the 95% confidence interval established. RESULTS: pH, oxygen partial pressure, and oxygen saturation showed a significant decrease with advancing gestational age, whereas the carbon dioxide partial pressure increased. The ranges of bicarbonate and base excess did not differ significantly. CONCLUSION: The results give information about blood gases in the fetus under physiological conditions, and the reference ranges can be used for comparison in fetuses at high risk of hypoxia or acidemia.

[Risk-adapted multimodal laboratory cervical screening---Pap test of the future?]. / Risikoadaptierte multimodale gynäkozytologische Krebsvorsorge. Pap-Test der Zukunft?

The objective of screening for cervical cancer is to reduce mortality and incidence of the disease. To date there is extensive and strong evidence that this can be achieved by cytology-based screening programs, which continue to be the mainstay of cervical prevention worldwide despite their inherent methodological limitations. This article presents a review on the utility of conventional, ancillary and experimental methods for cervical screening both as single tests and test combinations, and describes possible future directions for enhanced screening accuracy using risk-adapted protocols.