[Hospital infection by e coli 0111: b4 and pseudomonas aeruginosa (author's transl)]. / Krankenhausinfektion durch C. coli 0111: B4 und Pseudomonas aeruginosa

An endemic hospital infection caused by E. coli 0111:B4 together with Pseudomonas aeruginosa was observed in a county hospital over the period October 1973 till January 1974, which could not be brought under control by routine preventive measures against cross-infections established on the wards. By hospital sanitary examinations the waste water in the sinks and the hand-basins in some rooms of the newborn nursing wards were identified as sources. Their elimination by taking apart the sinks and placing the detached parts in 4% formalin solution for 2 hours, as well as disinfecting the basins also with a 4% formalin solution for 24 hours terminated the hospital infection. Some sporadic carriers of E. coli 0111:B4 among the newborn infants of the involved wards had been previously identified and could also be traced subsequently; hence, it may be concluded that the introduction of E. coli 0111:B4, which seems to be endemic in Vorarlberg, was due to patients or personnel. Voluntary submission to control investigations of the stool and appropirate treatment of the entire staff, involved in the infection, with strict routine surveillance of hand disinfection prior to washing seem to be justified by the successful results of these procedures. High risk of infection in newborn infants and babies, the special situation of an intensive care unit, as well as the combined appearance of Pseudomonas aeruginosa and enteritis coli from a source as an additional complication were the causes of this hospital infection.

[Resistance of blood culture isolates in vitro to 4 aminoglycoside antibiotics in Austria--1982/83]. / Resistenz von Blutkulturisolaten in vitro gegenüber 4 Aminoglykosidantibiotika in Osterreich--1982/83.

Over the period September 1982 to February 1983 268 blood culture isolates were consecutively collected in 4 microbiological laboratories in Austria (Linz, Vienna, Graz, Feldkirch) and 251 of these strains (streptococci excluded) were tested for resistance to Gentamicin (G), Tobramycin (T), Netilmicin (N) and Amikacin (A) using a microtitre broth dilution method. This investigation was part of an international study. Of the bacterial strains examined 57% were staphylococci (34% Staphylococcus aureus) and 43% gram-negative rods (18% E. coli, 17% other enterobacteriaceae and 5% Pseudomonas aeruginosa etc.). 25% of all strains tested were resistant to Gentamicin (MIC greater than 4 mg/l), 27% to Tobramycin (MIC greater than 4 mg/l), 6% to Netilmicin (MIC greater than 4 mg/ml) and 5% to Amikacin (MIC greater than 8 mg/l). The resistance rate of staphylococci was markedly greater towards Gentamicin (35%) and Tobramycin (39%) than Netilmicin (4%) and Amikacin (6%). The respective percentages of resistant gram-negative rods were considerably smaller, except in the case of Netilmicin (G 13%, T 11%, N 8%, A 4%). Regional differences were observed between Linz and Vienna in the resistance of staphylococci to Gentamicin (24% versus 49%) and Tobramycin (33% versus 53%). On a weight basis Netilmicin was the most active substance in combating nearly all groups of bacteria. Also in strains sensitive to the other aminoglycosides the MIC values of Netilmicin were considerably lower than for the other substances. A noteworthy feature in comparison with the results of other countries participating in this international study was the distinctly higher incidence of staphylococci among the blood culture isolates and the considerably higher percentage of aminoglycoside-resistant strains in Austria. Analysis of the data suggests that the high resistance rates among staphylococci are a consequence of selection by frequently used antibiotics. Hence, it appears essential to observe the development of aminoglycoside resistance in Austria closely and to recommend that these substances, of extreme value in the treatment of severe infections, should be used solely for the most stringent indications.

[Correlation of histology of the primary tumor with liver metastases in colorectal carcinoma]. / Beziehung zwischen der Histologie des Primärtumors und der Lebermetastasierung beim kolorektalen Karzinom.

The histology of colorectal tumors was correlated with the presence of liver metastases in a retrospective study performed on 179 patients who were autopsied between 1975 and 1990. For the analysis of metastatic patterns, 116 cases with at least one distant metastatic site were selected. A distinct relationship between mucin expression of colorectal tumors and liver involvement was found. Pure adenocarcinomas and their papillary variants showed the highest affinity to the hepatic tissue regarding the frequency as well as extent of involvement. A subtotal replacement of the liver by metastases was restricted to these two variants. An extracellular mucin component was associated with a lower frequency of liver involvement and a tendency to solitary or oligotopic metastases. Ten cases of signet ring cell carcinomas had no metastases in the liver. The results described here for colorectal cancers are similar to those previously reported for gastric cancer. The therapeutic implications were discussed. A detailed link between these clinical findings and the results found at the level of molecular biology is yet to be determined.

[Malignant hemangioendothelioma of the thyroid gland: new results on pathogenesis, therapy and prognosis]. / Das maligne Hämangioendotheliom der Schilddrüse: Neue Resultate zur Pathogenese, Therapie und Prognose.

BACKGROUND: Malignant hemangioendothelioma of the thyroid is a rare tumor predominantly described in areas with endemic goiter like the Alpine regions. The estimated incidence of the disease is between 0.15 and 0.25 per 100,000 inhabitants per year for Western Austria. The prognosis is reported to be dismal. MATERIALS AND METHODS: Between 1982 and 1995, 10 cases with immunohistochemically confirmed malignant hemangioendotheliomas of the thyroid were referred to our department for postoperative or palliative treatment. Two patients with clear margins at surgery received no adjuvant radiotherapy and were only observed. By surgery, clear margins (R-0 resection) were achieved in 5, microscopic residuals (R-1) were left in 3, and gross residual disease in 1 patient. One patient had an inoperable primary tumor. Postoperative radiotherapy was administered in 6 cases, 4 of them additionally received the radiosensitizer razoxane. Total tumor doses ranged between 58 and 65 Gy. RESULTS: Local tumor control was achieved in 9 of 10 patients; 4 of 10 lived longer than 4 years. The median survival time has not yet been reached and is presently between 7.5 and 21+ months.--Noteworthy is a complete regression of 2 lung metastases in a 72-year-old man by a combination of vindesine, razoxane and radiotherapy. The patient is still in complete remission under a maintenance therapy with vindesine and razoxane since 14 months.--It may also be of interest that 4 of the 10 patients were strongly exposed to vinyl chloride and other polymeric materials during their occupational life. CONCLUSIONS: This small series may indicate that the outcome of this disease may not be uniformly deleterious, and that the resistance to radiotherapy reported in the literature may be questioned.--The data offer new evidence of the occurrence of vinyl chloride-induced angiosarcomas outside the liver, and support observations which have already been published in case reports.

[Experiences with total parathyroidectomy and autotransplantation of intraoperatively selected parathyroid tissue in reactive renal hyperparathyroidism]. / Erfahrungen mit der totalen Parathyreoidektomie und Autotransplantation intraoperativ ausgewählten Parathyreoidea-Gewebes beim reaktiven renalen Hyperparathyreoidismus.

Surgery is indicated in cases of therapy-resistant reactive renal hyperparathyroidism with clinical symptoms and signs. The method of choice is total parathyroidectomy, with autotransplantation of parathyroid tissue into the forearm musculature. Twenty-two patients were parathyroidectomized. In 19 cases the intraoperative selection of tissue for autotransplantation was made by means of a stereoscopic magnifying glass. With one exception, only fragments of type 1a glands and type 1a-like areas obtained from type 2 glands were transplanted. In 18 of the 22 cases parathyroid hormone levels decreased from 1131 +/- 657 preoperatively to 87 +/- 53 pg/ml postoperatively. In 4 patients with postoperative values over 200 pg/ml a transplant-related recurrence of hyperparathyroidism or a remaining 5th gland in the cervical region was suspected. In all 22 patients serum calcium, as well as alkaline phosphatase levels returned to normal and the clinical signs of hyperparathyroidism disappeared.

[Focal proliferation in reactive hyperplastic parathyroid tissue in end-stage renal failure--implication for autotransplantation after total parathyroidectomy]. / Fokale Proliferationen in reaktiv hyperplastischen Nebenschilddrüsen bei terminaler Niereninsuffizienz-Implikation für die Autotransplantation nach totaler Parathyreoidektomie.

Total parathyroidectomy with simultaneous autotransplantation may be associated with recurrence of graft-dependent hyperfunction due to excessive proliferation. We performed macroscopic tissue selection with a stereomicroscope prior to autotransplantation, which resulted in very low recurrence rates. As this technique greatly depends on experience, we investigated the possibility of additionally using proliferation staining (PCNA, MIB-1) for the detection of dysfunctional tissue. Selected tissue from 26 patients was investigated. Serial sections of freshly removed parathyroid tissue were correlated with their macroscopic appearance, HE and immunohistochemically stained paraffin sections, and with semithin Epon sections. The asymptotic growth mode of clonal proliferating regions was reflected by highest staining intensity (1-5%) in small to medium sized foci (diffuse, up to 3 mm in diameter) and very low staining in large areas (diffuse or nodular, 5-15 mm in diameter, from 0.03 to 0.003% positive cells). Thus, very large dysfunctional regions with (almost) no proliferation could not be detected by this method. However, they were very evident on macroscopic investigation. In conclusion, multiple fulminant recurrence after parathyroidectomy can be prevented by selecting tissue after proliferation staining. This may allow a delayed autotransplantation after total parathyoidectomy for those surgeons lacking experience in macroscopic tissue classification.

[Sentinel node biopsy in breast cancer--a minimally invasive procedure for staging of the axilla]. / Die Sentinel Node Biopsy beim Mammakarzinom--ein minimal invasives Verfahren zum exakten Staging der Axilla.

Clinical examinations and imaging methods are not sufficiently reliable for an exact staging of axillary nodes in breast cancer. The sentinel node biopsy concept is a minimally invasive procedure to locate and remove the first and important nodes responsible for draining a tumor. Histologic examinations using immunohistochemical methods permit more accurate staging than hematoxylin and eosin staining alone. Between 4/1997 and 9/1998 a total of 62 patients with 65 breast cancers underwent surgery. The sentinel node procedure with radio tracers and/or blue dye was performed in patients with clinically negative or unclear positive findings in the axilla, with a primary tumor size less than 5 cm; 11 patients had received preoperative chemotherapy. The sentinel node biopsy was followed by axillary dissection in 44 cases. In 58 (89%) cases we found one or more (on an average 1.4) sentinel nodes with radio tracers (in 73%) and/or the blue dye method (in 85%). Axillary nodal status was correctly predicted in 43 of 44 (97.7%) cases; only in one patient was the sentinel node false negative. After preoperative chemotherapy sentinel nodes were found in 9 cases; all of these were predictive. Micrometastases were found in two patients only after cytokeratine staining. Our results concur with the experience of other study groups in regard of sentinel node biopsy. The sentinel node concept is a fascinating method; its importance in breast cancer treatment appears to be comparable with introduction of breast saving surgery in the 1980's.

[Clinical aspects of pseudomyxoma peritonei]. / Zum Krankheitsbild des Pseudomyxoma peritonei.

On the basis of two cases the problems of peritoneal pseudomyxoma (PP) are discussed with respect to pathogenesis, clinical diagnosis and therapy. The abundant quantities of mucus present in the peritoneal cavity in this syndrome originate primarily in ruptured histologically malignant or benign mucous ovarian cystomas or benign mucocele or mucogenic carcinomas of the appendix, respectively. Independent of the histological findings the clinical course and consequently the prognosis of PP basically depends on the amounts of mucus present. Besides extirpation of the primary tumour therapy consists primarily in removing mucus as completely as possible, even in the form of repeated interventions. Additional measures are mainly confined to radiotherapy and cytostatic treatment. Recently new possibilities in preoperative diagnosis and postoperative control have been opened up by ultrasound and computed tomography.

[A so-called atypical adenoma of the thyroid in an endemic struma area]. / Zur Problematik des sogenannten atypischen Adenoms der Schilddrüse im Strumaendemiegebiet.

In view of the benign clinical course of the atypical adenoma and the high diagnostic accuracy of our frozen sections we feel that subtotal strumectomy with in toto removal of the adenoma and closely spaced follow-ups constitutes an adequate treatment of this thyroid neoplasm. In our opinion primary lobectomy means unnecessarily exposing a disproportionately high percentage of patients to the higher complication risk of this more radical surgery. From 1977 to 1982 there were 47 cases of atypical adenoma among our patients. The ratio men: women was 1:3.7, the mean age of the patients was 44 years. The patients underwent subtotal strumectomy. In the period under review "atypical adenoma" diagnosed on the basis of frozen sections turned out to be carcinoma in 5 instances. The follow-up period of the 47 patients that underwent surgery ranges from 1 1/2 to 7 years. None of the patients has had tumor regrowth so far.

[Inverted urothelial papilloma (author's transl)]. / Das invertierte Papillom des Urothels

Casuistic report dealing with the observation of an inverted papilloma arising from the pars prostatica urethrae. By means of the literature, clinical and pathologic problems of this scarcely known neoplasm, which was not delimitated in the German literature before 1963, are discussed.

[Acute cardiac death in chronic-ischemic heart disease (CIHD)]. / Der akute Herztod bei der chronisch-ischämischen Herzkrankheit (CIHK).

Ischemic heart disease as a basic disease with accompanying findings and exogenous factors comes to a typical triad of SCD. There is a critical midlife situation due to O2-shortage. Dispositional and situational conditions come to be important, especially in cases in which morphological substrates are absent. The complex incident takes place on three levels (organism, heart, and myocardium). Several dying types may occur. Clinical accuracy and morphological diagnosis are of limited value for the relatively fatal importance of each of the single findings.

[On the relation between lobular angiomatosis and angiosarcomas of the breast (author's transl)]. / Zur Frage des Zusammenhanges zwischen lobulärer Angiomatose und multiplen Angiosarkomen der Mamma

A 38 year old woman showed first a lobular angiomatosis of the breast with regular neoplastic capillaries. After about one year multiple nodules of an agniosarcoma appeared. Their origin from the angiomatosis is suggested by the sequence of the lesions and for topical and histogenetic reasons.