[Rectal mucosa metastasis in recurrent prostate cancer : (68)Ga-PSMA-PET/CT allows targeted salvage radiotherapy]. / Rektummukosametastase beim Prostatakarzinomrezidiv : (68)Ga-PSMA-PET/CT ermöglicht eine gezielte Salvagestrahlentherapie.

This article presents for the first time a case of rectal mucosa metastasis of recurrent prostate cancer that was diagnosed with (68)Ga-PSMA PET/CT. After histological confirmation, the patient was treated with salvage radiotherapy. This case report underlines the specificity and efficacy of PSMA-based PET imaging. In case of biochemical relapse, it can be used even at low PSA levels to detect prostate cancer metastases that might also be in atypical locations. Thus, (68)Ga-PSMA PET/CT may allow new options for salvage therapy.

Esophagitis in an adolescent patient with Crohn's disease after changing treatment from prednisolone to budesonide.

Studies have demonstrated that budesonide is effective in the treatment of active Crohn's disease. Due to its extensive hepatic metabolism, budesonide has much lower adverse events compared to prednisolone. Consequently, the low systemic availability restricts its application to Crohn's disease of the terminal ileum and the colon. Esophageal ulceration is a rare complication of Crohn's disease. This article describes the case of a young lady who presented at the age of 16 with active Crohn's disease of the terminal ileum and the colon without dysphagia or pain in the chest. Her disease was successfully treated with prednisolone for almost two years. Because of weight gain, acne, and moon face she was switched to budesonide. A few days later she presented with intractable pain of the esophagus, dysphagia, and inability to eat. Endoscopy demonstrated aphthous ulcerations of the esophagus and the histology was compatible with Crohn's disease. After two weeks of treatment with prednisolone all symptoms resolved and at follow-up gastroscopy ulcers had disappeared.

Foamy myocardial transformation in a child with a disturbed respiratory chain.

A female infant presented with signs of general muscle hypotonia and increasing hypertrophy of the heart muscle. There was a constant lactic acidosis worsened after glucose intake. Serum lactate levels were increased up to 6.7 mmol/l. Serum alanine levels reached maximum concentrations of 2,800 mumol/l. The patient died after sudden cardiac arrest at 22 months of age. Histology of the heart showed the pattern of foamy myocardial transformation with accumulation of mitochondria and an increased glycogen content. Biochemical analysis of the skeletal muscle and the heart demonstrated signs of a disturbed respiratory chain. The content of cytochrome aa3 protein was decreased in skeletal muscle and heart mitochondria. It is suggested that respiratory chain defects may be the cause of foamy myocardial transformation of the heart.

Ischaemic colitis in a patient treated with glypressin for bleeding oesophageal varices.

This paper reports a case of ischaemic colitis observed in a male patient with acute oesophageal variceal bleeding treated with Glypressin (triglycyl lysine vasopressin). The therapeutic effect of this substance depends on the lowering of the portal vein pressure brought about by a vasoconstriction of the vessels of the splanchnic region. The undesired complication of ischaemic colitis occurred as a result of a reduction in blood flow to the colonic mucosa.

[Cholangiodysplastic pseudocirrhosis]. / Cholangiodysplastische Pseudozirrhose.

Non-cystic cholangiodysplastic pseudocirrhosis of the liver was found in a 7 month old infant. Hepatomegaly was the first clinical sign. The cause of this disease entity ist believed to be a developmental disturbance of the small bile ducts. The etiology is unknown and the clinical course is hard to control. The transition to cirrhosis and the development of hepatocellular carcinoma are described.

Prenatal diagnosis of trisomy 9 mosaicism possibly limited to fetal membranes.

In repeat amniotic fluid cultures mosaicism due to trisomy 9 was noted. Autopsy of the aborted female fetus showed a sinus urogenitalis and gonadal dysgenesis with absence of germ cells only. Fetal lymphocytes and skin fibroblasts had a normal karyotype but trisomy 9 was found in cells grown from placenta. It is likely that trisomic cells were limited to fetal membranes.

[Sonographic diagnosis and follow-up study of a congenital brain tumor]. / Sonographische Diagnose und Verlaufskontrolle eines angeborenen Hirntumors.

In a newborn with neurologic abnormalities a congenital brain tumor was found by gray scale sonography. By its dense structures the tumor could easily be separated from the surrounding healthy brain. Development of hydrocephalus and cystic degeneration of both hemispheres was observed by serial ultrasonography studies, which were in accordance with computerized tomography and post mortem examination.

[Acute liver failure in abdominal Wilson's disease in early adulthood]. / Akutes Leberversagen bei abdominellem Morbus Wilson im frühen Erwachsensenalter.

The acute abdominal form of Wilsons's disease was observed in three female patients aged 17, 18 and 30 years. Clinically uncharacteristic general symptoms and jaundice were dominant. Chemical pathology showed high bilirubin values with predominance of direct bilirubin, signs of hepatic and renal insufficiency and haemolytic anaemia. There were no neurologic symptoms and the Kayser-Fleischer ring was absent. Coeruloplasmin in blood was normal, copper concentration in blood and urine was clearly increased. Diagnosis of Wilsons's disease could only be established at post mortem by quantitative copper estimation in liver tissue. The patients succumbed 1--4 weeks after onset of symptoms through hepatic failure.

Decreased serum carnitine in valproate induced Reye syndrome.

A 3-year-old girl developed acute liver disease after treatment with valproate for 6 months. She developed the typical features of Reye syndrome. Serum free carnitine was decreased as well as 3-keto-valproic acid, the main metabolite of beta-oxidation of valproate. The serum valproate concentration was at the upper limit of the therapeutic range. The possible importance of carnitine in the pathogenesis of valproate induced liver disease is discussed.