[Prevention of aortic erosion by a bone cement skid : Thoracic endovascular aortic repair following kyphoplasty]. / Pelottierung der A. thoracica descendens durch einen Zementsporn : Endovaskuläre Behandlung nach Kyphoplastie.

The underlying case report describes the successful endovascular prevention of an aortic injury by a bone cement skid after kyphoplasty. The intervention was performed in order to prohibit fatal aortic rupture or embolisation and underlines the role of vascular surgery techniques in interdisciplinary clinical networks.

Constrictive Pericarditis in the Presence of Remaining Remnants of a Left Ventricular Assist Device in a Heart Transplanted Patient.

Constrictive pericarditis (CP) is a severe subform of pericarditis with various causes and clinical findings. Here, we present the unique case of CP in the presence of remaining remnants of a left ventricular assist device (LVAD) in a heart transplanted patient. A 63-year-old man presented at the Heidelberg Heart Center outpatient clinic with progressive dyspnea, fatigue, and loss of physical capacity. Heart transplantation (HTX) was performed at another heart center four years ago and postoperative clinical course was unremarkable so far. Pharmacological cardiac magnetic resonance imaging (MRI) stress test was performed to exclude coronary ischemia. The test was negative but, accidentally, a foreign body located in the epicardial adipose tissue was found. The foreign body was identified as the inflow pump connection of an LVAD which was left behind after HTX. Echocardiography and cardiac catheterization confirmed the diagnosis of CP. Surgical removal was performed and the epicardial tubular structure with a diameter of 30 mm was carefully removed accompanied by pericardiectomy. No postoperative complications occurred and the patient recovered uneventfully with a rapid improvement of symptoms. On follow-up 3 and 6 months later, the patient reported about a stable clinical course with improved physical capacity and absence of dyspnea.

[Cardiorenal syndrome: limits of heart failure therapy]. / Kardiorenales Syndrom : Grenzen der Herzinsuffizienztherapie.

The cardiorenal syndrome is an interdisciplinary challenge with increasing health economic relevance. Renal failure is a strong predictor for mortality in patients with severe congestive heart failure (CHF) and CHF is one of the fastest increasing morbidities in western countries. For successful therapy a close cooperation between cardiology und nephrology is required. Moreover, a good compliance of the patient is needed to improve symptoms and to reduce the frequency of cardiac decompensation. A broad cardiological and nephrological evaluation and consideration of optimal conservative options according to national and international guidelines are essential. However, a renal replacement therapy might be helpful in patients with refractory heart failure even if they are not dialysis-dependent. In cases of acute heart and renal failure an intensive care management might be necessary to reduce volume overload with the help of extracorporeal ultrafiltration or a dialysis modality. Nevertheless, in cases of chronic refractory CHF peritoneal dialysis should be preferred. The first analysis of the registry of the German Society of Nephrology (http://www.herz-niere.de) confirmed that there is a benefit for health-related quality of life in chronic CHF patients treated with peritoneal dialysis.

Investigations on common bile duct stones.

Common bile duct stones from 59 consecutive patients who underwent cholecystectomy more than 1 year before radiological detection of choledocholithiasis (group I) and from 31 consecutive patients with choledocholithiasis and gallbladder in situ (group II) were subjected to chemical analysis and compared with the composition of gallbladder stones from the same population (two consecutive biopsy and autopsy series, n = 343). In contrast to cholecystolithiasis, inorganic calcium salts were infrequent in choledocholithiasis while calcium bilirubinate and fatty acid calcium salts played an important role in the composition of common bile duct stones. This is of particular importance in terms of litholysis. With respect to stone pathogenesis, clinical and radiological data were analyzed, as was hepatic bile lipid composition. There was no significant difference in the lithogenic index (percent cholesterol saturation) in cholecystectomized and in non-cholecystectomized patients with choledocholithiasis. The most important cause of stone recurrence in the common duct after surgery was incrustation of unabsorbed suture material, which was the case in 30.5% of group-I patients.

[Screening of exocrine pancreatic function (author's transl)]. / Funktions-"Screening" des exokrinen Pankreas. FDL-, N-BT-PABA-Test, Stuhl-Chymotrypsinbestimmung im Vergleich mit dem Sekretin-Pankreozymin-Test.

The validity of oral pancreatic function tests (fluoresceine dilaurate-[FDL-], N-benzoyl-L-tyrosyl-para-amino-benzoic-acid-[PABA-]test) was assessed intra-individually in 67 patients in comparison with the secretin-pancreozymin test corrected for volume loss. Faecal chymotrypsin (CH-F) estimation was included in the comparison. According to the result of the secretin-pancreozymin test, patients were divided into those with normal pancreatic function (n = 28), those with borderline restricted function (n = 18), and those with manifest exocrine insufficiency (n = 21). Results show that in borderline decreased pancreatic function the diagnostic value of all screening tests is limited. The sensitivity (true pathological results) was 38% in the FDL-test, 40% in the PABA-test, and 31% in CH-F. In manifest exocrine pancreatic insufficiency FDL- and PABA-test as well as CH-F showed similar sensitivity of 67, 63, and 62%, respectively. Results show that oral pancreatic function tests, particularly the simple FDL-test, represent a diagnostic alternative to the relatively complicated CH-F assessment. However, none of the tests are able to replace the secretin-pancreozymin test as the most valid diagnostic investigation.

Biological and biochemical analysis of endoscopically aspirated bile.

Selective cannulation and aspiration of bile prior to ERCP may be helpful in bacterial contamination (suppurative cholangitis), in patients with choledocholithiasis, to determine lithogenicity of bile, and in studies where antibiotic concentration of different substances are analyzed in correlation to hepato-biliary diseases. Results of appropriate examinations are presented.

Treatment of choledocholithiasis using the transpapillary perfusion technique.

In 5 patients with common bile duct stones a dissolution therapy with the octanoate mixture Capmul 8210 was performed using the transpapillary perfusion technique. In 3 out of the 5 cases a passage of the stones without further endoscopic operative procedures could be achieved. Complaints were endurable except in one case. Further studies to dissolve common bile duct stones with a modified Capmul solution via a transpapillary tube seem justified.

[Irrigation treatment of concrements in the common bile duct with octanoate (Capmul 8210) (author's transl)]. / Spülbehandlung von Choledochussteinen mit Octanoat (Capmul 8210).

An irrigation treatment using the octanoate mixture Capmul 8210 of a maximum duration of 10 days was performed in 11 patients with concrements in the common bile duct using either a T-drain (n = 6) or a permanent naso-biliary tube (n = 5). In 6 out of the 11 cases total or partial dissolution led to voiding of concrements without further operative or invasive procedures. The treatment was tolerated in all but two cases. There was no evidence of systemic toxic side effects. Local inflammatory mucous membrane damage due to the instillation was observed in two cases.

Controlled trial of carbenoxolone sodium vs. cimetidine in duodenal ulcer.

The healing-rate of duodenal ulcer after short-term treatment with carbenoxolone was not significantly different from that after treatment with cimetidine. There seems to be no evidence of a significant difference in the tendency of duodenal ulceration to relapse following successful short-term therapy with either treatment. In the case of cimetidine treatment the rate of 58% relapse within 12 months after withdrawal of the drug corresponds well to the data of other authors (3, 19) and does not exceed the relapse rate during placebo medication. The post-treatment relapse study was markedly hampered by a low compliance of patients to cooperate in the long-term follow-up. The drop-out rate was greater in patients previously treated with carbenoxolone than in those of the cimetidine group.

[Long-term effect of calcium carbonate containing antacids on basally and peptone-stimulated hydrochloric acid secretion]. / Langzeiteffekt Kalziumkarbonat-haltiger Antazida auf die basale und die Peptone-stimulierte Magensäure-Sekretion.

Basal and meal-stimulated gastric acid secretion was measured before and after a 3-week-period of regular consumption of a calcium carbonate-containing antacid with 6 therapeutic doses per day in normal healthy volunteers. Furthermore the effect of a single large dose of 2000 mg calcium ions was studied on meal-stimulated gastric acid secretion before and after this period. The results suggest that (1) even a large single dose of calcium ions seems to have no major effect on meal-stimulated gastric acid secretion and (2) chronic consumption of calcium carbonate containing antacids over a 3-week-period does not change basal- and meal-stimulated gastric acid secretion in healthy volunteers nor does it increase the response to 2 g calcium ions.

[Clinical significance of bile acids]. / Klinische Bedeutung der Gallensäuren.

During the last years bile acids have gained more and more clinical importance. They play a decisive part in intestinal fat resorption. Increased bile acid content in the colon will result in diarrhea. By determination of serum bile acids the liver function can be judged exactly. It seems probable that bile acids take part in the pathogenesis of gastritis gastric ulcer and colonic cancer. By administration of chenodeoxycholic acid and ursodeoxycholic acid dissolution of cholesterol stones within the gall bladder is possible.

Experiments on the chemotheraphy of a transplantable glioblastoma in the rat, employing 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU).

A glioblastoma was induced in BD-II rats by weekly i.v. injections of methylnitrosourea and transplanted intracerebrally in numerous passages. The take rate was 100%. For the experiments with CCNU, solid pieces of tumour were implanted into the right parietal region. The cytostatically treated animals lived significantly longer. The untreated tumour rats had an average survival time of 18 days (counted from the time of transplantation), and the rats treated with CCNU had an average survival time of 28 days. The median values were 19 and 28 days.

Effects of 13-nle-motilin on salivary, gastric, and pancreatic secretions in man.

Salivary, gastric, and pancreatic secretory responses to intravenous 13-norleucine-motilin (13-nle-motilin), a synthetic analog of motilin and biologically equivalent to the natural polypeptide, were studied in healthy volunteers. 13-nle-Motilin in doses of 100 ng/kg body wt/hr significantly stimulated gastric pepsin output, while H + secretion and serum gastrin levels remained unchanged. Enhanced pepsin secretion was not accompanied by an increase in gastric secretion of cyclic 3', 5'-adenosine monophosphate, nor did gastric mucosal levels of the cyclic nucleotide rise. A dose of 13-nle-motilin, which stimulated gastric pepsin output, did not exert any significant effect on salivary and pancreatic secretions.