[Nonpalpable carcinoma of the breast - diagnosed by vacuum core breast biopsy and surgical management]. / Nonpalpable Mammakarzinome - Vakuumstanzbioptische Sicherung und chirurgisches Management -

The wire-localized extirpation is the "gold standard" for the examination of nonpalpable lesions suspicious of malignancy. Less invasive techniques were introduced in the last years, offering also a high diagnostic reliability, e. g. stereotactic core needle biopsy, the "advanced breast biopsy" and the vacuum core biopsy. Based on an analysis of 40 vacuum core breast biopsies and the following interventions in the case of carcinoma recommendations for the management of the nonpalpable breast carcinoma diagnosed by vacuum core biopsy should be developed. In 12 patients (33 %) carcinomas were found necessitating further operations. These were 92 % pTis or pT1pN0M0-carcinomas and only in one case an occult pT2pN1M0-carcinoma. We recommend a short interval between core biopsy and operation, a preoperative localization of the clips e. g. the residual microcalcification, and the controlled placement of the hooked wire that should also be performed at the Mammotome(R) using the same way to the tumor. Furthermore it is necessary to excise the core biopsy localization channel en bloc together with a wide tumour excision. An intraoperative histological examination of the specimen should be performed to confirm tumour-free excision borders. For this, the position of specimen should be marked by a thread and a specimen radiography should be made for the orientation of the pathologist and for documentation. A long-term follow-up of these patients under study conditions should be considered. Patients with benign diagnosis, not undergoing general anesthesia and operation with the consequences for later radiological evaluation, mostly profit from vacuum core breast biopsy. For patients with carcinoma the costs of the perioperative management increase. This should have consequences for the quality assurance of this method.

[Differential diagnosis of acute arthritis. Quickly assessing infectious etiology]. / Differenzialdiagnostik der akuten Arthritis. Infektiöse Ursachen rasch abklären.

Acute arthritis of abrupt onset producing symptoms showing peak intensity within a matter of hours, have a largely uniform clinical presentation. Urogenital or gastrointestinal infections (= reactive arthritis) or infectious conditions (= septic genesis) in the patient's history may provide further information of relevance for the differential diagnosis, which includes--in particular in the case of the reactive, infectious/allergic forms--direct and serological demonstration of pathogens. In contrast, imaging procedures in the early stages are of little help in clarifying causes.

[Indications and surgical therapy of thyroid gland diseases--analysis of 725 operated patients]. / Indikation und operative Therapie von Schilddrüsenerkrankungen--Analyse von 725 operierten Patienten.

Diseases of the thyroid gland are an important part of elective surgical procedures. The adequate surgical therapy is at present standardized and requires a permanent qualitative control to reduce avoidable complications. The relation between men and women in our patients (n = 725) was 1 to 5. The mean age was 51.2 years. 10% (n = 79) of the patients were hyperthyroid. 646 patients had benign disease; and 79 patients were found to have malignancy of the thyroid gland. The most common indication for an operation was bilateral multinodular goitre (n = 325) in combination with a cold nodule (n = 123), in 79 patients latent hyperthyroidism or Morbus Basedow (n = 22). Struma nodosa with retrosternal extension (n = 49), recurrence of goitre (n = 34), thyroiditis (n = 12) and dystopic goitre (n = 2) were rare in these patients. Patients with malignancy of the thyroid gland were always treated by thyroidectomy or completed thyroidectomy with lymphnode dissection. In the cases of benign disease the surgical methods were variable, although the bilateral subtotal resection (n = 413) predominated. While doing so the radical resection of parenchyma with a persistent functioning remnant of goitre of 5 cm3 was favoured. The resulting postoperative complications are discussed. An endocrinological appropriate follow-up of the patients is necessary.

[Incidence of damage to the recurrent laryngeal nerve in surgical therapy of various thyroid gland diseases--a retrospective study]. / Zur Häufigkeit der Schädigung des Nervus laryngeus recurrens bei der operativen Therapie verschiedener Schilddrüsenerkrankungen--eine retrospektive Untersuchung.

UNLABELLED: We investigated the incidence of the recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery in 725 cases. The incidence was correlated to the different diseases of the thyroid gland, to the operative procedure (subtotal resection, lobectomy, thyroidectomy), to the intraoperative exploration of the nerve and to the surgeons' state of training. RLN palsy was found in 7.6 per cent (4.8 per cent nerve at risk) five days after surgery. A permanent RLN damage was defined as a persisting paralysis of the vocal cord six months after surgery. Permanent nerve damage occurred in 2.1 per cent for euthyroid nodular goitre, for recurrent goitre in 11.7 per cent and for thyroid carcinoma in 10.1 per cent. There was a statistically significant difference between the number of RLN pareses occurring after nerve exposure with 4.2 per cent and that occurring after non-exposure with 1.1 per cent for subtotal lobectomy. 67.7 per cent of these pareses at day five were transient. The RLN palsy rate for Senior House Officers was 6.7 per cent but there where none for registrars and consultants. CONCLUSIONS: The RLN damage five days after thyroid gland surgery is mainly caused by the great number of recurrent goitre and thyroid cancer (16.1 per cent), the rate of procedures performed by younger surgeons and the near total resection of euthyroid goitre. The exposure of RLN is important for the training to manage thyroid gland surgery.

[Is pyodermia fistulans sinifica of clinical importance?]. / Ist die Pyodermia fistulans sinifica von klinischer Bedeutung?

Pyodermia fistulans sinifica is a retention dermatopathy. We report on 12 men and 2 women with this disease, and our radical surgical treatment. The prognosis is favourable.

[Routine hip ultrasonography in inflammatory rheumatoid diseases. Results in 119 consecutive patients of a rheumatism clinic]. / Routinemässige Hüftsonographie bei entzündlichen rheumatischen Erkrankungen. Ergebnisse bei 119 konsekutiven Patienten einer Rheumaklinik.

METHOD: In 119 consecutive inpatients with rheumatic diseases--mainly rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis--both hips were routinely investigated by sonography. RESULTS: In 52 of the 119 patients definite or possible pathological findings (in 18 cases bilateral) were observed. The relative frequency of sonographic findings in 223 evaluable hips was 33% and was somewhat higher in patients with rheumatoid arthritis than in those with other diagnoses. Changes were found significantly more often when the patient had joint complaints, limitation of movement, pathological X-ray changes or serological signs of inflammation (elevated ESR, positive C-reactive protein). The relative frequencies were higher than were expected on the basis of data in the literature. Of the pathological sonographic findings, 22% occurred in clinically and radiologically asymptomatic patients. CONCLUSIONS: In view of the therapeutic consequences and the importance of early treatment, routine sonographic examination of the hip joint is recommended.

[Basic therapy of rheumatoid arthritis. Comparison of methotrexate and sulfasalazine]. / Basistherapie der Rheumatoid-Arthritis. Methotrexat und Sulfasalazin im Vergleich.

In a retrospective analysis a total of 167 patients with rheumatoid arthritis (RA) who had been treated with the basic therapy formulas of methotrexate (MTX) or sulfasalazine (SUL) were evaluated with respect to therapeutical result and side effects after a period of 12 months. There was no randomization as to either MTX (n = 87) or SUL therapy (n = 80), but deliberate use of therapy according to prior treatment and activity of the illness. Apart from a significantly higher number of inflammatory joint conditions in the MTX group there was no difference in the two patient groups at the beginning of the study. MTX treatment led clearly to a more conspicuous activity decrease of the illness (ESR, joint index) and a more favourable effect on the locomotor function. Furthermore, the sphygmomanometer readings (for grip strength determination), the dose reduction of the concomitant prednisolone medication as well as the doctor's opinion were in favour of MTX. The portion of patients who had to discontinue the therapy because of side effects (= 11%) and lack of effect (= 9%) was exactly identical in both groups of patients. Both substances have shown to be effective basic therapy formulas for rheumatoid arthritis, while methotrexate has a few advantages.

[Behçet's syndrome. Possible differential diagnosis in multi-system symptoms]. / Das Behçet-Syndrom. Mögliche Differentialdiagnose bei multisystemischer Symptomatik.

Behçet's syndrome was described as a triad with recurrent ulcers of the mouth, aphthae of the genitals as well as changes of the eyes. A fourth later added main criterion comprises multifarious dermatological symptoms. Facultative signs of a disease, which, however, occasionally may stand also in the centre of the clinical picture are vascular, gastrointestinal and central-nervous participations, arthritic pains and swellings as well as an epididymitis. On account of the infrequency of the disease outside the endemic regions and the development of the individual manifestations over larger periods it is often recognized very late. Out of the six casuistics described three of them fulfilled the criteria of a complete Behçet's syndrome with evidence of all four main criteria, in the remaining casuistics the incomplete clinical picture was present with three main and one to four side criteria. In all cases the course was relatively benign. Recently, streptococcal antigens were considered to be etiological factors; correlations with the HLA-system are ascertained for patients from endemic regions. In phases of clinical activity the combination of immunosuppressive agents with cortisonoids is the therapy of choice.

[Effects of pentagastrin and somatostatin on duodenal motility in chronic experiments]. / Untersuchungen zur Wirkung von Pentagastrin und Somatostatin auf die Duodenalmotilität im chronischen Versuch.

Electromyography of the duodenums was performed in dogs, using two bipolar electrodes placed 5 and 10 cm aborally of the pylorus on the serosa of the duodenums. 10 days after implantation and 24 hours after the last meal the duodenal motility was registered in 9 bastard dogs for 5 hours. Pentagastrin, given as a 1-hour intravenous infusion, changed the interdigestive motility to an irregular (postprandial) pattern, which continued up to the end of measurement or was followed by a prolonged phase III with return to cyclic activity. Infusion of somatostatin for 1 hour interrupted the interdigestive motility leading to a prolonged phase I pattern and to partial discoordination. After the end of infusion phase III motility returning to cyclic activity or irregular activity were registered. A standard relaparotomy 10 days after implantation was performed in 3 dogs. Up to the second day of the postoperative period interdigestive cycles of duodenal motility were not obtained.

[Initial experiences in diagnosis of graft rejection following clinical heart transplantation. Detection of graft-directed activated T-cells]. / Erste Erfahrungen zur Abstossungsdiagnostik nach klinischer Herztransplantation. Der Nachweis transplantatgerichteter aktivierter T-Zellen.

The binding of antigen-loaded carrier to mononuclear cells of heart transplant recipients has been investigated by means of an antigen-specific rosette technique. The increase of rosette forming cells and the inhibition of this reaction with monoclonal antibodies against activated T-cells is a sign of a beginning rejection. 3-6 days later infiltrating immunological competent cells are seen in biopsy.