[A primary adenocarcinoma of the seminal vesicles. Case report of a rare malignancy]. / Primäres Adenokarzinom der Samenblasen. Fallbericht einer seltenen onkologischen Entität.

Primary malignancies of the seminal vesicles are extremely rare. They must be strictly differentiated from surrounding malignancies that may infiltrate the seminal vesicles from outside (e.g. prostate, rectum, and bladder carcinoma). MEDLINE and CANCERLIT review showed about 50 documented cases of primary seminal vesicle carcinoma so far worldwide in men between 19 and 90 years of age. Early diagnosis may be difficult due to lack of specific symptoms. Especially with a history of voiding dysfunction, haemospermia and/or haematuria, investigators should consider it. Primary diagnostic steps include digital rectal examination, transrectal ultrasound, and transrectal biopsy of the tumour. Additionally, CT and MRT scans show tumour masses corresponding to the seminal vesicles. Adenocarcinoma of seminal vesicles shows no expression of prostate-specific antigen or prostate-specific acid phosphatase, but there may be expression of carcinoembryonic antigen and cancer antigen 125. Radical surgery including radical prostatectomy and/or cystoprostatectomy including pelvic lymph node dissection offers a curative treatment pathway. Adjuvant or inductive medical treatment is of unproven worth, but a combination of hormonal deprivation and radiotherapy seems to be more effective than any chemotherapy.

[One-stage correction of scrotal and perineal hypospadias with buccal mucosa]. / Die einzeitige Korrektur skrotaler und perinealer Hypospadien.

Delayed correction of genital malformations can have a negative influence on the emotional, psychosocial and cognitive development. Early one-stage-correction to give as near-normal an appearance and function as possible is therefore desirable. This can now be realized in most forms of hypospadias. However, in the rare and most severe forms (5-6%; scrotal and perineal forms) this is technically very demanding. It is extremely difficult for a surgeon to accumulate enough relevant experience, so that one-stage correction is performed only by very few. To investigate results with one-step correction, 100 of 163 cases treated up to 2006 were analyzed. Analysis of the first group of 50 consecutive cases operated on between 1996 and 2001 showed a complication/reoperation rate of 22% (11 cases). The 11 children required a total of 18 (36%) corrective surgical interventions. In 42 cases buccal mucosa was used as a tube onlay. In this group one- stage correction was successful in 39 (78%); 4 patients required two operations and 7 three. Children in group II were consecutive patients operated on between 2003 and 2006. In this group there was a reoperation rate of 12% (6 cases, in 1 of which severe lack of skin made one-stage correction technically impossible). In 45 cases buccal mucosa was used for a tube-onlay. Thus, in group II 44 patients (88%) underwent successful one-stage correction and 6 had two operations; none had three. The significantly lower complication rate in group II is presumably due to greater experience of the surgeons. All strictures observed developed at the level of the glans. In no case was buccal mucosa rejected; nor did any strictures develop between urethra and neo-urethra, being reliably prevented by the connection, with an onlay, to the recessed urethral plate. None of the 100 children became a 'hypospadias cripple'; in all cases satisfactory correction was ultimately achieved. This means that with growing experience one-stage correction can be increasingly reliably achieved. This is not a general call for one-stage correction, but an appeal for patients with these most severe forms of hypospadias to be treated only in specialized centers with the aim of allowing experience to accumulate there so that the results become more reliable.

[Retroperitoneal extravasation as the primary symptom of a pancreatic carcinoma]. / Retroperitoneale Extravasation als primäres Symptom eines Pankreaskarzinoms.

Adenocarcinoma of the pancreas has a low 5-year survival rate of approximately 5%. Early diagnostics of pancreatic carcinoma during early tumor stages is made difficult by the lack of symptoms. In particular, individuals suffering from carcinomas located within the pancreatic tail are at high risk of a missed diagnosis. The early symptoms are usually nonspecific (e.g., nonspecific upper abdominal complaints, decrease in weight, loss of appetite, and impaired performance) and are characteristic only in carcinomas of the pancreatic head with painless icterus. If the patient complains of low back pain, a severe infiltration with no chance of a complete surgical resection is found in most cases. An adenocarcinoma of the pancreatic tail was diagnosed in this case report based on a large retroperitoneal extravasation missing further symptoms. The extravasation found represented a primary infiltration of the left ureter which was not diagnosed in primary computed tomography.

[Spontaneous renal angiomyolipoma rupture. Rare differential diagnosis of renal ruptures]. / Spontane Nierenruptur bei Angiomyolipom. Seltene Differentialdiagnose bei Nierenrupturen.

Spontaneous renal rupture is a rare but nevertheless life-threatening complication in cases of benign and malignant space-occupying lesions in the kidneys. A precise preoperative differentiation often turns out to be difficult because of the formation of a hematoma. We report on a 50-year-old female patient with a retroperitoneal hematoma due to a spontaneous renal rupture for which an angiomyolipoma could only by diagnosed after the nephrectomy with histological work-up. In search of the cause, sonography, abdominal computed tomography, and digital subtraction angiography were conducted, which could provide findings suggestive of a space-occupying lesion, but because of the distinct hemorrhagic infarction could not determine whether it was benign or malignant. As shown in this case, when the radiological result is ambiguous, renal exposure is indicated from both a diagnostic and therapeutic standpoint.

[Bacterial keratitis. Microbiological analysis as a principle for therapeutic recommendations]. / Bakterielle Keratitis. Mikrobiologische Analyse als Grundlage für Therapieempfehlungen.

PURPOSE: The study presented differentiates between the aetiological agents of bacterial keratitis in patients with and without a history of contact lens wear. Based on these results, recommendations are given for optimal antibiotic primary therapy. PATIENTS AND METHODS: Swabs and corneal scrapings were taken from 218 patients referred to the University Eye Hospital in Munich with a diagnosis of bacterial keratitis from 1989 to 1997. Ninety-two of these patients had a history of contact lens wear; 126 had none. The germs were isolated and identified by staining and microscopy. Observing polymicrobial growth in 51 patients, a total of 275 germs was isolated. RESULTS: The most frequent pathogens were Staphylococcus epidermidis (44%), S. aureus (18%), Streptococcus spp. (10%), Propionibacterium acnes (7%) and Pseudomonas aeruginosa (6%). Gram-negative germs were nearly exclusively isolated from contact lens wearers, gram-positive germs were predominant in non-contact lens wearers. CONCLUSION: Keratitis in patients with a history of contact lens wear is often caused by aggressive gram-negative germs. Those cases should immediately be treated with quinolones and erythromycin. In keratitis caused by gram-positive pathogens, a combination with aminoglycosides and erythromycin is sufficient.

[Bacterial keratitis in patients with and without contact lens anamnesis]. / Bakterielle Keratitis bei Patienten mit und ohne Kontaktlinsenanamnese.

BACKGROUND: The study shows differences between contact lens wearers and patients without history of contact lenses regarding the spectrum of etiological agents in bacterial keratitis. Based on microbiological analysis, there are given recommendations for an optimal initial antibiotic treatment in both groups. MATERIAL AND METHODS: From 1989 to 1997 smears, scrapings and corneal biopsies were taken from 218 patients with bacterial keratitis. The causing pathogens were isolated on directly inoculated culture media and identified by staining and microscopy. The resistance pattern of a total of 275 germs was analysed for different antibiotics. RESULTS: The most frequently isolated germs were Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus spp., Propionibacterium acnes and Pseudomonas aeruginosa. Whereas sensitive gram-positive germs were predominating in contact lens wearers as well as in non-contact lens wearers, multiresistant gram-negative germs could nearly exclusively be isolated from contact lens wearers. Frequently administered antibiotics like aminoglycosides and quinolones are effective in infections caused by Staphylococcus spp., but increasing resistance could be seen to Streptococcus spp. In this case, erythromycin is very sensitive. Gram-negative germs like Pseudomonas aeruginosa are sensitive to quinolones and some aminoglycosides (e.g. tobramycin). CONCLUSION: In contact lens wearers, more aggressive germs have to be considered than in non-contact lens wearers. In such cases, frequently administered antibiotics like amino-glycosides are not effective. To cover problematic gram-negative germs we recommend the application of quinolones alternating with erythromycin. The latter one is more effective than quinolones and aminoglycosides in case of Streptococcus spp. co-involvement.

[Blepharitis. Demodex folliculorum, associated pathogen spectrum and specific therapy]. / Blepharitis. Demodex folliculorum, assoziiertes Erregerspektrum und spezifische Therapie.

UNLABELLED: Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistant blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific therapy. METHODS: In all, 3152 cilia from 139 patients with blepharitis (38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons with quiet eyes were examined for demodex. Smears n = 125, from the conjunctive of symptomatic patients were investigated for bacteria, 3 weeks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolone, dexamethasone, hydrocortisone, fluorometholone) or antibiotics after antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxacin, polymyxin-B, colistin) followed in all Demodex-positive blepharitis patients (n = 41). RESULTS: Demodex was found in 52% (62/139) of patients with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi 2-test, alpha = 2.5%) and in 29% of quiet eyes (statistically significantly less, alpha = 2.5%, chi 2-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-negative patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha = 5%, chi 2-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n = 8) and lindan (n = 5) and 15% after cortisone and antibiotics (n = 13). (The best and statistically very significant results (alpha = 1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks). CONCLUSIONS: Gram-positive and gram-negative bacteria grew more often in patients with Demodex. Demodex seems to be a mediator of chronic blepharitis; we recommend that mites be sought in cilia of chronic blepharitis patients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being the laborious application and toxicity.