Imaging of mesothelioma of tunica vaginalis testis.

OBJECTIVES: To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis. METHODS: We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis. RESULTS: A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection. CONCLUSIONS: A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity. KEY POINTS: Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively. Most common finding is a complex hydrocele with hypervascular parietal vegetations. Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common. Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.

Relation of impaired interorgan communication and parasympathetic activity in chronic heart failure and multiple-organ dysfunction syndrome.

BACKGROUND: We investigated the relationship of impaired autonomic function and severity of illness in chronic heart failure (CHF) and multiple-organ dysfunction syndrome (MODS) as an end stage of CHF. Furthermore, we assessed the link of parasympathetic modulation of the heart rate and inflammatory activation in CHF and MODS. METHODS: Sixty-five patients admitted for worsening of CHF were retrospectively enrolled in this study. In addition, 65 age- and sex-matched patients with pronounced MODS were assigned for comparison of autonomic function and C-reactive protein in patients with CHF or MODS, respectively. Heart rate variability (HRV) parameters of the time and frequency domain as markers of autonomic function were analyzed from 24-hour Holter electrocardiograms. RESULTS: The more pronounced the severity of illness as expressed by the Acute Physiology and Chronic Health Evaluation score, the more the HRV was impaired. This effect was particularly seen for overall variability (SD of RR intervals) and HRV parameters characterizing the parasympathetic modulations of the heart rate (high, very low frequency power). C-reactive protein levels as markers of inflammation were inversely related to high and very low frequencies. CONCLUSION: Our results allow for speculation that autonomic dysfunction in CHF indicates a beginning of uncoupled interorgan communication potentially leading to MODS as characterized by disruption of communication between the organs.

Leiomyosarcoma of the inferior vena cava extending into the right atrium. A rare differential diagnosis of a right atrial tumor with fatal outcome.

A 54-year-old female patient presented with a progressive and deteriorating dyspnea at the slightest exertion in particular during the past few days before presentation. Transthoracic echocardiography revealed a large space-occupying lesion in the right atrium extending into the inferior vena cava (IVC). Abdominal magnetic resonance aortography showed an elongated space-occupying lesion in the IVC with a significant portion of the tumor and almost completely filling the right atrium accompanied by an infiltration of the hepatic and renal veins. A pronounced tumor infiltration of the IVC at the level of the liver was confirmed intraoperatively and immunohistochemical analysis showed a moderate to poorly differentiated leiomyosarcoma. The extended tumor was successfully removed by a complex operation of the thorax and abdomen but the procedure was accompanied by severe bleeding. A few hours following the procedure the patient died due to a further episode of irreversible intra-abdominal hemorrhage.

Spigelian-cryptorchidism syndrome: a case report and discussion of the basic elements in a possibly new congenital syndrome.

Pediatric cases of Spigelian hernias are rare. Only a few reports on this condition, in combination with ipsilateral cryptorchidism and testis in the hernia sac, have been published. We report on Spigelian hernia in a 3-week-old boy containing both the ipsilateral testis, without a gubernaculum and an incarcerated loop of the small intestine. It has been suggested that the combination of Spigelian hernia and ipsilateral cryptorchidism is part of a new syndrome. We discuss whether the lack of a gubernaculum and an inguinal canal reported in other similar cases may be additional elements of this new syndrome. We present a comprehensive overview of pediatric patients with Spigelian-cryptorchidism syndrome reported in the English language literature. In 75% of male infants with Spigelian hernia, there is an associated ipsilateral cryptorchidism, and in 87% of these patients, the testis is found inside the hernia sac. Thus, the surgeon dealing with a congenital Spigelian hernia should look for an undescended testis and be prepared to find it in the hernia sac.

[Balloon dilatation and local thrombolysis in massive pulmonary embolism--initial results of a new therapy concept]. / Ballondilatation und lokale Thrombolyse bei massiver Lungenembolie--erste Ergebnisse eines neuen Therapiekonzeptes.

The high mortality rate among patients suffering from massive pulmonary embolism makes it imperative to act quickly. The first and foremost goal must be to lower the pulmonary pressure rapidly and to relieve the right ventricle. In three patients with massive pulmonary embolism we therefore tried to crush the thrombus by means of a balloon catheter. The diameters of the balloons were adapted to the size of the vessels to be treated; the balloon diameters were between 10 and 20 mm. Recanalisation resulted in a rapid improvement of perfusion and haemodynamic relief of the right ventricle. This was clinically documented by the drop in pulmonary pressure levels and an impressive improvement of general well-being. Dilation was followed by thrombolytic therapy adapted to the relevant situation. This method of thrombus crushing by means of balloon catheters is indicated in case if massive thrombi in the main stem of the a. pulmonalis, with elevated pulmonary pressure levels, and corresponding clinical signs and symptoms. It can follow alternatively as a first possibility of pressure relief directly after diagnostic pulmangiography. The initial clinical results of this new treatment method are most encouraging. Complications have not been observed so far.

[Acute cor pulmonale as a sequela of tumor embolism]. / Akutes Cor pulmonale als Folge einer Tumorembolie.

It is reported on a 22-year-old female patient with a chondroplastic osteosarcoma in the sacrum in whom in the course of her disease a massive embolism due to a tumour developed under the clinical picture of an acute pulmonary embolism. The clinical tentative diagnosis of a massive pulmonary embolism was confirmed by means of lung perfusion scintigram and pulmonary angiography. All efforts for a rapid recanalisation of the left pulmonary trunk by means of mechanical alteration, use of balloon catheter and subsequent thrombolysis were without success. Pathologo-anatomically a recurred tumorous thrombus embolism with an extensive pulmonary infarction in the left inferior lobe of the lung was found. The incidence as well as diagnostic viewpoints of embolisms due to tumour are discussed.

[Early and late results after local streptokinase administration in massive lung embolism]. / Früh- und Spätergebnisse nach lokaler Streptokinaseanwendung bei massiver Lungenembolie.

In a total number of 44 patients with acute massive lung embolism 42 patients survived the acute phase. The treatment was carried out by thrombolysis with streptokinase. The application was performed as near to the thrombus as possible, in several patients after preceding balloon dilatation or also as multiphase treatment using urokinase. We altogether obtained favourable early results concerning the recanalisation got as well as also with regard to the clinical state and the subjective condition, particularly for patients with single acute occurrence and a latency period of less than 72 hours up to the beginning of the treatment. In follow-up examinations of 17 patients after more than 9 months (on an average after 32 months) without exception a good and further on ameliorated condition, respectively, was stated. Under long-term anticoagulation with phenprocoumon no recidivation embolisms appeared. Ergooxytensiometric investigations had as result a clear to extreme hypoxia on exertion as limiting factor for 12 out of 17 patients. Apart from this the majority of the patients a hyperdynamic regulatation of the circulation was to be observed. Therefore the ergooxytensiometry is recommended for the judgment of the result of the treatment as to the demandable exercise tolerance.

[Nifedipine therapy in uncomplicated essential hypertension and hypertensive problem cases]. / Nifedipin-Therapie bei unkomplizierter essentieller Hypertonie und Hochdruck-Problemfällen.

In altogether 54 patients with high blood pressure of the clinical degrees of severity I-IV the blood pressure-reducing effectiveness of the calcium antagonist nifedipine was investigated both in the framework of an oral long-term therapy and especially in problematic situations of high blood pressure. According to the results of own treatment nifedipine is particularly suited for the antihypertensive combination therapy with beta-receptor blockers. Monotherapeutically favourable possibilities of application exist in hypokinetic types of the regulation of circulation as well as in elderly hypertensives. Therapy-resistant as well as crisis-like developments of high blood pressure react with excessive, well tolerable and persisting reductions of blood pressure. Above all with regard to this still little considered indication in the meantime nifedipine represents an unavoidable enrichment in the therapeutic basis spectre of the hypertonus.

[Local streptokinase administration in massive pulmonary embolism]. / Lokale Streptokinaseanwendung bei massiver pulmonaler Embolie.

Five patients with acute massive pulmonary embolism were treated with streptokinase administered via the pulmonary artery as close as possible to the embolus. Streptokinase (Awelysin) was infused at a loading dose of 250,000 IU followed by a maintenance dose of 100,000 IU/hour under haemodynamic and angiographic control. In four of five patients (two patients with cardiogenic shock) the clinical signs, pulmonary artery pressure and the angiographic findings improved or they normalised within 5-12 hours. In one patient with recurrent embolisation over three weeks the clinical condition improved gradually, although the angiographic findings improved only slightly. The results demonstrate that local thrombolysis of acute massive pulmonary embolism is a highly effective form of treatment.

[Acute beta blocker poisoning]. / Akute beta-Blocker-Intoxikationen.

It is reported of acute beta-blocker intoxications in 34 patients (16 with talinolol, 18 with propranolol ingestion). The mean ingestion dose was for talinolol 2.5 g, for propranolol 1.55 g, the mean time of latency up to the appearance of intoxication symptoms 116 min after intake of talinolol, 79 min after intake of propranolol. The picture of intoxication was characterized in the two substances by the antiadrenergic effects, there was no more a cardioselectivity in the high ingestion doses. In talinolol were in the first place dysrhythmias, hypotension and vomiting and nausea, respectively, in propranolol central-nervous symptoms and hypotension. Substance-specific intoxication symptoms are also possible. In mixed intoxications alcohol accelerated the beginning of the effect, sedatives prolonged the latency. Threatening of life is to be expected in ingestion doses over 2 g. In 6 patients the course was lethal after extreme doses of talinolol - according to the present experiences due to the too late beginning of therapy and/or insufficient intensity of therapy. Distinct intoxication symptoms need extremely high applications of antidotes of beta-stimulants, in their inffectiveness glucagon. Furthermore, treatment with cardiac pacemakers and 24-hour control in an intensive care unit proved necessary.

[Report of experiences: frequency and significance of intestinal parasitoses in patients at a hospital in the Ethiopian highlands]. / Erfahrungsbericht: Häufigkeit und Bedeutung von intestinalen Parasitosen bei Kranken eines Krankenhauses im äthiopischen Hochland.

Intestinal parasitoses are of greatest importance in health policy in tropical developing countries. On account of the increasing numbers of travellers into these countries and the increasing number of inhabitants of these regions who stay in the GDR for purpose of study or training, these problems gain significance also for us. A report on experiences from Socialist Ethiopia illustrates the problems connected with intestinal parasitoses. A non-selected number of patients of a province hospital in the Ethiopian Highlands was evaluated. An epidemiologically obligatory evidence is of course not possible, but the actual situation is exactly characterized. The demonstration of the frequency of the individual parasites is followed by a short discussion of the main helminthic and protozoic diseases.

[Combined use of talinolol and beta adrenergic stimulants in status asthmaticus. Report on 3 patients]. / Kombinierte Anwendung von Talinolol und beta-adrenergen Stimulatoren beim Status asthmaticus. Ein Bericht über 3 Patienten.

Experiences in combined use of beta-adrenergic stimulants and cardioselective beta-receptor blocker Talinolol are reported in 3 patients in Status Asthmaticus. High dose Aminophyllintreatment in these 3 severe cases was insufficient, in 1 case it had to be finished because of toxic side effects respectively. For adrenergic stimulation in two cases Orciprenalin i.v. was given initially, in one case Terbutalinsulfat i.v. By cardioselective adrenergic blockade with low dose Talinolol it became possible to prevent cardiotoxic side effects in preexisting tachycardia and premature ventricular contractions. This combination treatment was continued successfully with Terbutalin and Talinolol p.o.