[Acute myocardial infarct in pheochromocytoma crisis. Early coronary angiography findings and echocardiography follow-up]. / Akuter Myokardinfarkt bei der Phäochromozytom-Krise. Frühe koronarangiographische Befunde und echokardiographischer Verlauf.

A myocardial infarction is a rare complication of a pheochromocytoma. A pheochromo-cytoma crisis may occur spontaneously, during pregnancy, or may be induced by a local trauma of the tumor or by drugs. We present a case report of a 41-year-old woman without anamnestic episodes of hypertension or angina pectoris. During angiography of the mesenteric arteries for further diagnostics of a sonographically suspected liver tumor, she developed an acute pulmonary edema and a cardiogenic shock with the electro- and echocardiographic findings of a large anterolateral-apical-diaphragmal myocardial infarction. The immediate coronary angiography 90 min after the onset of the myocardial infarction showed normal coronary arteries with normal coronary blood flow of the arteries supplying myocardial areas with akinetic segments and those arteries supplying hyperkinetic segments. The blood catecholamine levels at this time were excessively elevated. The left ventricular function improved to almost normal within the next 4 weeks with the beginning of the improvement already before the abdominal tumor was surgically removed at day five. The histology documented a pheochromocytoma with acute necrosis. The early invasive findings support the hypothesis that a reversible spasm of several epicardial arteries and not a direct toxic effect of catecholamines could have been the cause of the small myocardial infarction and the observed large myocardial stunning.

[Ileus of the small intestine as sequela of intraduodenal diverticulum. Contribution of roentgen diagnosis to pathophysiology of diverticulum formation]. / Dünndarmileus als Folge eines intraduodenalen Divertikels. Beitrag der Röntgendiagnostik zur Pathophysiologie der Divertikelentstehung.

The case of a 31-year-old male is reported who had recurrent, unexplained abdominal complaints. After hospitalization, an ileus was localized by plain abdominal film in the ileocecal region. A contrast meal revealed a typical intraluminal (duodenal) diverticulum with an enlarged prestenotic duodenum that was undetected during endoscopy. At operation, the cause of the ileus was revealed to be a phytobezoar near the ileocolic valve. After removal and after transluminal resection of the diverticulum, the postoperative course was uneventful. The authors discuss the importance of early roentgen cinematography to clear up the pathogenesis of this very rare intraluminal lesion.

Effect of local low-dose thrombolysis on clinical outcome in acute embolic renal artery occlusion.

PURPOSE: To determine the utility of local thrombolysis in treatment of acute embolic renal artery occlusion. MATERIALS AND METHODS: Fourteen patients with acute embolic renal artery occlusion treated with local low-dose thrombolysis were studied. Diagnosis was made with renal scintigraphy and selective renal arteriography. RESULTS: Thrombolysis was successful in 13 of 14 patients. During 1-72 months of follow-up (mean, 27.1 months), renal function did not improve on the side of complete renal artery occlusion, whereas stabilization of renal function at the pretherapy level was seen in patients with incomplete obstruction of the renal artery or complete obstruction at the level of segmental branches. In none of the patients did renal function return to normal. CONCLUSION: In acute embolic renal artery occlusion, thrombolytic therapy does not restore renal function and is therefore not indicated once the ischemic tolerance of the kidney (approximately 90 minutes) has been exceeded.

[The development and x-ray morphology of amiodarone pneumopathy]. / Die Entwicklung und Röntgenmorphologie der Amiodaronpneumopathie.

Besides general extracardiac physical side effects, the antiarrhythmic amiodarone hydrochloride gives rise to morphologically manifest organ changes. Pneumopathy has been reported in up to 8% of the patients treated with this preparation. Radiologically and histologically, the clinical picture can resemble that of exogenous allergic alveolitis. When the course is protracted there is interstitial fibrotic degeneration of the pulmonary parenchyma with a corresponding morphological correlate in the X-ray. The extent to which the changes observed result from dose-dependent toxicity of amiodarone has not been completely elucidated even now, since pulmonary changes suggestive of an immune process can occur even at low doses. When there is reason to suspect the presence of amiodarone pneumopathy, the preparation should be discontinued. Radiological and clinical findings generally regress with cortisone treatment.

Scintigraphic assessment of bowel involvement and disease activity in Crohn's disease using technetium 99m-hexamethyl propylene amine oxine as leukocyte label.

Using a novel labeling technique with technetium 99m-hexamethyl propylene amine oxine, we studied 29 patients with known or suspected Crohn's disease. Technetium 99m-hexamethyl propylene amine oxine leukocyte scanning (99mTc scan) was prospectively compared with the results of independently performed radiologic, endoscopic, and histologic examinations, and with findings at surgery, to assess the clinical usefulness of this technique to localize inflammatory lesions. In addition, uptake of technetium 99m-hexamethyl propylene amine oxine in the bowel was graded by comparing it with the uptake in liver and bone marrow and correlating this with established parameters of disease activity. The viability of homologous labeled leukocytes was greater than 95%. Less than 5% of lymphocytes were found in the final preparation. It was found that 45% +/- 12% of the label was bound to granulocytes, and 98% of the unbound label was washed off before reinjection. The results of 99mTc scan revealed a good correlation with those of barium enema (r = 0.880, p less than 0.001), of endoscopy/surgery (r = 0.983, p less than 0.001), and of all combined reference methods (r = 0.981, p less than 0.001). Activity as determined by 99mTc scan was weakly correlated with the results of Crohn's disease activity index (r = 0.559, p less than 0.01), van Hees index (r = 0.606, p less than 0.01), and erythrocyte sedimentation rate (r = 0.456, p less than 0.05) in 24 patients with proven Crohn's disease. The correlation was improved when the 99mTc scan was compared with a combination of these activity parameters and C-reactive protein (r = 0.781, p less than 0.001). Extraintestinal manifestations (joints) and complications (cholecystitis) were also identified correctly by the 99mTc scan. The study demonstrates that leukocyte scanning with technetium 99m-hexamethyl propylene amine oxine as a label can reliably assess the location and, to a lesser degree, activity of Crohn's disease. This technique is more convenient and provides images far superior to those produced by indium 111-labeled leukocyte scanning.

Extraction of an intracardial catheter embolus using combined radiography and transesophageal echocardiography.

Embolism of a fragment of a central venous catheter is a serious clinical complication, especially when the fragment cannot be made visible by radiological methods. We report a case where such a fragment could only be localized by transesophageal echocardiography (TEE). With combined use of x-rays and TEE, the catheter embolus was successfully extracted using a conventional Dormia catheter. For similar situations the described procedure is recommended.

[Nuclear magnetic resonance tomography of the sacroiliac joint. A new examination technic in the differential diagnosis of rheumatic diseases of the lumbosacral transition]. / Die Kernspintomographie des Sakroiliakalgelenkes. Eine neue Untersuchungstechnik zur Differentialdiagnose rheumatischer Erkrankungen im lumbosacralen Ubergang.

25 patients with the clinical diagnoses of possible sacroiliitis were investigated by Magnetic Resonance Tomography (MR). Using axial or coronal tomography in a T1-weighted sequence (7 slices, 1 echo, NEX: 2, slice thickness 8 mm, TR: 600 ms, TE: 33 ms) and in a T2-weighted sequence (7 slices, 4 echos, NEX: 2, slice thickness 8 mm, TR: 1800 ms, TE: 33, 66, 99, 132 ms) we found normal sacroiliac joints in 10 patients, in 12 patients we diagnosed a sacroiliitis, in 3 patients a sacroiliac sclerosis. Descriptive evaluation and T2-calculation we showed, that MR is specific in differentiation of inflammation from sclerosis. The mean T2-relaxation time is 126 ms in healthy subjects, 320 ms in sacroiliitis and 87 ms in sclerotic areas. The results are significant in the Student-T-test (5% level). In addition the method allows the distinction of sclerosis from inflammation with a resolution of 2 mm. In evaluating sacroiliac rheumatic diseases MR may be helpful as a new imaging technique to complete the information of conventional radiography, computer assisted tomography and scintigraphy.

A case of pneumonia caused by Legionella pneumophila serogroup 8 in West Germany. Etiological diagnosis by immunofluorescence, enzyme immunoassay, and immunoblot.

The severe and complicated course of a Legionella pneumonia in an 18-year-old female patient is reported. The serogroup 8 of Legionella pneumophila was identified as the infecting agent for the first time in West Germany. The etiological diagnosis was confirmed by immunofluorescence, enzyme immunoassay, and immunoblot. We emphasize the importance of serological testing of all Legionella pneumophila serogroups available.

[Diagnosis of thoracic aortic aneurysms and dissections using transesophageal echocardiography]. / Diagnostik thorakaler Aortenaneurysmen und Dissektionen mit Hilfe der transösophagealen Echokardiographie.

Transesophageal echocardiography was performed in 25 patients with the clinical suspicion of an aneurysm or dissection of the thoracic aorta. The results obtained were compared to those of conventional transthoracic echocardiography. An aortic dissection was found in 11 patients, an aortic aneurysm in 9 patients, and an aneurysm of the left subclavian artery, an abscess of the aortic ring and a perforated aortic sinus in one patient each. In 2 patients no abnormalities of the thoracic aorta could be found. The intimal flap was detected in 11 patients with transesophageal imaging and in 9 patients with the transthoracic approach. Aortic dissection was suspected in another 5 patients with transthoracic echocardiography which could be excluded by transesophageal echocardiography. In 13 patients (52%) imaging of the descending thoracic aorta was not possible with transthoracic echocardiography but in all patients it was possible from the transesophageal approach. Transesophageal echocardiography seems to be a useful diagnostic approach when diseases of the thoracic aorta were clinically suspected.

[Local fibrinolytic therapy in thrombotic complications of peritoneovenous shunt]. / Lokale Lysetherapie bei thrombotischen Komplikationen des peritoneovenösen Shunts.

Since 1981 in the University Hospital of Freiburg 41 patients with ascites have been treated by installation of a peritoneo-venous shunt system. In 9 patients thrombotic complications occurred. Two patients had to undergo a second surgical treatment. Seven patients have been treated by local fibrinolysis. In 6 patients local fibrinolytic therapy was partly or completely successful, in one patient local fibrinolysis was of no therapeutic effect.

[Spontaneous pneumoperitoneum in progressive systemic sclerosis (generalized scleroderma)]. / Spontanes Pneumoperitoneum bei Progressiver Systemsklerose (generalisierter Sklerodermie).

In a twenty-nine year old female patient with progressive systemic sclerosis (scleroderma) (PSS) and an impressing involvement of the intestine (disturbance of the oesophageal motility, pseudo-obstruction, malabsorption) a spontaneous, asymptomatic pneumoperitoneum is observed. Perforation or pneumatosis cystoides intestinalis (PCI) could not be proved. The possible pathogenesis, course, prognosis and therapy of this rare complication are discussed.

Non-surgical biliary drainage: endoscopic conversion of percutaneous transhepatic into endoprosthetic drainage.

Percutaneous transhepatic drainage (PTD) is associated with many long-term complications. Therefore a large-diameter endoscopic endoprosthesis is preferentially employed to bridge a malignant obstruction of the biliary tract. Only if the placement of an endoprosthesis fails, must PTD be established. We present a simple method for converting PTD into a large endoprosthesis (14 F) with the aid of endoscopy. We have performed this conversion successfully in 8 patients without complications.

[Peritoneovenous shunt in ascites therapy. Complications and their treatment]. / Peritoneo-venöser Shunt in der Aszitestherapie. Komplikationen und deren Behandlung.

Complications occurred in 29 of 37 patients after ascites retransfusion (n = 16) or introduction of a peritoneovenous shunt (n = 21). Blood clotting disturbances, that could either be successfully treated with drugs or which led to interruption of the reinfusion, appeared in 38%. Estimation of plasminogen proved to be of reliable prognostic value thus enabling prophylactic measures to be taken. Post-operatively 14 patients had transient fever not requiring specific treatment. Local fibrinolysis or shunt revision was successful in three patients with shunt thromboses. According to our experience most complications can be avoided by prophylactic and therapeutic measures.

[Benign and malignant tumors of the thoracic skeleton after percutaneous radiotherapy of Hodgkin's and non-Hodgkin's lymphomas]. / Gutartige und bösartige Tumoren des Thoraxskeletts nach perkutaner Strahlen-therapie von Hodgkin- und Non-Hodgkin-Lymphomen.

Disorders of the skeleton in the thoracic area after percutaneous irradiation of malignant lymphomas are relatively rare. The most common site for pathologic changes is the clavicula. Local overdosage and, in case of malignant alterations, an additional chemotherapy might be the reasons. Among our patients seven lesions occurred, three of them were malignant: two osteogenic sarcomas and one chondrosarcoma.

[Changes in the esophageal wall following sclerotherapy of varices--roentgen morphology and therapy]. / Veränderungen der Osophaguswand nach Varizensklerosierung--Röntgenmorphologie und Therapie.

Endoscopic sclerotherapy of esophageal varices is a widely used procedure. It reduces the frequency of rebleeding and improves the survival of cirrhotics with portal hypertension. The intravariceal or paravariceal injection of sclerosing agents causes structural changes of the esophageal wall recognisable radiologically. Stricture is a late complication which occurs in about 10 percent. In residual dysphagia balloon dilatation is recommended.