Colon cancers and peritoneal mesothelioma occurring 29 years after abdominal radiation for testicular seminoma. A case report and review of the literature.

Secondary malignancies represent an increasing problem for long survivors of primary malignancies treated by chemo- and/or radiotherapy. The occurrence of secondary myelodysplasia and leukaemias after treatment for Hodgkin's disease is well established. Secondary solid tumors are mostly observed following radiation therapy. We report the case of a patient who presented 3 abdominal solid malignancies within 3 years, 29 years after abdominal radiotherapy for a testicular seminoma, namely 2 colon cancers and a peritoneal mesothelioma. Both types of cancer are independently reported in the literature to be more frequent in patients with a history of abdominal radiation than in the general population. To our knowledge there is no other reported case with 3, nearly simultaneously occurring separate solid tumors, which could all be related to former abdominal irradiation. Such a radiotherapy-related long-term side effect should be taken into account when considering adjuvant radiotherapy in patients with low-risk stage I testicular seminoma.

[Ischemic colitis and mesenteric ischemia after abdominal aortic reconstruction]. / Ischämische Colitis und mesenteriale Ischämie nach abdominaler rekonstruktiver Aortenchirurgie.

Ischemic colitis is quite a rare condition, which can be subdivided into two categories, a so-called occlusive form as a complication of various vascular diseases, and a non-occlusive form caused by exogenous administration of drugs, or i.e. higher cocentrations of various endotoxines or cytokines. Besides the most serious cases with transmural ischemia, needing operation and resection, over 50% of all cases suffer from non-transmural or mucosal ischemia which can be treated conservatively. These cases usually show a rather favourable outcome. A part of these patients will suffer from bowel stenosis or strictures later on and may need secondary resections. Ischemic colitis following aorto-iliac reconstructive surgery is a rare but well known complication. Although it should be suspected much more frequently, only 1 to 2% of the patients will present a condition of clinical importance. The complication is more frequent in patients who undergo surgery as an emergency, especially reconstruction for aneurysmal disease, and it is less frequent in patients who undergo aorto-iliac reconstruction for occlusive disease; probably because the latter have already developed collateral vessels in the visceral area. A preoperative evaluation of this specific risk is rarely possible by angiography. Intraoperative strong pulsating backflow from the inferior mesenteric artery is considered as a quite reliable prognostic factor for a sufficient mesenteric circulation. Measurement of inferior mesenteric stump pressure, fluoresceine instillation and doppler ultrasound have been proposed as more reliable predictive elements. Wherever mesenteric circulation seems to be doubtful, inferior mesenteric replantation is advisable. In the postoperative course, a thorough clinical surveillance and probably systematic sigmoidoscopy especially on patients with prolonged intubation in strongly advisable in order to detect ischemic lesions in an early stage. Early operations on transmural lesions will help to improve this otherwise very serious and life threatening complication.

Automated and computer-controlled method for the measurement of the crystallization of calcium oxalate monohydrate in urine.

Monitoring of crystallization of calcium salts with ion-selective electrodes has turned out to be a very sensitive method. The difficulties of handling these electrodes in native whole urine and other biological fluids have been eliminated by new calcium analyzers, which clean and calibrate the electrodes after each measurement. To study crystallization kinetics, repeated calcium ion measurements have to be performed at regular intervals. For this purpose we have developed a special sampler and software. The sampler brings a thermostat-controlled crystallization chamber to the analyzer at preselected intervals. The computer directs and coordinates the sampler and the analyzer, stores the received results and prints out growth curves. Furthermore it calculates the half-time (h) and the maximum decrease of ionic calcium at infinite incubation time (delta Ca2+ infinity). Both values are shown to characterize the growth of calcium oxalate monohydrate in urine. Results are obtained within 40 min.