[Fever, atrial fibrillation, and angina pectoris in a 58-year-old man]. / Fieber, Vorhofflimmern und Angina pectoris bei einem 58-jährigen Patienten.

Primary cardiac lymphoma (PCL) respresents a very rare type of cardiac tumour. This report illustrates a case of PCL in an immunocompetent 58-year-old man presenting with atrial fibrillation and febrile syndrome. Comprehensive imaging [computer tomography (CT), cardiac magnetic resonance imaging (cMRI), 3-dimensional transesophageal echocardiography (3D-TEE)] identified a large right atrial tumour, leading to pericardial effusion. Isolated cardiac involvement was confirmed by positron emission tomography (PET)-CT. A diffuse large B-cell lymphoma (DLBCL) was diagnosed based on the results of a TEE-guided biopsy. A normalized PET scan (PETAL study) indicated complete remission following R-CHOP 14 immunochemotherapy. Thus, an interdisciplinary and multimodal approach avoided unnecessary cardiac surgery.

Influence of the potassium concentration on functional and structural preservation of the lung: where is the optimum?

BACKGROUND: Low-potassium solutions have been shown to improve lung preservation. The optimal potassium concentration, however, has not been investigated systematically. The purpose of this study was to evaluate the effect of solutions with different potassium concentrations on functional and structural preservation after flush-perfusion and ischemia. We used our established extracorporeal working heart-lung model and a modification of this model with isolated pulmonary perfusion at defined flow rates. METHODS: In two sets of experiments 42 rat heart-lung blocks (experiment I and II: n=7/group) were used. Lungs were flush-preserved with 20 ml Euro-Collins solution (EC115; K+ 115 mmol/L), potassium-reduced Euro-Collins solution (EC40; K+ 40 mmol/L), or low-potassium Euro-Collins solution (EC10; K+ 10 mmol/L) and stored for 2 hours at 10 degrees C. Reperfusion was performed for 40 minutes with Krebs-Henseleit solution containing washed bovine red blood cells (38%) while the lungs were ventilated with room air. In experiment I pulsatile perfusion of the lungs was achieved by the working right side of the heart. In experiment II lungs were perfused at defined flow rates by a roller pump. Postischemic function was assessed by means of oxygenation capacity and pulmonary vascular resistance. The degree of structural damage to the air-blood barrier was assessed by quantitative stereologic light and electron microscopic evaluation. RESULTS: In both experiments after 40 minutes reperfusion oxygenation capacity was significantly higher in EC40 than in EC115 and EC10, whereas pulmonary vascular resistance was significantly higher in EC115 than in EC40 and EC10. Quantitative histologic examination showed surprisingly modest damage to the endothelial side of the air-blood barrier but a considerable degree of damage to the epithelium in both experiments. The alterations in the pump-perfused isolated lung experiments exceeded those of the pulsatile perfused heart-lung experiments. The comparative analysis of the study groups revealed a minor degree of epithelial swelling and fragmentation in EC40 than in EC115 and EC10, respectively. CONCLUSIONS: The results obtained with two modifications of an extracorporeal model indicate that flush perfusion of the lung with a potassium-reduced solution results in better functional and structural preservation than flush perfusion with either high- or low-potassium solutions. The optimum may lie in the vicinity of 40 mmol/L. Further studies are necessary to verify these initial findings.

A negative rapid urease test is unreliable for exclusion of Helicobacter pylori infection during acute phase of ulcer bleeding. A prospective case control study.

BACKGROUND: The reliability of the rapid urease test has not been proven in patients with peptic ulcer bleeding. Some studies show bad diagnostic results with the rapid urease test for gastrointestinal bleeding. AIMS: To evaluate the efficacy of the rapid urease test in patients with bleeding gastric or duodenal ulcers. PATIENTS AND METHODS: A total of 96 patients with acute peptic ulcer bleeding without proton pump inhibitor or antibiotic therapy within the last 14 days before bleeding were included into the study. During index endoscopy, specimens for histological and rapid urease test were obtained from the antrum and corpus mucosa of the stomach. Patients were also investigated by the 13C-urea breath test. Diagnostic quality parameters were calculated with the histology and the 13C-urea breath test as reference and compared with a matched control group with uncomplicated ulcers. RESULTS: The sensitivity of the rapid urease test was 80% and the specificity 100% compared to histology and 13C-urea breath test. The negative predictive value was 75%. These values were statistically significantly different from those of the control group (sensitivity 96%, specificity 100%, negative predictive value 88%). CONCLUSION: The exclusive use of the rapid urease test cannot be recommended in patients with peptic ulcer bleeding.

[The hyperplastic gastric polyp - a praecancerosis?]. / Der hyperplastische Polyp des Magens - eine Präkanzerose?

In general, hyperplastic polyps of the stomach are regarded as benign lesions. Still there is the chance to find carcinomas within them as documented in this case report. This finding can be interpreted as an incidental appearance. At the moment there are no standardized guidelines regarding diagnostics and therapy of gastric hyperplastic polyps. Referring to a short review of the literature endoscopic snare polypectomy seems to be a reasonable therapeutic option of hyperplastic polyps with a size of 0.5-1 cm. Although it is possible to determine the histology by forceps biopsy, it is possible to be misled by missing areas of focal carcinomas. Complications after polypectomy are rare and often no further intervention is needed. A further point for polypectomy is the fact that surfaces of hyperplastic polyps are eroded in about 90 % and therefore there is the risk of bleeding, chronic anaemia and positive stool tests for occult blood.

Helicobacter pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis: a prospective single-center trial.

BACKGROUND AND STUDY AIMS: Eradication of Helicobacter pylori infection can reduce the rebleeding rate of peptic ulcer bleeding in the long term. There are few data on the influence of H. pylori on the rebleeding rate in the acute phase of bleeding however. We therefore prospectively investigated the influence of H. pylori infection on the early rebleeding rate in patients who had undergone successful endoscopic hemostasis treatment for peptic ulcer bleeding. PATIENTS AND METHODS: Between January 1996 and November 2000 all patients with peptic ulcer bleeding were evaluated consecutively. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. Bleeding activity was assessed using the Forrest classification. After successful endoscopic hemostasis all patients received omeprazole 40 mg or pantoprazole 40 mg, intravenously, twice a day for 3 days. Rebleeding episodes were recorded over 21 days following primary hemostasis. RESULTS: 344 patients were enrolled into the study. The prevalence of H. pylori infection was 62.9 %. A total of 51 patients showed rebleeding (14.8 %), of whom 31 were H. pylori-positive (60 %). There was no statistically significant difference between the H. pylori-positive and -negative patients, however. The rebleeding rate did not differ between patients with H. pylori infection alone and patients also using nonsteroidal anti-inflammatory drugs. When stratifying patients according to activity of bleeding at index endoscopy, we were also unable to find any significant influence of H. pylori infection on the outcome of Forrest class I and IIa bleedings. CONCLUSION: Based on our data, it can be concluded that H. pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis.