Colour Doppler ultrasound patterns and clinical follow-up of incidentally found hypoechoic, vascular tumours of the spleen: evidence for a benign tumour.

Between January 1990 and January 2005, incidental hypoechoic, vascular tumours of the spleen were identified in 13 patients using B-mode and colour Doppler ultrasound (CDS). All lesions found were well demarcated, intrasplenically located, and ranged in size between 1 cm and 4 cm. The increased vascular pattern on CDS was confirmed in 9 of the 13 cases by contrast enhanced ultrasound (CES), while two patients showed reduced vascularity on CES. In 10 patients, lesions were confirmed by contrast enhanced CT. Histological examination was performed in three patients with the diagnosis of capillary haemangioma (n = 2) and hamartoma (n = 1). In the remaining cases, ultrasound follow-up was performed (range 4 months to 13 years) and demonstrated no evidence of tumour growth in all but one patient. During a 4 year follow-up, one lesion increased in size from 1.0 cm to 1.5 cm and in the same patient an additional 0.5 cm sized hypoechoic increased vascular lesion was also found. In the spleen a hypoechoic lesion with an increased vascular pattern incidentally found by ultrasound most likely indicates a benign tumour with capillary haemangioma/hamartoma as the most likely diagnosis. However, it should be emphasised that in all cases a careful ultrasound follow-up is warranted.

Colour Doppler ultrasound mapping of chest wall lesions.

Spectral curve-analysis of arterial flow signals (FS) in patients with pulmonary lesions is able to discriminate FS of bronchial arteries (BA) from FS of pulmonary arteries (PA). In patients with chest wall lesions a different FS from that of the BA/PA can be obtained. The aim of the study was to evaluate and characterize arterial supply of chest wall lesions using quantitative colour Doppler ultrasound (CDS). Between September 2002 and June 2003, 29 consecutive patients with chest wall lesions were examined by CDS. 16 lesions were located strictly to the chest wall (group I). 13 lesions had a chest wall lesion with pulmonary extension (group II). The following parameters were prospectively determined: (1) qualitative CDS (absence or evidence of vascularity); (2) quantitative CDS of intercostal or non-intercostal located arterial FS (resistive index (RI) and pulsatility index (PI)); (3) number of different arterial FS in one lesion using CDS-mapping. In a control group of 17 healthy volunteers quantitative measurement of RI and PI of the intercostal artery (ICA) was performed. 4 of 29 patients (14%) had no FS by CDS mapping. Quantitative CDS parameters of the control group were mean RI of ICA 0.88 (+/-0.056); mean PI of ICA 2.88 (+/-0.643); of group I mean RI of ICA 0.79 (+/-0.127) mean PI of ICA 1.93 (+/-0.641), and of group II mean RI of ICA 0.79 (+/-0.144), mean PI of ICA 2.1 (+/-1.015), mean RI of non-ICA 0.68 (+/-0.675) mean PI of non-ICA 2.5 (+/-2.506). Median RI as well as PI-value obtained within the chest wall (ICA) do not differ between group I, group II, and the control group. Within group II impedance measurements discriminates intercostal from non-intercostal arterial supply. In 29 patients 37 different arterial FS were obtained. None of the 16 patients in group I and 8 of the 13 patients in group II had 2 or more different FS. Lesions strictly located to the chest wall had an arterial supply characteristic for ICA by quantitative CDS. Chest wall lesions with pulmonary extension demonstrate a complex arterial supply by quantitative CDS.

Multiple myeloma of the serosa coat.

We report on a 47-year-old male patient with IgA-kappa plasmacytoma, who 12 months subsequent to diagnosis developed marked ascites. On light and electron microscopy morphologically identical plasma cells with bizarre intracytoplasmatic material were found in the bone marrow, pleural exudate, and ascites fluid. This kind of extramedullary spread is extremely rare and usually resists therapy. The mean survival rate for the 9 patients with malignant plasmacellular ascites whose cases have been documented so far was 2 months. After progression under VCMP regimens our patient has been successfully treated over a period of more than 4 years with i.v. VP16 monotherapy with additional intermittent local administration of methotrexate and systemic poly-chemotherapy according to the VAD scheme.

Atypical mycosis fungoides with cerebral involvement.

This report concerns a 17-year-old male patient with atypical mycosis fungoides (m.f.). Initial examination revealed generalized lymphoma and uncharacteristic livid skin efflorescence. The patient developed bone marrow involvement and meningeal leukaemia 6 months later. Diagnosis was confirmed by immunohistochemistry and electron microscopy. Aggressive chemotherapy yielded no response.

Spontaneous rupture of the spleen: ultrasound patterns, diagnosis and follow-up.

Spontaneous rupture of the spleen is an extremely rare complication usually of infectious diseases or disorders of the haematopoietic system and has been described mostly in case reports. The incidence, symptoms, causes, therapy, and prognosis are poorly defined. From July 1985 to January 2000 41 patients with spontaneous splenic rupture were diagnosed by abdominal ultrasound and confirmed by splenectomy (n=12), CT (n=15), and ultrasound follow up (n=26). An ultrasound grading system was retrospectively established based on the degree of splenic injury (grade 0-2=low grade injury, grade 3=high grade injury) and correlated with surgical procedures. 30 day mortality rate was studied in relation to underlying disorders, ultrasound grades and treatment decisions. 21 patients had underlying malignant disorders (group I) and 20 patients had benign diseases (group II). Between group I and II we observed a highly significant difference in 30 day mortality rates (n=7; 38.1% vs n=1; 5%, p<0.01), but no significant difference in high grade injury rate (n=3; 14.3% vs n=2; 10.0%; p=ns) and surgical treatment rate (n=5; 23.8% vs n=7; 35.0%; p=ns). Depending on ultrasound grades the surgical procedures were 0% for grade 0, 16.7% for grade 1, 30.4% for grade 2, and 60% for grade 3. There were no significant differences between patients, who died within the first 30 days (n=9) and those who survived more than 30 days (n=32) regarding high grade splenic injury rate (n=0; 0% vs n=5; 15.6%; p=ns), and surgical treatment rate (n=2; 22.2% vs n=10; 31.2%; p=ns). Spontaneous rupture of the spleen is an extremely rare event. It is associated with a high mortality rate within 30 days in patients with malignant disease. Sonomorphologic grading is helpful for treatment decisions. 30 day mortality rate is correlated with neither ultrasound grades, nor surgical treatment rates.

Clinical pharmacokinetics of atenolol--a review.

Atenolol is a hydrophilic betareceptor blocking drug, which is predominantly eliminated via the kidneys, only about 5% of the atenolol is metabolised by the liver. After oral administration atenolol is incompletely absorbed from the intestine, so about 50% of the beta blocker are finally biovailable. In plasma only 3% of atenolol are protein-bound. There exists a linear relationship between the atenolol plasma levels and the degree of beta blocking effect measured by inhibition of the exercise-induced tachycardia. No correlation was found between plasma levels of atenolol and blood pressure lowering activity of the drug. After oral administration elimination half life of atenolol is calculated from 6 to 9 h by different authors. In patients with impaired renal function elimination half life of atenolol gradually increases to values of 36 h in uraemic patients (glomerular filtration rate (GFR) less than 10 ml/min). Between GFR and atenolol plasma clearance as well as renal clearance a close significant correlation is described. Prolongation of elimination half life requires a dosage adjustment of atenolol in patients with renal failure. A marked interaction of atenolol is found when calcium or aluminium hydroxide are concurrently administered with the beta blocker whereas cimetidine does not influence atenolol kinetics.

Acute, complete splenic infarction in cancer patient is associated with a fatal outcome.

Splenic infarction frequently occurs in patients with myeloproliferative diseases, endocarditis, and sickle cell anemia. Various sonographic patterns of splenic infarction do exist. but little is known about tumor associated splenic infarction in cancer patients. Between January 1992 and December 2002, 66 patients were diagnosed with splenic infarction by color Doppler sonography (CDS). Ten patients had an underlying solid cancer. Clinical and sonographic data of cancer patients were evaluated retrospectively with regard to age, sex, frequency of thrombotic episodes, splenic size, echomorphology and vascularity of splenic lesions, and follow-up examination. The median age was 53 years (range, 16-73 years). Nine of 10 patients had abdominal metastases, four had evidence of a hypercoagulable state, five had a small spleen (< 7 x 3 cm), and seven had acute complete infarction of the spleen without hilar and parenchymal vessels on CDS. Survival of six patients with acute complete infarction ranged from 1 to 30 days. In cancer patients with splenic infarction, an acute complete infarction is the most common pattern. It is caused predominantly by a hypercoagulable state and is associated with an extremely short survival.

[Fulminating course of IgG plasmacytoma at a young age]. / Foudroyante Verlaufsform eines IgG-Plasmozytoms im jugendlichen Alter.

The case of a 27 year old patient with IgG-lambda-myeloma is reported. Examination revealed hypercalcemia and acute renal failure. The patient died of heart failure two days after diagnosis. Autopsy revealed an extensive calcification of the inner organs, in particular the heart.

Ultrasound-guided percutaneous drainage of pyogenic splenic abscesses.

This report summarizes the results of ultrasound-guided percutaneous drainage procedures in eight patients with solitary (n = 6) and multiple (n = 2) splenic abscesses. Seven patients underwent a total of 15 closed-needle aspirations with local installation of antibiotic solution. In one case, catheter drainage was performed. All patients received parenteral broad-spectrum antibiotic therapy. Seven (88%) of the eight patients with splenic abscesses recovered completely following percutaneous drainage procedures and none of these required splenectomy later. In one patient with multiple splenic abscesses, repetitive needle aspiration was ineffective, necessitating splenectomy. The only complication associated with nonsurgical percutaneous interventions was a pleural empyema that resolved with chest tube drainage (complication rate, 13%). These results and those reported in the literature indicate that pyogenic splenic abscesses can be treated effectively by (repetitive) closed aspiration technique or catheter drainage with a relatively low rate of complications. From our experience, splenectomy should only be performed in splenic abscesses that are not accessible percutaneously and in those cases with percutaneous drainage failure.

[Aggressive chemotherapy in generalized eosinophilic granuloma in adults]. / Aggressive Chemotherapie bei generalisiertem eosinophilen Granulom im Erwachsenenalter.

Case report of a 21 year old male patient with acute spinal cord injury caused by compression from dissiminated eosinophilic granuloma. Chemotherapy with cyclophosphamide, vincristine and prednisone (COP) yielded partial response, but the addition of adriamycin (CHOP) a complete remission.

[Localized edema following cytostatic therapy]. / Lokalisiertes Odem nach zytostatischer Therapie.

In a phase II trial for non-small cell carcinoma of the lung and squamous cell carcinoma of the head and neck 16 patients were treated with a 3 drug combination chemotherapy: Cis-platinum, VP16, and vindesine. During therapy 4 patients suffered from localized transitory edema. This side effect has not been reported yet.

[Sonography of the diaphragmatic pleura in tumor patients]. / Sonographie der Pleura diaphragmatica bei Tumorpatienten.

Report on twelve patients suffering from malignant primary disease associated with pleural effusion and diaphragmatic metastasis, basically diagnosed via sonography. In no case tumour formation could be detected by x-ray film. Cytohistological evidence of diaphragmal metastasis can be found by sonographically detected pleural tumours malignant effusion must be assumed, despite negative exudate cytology. In such cases diagnostic thoracoscopy is not necessary.

[Hodgkin's disease following kidney transplantation with cyclosporin A]. / Hodgkinsche Erkrankung nach Nierentransplantation unter Cyclosporin A.

A 44-year-old patient with polycystic kidney disease received a renal transplant in December 1984. Nine months after immunosuppressive therapy with cyclosporin A and prednisolone the patient developed Hodgkin's disease of the mediastinum.

Focal involvement of malignant lymphoma in the liver.

In this study the sonographic findings of 30 patients with hepatic lymphoma have been reviewed. Lesions have been confirmed by autopsy (n = 1), laparatomy (n = 1), sonographically guided biopsy (n = 15), and during long-term follow-up (n = 13). Ten patients had Hodgkin's disease (HD) and 20 non-Hodgkin lymphomas (NHL). Focal lesions, less than 3 cm in diameter, were seen in 20 patients. The remaining ten cases presented large-nodule transformation of the parenchymal texture. All lesions were predominantly hypoechoic with a halo sign in two cases. No diffuse involvement of the liver was observed, and no correlation between histological lymphoma subtyping and patterns of hepatic infiltration was found.

[Ultrasound manifestations of abdominal lymphomas. An overview]. / Sonographische Erscheinungsformen abdomineller Lymphome. Eine Ubersicht.

Abdominal sonography is now the most frequently used screening method for the detection of abdominal lymph node enlargement. For proper classification, size, localisation and infiltration pattern must be known. The definitive determination whether lymph nodes are benign or malignant cannot be made by the size of the lesion alone. The localisation (parietal/visceral) of enlarged lymph nodes has been shown to be of significance in the staging of abdominal carcinomas. Different infiltration patterns (diffuse small nodular, focal small nodular, focal large nodular, bulky formations) show the broad spectrum of abdominal lymphomas detected by ultrasound. Knowledge of these different infiltration patterns together with clinical information often helps to discriminate between lymph node enlargement caused by inflammation, metastasis, or malignant lymphoma. The definitive diagnosis is made via laparotomy, ultrasound guided biopsy or sonographic follow-up studies.

[Extrahepatic biliary obstruction caused by infiltration of the pancreas by plasmacytoma]. / Extrahepatische biliäre Obstruktion durch Pankreasinfiltration bei Plasmozytom.

This is a report about a 61 year old male suffering from IgG-Kappa plasmocytoma. 12 months after the initial diagnosis, he developed an intrathoracal plasma cell tumour, primarily affecting the pleura. One year later obstructive jaundice was caused by a mass of the head of the pancreas, diagnosed by ultrasound. Percutaneous fine needle aspiration biopsy revealed homogeneous plasma cell infiltration of the gland.

[Percutaneous puncture and drainage of pancreatic pseudocysts]. / Perkutane Punktionen und Drainagen von Pankreaspseudozysten.

A total of 63 patients with cystic pancreatic lesions (60 pseudocysts, 3 true cysts) underwent percutaneous therapeutic procedures with ultrasound guidance. Repeated needle aspirations were performed in 50 patients, 13 underwent transabdominal catheter drainage. Complete resolution of the cystic lesion was obtained in 37 (59%) patients overall, while 41% required further therapy. Thirty seven (62%) of the 60 pancreatic pseudocysts were successfully drained by percutaneous procedures, in 23 (38%) fluid collections recurred. Complications of the drainage procedures occurred in two patients (3.2%). Considering these results, ultrasound guided needle aspiration and catheter drainage of pancreatic pseudocysts have proved to be of value for both nonsurgical temporary and definitive treatment.

[Sonographically guided fine-needle puncture of adrenal tumors]. / Sonographisch gesteuerte Feinnadelpunktion von Nebennierentumoren.

Ultrasound-guided fine-needle aspiration biopsies were performed in 37 patients (23 women, 14 men; mean age 58 [47-81] years) out of 310 patients in whom an adrenal tumour had been diagnosed by ultrasound between 1985 and 1991. In 21 the tumour diameter was 2-4 cm, in 16 over 4 cm. In 36 patients (97%) the material was suitable for histological analysis. There were 15 metastases, 4 primary adrenal carcinomas and 17 adenomas. 20 of 27 with an underlying malignant tumour had a malignant adrenal tumour (one of the aspiration biopsies in these cases was false-negative), while in 7 the space-occupying lesion was found to be benign. There were no false-positive findings. Ultrasound-guided fine-needle biopsy thus proved to be a reliable and informative method in the diagnosis of adrenal tumours. It should be undertaken under appropriate indication to ascertain the benign or malignant nature of a suspected adrenal lesion.

[Percutaneous drainage of liver and splenic abscess]. / Perkutane Drainagen von Leber- und Milzabszessen.

42 patients with solitary (n = 34) and multiple (n = 8) abscesses of the liver (n = 36) and the spleen (n = 6) were treated with ultrasound guided percutaneous interventions. 38 patients (90%) underwent a total of 97 closed abscess aspirations using needles of 0.9 and 1.3 mm in diameter. In 4 cases (10%) percutaneous catheter drainage was performed. Intravenous antibiotics were used in all cases. Those patients with closed abscess aspiration additionally received local injection of aminoglycosides into the cavity. 40 out of the 42 patients could be treated successfully by percutaneous methods for a cure rate of 95.2%. Percutaneous drainage failure occurred in 2.4%. One patient with multiple liver abscesses and catheter drainage died from myocardial infarction (hospital mortality 2.4%). Complications of ultrasound-guided interventions included two minor bleedings, requiring no therapy, and one pleural empyema (complication rate 7.1%). There were no treatment related lethal complications. These results indicate that abscesses of the liver and the spleen up to 10 cm in diameter can be effectively treated by closed (repetitive) needle aspiration and antibiotic therapy with a relatively low rate of complications. About half of our patients with abscesses of more than 10 cm received percutaneous catheter drainage. On the basis of our experience surgical drainage of liver abscesses and splenectomy in splenic abscesses should be restricted to those cases with percutaneous drainage failure.