Hypertension in rats induced by renal grafts from renovascular hypertensive donors.

Renal transplantations were performed, using microsurgical techniques, with adult male two-kidney, one clip hypertensive rats (n = 9) and sham-operated normotensive Wistar-Kyoto rats (n = 8) as kidney donors and with F1 hybrids, bred from Wistar-Kyoto and stroke-prone spontaneously hypertensive rat parents, as recipients. Systolic blood pressure before surgery was 200 +/- 2.7 mm Hg in hypertensive and 115 +/- 1.7 mm Hg in normotensive donors and 144 +/- 7.1 and 138 +/- 3.5 mm Hg in the two groups of recipients. Renal hypertension in donors was maintained for 14 weeks before surgery was performed and the nonischemic kidneys were transplanted. Bilaterally nephrectomized recipients of renal grafts from hypertensive donors developed sustained hypertension (185 +/- 3.9 mm Hg). In contrast, in recipients of renal grafts from normotensive donors, blood pressure decreased significantly to the level of the donors (111 +/- 3.7 mm Hg). Posttransplantation hypertension in recipients of renal grafts from hypertensive donors was associated with intrarenal vascular hypertrophy, smaller kidneys, a decreased glomerular filtration rate, an increased plasma urea concentration, and polydipsia as compared with normotensive transplanted controls. Renal pyelograms revealed no gross anatomic alterations of transplanted kidneys. Our data indicate that secondary damage to the renal grafts caused by high perfusion pressure before transplantation can induce hypertension in recipients of these kidneys. Furthermore, our data suggest that renal mechanisms may be necessary to maintain borderline hypertension in F1 hybrids.

Localization of occult persisting medullary thyroid carcinoma before microsurgical reoperation: high sensitivity of selective venous catheterization.

In 14 patients with occult persisting medullary thyroid carcinoma, tumor tissue was removed by microsurgical reoperation in 13 of 14 patients. This resulted in biochemical improvement in all but 1 patient and biochemical cure in 3 patients (21%). The lateral compartment of the neck or the upper mediastinum was involved in all but 1 patient. Before microsurgical reoperation, selective venous catheterization (SVC) for serum sampling along with serum calcitonin (CT) determination was done and compared to other localization methods. Tumor tissue could be localized correctly by SVC in 89% (CT gradient 1.21-2.02), computed tomography in 38%, and ultrasound in 28%. In patients with an elevated CT level after initial surgery and clinically occult disease, SVC is recommended for localization of tumor tissue. The affected side of the neck should be reoperated on with microdissection of the central and lateral compartment of the neck and the upper mediastinum. With this procedure, the cure rate of reoperation in patients with persistent occult MTC can be improved.

Prediction of breakthrough patterns of organics from laboratory tests.

The investigations have shown that it is possible to predict the breakthrough behavior of complex mixtures in a pilot-plant filter. The aim of future studies will be to predict the breakthrough behavior of waterworks filters in the same way as discussed here. This seems to be fairly simple if the filters are working with adsorption only. If, in addition, biological processes occur in a filter (as is generally observed), these processes have to be taken into account because an additional mechanism exists for removal of organic substances in the activated carbon filter. Investigations in a new research program will also need to consider the influence of ozone on biodegradation. Use of the methods already discussed, can help to optimize existing plants, as well as a proper control of the efficiency of the regeneration processes.

[Vitamin D deficiency. Osteopathy after prolonged treatment with anticonvulsents (author's transl)]. / Vitamin-D-Mangel - Osteopathie nach antikonvulsiver Langzeitbehandlung

Several substances with anticonvulsent activity can lead to hypovitamenosis D after prolonged use through their effect on vitamen D metabolism in the liver. This results in abnormal bone mineralisation and produces rickets or osteomalacia. Radiological examination of the skeleton should be performed on patients receiving prolonged anticonvulsent therapy, in order to arrive at an early diagnosis. This requires an accurate knowledge of the types of bone abnormality and of their most frequent localisation. Pathological findings such as Looser's zones, epiphyseolysis or delayed development must be considered in this context. Radiological examination provides an accurate diagnosis if combined with clinical findings and important biochemical results: reduced calcium and raised alkaline phosphatase. Treatment with vitamen D must then be instituted. Healing may be complete or leave residual changes, depending on the severity of the bone changes.

[Value of various radiological study results in the follow-up of Camurati-Engelmann disease]. / Die Wertigkeit verschiedener radiologischer Untersuchungsverfahren in der Verlaufskontrolle der Camurati-Engelmannschen Krankheit.

Camurati-Engelmann disease is a rare progressive bone dysplasia; involvement of the skull base can lead to deafness, vestibular disturbances, facial paralysis and damage to the optic nerves. Treatment with corticosteroids, calcitonin and diphosphonates promises only very limited success. Conservative treatment of compression of the cranial nerves is almost ineffective, but the aim of surgical treatment is decompression of involved nerves. The differential diagnosis depends on radiological findings and clinical symptoms. Follow-up depends on radiographic examination and skeletal scintigraphy for showing the extent of the disease. CT may help in demonstrating compression of cranial nerves and define the indications for surgical decompression.

[Paget's osteitis deformans. Significance and control]. / Ostitis deformans Paget. Bedeutung von Verlaufskontrollen.

Follow-up observation of patients with Paget's disease by conventional radiology is useful to evaluate the spontaneous course of the disease in untreated cases and to determine the regeneration of the affected bone after therapy. This also includes complications of the otitis deformans Paget--mainly complete or incomplete fractures, severe deformations as well as rare malignant changes.

[Paget disease of the skeleton. Internal medicine aspects]. / Morbus Paget des Skelettes. Internistische Aspekte.

Paget's disease of bone seems to be a slow virus infection of a single or several areas of the skeleton. Pagetic lesions are rather common among elderly people, but the disease does not manifest itself very often. Compared to the incidence of Paget's disease in England it seems to be rarer in this country. The pelvis is most frequently involved, followed by bones of the leg, skull, lumbar spine. The patients suffer from pain and deformities, arthroses of the adhering ankles, increased temperature of the area, nerve irritation and nerve damage due to increased bone growth (e.g. hearing loss due to Paget's disease of the skull). The development of sarcoma is rare and is only seen in severe cases. Diagnosis is made by X-ray, confirmed by bone biopsy, if necessary. Asymptomatic lesions are detected by bone scintigraphy. The activity of the disease is expressed by increased alkaline serum phosphatase and urinary hydroxyproline excretion. For treatment calcitonins and diphosphonates (especially EHDP, Diphos) are used. Both inhibit the overactive osteoclasts, and the increased bone turnover is normalized. The patients feel considerable relief; the elevated biochemical parameters fall to about 50% of initial values after calcitonin or EHDP monotherapy. In severe cases the combination of both substances may be profitable. The cytostatic drug mithramycin which can also be effective is only needed in exceptional cases.

[The distribution of destructive polyarthritic changes in the hand skeleton]. / Das Verteilungsmuster der destruierenden Polyarthrose am Handskelet.

The distribution of common and erosive changes in advanced polyarthrosis is radiologically demonstrated in the hands of 32 patients. 23 of them showed erosive destructions in at least one joint. In general the alterations were symmetrical. Most of the destructions were seen in the distal and proximal interphalangeal joints, especially in DIP II, III, V and PIP III. Usually the thumb was spared. Most emphasis has been put on the differential diagnosis to rheumatoid arthritis and arthritis in psoriasis and gout. A recent concept concerning mechanical factors in the pathogenesis of so called primary osteoarthritis in the small finger joints is discussed.

[Mediastinal space-occupying lesion as a rare cause of atrial arrhythmia]. / Mediastinale Raumforderung als seltene Ursache atrialer Rhythmusstörungen.

HISTORY AND CLINICAL FINDINGS: A 61 year old man presented with newly developed tachyarrhythmia. Echocardiographically a tumour of unclear origin in the left atrium was diagnosed. INVESTIGATIONS: The heart rate in the ECG was arrhythmic at 146/min; intermittently sinus rhythm was established. Transoesophageal echocardiography revealed a 90 x 50 mm tumour with sharp borders displacing both atria. The chest x-ray showed a mediastinal rounded mass in the dorsal part overlapping the right mediastinal border. Computer tomography was unable to discriminate the atrial wall from the tumour masses; hence the difference between an (intra-)cardiac tumour (i.e. myxoma) and a tumour of extracardiac (mediastinal) origin could not be established. Additional magnetic resonance tomography led to the most probable diagnosis of a bronchogenic cyst, which spread ventrally up to the ascending aorta and dorsally to the paravertebral region, thus displacing and shrinking the left pulmonary artery and the left atrium. THERAPY: For certain exclusion of malignancy and because of displacement of other thoracic structures the patient was operated on this mediastinal mass by anterolateral thoracotomy. Histologically a dysontogenetic, benign cyst with an inner layer of mesothel and nerval as well as vascular structures in the capsule was diagnosed. Since the operation the patient has persistent sinus rhythm without symptoms of relevant rhythm disorders. An overview of different kinds of intrathoracical cysts is given.

Sternocostoclavicular hyperostosis: its progression and radiological features. A study of 12 cases.

Twelve cases of sternocostoclavicular hyperostosis were followed up over four to 16 years. The patients underwent repeated radiological examinations of the sternocostoclavicular joints and the sternum, and the extrasternal osseous manifestations of the disease were studied to show changes in the radiological features during long term follow up. Five of 12 (41%) patients had extrasternal manifestations. With the exception of one patient extrasternal manifestations were first detected by scintigraphs because they were asymptomatic. With respect to the sternal manifestations the initial radiological diagnosis was made during an acute phase while painful swelling over the sternum and decreased mobility of the shoulders occurred. The radiological examinations showed the signs of a proliferative destructive arthritis in most patients. In contrast with the frequent occurrences of clinical symptoms, the radiological signs of progression take several years to become detectable. There are no specific bacteriological, serological or histological findings. Usually a permanent increase in the erythrocyte sedimentation rates is found. Sternocostoclavicular hyperostosis is a slowly progressing disease, characterised by a chronic aseptic destructive sternoclavicular arthritis with a reactive low turnover sclerosis that begins in a similar way to an enthesopathy and ends after several decades with total ankylosis. The radiological identification of retrosternal proliferation of soft tissue by computed tomography was found to be a valuable criterion for the differential diagnosis from other benign hyperostotic processes of the sternoclavicular region.

[Notes on the differential diagnosis of nodules in the lung: Rendu-Osler-Weber disease (author's transl)]. / Zur Differentialdiagnose von Lungenrundherden: Der Morbus Rendu-Osler-Weber, a.-v.-Shunts in der Lunge.

The hereditary hemorrhagic teleangiectasia, commonly known as "Rendu-Osler-Weber" disease, is a relatively seldom found affection manifesting itself by the formations of localized arteriovenous capillary connections which are tiny arteriovenous fistulas. They are found in the skin, the mucous membranes and in nearly all organs of the body. The diseases is transmitted by a dominant character. Affections of the lung can be seen in 89% of the cases (1). In the following paper five exemplary cases are to show that the simple radiological method of the roentgenogram of the thorax taken in the frontal projection and in the lateral view, assisted by the conventional tomography in most cases will bring the last diagnosis. In the differential diagnosis nodules in the lung can be delimited by the connecting arteries and veins.

[Ossification of the auricle in partial pituitary failure with selective ACTH and STH deficiency (author's transl)]. / Verknöcherung der Ohrmuschel bei partieller Hypophyseninsuffizienz Mit selektivem ACTH- und STH-Mangel.

An acquired partial pituitary insufficiency of unknown origin with selective ACTH and STH deficiency was demonstrated in a 44-year-old patient. The clinical course over many years corresponds to subclinical Addison's disease with occasional acute crises. Ossification of both auricular cartilages and anhidrosis were outstanding signs. There is possibly a connection between the glucocorticoid deficiency over many years with normal mineralocorticoids and the auricular cartilage ossification.

[Eight years of gardner's syndrome in a family (author's transl)]. / Acht Jahre Gardner-Syndrom in einer Familie.

In all affected members of a family with Gardner's syndrome the complete triad of skin tumours, osteomas and polyps of the colon has developed since 1968 when examination revealed an apparently bisymptomatic variant of Gardner's syndrome. In this family bony changes consisting of circumscript osteomas, diffuse sclerosing zones within certain bones, and ridge-like widening of the corticalis were noted, having developed during puberty but remaining constant thereafter. Similarly, no significant new skin tumours appeared after puberty. Most colonic polyps however, occurred in adolescence or thereafter, with malignant transformation after a variable interval of several years. The necessity of long-term observation of the colon, also in patients presenting with a bi- or monosymptomatic form, is stressed. Coloscopy has proven to be more useful diagnostically than radiological methods.

[Pulmonary candida manifestation with cavitation in immunosuppressed patients]. / Pulmonale Candidamanifestation mit kavernöser Einschmelzung bei immunsupprimierten Patienten.

The roentgenologic pattern of the pulmonary manifestation of candida species, resulting in a rapid development of pulmonary cavitations with mycetoma-like structures, was described in three patients. All patients, undergoing antineoplastic chemotherapy because of acute leukemia, presented with fever and expectoration, which were resistant to various antibiotic regimes. Cultures of blood and urine were sterile; but Torulopsis glabrata, a candida species, was found in multiple cultures of the sputum of all patients and also in a bronchoscopic lavage obtained from one patient after reconstitution of the granulopoesis. The roentgenologic appearance of the infiltrates was accompanied by a rise of the Ig-M immunoglobulins against candida. Following intravenous treatment with amphotericin B a reduction of the cavitation and of the infiltrates to small residues was observed. Simultaneously the body temperature and the sputum became normal and a fall in the immunoglobulin titers was found. The diagnostic problems of pulmonary cavitation and especially of pulmonary mycosis in immunosuppressed and therapy-induced granulocytopenic and thrombocytopenic patients with acute leukemia were discussed.

[Percutaneous reconstruction of a pelvic vascular occlusion using the "kissing-balloon" technique]. / Perkutane Rekonstruktion eines Beckengefässverschlusses in "kissing-balloon"-Technik.

UNLABELLED: A 43-year-old patient was admitted for severe claudication in his right leg, doppler ultrasound and angiography revealed an occluded right common iliac artery. Using the cross-over-approach from the contralateral side, it was possible to navigate a guide wire through the occlusion, and after passage with an excimer laser an ipsilateral retrograde puncture with placement of a sheath was performed. In order to protect the the aortoiliac bifurcation, a primary stent implantation of the occluded side was carried out using the kissing balloon technique. Afterwards three stents were placed. Subsequently the patient completely improved; treadmill exercise test and duplex sonography showed good results. CONCLUSION: Using the kissing balloon technique, laser-assisted recanalisation of iliac artery occlusions even involving the aortoiliac bifurcation compare favorable to other more invasive treatments. A surgical procedure can thus be avoided.