[Hemoglobin drop after thrombolytic therapy in a 57-year-old stroke patient with "erosive gastritis"]. / Hämoglobinabfall nach einer Thrombolysetherapie bei einer 57-jährigen Patientin mit Schlaganfall und "erosiver Gastritis".

A 57-year-old woman underwent esophagogastroduodenoscopy due to a continuous drop in hemoglobin levels reaching 7.4 g/dl after treatment with intravenous thrombolytic therapy 1 week earlier because of an ischemic insult. Numerous erosive lesions were found in the gastric corpus. Histological staining of a specimen from the gastric lesions revealed a poorly differentiated adenocarcinoma. Immunohistochemical examination confirmed the diagnosis of gastric metastasis from lung cancer based on positive staining for thyroid transcriptional factor­1 (TTF-1) and cytokeratin 7 (CK7) as well as via negative staining for caudal-type homeobox­2 (CDX-2). Chest computed tomography demonstrated a mediastinal mass, measuring 3.2 cm and involving the cervical and supraclavicular lymph nodes. A lymph node was subsequently extirpated. Immunohistochemical examination confirmed the diagnosis of lymph node metastasis from lung cancer by positive staining for TTF­1 and CK7. Symptomatic gastric metastasis from lung cancer is an extremely rare clinical entity. Transesophageal echocardiography detected a mass measuring 1.6 cm at the mitral valve with pericardial effusion. On the basis of the echocardiographic findings, a malignant origin was suggested after exclusion of infectious endocarditis. We assumed that the multiple organ infarctions (spleen, kidney, and brain) and gastric hematogenous metastasis must have been caused by disseminated arterial tumor embolism from the intracardiac metastasis. The patient was treated palliatively and died.

[Cystic diseases in urology : Recommendations for patients with systemic mast cell disease]. / Zystische Erkrankungen in der Urologie : Handlungsempfehlungen für Patienten mit systemischer Mastzellerkrankung.

The systemic mast cell disease (MCAD; prevalence 17%) may occur frequently in urological patients. MCAD-induced changes include cysts in all organs, also in the urogenital system. In the presence of MCAD, the surgical removal of such cysts must consider specific features of the MCAD in order to reduce surgical and complication risks. Vice versa, if in urological examinations multiple cysts are found, this could be an indication of a possibly existing, in some circumstances, unrecognized MCAD.

Leakage of Majorana mode into correlated quantum dot nearby its singlet-doublet crossover.

We study quasiparticle spectrum of the correlated quantum dot (QD) deposited on superconducting (SC) substrate which is side-coupled to the Rashba nanochain, hosting Majorana end modes. Ground state of an isolated QD proximitized to SC reservoirs is represented either by the singly occupied site or BCS-type superposition of the empty and doubly occupied configurations. Quantum phase transition between these distinct ground states is spectroscopically manifested by the in-gap Andreev states which cross each other at the Fermi level. This qualitatively affects leakage of the Majorana mode from the side-attached nanowire. We inspect the spin-selective relationship between the trivial Andreev states and the leaking Majorana mode, considering (i) perfectly polarized case, when tunneling of one spin component is completely prohibited, and (ii) another one when both spins are hybridized with the nanowire but with different couplings.

[Surgical interventions in patients with systemic mast cell activation disease : Recommendations for perioperative management]. / Chirurgische Eingriffe bei Patienten mit systemischer Mastzellaktivierungserkrankung : Empfehlungen für das perioperative Management.

BACKGROUND: Systemic mast cell activation disease (MCAD, prevalence 5-10%) is a multifactorial, polygenic disease with multisystemic symptoms that is characterized by an unregulated increased release of mast cell mediators and an accumulation of activated mast cells potentially in all organs and tissues. Due to the high prevalence of the disease, physicians involved in surgical, anesthesiological and interventional procedures are often unknowingly faced with MCAD patients experiencing unexpected preoperative, intraoperative and postoperative complications, if no mast cell-specific treatment regimens have been applied. OBJECTIVE: The findings from a literature search, consensus recommendations of the various international expert groups and extensive own experience in the treatment of MCAD patients enable an empirical and evidence-based care of MCAD patients in association with invasive procedures. RESULTS AND CONCLUSION: Due to the high prevalence of MCAD in the population, it can be assumed that patients with MCAD are correspondingly frequently represented in the surgical patient collective. When MCAD-specific peculiarities are preventively considered in the anesthesiological and surgical procedures in patients with proven or suspected mast cell disease, MCAD patients should not be classified as being at risk.

Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings.

Transesophageal echocardiography (TEE) is accepted as the method of choice for the diagnosis of the patent foramen ovale (PFO). However, direct anatomic confirmation regarding the presence or absence of a PFO on transesophageal imaging has been obtained in only a limited number of patients. Consequently, this study was performed to assess the diagnostic accuracy of contrast and color Doppler TEE for detection of a PFO by comparing the results of TEE with autopsy. The study population comprised 35 consecutive patients (mean age 64 +/- 14 years) who underwent autopsy and prior TEE with examination of the atrial septum. For diagnosis of a PFO, the following criteria were used: (1) no defect in the continuity of the atrial septum on 2-dimensional imaging; (2) > or = 1 bright microbubble appearing in left the atrium within 3 heart cycles after opacification of the right atrium during contrast TEE; and (3) turbulent color jet within the atrial septum by color Doppler TEE. For estimating the PFO size, positive contrast studies were graded semiquantitatively (from 1 to 3), and the maximal color Doppler jet width was measured within the atrium septum at the area of maximal turbulence. At autopsy, a PFO was present in 9 of 35 patients (26%). All were correctly diagnosed by color Doppler TEE. The color Doppler jet width correlated well with the PFO diameter determined at autopsy (r=0.99, SEE=0.51 mm, p<0.0001). By contrast TEE, 8 of the 9 patients with autopsy-proven PFO were correctly identified. In 1 case with left heart disease and a long interatrial channel, a PFO was missed by contrast TEE but clearly demonstrated by color Doppler TEE. All patients with a PFO diameter >10 mm showed intense left atrial opacification of grade 3. With both methods, there were no false-positive results. Sensitivity and specificity for diagnosis of a PFO were 89% and 100% respectively, for contrast TEE, and both 100% for color Doppler TEE. Thus, contrast and color Doppler TEE are complementary and represent a highly sensitive and specific method for diagnosis of a PFO and for estimation of the PFO size.

[A very rare cause of haemoptysis - coexistence of primary oncocytic adenoma of trachea with bronchial carcinoma]. / Eine äußerst seltene Ursache von Hämoptysen. Koexistenz eines primären onkozytären Adenoms der Trachea und eines Adenokarzinoms des linken Oberlappens.

HISTORY AND ADMISSION FINDINGS: A 70-year-old man with a past history of COPD stage GOLD D with home oxygen therapy and tracheotomy due to long-term ventilation (898 hours) 6 years ago was admitted for investigation of haemoptysis during oral anticoagulation. He suffered from peripheral arterial disease (PAD) with bypass and repeated thrombectomy due to recurrent bypass caps, despite effective warfarin therapy. He had all cardiovascular risk factors. INVESTIGATIONS: The suspicion of a bronchial carcinoma was confirmed by CT. Bronchoscopically a 2 cm lesion in the left upper lobe was biopsied. Additionally, bronchoscopy revealed an approximately erythematous, bloody discolored lesion (diameter 7 mm) at a tracheotomy scar. DIAGNOSIS, TREATMENT AND COURSE: The biopsies revealed an adenocarcinoma in the left upper lobe and an oncocytic adenoma of the trachea - an extremely rare adenoma. The staging result was cT1b cN0 cM0 G2 IASLC Ia. Because of his severe multiple diseases the patient was in an inoperable condition. An interdisciplinary tumor conference recommended an individualized approach with a definitive radiotherapy of the adenocarcinoma. Endoscopic control of the macroscopically completely removed oncocytic adenoma of the trachea shall be performed one year later. CONCLUSIONS: Oncocytoma is an extremely rare adenoma (of the trachea), which in this case, has caused haemoptysis in addition to lung cancer during anticoagulation. For tumor genesis a reactive or hyperplasic response after tracheotomy 6 years ago is considered. Resection is the treatment of choice because of the potential for infiltrative growth. But the decision to treat always depends on individual benefit.

[Seminoma necrosis by testicular torsion]. / Seminomnekrose durch Hodentorsion.

The coincidence of a classical scrotal testicular torsion with a scrotal tumor is a rare event. In the case described here the classical histological characteristics of a seminoma were present in addition to clear signs of testicular torsion with fibrin-containing thrombi in the intratesticular capillaries, so that the ischemia time predicted by the pathologists correlated well with the clinical data of 7.5 h for the testicular torsion estimated at the time of the intervention. The intraoperative diagnosis made by the surgeon allowed a rapid response with only a semi-castration, excision of the wound edges and a highest possible amputation of the funiculus.

Quantitative lectin-histochemical and immunohistochemical studies on the occurrence of alpha(2,3)- and alpha(2,6)-linked sialic acid residues in colorectal carcinomas. Relation to clinicopathologic features.

BACKGROUND: Enhanced sialylation has been considered important for the metastatic growth of colorectal carcinomas. Using sequence- and sialic acid-specific lectins and a monoclonal antibody, the tumor-associated expression of alpha(2,3)- and alpha(2,6)-sialylated oligosaccharides was investigated. The study was designed to examine whether a random increase of sialylation or the expression of oligosaccharides carrying distinct sialic acid residues affect the biology of colorectal carcinomas. METHODS: Using computerized image analysis, formalin fixed and paraffin wax embedded specimens from 152 primary colorectal carcinomas were subjected to a quantitative analysis of the occurrence of sialoglycoconjugates detected by the maackia amurensis agglutinin (MAA: specific for alpha(2,3)-linked sialic acid residues), sambucus nigra agglutinin (SNA: specific for alpha(2,6)-linked sialic acid residues), and the monoclonal antibody B72.3 (MAB B72.3: specific for alpha(2,6)-N-acetyl-galactosamine-1-O-Ser/Thre). The data obtained by quantitating lectin/immunohistochemistry were related to morphologic and clinical parameters. RESULTS: Alpha(2,3)-linked sialic acid residues increased from Stage I to Stage II tumors but decreased in advanced carcinomas. Alpha(2,6)-sialylated glycoconjugates did not show any association with local tumor growth (depth of invasion). However, metastatic tumor growth was accompanied by a significant increase of alpha(2,6)-sialylated carbohydrate sequences. Univariate survival analysis revealed that the expression of SNA- and MAB B72.3-defined reactivity displayed an inverse relation to 5-year survival. Although more advanced tumor stage was associated with poor 5-year survival, tumors below the cutoff points for SNA- and MAB B72.3-defined reactivity indicated a better prognosis than the neoplasms above the cutoff points. In contrast, the expression of alpha(2,3)-linked sialic acid residues as detected by MAA had no significant effect on survival. Multivariate regression analysis revealed that SNA-reactivity, followed by tumor stage and the MAB B72.3-defined antigen reactivity were independent prognostic variables predicting overall survival, whereas MAA-reactivity, sex, age, histologic differentiation, and tumor grade had no independent prognostic value. The simultaneous expression of both sialyl-Tn- and SNA-reactivity determined tumors of high risk patients within the different tumor stages. CONCLUSIONS: Sequence-specific sialylation is associated with altered biologic behavior of colorectal carcinomas.