Videoendoscopic removal of a mediastinal cyst.

A 41-year-old woman was admitted to the hospital for obstetric surgery. A preoperative chest x-ray film showed a mediastinal mass. After examinations with echocardiography, computed tomography, and magnetic resonance imaging, we removed a cyst that was 2.7 x 3.5 cm in size by thoracoscopic means. The patient left the hospital 3 days after the operation.

Portal hypertension due to traumatic hepatic arterioportal fistula: report of successful embolization.

We report a case of severe portal hypertension due to a post-traumatic hepatic arterioportal fistula. A 77-year-old male patient was admitted for abdominal pain, inappetence and weight loss. Further clinical signs were ascites and splenomegaly. Sonography showed a marked enlargement of an arterioportal fistula, which was diagnosed some years before as a consequence of abdominal trauma during the Second World War. Angiography demonstrated an imposing dilatation of the right hepatic artery filling an intrahepatic pseudoaneurysmatic cavity with fistula formation to the portal vein. By means of selective hepatic artery embolization, complete occlusion of the right hepatic artery and the arterioportal fistula was achieved. Within 4 weeks the patient recovered and sonography showed disappearance of ascites and splenomegaly.

[Magnetic resonance tomographic studies of pancreatic transplants]. / Kernspintomographische Untersuchungen von Pankreastransplantaten.

In a pilot study, a total of 16 recipients of a combined pancreatic-renal allograft were examined by means of magnetic resonance imaging. Two groups were formed according to the management of the exocrine secretion: In group I patients (n = 8) the pancreatic duct was occluded with an alcoholic prolamine solution, in group II (n = 8) pancreatic juice was diverted either into a Roux-loop of jejunum (IIa, n = 4) or into the urinary bladder (group IIb, n = 4). On the T1-weighted images no difference was found between both groups with respect to signal intensity. In contrast, on T2-weighted images of group IIb, which were in situ for a significantly shorter time, a higher signal intensity was noticed as compared with the other patients. From these findings it is concluded that graft fibrosis may occur even in pancreas transplants with diversion of the exocrine secretion.

[Sirolimus-eluting stents for the treatment of symptomatic extracranial vertebral artery stenoses: early experience and 6-month follow-up]. / Die Behandlung symptomatischer extrakranieller Stenosen der Arteria vertebralis mit sirolimusbeschichteten Stents: erste Erfahrungen und Ergebnisse nach 6 Monaten.

PURPOSE: To evaluate the clinical and morphological effectiveness of sirolimus-eluting stents in patients with stenoses in the extracranial vertebral artery and to assess the 6-month results. MATERIALS AND METHODS: Sirolimus-eluting stents were implanted in 8 stenoses of the extracranial vertebral artery in 7 patients with symptoms of vertebrobasilar insufficiency. Seven stenoses were located at the ostium, and one further cranially in segment V 1. The mean grade diameter of the stenoses was 85.1 % (60.9 % - 98.3 %). Clinical and angiographic follow-up was performed over a period of 6 months in all patients. RESULTS: All lesions were successfully stented with a residual stenosis of 20.2 % (0.0 - 38.5 %). Clinically, all patients showed resolution or improvement of the symptoms after stenting. After 6 months, 5 of the 8 stenoses developed intimal hyperplasia with a stenosis grade > 50 %. The mean measured grade of stenosis after 6 months was 56.2 % (0.0 - 94.1 %). Five patients had no clinical symptoms of a vertebrobasilar insufficiency while two had recurrent symptoms. CONCLUSION: Sirolimus-eluting stents in the extracranial vertebral artery have a high and unsatisfactory re-stenosis rate after 6 months.

[Gastrointestinal hemorrhage after operation for dissecting aneurysm of the thoracic aorta]. / Gastrointestinale Blutung nach Operation eines Aneurysma dissecans der Aorta thoracica.

We present the case of a 45-year-old man who underwent surgical repair of a dissecting aneurysm of the descending thoracic aorta. 25 days postoperatively, the patient unexpectedly developed hematemesis and hypovolemic shock. Emergency gastroscopy was performed and a suspected aortoesophageal fistula was diagnosed. Unfortunately, the patient died prior to emergency surgery. Aneurysms of the aorta or of aortic grafts occasionally lead to the development of fistulae to the upper gastrointestinal tract. Once this rare, but life-threatening complication is suspected, endoscopy must be performed immediately. Emergency surgery is associated with a high risk, but represents the only possibly chance of survival for the patient.

[Aneurysm of the cystic artery as a rare cause of hemobilia]. / Aneurysma der Arteria cystica als seltene Ursache einer Hämobilie.

A 52-year old woman was admitted to the hospital because of upper abdominal pain and hematemesis. Laboratory parameters showed marked cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP) lead to the diagnosis of hemobilia. CT-scan and angiography revealed an aneurysm of the cystic artery as the cause of hemobilia. Cholecystectomy was performed because of concomitant cholecystitis. Anatomical examination confirmed clinical diagnosis.

Local transrectal enzymatic treatment for chronic nonbacterial prostatitis and prostatodynia: initial clinical experience.

We report our initial clinical experience with local transrectal application of enzymatic treatment for chronic nonbacterial prostatitis and prostatodynia in 20 patients. Using a specially designed symptom score for evaluation of subjective treatment parameters, a statistically significant improvement of symptoms was found in the areas of pain, micturition, and recreational activities. No statistically significant differences were noted in laboratory values before and after treatment. Minimal local side effects were seen in only one patient. A favorable clinical response was noted in 75% of patients, whereas the remaining 25% showed only moderate improvement of symptoms. No patient experienced complete treatment failure.

Magnetic resonance urography in the evaluation of acute flank pain.

We report our clinical experience with magnetic resonance urography in 13 patients. This noninvasive relatively new application of magnetic resonance to initial radiologic evaluation of patients with acute flank pain offers valuable diagnostic information and may provide additional support in defining the need for possible further therapeutic intervention in selected cases.

[Duplex sonography in carotid-cavernous sinus fistula]. / Duplexsonographie bei Karotis-Sinus-cavernosus-Fistel.

The absence of valves in the ophthalmic veins leads to a reversal of flow and marked vascular dilatation if there is a carotid-cavernous sinus fistula. Based on a case report, the possibility of accurate duplex sonographic evaluation of these findings is shown. Duplex sonography should be employed as a simple, non-invasive and inexpensive diagnostic method even if the likelihood of a carotid-cavernosus sinus fistula is remote.

Lumbar myelography with three-dimensional MR imaging.

A strongly T2*-weighted, three-dimensional (3D) PSIF (time-reversed FISP [fast imaging with steady-state precession]) gradient-echo magnetic resonance (MR) sequence, with postprocessing of the 3D data set with a maximum-intensity projection (MIP) algorithm, produced x-ray myelography-equivalent images. The method was tested in 10 healthy volunteers to optimize sequence parameters and was evaluated in 30 patients with proven lumbar disk disease. MIP myelograms, unlike two-dimensional MR images, could not show the pathologic disks themselves but clearly demonstrated the effect on the thecal sac, giving a clear overall view of its geometry and dimensions, especially when displayed in a cine loop. All 28 medial and mediolateral disk herniations could be visualized, whereas only three of eight intraforminal disk herniations were seen on MR myelograms.

Transrectal puncture and drainage of seminal vesicle abscess.

Seminal vesical abscesses are extremely rare. We report a case in which successful treatment was achieved using a minimally invasive transrectal approach.

[Stent implantation in solitary aneurysm of the common iliac artery]. / Stent-Implantation bei solitärem Aneurysma der Arteria iliaca communis.

A 56-year-old man had intermittent claudication in the right leg for 11 months, gradually worsening of late. Digital subtraction angiography demonstrated an aneurysm, 8 x 2.5 cm, of the right common iliac artery and 70% stenosis of the right external iliac artery. As the patient refused full surgical intervention the aneurysm was treated by the insertion of two exactly adjoining wall stents (diameter 9 mm, length 7 cm), and the arterial stenosis was balloon-dilated. One month after stent implantation the aneurysm had thrombosed outside of the stent and the stent lumen was being perfused normally. 6 months later the local findings were identically. The patient remained symptom-free. --The case illustrates that management of circumscribed aneurysms by stent implantation could well be an alternative to surgical treatment, as long as the stent can prevent enlargement and rupture of the aneurysm.

[Thrombosis of the upper thoracic inflow vessel. Spiral CT and 3-D reconstruction]. / Thrombose der oberen thorakalen Einstrombahn. Spiral-CT and 3-D-Rekonstruktion.

Spiral-CT-Depiction and 3D-Reconstruction: A patient complaining of upper thoracic inlet syndrome after thyroidectomy underwent contrast-enhanced spiral-CT. Coronal reconstructions and three-dimensional reconstructions were used to generate phlebographic images of the thoracic inlet veins thrombosis. The diagnosis of thrombosis was confirmed by phlebography.

[Improved imaging of mandibular cysts using dental-CT]. / Verbesserung der Darstellung von Unterkieferzysten mittels Dental-CT.

The purpose of this study was to evaluate orthopantomography and a newly developed CT software package (Dental-CT) in the preoperative assessment of mandibular cysts. In this study 16 cysts in 13 patients were examined radiographically by orthopantomography and dental-CT to reformat the axial scans into truly cross-sectional views perpendicular to the anatomical axis of the jaw. The obtained images were compared for visualisation of the alveolar canal, the mandibular anatomy and the cortical involvement. Dental-CT proved superior for establishing a correct radiographic diagnosis and was rated significantly (p < 0.001) higher with regard to examined points. Dental-CT has to be considered the method of choice in the preoperative evaluation of mandibular cysts providing detailed anatomical information needed for the further management. Radiation exposure remains within an acceptable range.

Videoendoscopic procedures in thoracic surgery: technical aspects and report of removal of a mediastinal cyst.

Current videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favorable results. Application of this technology to our practice of thoracic surgery is the basis of this report. Video-assisted thoracic surgery was performed in 36 patients for the following indications: Raynaud's syndrome, undefined pulmonary nodule, persisting spontaneous pneumothorax, T1 bronchial carcinoma, and mediastinal cyst. Videoendoscopic surgical procedures were accomplished using double-lumen endotracheal anaesthesia and a percutaneous stapling device. Procedures performed using this technique include thoracic sympathectomy, wedge or keel excision, blebectomy, lung apex stapling, parietal pleurectomy, and dissection of the mediastinal cyst. Median operating time was 45 min (range, 15 to 90 min). Tissue diagnosis was obtained in all patients. Median diameter of excised nodules was 10 mm (range, 7 to 70 mm). There were no operative deaths. The single complication was a prolonged air leak. This new method of thoracic surgery appears to benefit the patients. For us it proved a secure way to perform thoracic surgery. Our case of removal of a benign cyst in the posterior mediastinum shows that video-assisted thoracic surgery has expanding applications in the field of general thoracic surgery.