[Medically indicated termination of pregnancy in giant uterine myoma and mono-amniotic twin pregnancy: a case report]. / Medizinisch indizierter Schwangerschaftsabbruch bei riesigem Uterus myomatosus und monoamnioter Zwillingsschwangerschaft: eine Fallvorstellung.

We report the rare combination of a monoamniotic twin pregnancy with giant uterine leiomyomas in a 33-year-old para 0, gravida 1. Considering the restricted capacity of uterine expansion during pregnancy and the known complications associated with myomas, as well as the elevated morbidity and mortality of monoamniotic twin pregnancies, we opted for a medically indicated abortion at 12 weeks' gestation. After abortion the patient developed fever and abdominal pain. In differential diagnosis we considered endomyometritis and necrosis of the myomas. Despite adequate conservative treatment the symptoms persisted and myomectomy was performed in view of the patient's desire to maintain fertility.

[Postpartum pelvic vein and vena cava thrombosis after water immersion delivery]. / Postpartale Beckenvenen- und Cavathrombose nach Wassergeburt.

A 26-years old primipara experienced a laparotomy with thrombectomy because of pelvic vein thrombophlebitis and cavathrombosis 18 days after ambulant water-birth. The pelvic vein thrombophlebitis is a potentially life-threatening complication in puerperium and to our knowledge, this is the first case reported after water-birth. Even after ambulant childbirth those rather rare complications are able to appear. To think of such events makes professional help possible in time.

[Childhood masturbation--a genetic viewpoint, especially in anorexia and bulimia nervosa]. / Kindliche Masturbation--ein genetischer Gesichtspunkt, insbesondere bei Anorexia und Bulimia nervosa.

The author examines the functions of child masturbation in the development of narcissim and distinguishes a demarcation function, a compensation function and a function serving to establish autonomy. In Binswanger's view, certain reactions to child masturbation on the part of parents may affect the interactive relationship between the child and the parent representing the primary object in such a way as to thwart or undermine these functions. The result is the appearance of masturbation substitutes in the form of certain symptoms. Binswanger distinguishes "horrified", "liberal", and "eroticized" reactions by parents, relating the first to compulsion neurosis, the second to obesity, and the third to anorexia/bulimia. The author illustrates his hypotheses with copious references to cases from his own practice.

[Bouveret syndrome--a rare gallstone complication]. / Das Bouveret-Syndrom--eine seltene Gallensteinkomplikation.

A 62 year old woman presented with the symptoms of a gastric outlet obstruction together with severe metabolic hypochloremic alcalosis. A gallstone in the duodenum with gastric outlet obstruction was diagnosed by abdominal ultrasonography. In a one-stage surgical procedure, cholecystectomy, enterolithotomy and repair of the cholecytoduodenal fistula were performed. The postoperative course was uneventful. Pathogenesis, clinical findings, diagnostic procedures and therapeutic options of gastric outlet obstruction secondary to a gallstone impacted in the duodenal bulb (Bouveret's Syndrome) are discussed.

[Imaging of abdominal hernias by herniography. Imaging technique, results and tolerance in 67 patients]. / Die Darstellung abdominaler Hernien durch die Herniographie. Untersuchungstechnik, Resultate und Verträglichkeit bei 67 Patienten.

PURPOSE: Role of herniography in patients with unexplained pain and/or clinically doubtful hernia of the abdominal wall, especially after previous operation (for hernia). Patient tolerance and side effects of herniography. MATERIAL AND METHODS: After puncture of the linea alba caudal of the umbilicus water soluble low osmolar contrast medium is injected into the peritoneal cavity. 8 radiographs of the inguinal region are taken. In order to visualize umbilical and cicatricial hernias tangential projections of the anterior abdominal wall are taken in ventral decubitus. In 67 Patients herniography was performed with the following indications: groin pain in 47, groin swelling or anterior abdominal wall swelling in 7, pain in the groin combined with swelling or other indications in 6, other indications in 12. 20 Patients had previously been operated for an inguinal hernia. In order to evaluate possible side effects 57 patients filled out a questionnaire. RESULTS: 66 herniographies were performed successfully. In 31 Patients a total of 51 hernias was found: 18 indirect, 21 direct inguinal hernias, 1 femoral hernia, 4 umbilical hernias, 1 epigastric and 6 incisional hernias. In the group with recurrent hernias, direct inguinal hernias predominated. Subsequently 12 patients were operated. In 11 cases the presence and type of the radiologically diagnosed hernias was confirmed. 1 Patient had a false negative result. No serious side effects were noted. 9 Patients had slight abdominal discomfort during or shortly after the examination. One patient with a persistent open tunica vaginalis testis experienced painless scrotal swelling. CONCLUSION: Hernias of the abdominal wall can be well demonstrated and classified by herniography with little side effects.

[Bursitis iliopectinea--a rare differential diagnosis of painful inguinal swelling]. / Bursitis iliopectinea--eine seltene Differentialdiagnose der schmerzhaften inguinalen Schwellung.

The syndrome of iliopectineal bursitis is an important differential diagnosis of a painful swelling in the inguinal region. Symptoms are local swelling and pain, radiation of pain along the femoral nerve, troubles of arterial or venous circulation and even dysuria or dysmenorrhoea in case the bursa penetrates into the pelvis. The diagnosis is established by conventional radiology (signs of osteoarthritis as one of the pathogenetic reasons), ultrasound (liquid mass lateral to the femoral vessels), punction (clear fluid, eventually synovial cells), contrast injection (dimension of the bursa and communication to the hip joint) and computed tomography (dimension, relation to hip and vessels). The treatment is the excision of the bursa, if conservative therapy is not successful. The excision requires tedious, cautious dissection because of the important structures adjacent and a possible communication to the hip joint must be eradicated.

[Somatostatin-producing endocrine pancreatic tumor in Recklinghausen's neurofibromatosis. Case report and literature review]. / Somatostatin produzierender endokriner Pankreastumor bei Neurofibromatose von Recklinghausen. Fallbericht und Literaturübersicht.

Somatostatin-producing tumors of the pancreas were first described in 1977. In 1983 a syndrome involving multiple endocrine neoplasias (MEN) was named type III A. This syndrome consists of carcinoid of the duodenum, often producing somatostatin, and von Recklinghausen's disease (neurofibromatosis) or pheochromocytoma. The case is reported of a 62-year-old man with familial neurofibromatosis and a tumor of the head of the pancreas spreading into pars II of the duodenum. After Whipple's duodenopancreatectomy the patient exhibited no further symptoms. Immunohistochemistry served to prove the production of somatostatin and small amounts of calcitonin in the tumor.

[Use of ultrasound, ultrasound-directed fine needle puncture and aspiration in amebic abscess of the liver. Case report and short overview]. / Einsatz von Ultraschall, ultraschallgezielter Feinnadelpunktion und -aspiration bei Amöbenabszess der Leber.

Case report on a 48-year-old Swiss male living in Burundi who suddenly fell ill with vomiting and anorexia, followed by pappy stools, weakness and impotence. He presented with hepatomegaly, while sedimentation rate and alkaline phosphatase were both elevated. Stool examination revealed cysts and vegetative forms of Entamoeba histolytica, while amebic serology was negative. Treatment with ornidazole and later with diloxanide furoate was given. Sonography showed two cystoid areas in the right lobe of the liver. In the third sonographically guided fine-needle puncture both lesions were fully aspirated. Amebic serological tests were now positive for the first time. Six weeks later the sonogram showed a normal liver feature. The symptomatology and diagnosis of hepatic amebic abscess are discussed, with special reference to the important role of sonographically guided fine-needle puncture and drainage. Sonographic technique and differential diagnosis are briefly demonstrated.

[Enteroclysis: improved and simplified contract media imaging of the small intestine]. / Die Enteroklyse: verbesserte und vereinfachte Kontrastmitteldarstellung des Dünndarms.

Enteroclysis as a routine procedure is a major advance in the field of radiological small bowed examination. Its most important features are the duodenal infusion of a barium contrast fluid of low specific gravity (less than 1,32), good preparation of the patient and demonstration of all loops in various phases of contraction.

Role of computed tomography in the diagnosis and radiotherapy planning of recurrent rectal carcinoma.

The incidence of local recurrences after surgical treatment forms one of the main problems in the treatment of rectal carcinoma. Computer tomography is of great help in these cases not only for diagnosis, but also in radiotherapy planning procedures. Diagnostic and radiotherapeutic aspects will be discussed.

The bedside determination of extravascular lung water: a non-invasive double indicator technique using 123I-antipyrine, 113mIn-transferrin and external counting.

Using the formulae of Fazio and coworkers, we calculated the extravascular lung water per unit of blood volume (ELW/V) and per unit of blood flow (ELW/F) after intravenous injection of 113In-transferrin as the blood label, and 123I-antipyrine as the diffusible, i.e. water label. Time-activity curves were recorded over the right anterior upper chest wall using a mobile detector. The curves were digitalized and fitted to a gamma-variate using a GAMMA-11 computer. Area over height calculations gave the mean transit times (t). Sixteen control subjects, without evidence of cardiac or pulmonary disease, and 10 patients, with clinical and radiological evidence of left heart failure, were examined. In the control group ELW/V was 0.37 plus or minus 0.17 and ELW/F 3.39 plus or minus 1.56 (mean plus or minus 1 SD). In the patients ELW/V was 0.71 plus or minus 0.26 and ELW/F 13.10 plus or minus 5.67. The difference between both ELW/V and ELW/F for the control group and the patient group is statistically significant. Our values for ELW/V both in patients and control subjects are very similar to those obtained by Fazio and coworkers using H2 15O. However, our values for ELW/F differed from those of Fazio; this could be partly due to dependence of this parameter on the cardiac output.