[A rare complication of percutaneous endoscopic gastrostomy: metastasis of adenocarcinoma of the stomach in the area of the gastric stoma]. / Eine seltene Komplikation der perkutanen endoskopischen Gastrostomie: Metastasierung eines Adenokarzinoms des Magens im Bereich des Gastrostoma.

A percutaneous endoscopic gastrostomy (PEG) was placed by the "pull technique" in a 67-year old patient before initiation of palliative radiation therapy of a gastric adenocarcinoma invading the distal esophagus. A tumor metastasis developed in the peristomal area and around the gastrocutaneous fistula tract; it was most likely caused by implantation of tumor tissue adhering to the PEG tube. This complication of PEG placement appears to be very rare.

Postoperative orthopedic autotransfusion. Successful management for the total knee arthroplasty patient.

Orthopedic autotransfusion is an effective technique that should be available to patients having total knee arthroplasty. Patient safety, however, must not be compromised simply because the blood is autologous. Blood products, in any form, require close observation and careful administration. The best results are achieved when the physician and all nursing departments involved have comprehensive knowledge of the system and the guidelines for its safe use.

[Additional treatment with Esberitox N in patients with chemo-radiotherapy treatment of advanced breast cancer]. / Zusatzbehandlung mit Esberitox N bei Patientinnen mit chemo-strahlentherapeutischer Behandlung eines fortgeschrittenen Mammakarzinoms.

A study was made at random on 70 female patients with advanced mamma carcinoma to find out whether an additional treatment with Esberitox N prevents or diminishes the sideeffects of a combined chemo-radiation therapy. As it could not be excluded that the efficacy of Esberitox N on previous affliction by haematotoxic therapy would probably differ, the study was made on various groups of risk. The parameter to form an opinion were either the peripheral hematosis or the appearance of infections. It turned out, however, that Esberitox N proved only effective if there was only a minor damage of the bonemarrow. The efficacy seems to promote the recuperation of the haemapoetic system. There was no significant frequency of infections by the additional Esberitox N treatment, yet in tendency favourably influenced.

Cardiopulmonary effects of betamimetic tocolytic and glucocorticoid therapy in pregnant women.

In 35 present women, undergoing tocolytic treatment with betamimetics had intensive monitoring by balloon-tipped catheter. After the administration of 2-4 micrograms/min of fenoterol the cardiac output (CO) increased from 8.2 l/min to over 11 l/min with a corresponding increase in mean pulmonary artery pressure (MPAP) from 11.7 mmHg to over 18 mmHg. The correlation coefficient between MPAP/CO was highly significant. In the 10 patients in whom we were able to monitor pulmonary capillary pressure (PCP), we observed no significant increase to suggest compromised cardiac performance. The calculated total resistance of the pulmonary vessels (TPR) decreased during the first 24 h followed by a return to initial values. Our investigations suggest that the principal cardiovascular effect of betamimetics in pregnant women is a volume-dependent increase in pressure in the pulmonary circulation. The simultaneous administration of betamethasone had no additional effects.

Exercise capacity before and after cardiac valve surgery.

Exercise stress testing and right-heart catheterization were carried out in 131 patients before and 6 months after cardiac valve surgery. The exercise capacity increased only a little in patients with mitral or double-valve surgery. In contrast, most patients with an aortic valve replacement had good exercise performance after surgery. Corresponding to the reduced exercise capacity most of the patients also had disturbed hemodynamics after surgery, with an elevated mean pulmonary artery pressure at rest, that raised inappropriately during exercise, and a diminished cardiac output at rest, that failed to increase during exercise, in relation to oxygen uptake.

[Diagnostic value of the conventional chest X-ray for the assessment of the hemodynamics after combined aortic and mitral valve replacement]. / Diagnostische Aussagekraft der Nativröntgendiagnostik für die Beurteilung der Hämodynamik nach kombiniertem Aortenmitralklappenersatz.

Conventional roentgenograms of 25 patients who underwent combined aortic and mitral valve replacement were evaluated and correlated with pre- and postoperative functional and haemodynamic parameters. The roentgenograms were obtained 6 months before and up to 25 months after valve replacement. A reduction in heart size could be seen in nearly all patients. This was independent of clinical and haemodynamic results. An increase in heart size always suggests severe haemodynamic worsening, especially a paravalvular leakage. The most valuable x-ray sign is the degree of pulmonary congestion, which is well correlated with the cardiac index.

[What is the exercise capacity of patients with heart infarction after surgery of heart wall aneurysms?]. / Wie belastbar sind Infarktpatienten mit operierten Herzwand- Aneurysmen?

29 patients with a postinfarction left ventricular aneurysm underwent an aneurysmectomy. The majority of patients exhibited a marked symptomatic improvement, a decrease in pulmonary artery pressure and an increase in cardiac index. The exercise capacity however was lower than normal in 80%. Good results were especially seen in patients with involvement of only one major coronary vessel by coronary artery disease and a good contractile function of the residual myocardium not involved by aneurysm.

[Left atrial enlargement in mitral valve disease - a comparison of conventional roentgen signs and methods of roentgenographic measurement (author's transl)]. / Der vergrösserte linke Vorhof bei Mitralvitien - Vergleich nativröntgendiagnostischer Zeichen und Messmethoden.

The different signs of left atrial enlargement on the conventional biplane chest roentgenogram and the methods of measurement are discussed and evaluated in 85 patients with mitral valve disease. The posterior displacement of the barium-filled esophagus is the most sensitive qualitative sign for left atrial enlargement. The sagittal left atrial diameter recording to Westcott and coll. can be easily measured and reproduced. It is recommended for quantitative studies of left atrial size.

[The differential diagnosis of heart failure (author's transl)]. / Die Differentialdiagnose der Herzinsuffizienz.

The causes of heart failure may be classified into three groups, hemodynamic causes, disturbances of cardiac rhythm and conduction and diseases of the myocardium. Accordingly the different causes of heart failure are discussed and the technics for diagnosis reviewed. Particular diagnostic problems are mentioned, which may arise in connection with cardiac echinococcosis, atrial myxoma, sarcoid heart disease and myocardial aneurysm.

[Echocardiographic detection of a left ventricular tumor after myocardial infarction (author's transl)]. / Echokardiographischer Nachweis eines linksventrikulären Tumors nach Vorderwandinfarkt.

A mobile left-ventricular tumor was detected by echocardiography in a 28-years-old patient, who has sustained an anteroseptal infarction four years before. The patient was admitted to hospital because of arterial embolism. The echocardiographic finding was validated by left-ventricular angiography. In open-heart surgery a pedunculated tumor was excided, in microscopic study the tumor revealed the findings of an organized thrombus. The echocardiographic and angiographic findings are shown, the echocardiographic differential diagnosis is pointed out.