Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax.

In this prospective study, the value of computed tomography (CT) in detecting bullae and bleb formation of the lung in 35 patients with primary spontaneous pneumothorax (PSP) has been determined. The ability of CT in the detection of bullae and bleb formation and fibrotic changes is compared with the chest film in PSP. CT showed pathological lung changes in 31/35 patients. In most cases, few (n < 5) and small blebs (i.e., < 2 cm in diameter) were found. In 16/35 cases, blebs (< 2 cm) and bullae (> 2 cm in diameter) occurred in the extra-apical region. Contralateral pathological changes were found in 23/35. Bullae (> 2 cm) could be detected only in 6/35. In the chest film, bullae and blebs could be detected in 11/35 cases on the ipsilateral (in 2/35 cases not confirmed by CT), in 3/35 on the bilateral and in 4/35 only on the contralateral side. Thus, CT was proved to be of high value in the assessment of bullae and bleb formation in PSP compared with chest film. Negative pressure drainage was instituted as primary therapy. In a follow-up of 9.6 (+/- 5.7 SD) months, only early recurrences were noticed (n = 35). The rate of recurrences was 6/35 patients. The longer follow-up period (mean 31.7 +/- 6.1 months) could be performed for 32 patients; 3 were lost. Additionally, 2 recurrences occurred. No correlation between recurrences and anatomical status (number, size and distribution of blebs/bullae) as assessed by CT was found. Differential treatment protocols on the basis of the initial findings do not appear to be warranted.

Death due to fulminant toxic-shock syndrome: differential diagnosis of a multilayered clinical picture.

Reported is the case study of a 27-year-old top-performance sportswoman who died of a fulminant illness with multiple organ failure. Long-term polypragmatic therapy and pharmacotherapy as well as acute analgesic and non-steroid antirheumatic treatment due to lumbago led to the diagnosis of a "complex toxic-allergic process". Numerous pathologic-anatomical findings, including the absence of septic spleen reaction and the demonstration of hyperacute polyradiculitis, supported this diagnosis. The present article discusses the possible differential diagnoses of the illness with the conclusion that its symptoms, clinical course, laboratory constellation and pathologic-anatomical findings better correspond to infection-caused toxic-shock syndrome (TSS) than to a toxic-allergic process.

[2 cases of death following cell therapy]. / Zwei Todesfälle nach Zelltherapie.

Fresh-cell therapy is a paramedical procedure whose claimed therapeutic success has not been proven by customary clinical tests (randomized, double-blind trials). In addition, the qualitatively and quantitatively non-standardized parenteral application of heterologous antigens presents considerable danger for the recipient in the form of fatal immune reactions. Two cases are reported in which history, clinical findings and autopsy provided evidence of a causal relationship between cell therapy and death. In one instance, a 75-year-old woman died 30 days after an intramuscular injection of quick-frozen fresh cells from the effects of an immune-complex vasculitis; in the other, a 60-year-old woman died 14 days after "original fresh-cell treatment after Prof. Niehans" from perivenous leucoencephalitis.

[Pseudotumorous liver tuberculosis with multiple organ abscesses. A contribution to the differential diagnosis of liver abscess]. / Pseudotumoröse Lebertuberkulose mit multiplen Organabszessen. Ein Beitrag zur Differentialdiagnose des Leberabszesses.

In a patient hospitalized with the diagnosis "fever of unclear etiology", a large liver abscess with multiple organ abscesses (soft tissues of the throat, spleen) was found. The bacteriological investigation of the liver abscess punctation material and the histological investigation of material from a throat abscess did not lead to a diagnosis. The causative organism was only detected by a specific investigation for M. tuberculosis (bacteriological, ELISA). Apart from one exception, there has been no reference to the possible causation of large liver abscesses by M. tuberculosis in the review literature in this country and abroad. In the case described, the tuberculous liver abscess was caused to regress by pharmacotherapy.

[Postoperative peritonitis. A contribution on diagnosis]. / Die postoperative Peritonitis. Ein Beitrag zur Diagnostik.

Symptoms and signs of 18 patients with postoperative bacterial peritonitis were compared with the findings in uncomplicated postoperative cases. Their diagnostic values were examined: 1. Elevated temperature, hyperventilation, and somnolence are relevant, being indicative of bacterial peritonitis and already occurring before the typical findings on abdominal examination. 2. In those patients with peritonitis, hemodynamics, and metabolism are characterized by hyperdynamic circulation, premature arterial hypotension with dry warm skin, and lactate accumulation. 3. Laboratory data often reveal thrombocytemia, leucocytosis with shift to the left, and a relative and absolute hypophosphatemia.

[Lactic acidosis and biguanid therapy (author's transl)]. / Biguanidtherapie und Lactatacidose

Ten case histories of patients with lactic acidosis and biguanide therapy are presented. 6 patients received phenformin, 4 buformin. The symptomatology was characterized by somnolence or unconsciousness with hyperventilation, renal insufficiency, signs of infection occasionally with detection of gram negative rods and in later stages circulatory insufficiency with high central venous pressure. Glucose, insulin, bicarbonate, dialysis, antibiotics and katecholamines were the therapeutic measurements. It is the proposal of this communication to call attention again to the potential toxicity of biguanids which makes necessary the strict observation of contraindications.

[Hospital care of patients with myocardial infarction in West Berlin (author's transl)]. / Die Versorgung von Patienten mit Myokardinfarkt in West-Berlin

An inquiry with Berlin hospitals on the care of patients with acute myocardial infarction revealed that only 30% were treated on wards guaranteeing optimum supervision and treatment according to their equipment and staff. The inquiry further shows which procedures have gained ground in the treatment of dysrhythmias and heart failure and in the prevention of thrombosis. An improvement of the care is to a lesser extent to be expected from the further development of costly therapeutical specialities but rather from administrative measures ensuring disease-specific admission to appropriate hospitals. This calls for authorities to attend to this task.

[Pressures, blood gases, pH, lactate and pyruvate concentrations in the portal venous blood in patients after laparotomy during the first 9 days (author's transl)]. / Drücke, Blutgase, pH, Lactat und Pyruvat im Pfortaderblut bei bauchoperierten Patienten während der ersten 9 Tage

In 24 patients (16 women, 8 men, mean age 60 years), who underwent abdominal operations and who had a uncomplicated postoperative course, a teflon-tube was inserted into the portal vein at the end of laparotomy and remained there for maximal 9 days. The mean values of the portal venous pressure as well as of the portal-central venous pressure gradient are unchanged during the period of all 9 days and are between 7,4 and 7,9 mmHg, between 5,6 and 6,9 mmHg respectively. The arterio-portal venous 0(2)-content difference shows in the mean no fluctuations and is about 2 Vol.%. On the first postoperative day the lactic and pyruvic acid concentrations in the artery and portal vein are moderately, but significantly elevated and decrease to normal values until day 7. - 9.

Behavior of the portal vein system in man after laparotomy.

At the end of an abdominal operation, a Teflon catheter was inserted into the portal vein, where it remained for nine days. Thus, blood samples could be withdrawn for analyses, and pressures could be recorded. The investigations were carried out in 41 patients who had a gastric or intestinal operation and had an uncomplicated postoperative course. The pressures in the portal vein and the arterioportal oxygen content difference were constant with 7 to 8 millimeters of mercury and by 2 volume per cent, respectively, during the period of all nine postoperative days. The pressure gradient between portal and central veins was about 6 millimeters of mercury. By infusing 350 to 500 milliliters of dextran 60 on day one or two postoperatively, the cardiac output was elevated about one-third, the central venous pressure increased from 0.9 to 4.9 millimeters of mercury and the portal venous pressure increased from 7.8 to 9.7 millimeters of mercury. This means that the pressure difference between the portal and central veins diminished. Simultaneously, the oxygen content difference between the systemic and pulmonary artery decreased from 4.7 to 3.3 volume per cent and between the systemic artery and portal vein, from 1.8 to 1.3 volume per cent. By assuming a constancy of the oxygen consumption in the region of the mesenteric circulation during infusion, it can be calculated from the behavior of the arterioportal oxygen content difference that the flow increase in the portal vein nearly equals that of cardiac output. The physical transhepatic resistance decreased about 50 per cent.