[Scrotal Mass as a Rare Initial Manifestation of Necrotising Pancreatitis]. / Skrotale Raumforderung als seltene Erstmanifestation einer nekrotisierenden Pankreatitis.

A scrotal mass as initial manifestation of necrotising pancreatitis is very rare. In addition, the diagnosis is very difficult because diseases that occur more frequently produce similar symptoms. Therefore, it is very important to think about rare entities in the differential diagnosis for testicular pain.

[Duplication of the stomach as a rare cause of cystic epigastric tumor]. / Die Magenduplikatur als seltene Ursache für einen zystischen Oberbauchtumor.

Duplications of the gastrointestinal tract are congenital anomalies seen in about 0.2% of all children. These include the rare gastric duplications. Latter diagnosis is usually made in the first months after birth on recurrent vomiting by detection of an abdominal tumor. The most important imaging modality is ultrasonography. The case of a prematurely born child weighing 1900 g is presented in whom at the age of three weeks a gastric duplication of the greater curvature was diagnosed and who was successfully treated by resection. The postoperative follow-up for 24 months was uncomplicated.

Congenital myasthenic syndromes in two kinships with end-plate acetylcholine receptor and utrophin deficiency.

We studied two families with five affected members suffering from ptosis and slowly progressive limb-girdle muscle weakness. All patients had abnormal decremental response on low-frequency nerve stimulation, but there were no repetitive responses to single stimuli. The patients improved on anti-acetylcholinesterase drugs. Intercostal muscle was obtained for special studies from one patient of each family. In vitro microelectrode studies were done in Patient 1. Miniature end-plate potentials were of low amplitude, and the quantal content of the evoked end-plate potentials was normal. Light microscopy revealed a marked type 1 fiber predominance. Acetylcholinesterase reactivity was dispersed over increased length of individual fibers in Patient 2. On morphometry of the end-plate ultrastructure, the number of secondary synaptic clefts per neuromuscular junction and the expansion of the postsynaptic area were markedly reduced. In Patient 1, but not in Patient 2, the envelopment of the nerve terminal by Schwann cell was increased. Acetylcholine-receptor (AChR) density was reduced as judged by the reduced immunoreactivity to antibodies against different receptor subunits. Immunohistochemical analysis of proteins known to be involved in orchestrating the end-plate structure showed deficiency of the AChR-associated protein utrophin. These patients appear to have a defect in the development or maintenance of the postsynaptic clefts; whether this defect results from or causes a reduced expression of utrophin or AChR is unclear.

Presynaptic imidazoline receptors and non-adrenoceptor [3H]-idazoxan binding sites in human cardiovascular tissues.

1 In segments of human right atrial appendages and pulmonary arteries preincubated with [3H]-noradrenaline and superfused with physiological salt solution containing desipramine and corticosterone, the involvement of imidazoline receptors in the modulation of [3H]-noradrenaline release was investigated. 2 In human atrial appendages, the guanidines aganodine and DTG (1,3-di(2-tolyl)guanidine) which activate presynaptic imidazoline receptors, inhibited electrically-evoked [3H]-noradrenaline release. The inhibition was not affected by blockade of alpha 2-adrenoceptors with 1 microM rauwolscine, but antagonized by extremely high concentrations of this drug (10 and/or 30 microM; apparent pA2 against aganodine and DTG: 5.55 and 5.21, respectively). 3 In the presence of 1 microM rauwolscine, [3H]-noradrenaline release in human atrial appendages was also inhibited by the imidazolines idazoxan and cirazoline, but not by agmatine and noradrenaline. The inhibitory effects of 100 microM idazoxan and 30 microM cirazoline were abolished by 30 microM rauwolscine. 4 In the atrial appendages, the rank order of potency of all guidelines and imidazolines for their inhibitory effect on electrically-evoked [3H]-noradrenaline release in the presence of 1 microM rauwolscine was: aganodine > or = BDF 6143 [4-chloro-2-(2-imidazolin-2-yl-amino)-isoindoline] > DTG > or = clonidine > cirazoline > idazoxan (BDF 6143 and clonidine were previously studied under identical conditions). This potency order corresponded to that previously determined at the presynaptic imidazoline receptors in the rabbit aorta. 5 When, in the experiments in the human pulmonary artery, rauwolscine was absent from the superfusion fluid, the concentration-response curve for BDF 6143 (a mixed alpha 2-adrenoceptor antagonist/imidazoline receptor agonist) for its facilitatory effect on electrically-evoked [3H]-noradrenaline release was bell-shaped. In the presence of 1 microM rauwolscine, BDF 6143 and cirazoline concentration-dependently inhibited the evoked [3H]-noradrenaline release. 6 In human atrial appendages, non-adrenoceptor [3H]-idazoxan binding sites were identified and characterized. The binding of [3H]-idazoxan was specific, reversible, saturable and of high affinity (KD: 25.4 nM). The specific binding of [3H]-idazoxan (defined by cirazoline 0.1 mM) to membranes of human atrial appendages was concentration-dependently inhibited by several imidazolines and guanidines, but not by rauwolscine and agmatine. In most cases, the competition curves were best fitted to a two-site model. 7 The rank order of affinity for the high affinity site (in a few cases for the only detectable site; cirazoline = idazoxan > BDF 6143>DTG> or = clonidine) is compatible with the pharmacological properties of I2-imidazoline binding sites, but is clearly different from the rank order of potency for inhibiting evoked noradrenaline release from sympathetic nerves in the same tissue. 8 It is concluded that noradrenaline release in the human atrium and, less well established, in the pulmonary artery is inhibited via presynaptic imidazoline receptors. These presynaptic imidazoline receptors appear to be related to those previously characterized in rabbit aorta and pulmonary artery, but differ clearly from I1 and I2 imidazoline binding sites.

[Interventional therapy of nonocclusive mesenteric ischemia with captopril: an experimental animal study]. / Interventionelle Therapie der nonokklusiven mesenterialen Ischämie mit Captopril--Eine tierexperimentelle Untersuchung.

PURPOSE: To clarify whether in nonocclusive mesenterial disease the extent of damage to the intestinal wall can be limited by local intraarterial application of Captopril. METHOD: Producing shock by means of pericardial tamponade in 18 piglets. Examination of three groups: Intraarterial application of Captopril at the beginning of the shock phase (n = 6) or administration one hour after the beginning of the shock phase (n = 6), as well as a control group (n = 6). Analysis of clinical pathology (laboratory chemistry) and haemodynamic parameters over a test period of 4 hours and histological preparation of resected segments of the small intestine. RESULTS: The initiation of therapy at the beginning of the shock improved the blood supply of the intestinal wall (measured by means of laser sonography in relative flow units RFU) from 226 RFU to 303 RFU; the rise in lactate from 2.7 to 3.6 mmol/l was significantly less (p = 0.05) than for the control group (from 3.1 to 11.5 mmol/l). The frequency and severity of the histological changes that are typical for ischaemia were less pronounced. If therapy was started only after a one-hour shock phase, this effect was no longer noticeable (rise in lactate from 5 to 9.5 mmol/l, intestinal wall blood flow from 168 to 170 RFU). CONCLUSION: Intraarterial administration of Captopril can reduce the extent of damage in nonocclusive mesenterial ischaemia (nonocclusive disease) if therapy is initiated early enough.

[Self-expanding nitinol stent--use in esophageal carcinoma]. / Der selbstexpandierende Nitinol-Stent--Anwendung beim Oesophaguscarcinom.

In recent years the implantation of self-expanding metal-stents has been recommended as a palliative kind of therapy for dysphagia caused by esophageal carcinoma. The metal-stent has a high flexibility, so that it can fit according to the preformed angel of the esophagocardial transition and does not cause a feeling of pressure when placed in the cervical position. From July 1992 to February 1995 in the surgical department of the University of Bonn 21 patients have got a self-expanding Nitinol stent. No dislocation, bleeding or perforation occurred. The dysphagia improved in all patients. The lethality rate was 9.5%, the mean survival rate 4,6 month. The growth of the tumor through the mesh of the stent was a problem which occurred from the tenth week onwards after implantation. Even when the self-expanding metal-stent does not solve all problems, it enlarges the spectrum of palliative kinds of therapy.

[Significance of therapy timing for the effects of systemic and local therapy with the ACE inhibitor captopril on intestinal microcirculation in manifest mesenteric ischemia. An animal experiment study in the swine]. / Die Bedeutung des Therapiezeitpunktes für die Auswirkungen der systemischen und lokalen Therapie mit dem ACE-Hemmer Captopril auf die intestinale Mikrozirkulation bei bestehender mesenterialer Ischämie. Eine tierexperimentelle Studie am Schwein.

We present the results of a study based on an animal model concurring whether captopril can improve microcirculation in the small intestine in nonocclusive mesenteric ischemia dependent on when therapy is begun. Cardiogenic shock was produced by pericardial tamponade with starch solution. The flow in the carotid artery could be reduced to 43% of the preshock value. In four therapy groups and a control group the intestinal microcirculation was examined by laser Doppler flowmetry in the serosa and mucosa. The measurements were taken at regular intervals during the 4 h of the experiments. Captopril was either given systemically or locoregionally through the upper mesenteric artery. Therapy was given at the beginning of the shock or 1 h after induction of shock at a dosage of 0.25 mg/kg body weight as a bolus and continuous application of 10 micrograms/kg body wt. Concerning the hemodynamic changes during shock the group receiving captopril systemically at the beginning of shock showed a significant (P = 0.05) improvement in microcirculation compared to the controls and other therapy groups. Flow reduction was seen in the controls (156-32 relative flow units = RFU) in group Ia (systemic therapy 1 h after shock), as well as the controls (129 to 12 RFU) and, in group Ib (systemic therapy beginning with shock) a flow rise could be seen (307 to 481 RFU). In group IIa (local therapy 1 h after shock) (a steady flow was seen (168-170 RFU) and in group IIb (local therapy beginning with shock) and group Ib an increase in flow was also measured (226-303 RFU). This positive effect of captopril on the intestinal perfusion was observed when applied 1 h after the induction of shock.

[How urgent is an operation in enterothorax?]. / Wie dringlich ist die Operation beim Enterothorax?

The emergency treatment of the enterothorax is problematic due to weak lung functions and unstable hemodynamics, and because it does not influence the stage of maturity of the lungs. By delayed operation children with a critical starting position have a greater chance to survive, after their condition has been stabilised by intensive care treatment. During the stabilising period we managed to decrease the FiO2 level below 50% and to decrease the pCO2 level to 43 +/- 13 mm Hg in our patients (n = 10). Furthermore we succeeded to raise the O2 degree of saturation from 72 +/- 13 to 89 +/- 9%. The pH level went up from 7,238 +/- 0,181 to 7,394 +/- 0,060. If the condition of the patients worsens during the stabilising period--in our patients the stabilising period was between 12 and 24 hours--immediate operation is indicated. We have no experience so far in using ECMO in such situations.

Modulation of noradrenaline release from the sympathetic nerves of the human saphenous vein and pulmonary artery by presynaptic EP3- and DP-receptors.

1. Spirally cut strips of the human saphenous vein and pulmonary artery were used to determine the pharmacological properties of the presynaptic prostanoid receptors involved in the modulation of sympathetic [3H]-noradrenaline release. Strips preincubated with [3H]-noradenaline were superfused with physiological salt solution containing inhibitors of uptake1 and uptake2 and rauwolscine to eliminate involvement of presynaptic alpha 2-adrenoceptors. Tritium overflow was evoked by transmural electrical stimulation (standard frequency: 2 Hz). 2. In the saphenous vein, prostaglandin E2 (PGE2) inhibited the electrically-evoked tritium overflow; at the highest concentration investigated, tritium overflow was inhibited by more than 75% and the pEC50 value was 7.00. These effects were mimicked by prostaglandin E1, the EP1/EP3 receptor agonist, sulprostone and the EP2/EP3 receptor agonist, misoprostol with the rank order (pEC50): sulprostone (8.60) > PGE1 (7.25) > misoprostol (6.96). This rank order of potency suggests that the inhibitory effect of the drugs is mediated by presynaptic EP3-receptors. In contrast, PGF2 alpha did not inhibit evoked tritium overflow; the IP/EP1 receptor agonist iloprost and the stable thromboxane A2 analogue U 46619 (9, 11-dideoxy-11 alpha,9 alpha-epoxy-methanoprostaglandin F2 alpha) produced inhibition only at concentrations above 1 microM. 3. The EP1-receptor antagonist, AH 6809 (6-isopropoxy-9-oxoxanthene-2-carboxylic acid) had no effect on the evoked tritium overflow nor did it modify the inhibitory effect of PGE2, further excluding involvement of inhibitory presynaptic EP1-receptors. 4. PGD2 caused a facilitation of evoked tritium overflow in the saphenous vein; this facilitation is probably mediated by presynaptic DP-receptors, since it was abolished by the selective DP-receptor antagonist, BW A868C (3-benzyl-5-(6-carboxyhexyl)-1-(2-cyclohexyl-2-hydroxyethylamino)hydantoin).5. In the pulmonary artery, sulprostone (pECm value 8.35), misoprostol (7.70) and PGE2 (6.80)inhibited electrically-evoked tritium overflow. This rank order of potency is consistent with the involvement of inhibitory presynaptic EP3-receptors.6. These results suggest that the sympathetic nerve fibres of both human saphenous vein and pulmonary artery are endowed with presynaptic inhibitory EP3 receptors. The EP3-receptors do not interact with the alpha 2-autoreceptors. In addition, the human saphenous vein seems to be endowed with presynaptic facilitatory DP-receptors.

[Superselective intra-arterial chemotherapy in breast cancer]. / Superselektive intraarterielle Chemotherapie bei Mammakarzinomen.

Forty-two patients with locally advanced breast cancer (n = 8) or recurrent breast cancer (n = 34) received regional chemotherapy (mitoxantrone 25 mg/m2 per 24 h) via the internal mammary artery or other vessels of the subclavian artery. To prevent artery thrombosis 500-1000 U heparin per hour were administered i.v. Tumour perfusion was monitored by intra-arterial angio-CT. Remission rates (CR + PR) were 100% (primary breast cancer) and 89% (recurrent tumours), respectively. Intra-arterial chemotherapy was well tolerated. No complications were noted.

[Acute upper gastrointestinal hemorrhage caused by ruptured aneurysm of the right gastroepiploic artery]. / Akute obere gastrointestinale Blutung aufgrund eines rupturierten Aneurysmas der A. gastroepiploica dextra.

Visceral aneurysms are very rare (0.1% in autopsy-statistics). In our own review of literature we have found only 9 described cases of an aneurysm of the gastroepiploic artery. In the presented case an aneurysm was found when the patient developed an acute upper gastrointestinal bleeding. Due to the high risk of rupture (20% of all visceral aneurysms), which can be either intraperitoneally, intraluminally or into the satellite vein, the treatment should be surgically on finding.

[Qualitative and quantitative NMR tomographic findings in focal nodular hyperplasia of the liver]. / Qualitative und quantitative kernspintomographische Befunde der fokal nodulären Hyperplasie der Leber.

The qualitative and quantitative MRI findings in 16 patients with focal nodular hyperplasia (FNH) of the liver are described; nine of these were confirmed histologically. A central scar is typical of FNH and provides a reliable diagnosis. This finding was seen in half the cases. If the scar is not demonstrable, the following features suggest the diagnosis: smooth margins, homogeneous signal distribution, increased signal intensity in T2-weighted spin-echo images and reduced signal intensity in inversion-recovery sequences. The T1 and T2 relaxation times in FNH are increased by about 30% compared with normal liver tissue.

[The esophageal cyst--a rare congenital abnormality]. / Die Osophaguszyste--Eine seltene kongenitale Anomalie.

Esophageal cysts are among the embryonic malformations of the gastrointestinal tract. They develop from persisting diverticulum-like evaginations of the embryonic esophagus. The esophageal cyst is usually asymptomatic and is frequently diagnosed as an incidental finding. Since, however, a clear differentiation from malignancies is not possible with conventional diagnostic procedures. Surgical treatment is advisable in these cases.

[Measuring device for rapid determination of tube peak voltage and the switch-on time of roentgen equipment]. / Ein Messgerät zur schnellen Bestimmung des Scheitelwertes der Röhrenspannung und der Einschaltzeit von Röntgeneinrichtungen.

A prototype of a measuring device is described, which reads the tube peak voltage and the switch-on time of x-ray units by means of two radiation detectors with different energy dependences due to detector materials (Caesium Iodine and Silicon). With a storage oscilloscope the curves of the tube voltage and the relative absorbed dose rate of intensifying screens can be displayed. The measuring range of the tube peak voltage is 60 kV to 150 kV. It is possible to measure exposure times of radiography equipment above 2 ms wit sufficiently low uncertainty. The tube peak voltage has been read with a relative uncertainty below 5% for almost all dose rates, which arise in practical application of medical x-ray units, and its calibration is made by means of x-ray apparatus with tube voltage reading, which has been compared to a Ge(Li) spectrometer. The stability of tube voltage reading of the measuring device is only effected by radiation damage of the detectors after a long time of utilization. The small diameter of the probe permits the accommodation of other probes, ionization chambers, phantoms, etc. in the radiation field at the same time.