[Huge retrovesical tumor as an incidental finding: desmoid-type fibromatosis: a case report]. / Monströse retrovesikale Raumforderung als Zufallsbefund : Desmoidfibromatose: ein Fallbericht.

We report the case of a 57-year-old patient with a huge, retrovesical, aggressive desmoid fibromatosis detected incidentally during preoperative staging for radical prostatectomy. The tumor was locally invasive consisting of monoclonal and fibroblastic proliferations. The etiology of such tumors is not well known but they are mostly sporadic and aggressive fibromatosis is sometimes associated with familial adenomatous polyposis (FAP) or Gardner's syndrome. Such desmoid tumors are slow growing and locally invasive but lack metastatic potential. Complete resection with wide margins is the therapy of choice and the tendency to recur is high. Radiotherapy following surgery is controversial. We discuss the pathogenesis, clinical manifestations and therapy of such rare tumors.

Uptake of provider-initiated counselling and testing among tuberculosis suspects, Ethiopia.

SETTING: Twenty-seven health centres in Addis Ababa, Ethiopia. OBJECTIVE: To assess the uptake of human immunodeficiency virus (HIV) testing among tuberculosis (TB) suspects in Addis Ababa, and to determine reasons for non-acceptance of the test. DESIGN: From February to March 2009, new TB suspects identified in 27 health centres in Addis Ababa were offered HIV testing. Patients were interviewed by trained nurses using a pretested questionnaire. RESULT: Of the 506 TB suspects, 59% were tested for HIV and accepted the test result. Individuals with knowledge about HIV counselling and testing procedures were 2.5 times more likely to be tested than individuals with poor knowledge. TB suspects who had previously been tested for HIV were twice as likely to accept HIV testing and to receive the result of the test (OR = 2.0, 95%CI 1.4-2.9). Government employees (OR = 2.8, 95%CI 1.2-6.3) and merchants (OR = 2.7, 95%CI 1.2-5.7) were more likely to be tested for HIV as compared to jobless individuals. CONCLUSION: The TB control programme in Ethiopia should increase its educational efforts among all TB suspects, but especially among jobless individuals, to increase the uptake of HIV testing.

Management of combined hepatocellular and cholangiocarcinoma.

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy composed of cells with histopathological features of both cholangiocarcinoma (CC) and hepatocellular carcinoma (HCC). It reportedly accounts for 0.4-14.2% of all primary liver carcinomas, with incidence varying in different regions. The clinical features are similar to those of either HCC or CC. Preoperative noninvasive diagnosis of cHCC-CC with conventional radiography is difficult. Because the origin of cHCC-CC is from two different tumour entities, despite intensive preoperative imaging studies, most studied patients were misdiagnosed either as HCC or CC. Accurate preoperative diagnosis is important because the most appropriate treatment depends on the major component of the tumour (HCC or CC). A high index of suspicion, imaging studies (ultrasound, computed tomography, positron emission tomography), levels of serum tumour markers (alpha-fetoprotein, carbohydrate antigen 19-9), and histology assist case detection and treatment choice. Patients who qualify for surgery should have a partial hepatectomy with hilar lymph node dissection, which can result in 5-year survival rates exceeding 50%. The role of liver transplantation is not yet known.

[65-year old female patient with persistent hypercalcemia]. / 65-jährige Patientin mit persistierender Hyperkalzämie.

A 65-year old patient presented with newly diagnosed hypercalcemia and elevated parathyroid hormone levels. Exploration of parathyroid glands was performed under the diagnosis of primary hyperparathyroidism and was combined with thyreoidectomy due to concomittant multinodular goiter. However, no parathyroid adenoma was identified despite careful exploration. Therefore, the operation was terminated and an ectopic adenoma was suspected. A (99m)Tc-sestamibi scintigraphy with SPECT, neck ultrasound, neck CT scan with contrast media and selective venous sampling were performed for further localization of the adenoma. A single adenoma localized in the submandibular area of the left jaw was suspected and confirmed during surgical reexploration. Postoperatively, parathyroid hormone levels were below detection level and the patient required short-term calcium supplementation for symptomatic hypocalcemia.

The effect of providing feed supplementation and anthelmintic to donkeys during late pregnancy and lactation on live weight and survival of dams and their foals in central Ethiopia.

Anthelmintic treatment (A), feed supplementation (F), anthelmintic and feed supplementation (A+F) or traditional management (Control) was given to 166 pregnant female donkeys in three localities (Holetta, Debre Zeit and Adami Tulu) in Ethiopia during an on-farm study. Treatments started during the last trimester of pregnancy and continued until 6 months after parturition when the foals were weaned. The same treatments were administered to foals once they reached 1 month of age. Live weights of adults and foals were measured throughout the study along with work output of adult donkeys and survival to weaning of the foals. Faecal worm egg counts (FEC) and blood packed cell volumes (PCV) were recorded monthly. When applied alone, anthelmintic treatment (A) or feed supplementation (F) had no significant effect on live weight gain or foal survival. However, when combined, anthelmintic and feed supplementation (A+F) significantly (p<0.05) improved both live weight gain in adults and foals and foal survival. Workout was not affected by any of the treatments. Treatments A and A+F resulted in a highly significant (p<0.001) reduction in FEC in all three localities during the course of study and for at least 6 months after the last dose of anthelmintic in one of the study areas (Holetta). None of the treatments had any significant effect on PCV. Donkey owners in Ethiopia should be encouraged to adopt both anthelmintic treatment and feed supplementation if they expect tangible benefits in animal performance.

Alpha1-and beta2-adrenoceptors in the human liver with mass-forming intrahepatic cholangiocarcinoma: density and coupling to adenylate cyclase and phospholipase C.

Besides the regulation of hepatic metabolic pathways in which adrenoceptors are mainly involved, their effect on the second messenger cAMP is thought to be related to the growth and differentiation of neoplastic cells. However, few studies have been done on the status of these structures in the human liver affected by cholangiocarcinoma (CC). Thus, in this study, changes in densities of alpha1- and beta2-adrenoceptors (alpha1-and beta2-ARs) were investigated in membranes of human liver with cholangiocarcinoma, and for comparison, in membranes of non-adjacent non-tumour liver using the potent antagonists [3H]-prazosin and [1I]-iodocyanopindolol (ICYP) respectively. In addition, the activity of membrane-bound phospholipase C (PLC) and adenylate cyclase (AC) was also studied. In CC liver, the density of alpha1-and beta2-ARs was significantly reduced, compared with non-tumour liver tissues (alpha1-ARs: 23.38+/-4.69 vs 80.35+/-10.52, P=0.0002 beta2-ARs: 14.27+/-2.93 vs 33.22+/-4.32 fmol/mg protein, P=0.03), whereas the ligand affinities (KD) remained unchanged. The beta2-selective antagonist ICI 118,551 was about 100 times more potent in inhibiting ICYP binding than the beta1-selective antagonist CGP 20712A; thus, more than 98% of the beta-ARs were of the beta2-subtypes. The AC activity upon stimulants acting on beta-AR (isoprenaline), G-protein (GTP, NaF) and AC (forskolin) was decreased in CC liver. Similarly, noradrenaline-stimulated PLC activity was significantly reduced in tumour tissues. In conclusion, in CC liver the alpha1- and beta2-ARs density was down-regulated and the neoplastic invasion blunted AC and PLC activity. These quantitative changes may help to elucidate not fully understood pathogenetic mechanisms of disturbed hepatic metabolic processes, such as hypoglycemia during cancer in human liver.

[Amebic colitis and amebic liver abscess--epidemiology and personal case report]. / Amöbenkolitis und Amöbenleberabszess--Epidemiologie und eigene Kasuistik.

The large intestine reacts relatively monomorphically to different stimuli. From this differential-diagnostic problems may result. The history of a patient is described which could be pursued clinically over 12 weeks and during the course of which the correction of the diagnosis ulcerative colitis into amoebic colitis was necessary. It is concluded that in every symptomatology of colitis bacterial and parasitologic examinations of the faeces should be performed primarily specially if there is a history of overseas travel. In these cases it must be also thought of spontaneous amoebic infections.