[Recurring pulmonary artery embolisms and disseminated intravascular coagulation in right atrial myxoma]. / Rezidivierende Lungenarterienembolien und Verbrauchskoagulopathie bei rechtsatrialem Myxom.

A 33 year old woman presented with dyspnea and dizziness. These symptoms had recurred several times during the months preceding. At initial investigation we palpated a tumor in the upper abdomen corresponding to the sonographic finding of a 10 X 10 cm sized cystic tumor in the liver. Because of reduction of fibrinogen, prolonged thrombin time and thrombocytopenia a malignant disease involving the liver and producing pulmonary embolism and disseminated intravascular coagulation was suspected. However, during routine echocardiography a right atrial mass prolapsing in the right ventricle was detected. After normalization of fibrinogen and thrombin-time following a low dose heparin therapy a myxoma sized 6 X 5 cm was removed from the right atrium. The patient did not recover and died 20 days following surgery. At autopsy the liver tumor proved to be a benign cholangioendothelial cyst.

[Serum level of digoxin and digitoxin and glomerular filtration rate in hyper- and hypothyroidism]. / Serumspiegel von Digoxin und Digitoxin und glomeruläre Filtrationsrate bei Hyper- und Hypothyreose.

In a comparative prospective study the serum levels of digoxin and digitoxin and the glomerular filtration of the kidneys were determined radioimmunologically in thyroid function disorders using the endogenous creatinine clearance and the 51Cr-EDTA clearance. Compared to a euthyroid control group 17 patients with hyperthyroidism showed a decreased and 5 patients with hypothyroidism showed a largely toxic digoxin level, both groups being on a maintenance therapy of 0.25 mg digoxin b. i. d. During an oral maintenance therapy of daily 0.1 mg digitoxin unchanged therapeutic serum levels were found in 35 hyperthyroid and 18 hypothyroid patients when compared to a euthyroid control group. Assessment of clearances showed that glomerular filtration rates were clearly increased in the hyperthyroid and lowered in the hypothyroid patients. Renewed assessment of the clearance in four hyperthyroid patients and three with hypothyroidism after thyroid recompensation showed a marked decrease of clearance values in hyperthyroidism and an increase in hypothyroidism. Increased clearance values in hyperthyroidism were associated with lowered digoxin serum levels. In contrast, lowered clearance values in hypothyroidism were accompanied by increased serum digoxin levels. There was no such association detectable for digitoxin.

[A contribution on diagnostic and therapy of myxoedema coma (author's transl)]. / Ein Beitrag zur Diagnostik und Therapie des Myxödemkomas

With special reference to diagnostic and therapeutic problems, a case of myxoedema coma with secondary hyperaldosteronism and raised LDH-concentration is described. The significance of different states of consciousness due to this endocrine disorder is pointed out with respect to the differential diagnosis and particularly to the clinical symptoms. In addition, experience with an intravenously administrable triiodothyronine compound is described and the different dosages previously mentioned in the leterature are discussed. The long interval of 5 weeks from the beginning of the therapy until the remission of the omatous state was surprising.