Transluminal removal of an embolized venous catheter fragment with simple means: a case report.

Vascular catheters are associated with complications like infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. This report presents a successful transluminal removal of an embolized catheter fragment in a 87-year-old patient who underwent on operative revision with renewed resection and postoperative multiorgan failure. The patient needed a large-bore catheter due to acute renal failure. By replacing the central venous catheter using the Seldinger technique a catheter fragment embolized in the right ventricle. This catheter fragment was removed with a Dormia basket.

Postnatal depression: a Christchurch study.

AIMS: The aims of the study were to enquire into the incidence of postnatal depression (PND) and factors associated with it, in a New Zealand population. METHODS: A wide ranging postal questionnaire, which included the Edinburgh postnatal depression scale (EPDS), was administered to a sample of 1330 women 6-9 months after the birth of their babies at Christchurch Women's Hospital, in 1991/2. RESULTS: Measured on the EPDS, 80% of the women were not depressed, 7% were at a threshold level of depression and 13% were more severely depressed. Only 6% recognised their symptoms as depression. The factors having the greatest association with high depression scores were: depressive symptoms before and during the pregnancy; serious deterioration in the partner relationship after the birth; decreased energy, confidence and happiness levels after the pregnancy; moderate or severe premenstrual tension prepregnancy; frequent nausea in later pregnancy; low education and low income. CONCLUSIONS: Postnatal depression appears to be more widespread than is generally realised. The findings suggest that, at the time of postnatal checks on the baby, greater use could be made of the EPDS to increase confidence in a diagnosis of depression. Involvement of male partners in the treatment process is highly desirable.

[Cardiac function and the skin microcirculation in acromegaly]. / Kardiale Funktion und kutane Mikrozirkulation bei Akromegalie.

The microcirculation was measured by nail-fold capillary video microscopy in 21 patients (12 men, 9 women; mean age 54.7 [29-74] years) with acromegaly. Levels of growth hormone (12.0-71.7 microU/ml) and of somatomedin C (2.4-10.5 IU/ml) were elevated in 10 patients, despite preceding treatment. Eleven patients had an increase in myocardial thickness and nine had impairment of left ventricular function, although only slight in most. Left ventricular hypertrophy was demonstrable even in the absence of hypertension. No patient had evidence of coronary heart disease. Nail-fold capillary video microscopy (capillary density, torque index, reactive hyperaemia, epidermal blood flow) failed to distinguish between successfully treated patients and those with persistently elevated growth hormone concentrations or disease duration of over 5 years. There was no evidence of inadequate capillary blood flow as a cause of abnormal function in hypertrophied organs.

Hypomagnesaemia-induced hypocalcaemia: concentrations of parathyroid hormone, prolactin and 1,25-dihydroxyvitamin D during magnesium replenishment.

Three patients with hypomagnesaemia-induced hypocalcaemia were investigated during the phase of magnesium replenishment. Before treatment, serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were at the lower limit of normal. In spite of a rapid rise of parathyroid hormone (PTH) after intravenous administration of magnesium, a reactive increase in 1,25-dihydroxyvitamin D in serum was absent or delayed. The increase of serum calcium into the normal range occurred before any consistent change in the concentrations of this vitamin D metabolite. The rise of serum prolactin in response to the increase in PTH was blunted or absent, and is a further example of a transient PTH resistance during the phase of magnesium replenishment.

[Cardiac metastasis as cause of therapy-resistant heart failure]. / Herzmetastase als Ursache einer therapierefraktären Herzinsuffizienz.

Ultrasonography revealed a renal tumour (4 x 4 cm) in a 67-year-old man with right-sided lumbar pain and macrohematuria. In addition he had marked nocturnal dyspnoea with dry cough. He had lost about 10 kg in weight. On admission he had atrial fibrillation with an irregular ventricular rate (140 beats/min) and engorgement of the neck veins. Two-dimensional echocardiography, undertaken because of signs of increasing heart failure and a fall of systolic blood pressure to below 100 mm Hg, demonstrated a space-occupying lesion in the right ventricle, 4 x 2 x 1 cm, indicating an intracardiac thrombus or solid tumour. The heart failure continued to worsen, despite treatment with cardiac glycosides, verapamil and diuretics. Hence an exploratory thoracotomy was performed. This revealed an intracardiac tumour which had markedly displaced the right ventricular inflow tract and infiltrated the entire myocardium, but not the tricuspid valve. As much of the tumour as possible was resected, but the patient died postoperatively of heart failure. The intracardiac tumour proved to be a metastasis from the papillary carcinoma of the kidney. This had infiltrated the renal capsule and pelvis and invaded the branches of the right renal vein.

Tumor-induced osteomalacia: pre- and postoperative biochemical findings.

A patient with late-onset hypophosphatemic osteomalacia was treated with oral supplements of phosphate (1.5 g/day) and calcitriol (1.5-3.0 micrograms/day) for 17 months, before a slowly growing tumor in the first metatarsal space became evident. Before treatment concentrations of inorganic phosphate (Pi) and calcitriol in serum and tubular reabsorption of phosphate (TRP) were very low, calcium and parathyroid hormone (PTH) in serum were normal, urinary cyclic adenosine monophosphate (cAMP) was strongly elevated. During the first weeks of conservative treatment urinary cAMP returned to normal; concomitantly there was a transient slight fall in PTH. Serum calcium was in the low normal range and did not significantly change during conservative therapy. During the further course PTH rose to pretreatment values, but urinary cAMP remained normal. When the dose of calcitriol was elevated to 3 x 1.0 micrograms/day, leading to slightly elevated serum concentrations of this substance, Pi in serum rose to the low normal range, but TRP remained low and bone pain, although improved, did not subside. The tumor was locally excised. Postoperatively calcitriol concentration became elevated within 48 hours and remained so for several weeks. The rise in calcitriol concentration preceded the elevation of Pi in serum, not, however, the increase of TRP. The elevation of urinary cyclic AMP before therapy may have been due to a direct action of the substance secreted by the tumor.

[Hypomagnesemia-induced hypocalcemia: functional hypoparathyroidism, parathyroid hormone- and vitamin D-resistant]. / Die Hypomagnesiaemie-bedingte Hypocalciaemie: Funktioneller Hypoparathyreoidismus, Parathormon- und Vitamin D-Resistenz.

In four patients with severe hypomagnesemia, hypocalcemia, and functional hypoparathyroidism (three patients with shortened bowel, one with alcoholism), sequential measurements of parameters of calcium metabolism were performed before and during intravenous administration of magnesium. Parathyroid hormone was immeasurably or inadequately low in all patients before magnesium injection, but rapidly rose to elevated values thereafter. Even without calcium supplements, serum calcium rose to normal levels within 2-5 days, although 1,25(OH)2-Vitamin D levels did not rise significantly. In the patient with alcoholism, hypophosphatemia developed during the first days after admission; the rise of serum calcium preceded the elevation of cyclic adenosine monophosphate in urine. A transient rise of urinary calcium was observed in two patients after initiation of magnesium therapy, with a subsequent fall to subnormal levels in spite of normal serum calcium concentrations. The findings were considered to be due to partial parathyroid hormone resistance during the phase of magnesium replenishment.

[Familial nonneoplastic inappropriate thyrotropin secretion]. / Familiäre, nicht-neoplastische inadäquate Thyreotropin-Inkretion.

A follicular thyroid carcinoma was suspected in a 62-year-old woman after the fifth goitre excision for non-neoplastic inappropriate thyrotropin secretion. Small-follicular adenoma could not be excluded histologically. After an attempt at thyrotropin suppression with L-thyroxine, triiodothyronine, D-thyroxine with L-thyroxine, and bromocriptine had failed, lasting if partial decrease in the maximally elevated TSH levels was achieved with triiodothyroacetic acid (TRIAC). One of the patient's three daughters also has non-neoplastic inappropriate thyrotropin secretion and has had two goitre excisions. It is most likely a familial form of inappropriate TSH secretion.