[Congenital Fibrosarcoma of the Left Index Finger - An Unusual Case]. / Kongenitales Fibrosarkom am linken Zeigefinger - ein ungewöhnlicher Fall.

Congenital fibrosarcoma is a rare mesenchymal soft tissue tumour, which most commonly develops in the peripheral extremities during infancy. Diagnostic work-up is a challenge for clinicians and pathologists alike, because in many cases the lesion initially resembles a haemangioma on macroscopic inspection. A 4-month-old boy presented with a strongly vascularised tumour of the left index finger, which had been diagnosed as a capillary haemangioma by means of a biopsy performed in another facility. The lesion had been treated with systemic and intralesional cortisone injections. Due to ulceration and the risk of infection, the tumour mass was resected with the index finger being preserved. The histological appearance was inconclusive. PCR revealed a congenital fibrosarcoma. 2 years after surgery, the boy is free from recurrence.

[Value of training courses in minimally invasive surgery]. / Die Wertigkeit von Trainingskursen in der Minimal-Invasiven Chirurgie.

The actual situation regarding the education für MIS requires the optimisation and standardisation of the training system. This paper presents the results of an inquiry about the evaluation of the course of operative laparoscopy. 80-90% of those interviewed made the comments "very good" and "good", with regard to the imparting of the theoretic foundation of the technique of endoscopic operations, for sufficient possibility of manual training and for the realistic setting of the animal organ model compared with the clinical operation. Because of our experience, we recommend attending such training courses before starting laparoscopic operations.

Emphasis on high-density lipoprotein cholesterol in patients with coronary artery disease.

Although numerous epidemiologic and lipid intervention studies clearly demonstrate the pivotal role of high-density lipoprotein cholesterol (HDL-C) on risk of coronary artery disease (CAD), the National Cholesterol Education Program (NCEP) has emphasized only total cholesterol and low-density lipoprotein cholesterol (LDL-C), and has underemphasized the role of HDL-C in their lipid assessment and treatment recommendations. In a review of 113 consecutive patients in our cardiac rehabilitation program, lipid levels improved modestly with cardiac rehabilitation. "Ideal" lipids (LDL-C < 130 mg/dL according to the NCEP) were present in 49% before the rehabilitation program and in 46% afterward. In fact, 60 (53%) of our patients had total cholesterol levels < 200 mg/dL and would require no further lipid assessment or treatment according to the NCEP. Of these 60 patients, 40 (67%) had low HDL-C (< or = 35 mg/dL). In our total study group, 56% (63/113) had HDL-C < or = 35 mg/dL and 33% (37/113) had HDL-C < or = 30 mg/dL before rehabilitation (compared to 42% and 21%, respectively, after rehabilitation. On the other hand, a "high-risk" LDL-C value (> or = 160 mg/dL) was found in only 17% of patients at baseline and in only 13% after the cardiac rehabilitation program. Using an approach that incorporates the pivotal role of both LDL-C and HDL-C (LDL-C > or = 160 mg/dL or HDL-C < or = 35 mg/dL) for our patients with known CAD, 65% would require drug treatment before rehabilitation and 53% after rehabilitation. We conclude that: (1) lipids improve only modestly (though the change is significant statistically) with cardiac rehabilitation; (2) low levels of HDL-C are prevalent in cardiac rehabilitation patients and are much more prevalent than elevated LDL-C, both before and after rehabilitation; and (3) the NCEP should reevaluate the pivotal role of HDL-C in its assessment and treatment guidelines, particularly in patients with known CAD, since emphasis on both LDL-C and HDL-C is needed for optimal primary and secondary prevention of CAD.

Adjunctive therapy in thrombolysis for acute myocardial infarction.

The value of prompt coronary reperfusion utilizing thrombolytic therapy during acute myocardial infarction has been well established. However, new data indicates that although rapid reperfusion is imperative, this positive effect may, in fact, be partially or totally negated if patency is not sustained and complete. The following manuscript discusses the role of adjunctive agents in thrombolysis that are essential in preventing coronary reocclusion. It is this important function that serves to prevent recurrent ischemia and reinfarction, thereby improving resultant left ventricular function. This, in turn, should have a positive effect on post-thrombolytic mortality. The data presented in this paper supports high dose, titrated intravenous heparin and aspirin as required adjunctive therapy to thrombolytic treatment in the setting of acute myocardial infarction.

Chylopericardium after orthotopic heart transplantation.

Chylopericardium is an infrequent cause of pericardial effusions after heart surgery and to our knowledge has not been reported after orthotopic transplantation. We report the occurrence of chylopericardium in a heart transplant recipient who was successfully treated with a pericardial window, pericardiocentesis, and a diet rich in medium-chain triglycerides.