[Primary malignant non-Hodgkin's lymphoma of the breast: breast preserving therapy in 3 patients]. / Primäres malignes Non-Hodgkin-Lymphom der Mamma: Brusterhaltende Therapie bei 3 Patientinnen.

Primary malignant non-Hodgkin lymphoma is rare. The mammographic appearance is unspecific. The final diagnosis can usually be made after examination of paraffin-embedded tissue only. There exists no therapeutic standard for this disease. In the case of 3 patients treated at our institution, tumorectomy only and adjuvant therapy have been performed because there is no survival advantage for patients who underwent radical surgery.

Bone marrow lymphocyte subsets in myelodysplastic syndromes.

AIM: To examine lymphocyte subsets in patients with myelodysplastic syndromes (MDS); and to correlate immunohistological variables with prognosis. METHODS: Bone marrow trephine biopsy specimens from 65 patients with MDS were immunophenotyped using a panel of antibodies. A minimum of 1000 cells from representative areas of marrow sections were counted at light microscopy. The association between immunohistological variables and prognosis was assessed. RESULTS: Compared with normal control marrows (n = 23) no major abnormalities of T cells (CD3), T cell subsets (CD4, CD8, CD25, TCR gamma/delta) or natural killer cells (CD56, CD57) were seen in the 65 patients. In high risk MDS (RAEB, RAEB-t) 19% of the cases showed increased numbers of B lymphocytes compared with none in the low risk group (RA, RARS) (p < 0.0090). Only percentages of B cells above 3% significantly correlated with poor survival (p = 0.0121 for CD19, p = 0.046 for CD22). CONCLUSIONS: The deviations in T lymphocyte counts seen in peripheral blood and in bone marrow aspirates could not be verified in bone marrow biopsy specimens.

Persistence of virus and viral genome in myocardium after coxsackievirus B3-induced murine myocarditis.

Following infection with Coxsackievirus B3 (CVB3), A-strain mice develop ongoing myocarditis that persists after the virus ceases to be cultivatable from heart tissue. We studied the natural history of this virus-induced but apparently autoimmune inflammation by means of in situ hybridization (ISH) and by polymerase chain reaction (PCR). Both ISH and culture allowed detection of virus up to 2 weeks post-infection in virtually all heart tissues. In contrast, PCR revealed the presence of viral genome for a substantially longer period of time, i.e. at least 34 days after CVB3 infection. Similarly, the majority of mice showed myocardial inflammation at this time point. However, the persistence of virus did not correlate with ongoing myocarditis, and vice versa. Most mice with ongoing myocarditis produced heart myosin autoantibodies, most probably as a result of tissue damage. The lack of correlation between presence of ongoing inflammation and persistence of virus supports our previous view that the late phase of CVB3-induced myocarditis is mediated by autoimmunological mechanisms.

[ECG of the athlete's heart]. / Das EKG des Sportherzens.

The athlete's heart is characterized by eccentric hypertrophy of all cardiac cavities and there is a close connection to increased tone of the vagal system. As a consequence, not only arrhythmias are observed in the ECG of healthy athletes, but also changes in the QRS complex and in the ST-T-segment. Left ventricular hypertrophy is diagnosed in ECG by a positive Sokolow-Lyon index. The frequent finding of a right ventricular conduction delay is possibly due to hypertrophy of the myocardium in the apex of the right ventricle. The causes of various T wave changes are generally unclear and await further diagnostic clarification. In cases when normalization of the T-wave deviation is observed under stress, such changes are of functional nature. Echocardiography is indicated in any case to establish the heart's size and function; hypertrophic cardiomyopathy has to be excluded. Frequent cardiac dysrhythmias found in athletes are sinus bradycardia and sinus arrhythmia, less often escape rhythms are seen. A arrhythmia more often found in athletes is the respiration-dependent simple atrioventricular dissociation. Also, escape rhythms are observed in some cases with ventricular origin. Finally, a pronounced vagotonia can lead to a prolonged conduction time; AV-blocks of all degrees of severity are observed in athletes. The functional character of these arrhythmias can be easily demonstrated by their disappearance under stress.

[Oligosymptomatic Bourneville-Pringle tuberous sclerosis of the brain with giant cell astrocytoma]. / Oligosymptomatische tuberöse Hirnsklerose Bourneville-Pringle mit Riesenzell-Astrozytom.

We report on a 9-year-old boy who developed subependymal giant-cell astrocytoma associated with tuberous sclerosis. Apart from a few hypopigmented skin patches, the boy's clinical picture was completely unremarkable until the onset of diplopia and vertigo reflecting increased intracranial pressure. Magnetic resonance imaging of the brain revealed subcortical hamartomas in addition to the intraventricular tumour. Seizures and mental retardation were absent. The boy's mother had suffered from seizures during childhood and presented with typical skin lesions. The importance of thorough examination and regular follow-up even in patients with oligosymptomatic variants of tuberous sclerosis is emphasized.

[Oligosymptomatic variant of tuberous sclerosis with subependymal giant cell astrocytoma]. / Oligosymptomatische Variante der tuberösen Sklerose mit subependymalem Riesenzell-Astrozytom.

We report on a 9-year-old boy who developed subependymal giant-cell astrocytoma associated with tuberous sclerosis. Remarkably, the boy was not mentally retarded and never had suffered from seizures. Apart from white skin patches symptoms of increased intracranial pressure were the presenting symptoms. The boy's mother, who was present at the boy's admission, presented with skin lesions typical of tuberous sclerosis. The importance of thorough examination of apparently asymptomatic relatives of patients with tuberous sclerosis is emphasized.

[MR study of bone marrow changes of the spine following radiotherapy]. / MR-Untersuchung von Knochenmarksveränderungen in der Wirbelsäule nach Strahlentherapie.

MR examinations of bone marrow variations in the spine after radiotherapy were performed on 24 patients in the thoracic and lumbar vertebral column. The actinically affected bone marrow showed a characteristic increase of signal intensity in T1-weighted sequences in the sagittal plane, due to conversion of red marrow to fatty marrow. The dose in the well-defined radiation areas was between 28 and 70 Gray (Gy). The lowest dose, applied to the bone-marrow bordering on the defined radiation areas, where we still could find an increase of signal intensity, was below 2.6 to 5 Gy. MR imaging was performed between 6 and 9 month after radiotherapy.

[Virus demonstration and pathologic changes in different phases of coxsackievirus B myocarditis in mice]. / Virusnachweis und pathologische Veränderungen in verschiedenen Phasen der Coxsackievirus B Myokarditis bei Mäusen.

A/J mice between 15 days and 10 weeks of age were infected intraperitoneally with Coxsackievirus B3 (CVB3). To search for virus in the myocardium various methods were applied: virus isolation from the myocardium, RNA extraction for dot blot hybridization and in situ hybridization. Two different RNA probes, one specific for CVB3 the other cross-reacting with other enteroviruses, were radioactively labeled with 35S or 32P by in vitro transcription. In paraffin sections histological alterations were assessed semiquantitatively. The animals developed acute myocarditis with myolysis and virus in the myocardium until 14 days after infection. The second stage of the disease was characterized by a persistent inflammatory infiltrate. At this stage no virus could be shown in the myocardium. Antibodies against cardiac myosin appeared 16 days after infection. Autoimmune mechanisms thus seem to be a most relevant factor for persistent inflammation after the acute viral phase of the disease.

Prophylactic sclerotherapy before the first episode of variceal hemorrhage in patients with cirrhosis.

The value of sclerotherapy as prophylaxis against the first episode of variceal hemorrhage has not been established. Therefore, we randomly assigned 133 patients with cirrhosis of the liver (of alcoholic origin in 66 percent), esophageal varices, and no previous intestinal bleeding to either prophylactic sclerotherapy (n = 68) or no prophylaxis (n = 65). The groups were comparable in hepatic function, endoscopic findings, and the pathogenesis of cirrhosis. All patients who subsequently had a first episode of variceal hemorrhage received sclerotherapy whenever possible. During a median follow-up of 22 months, variceal hemorrhage occurred in 28 percent of the patients receiving sclerotherapy and 37 percent of the controls (P = 0.3). Thirty-five percent of the sclerotherapy group and 46 percent of the control group died. The survival curves (Kaplan-Meier) of both groups were similar (P = 0.2). However, among patients with alcoholic and moderately decompensated cirrhosis (Child-Pugh group B), survival was significantly higher in those receiving sclerotherapy, although the risk of bleeding was only marginally reduced by this procedure. We conclude that prophylactic sclerotherapy does not significantly reduce the risk of bleeding from esophageal varices, but that a subgroup of patients with esophageal varices and moderately decompensated alcoholic cirrhosis may benefit from prophylactic sclerotherapy because of factors not solely attributable to prevention of an initial episode of variceal bleeding.