ABSTRACT
Q fever is a worldwide distributed zoonotic disease with a mostly benign course, which regularly reoccurs in Germany. This report is about a patient with sporadic serologically proven Q fever, which also showed typical histopathological findings with nonspecific granulomatous hepatitis, usually seen in acute disease. The bone marrow biopsy revealed so-called doughnut granulomas, which are not pathognomonic but a typical finding in Q fever. This case report impressively underlines that the histomorphological findings can make a decisive contribution to the clarification by extended differential diagnostics, even though it plays a subordinate role in the routine diagnostics of disseminated Q fever.
Subject(s)
Granulomatous Disease, Chronic/diagnosis , Granulomatous Disease, Chronic/pathology , Hepatitis A/diagnosis , Hepatitis A/pathology , Q Fever/diagnosis , Q Fever/pathology , Rare Diseases , Adult , Anti-Bacterial Agents/therapeutic use , Aortic Valve/pathology , Biopsy, Needle , Bone Marrow/pathology , Diagnosis, Differential , Drug Therapy, Combination , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/pathology , Granulomatous Disease, Chronic/drug therapy , Hepatitis A/drug therapy , Humans , Liver/pathology , Male , Q Fever/drug therapy , RecurrenceABSTRACT
Magnetic resonance imaging of rare cystic prostate cancers using multiparametric MRI (mp-MRI, 3 Tesla) shows, especially in solid tumor masses, the criteria of ESUR-MR classification with a PI-RADS >3 ("probably malignant"). In association with additional morphological evidence of intracystic hemorrhage and evidence of villous tumor nodules and irregular septa on the cyst wall, further malignancy criteria are met. MRI complementary to TRUS may be useful for targeted biopsy in solid tumor areas.
Subject(s)
Carcinoma, Adenoid Cystic/pathology , Magnetic Resonance Imaging/methods , Multimodal Imaging/methods , Prostatic Neoplasms/pathology , Aged, 80 and over , Diagnosis, Differential , Humans , Male , Rare Diseases/pathologyABSTRACT
Lymphangiomas are rare benign tumors. In most cases, resection is necessary to obtain a precise histopathological analysis. There are capillary, cavernous and cystic lymphangiomas. The therapy of choice is a complete excision. Recurrence has been reported after incomplete resection. We present the case of a 45-year-old man with a lymphangioma of the omentum minus and -review the literature.
Subject(s)
Lymphangioma, Cystic/diagnosis , Lymphangioma, Cystic/surgery , Omentum , Peritoneal Neoplasms/diagnosis , Peritoneal Neoplasms/surgery , Diagnosis, Differential , Endosonography , Follow-Up Studies , Humans , Lymphangioma, Cystic/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Omentum/pathology , Omentum/surgery , Peritoneal Neoplasms/pathology , Stomach/pathology , Stomach/surgery , Tomography, X-Ray ComputedABSTRACT
Biological markers in various compartments of the human body have demonstrated potential value in diagnosis, prediction, guidance of therapy as well as in monitoring the clinical course of diseases of the airways and the lung. But only certain surrogate parameters are from clinical value, such as procalcitonin in pneumonia and sepsis, alpha-1-antitrypsin to diagnose alpha-1-antitrypsin deficiency, D-Dimers to detect emboli, nitric oxide in exhaled air in asthma, or isolation of germs from sputum to guide antibiotic treatment. Quantification of numerous markers in exhaled breath condensate or the detection of compounds in exhaled air are more recent attempts to further elucidate those biomarkers for clinical use. In general, biomarkers have an important supportive value in addition to routine diagnostic methods. The article reviews recent data regarding the usefulness of markers in non-malignant pulmonary diseases.
Subject(s)
Biomarkers/analysis , Biomarkers/metabolism , Lung Diseases/diagnosis , Lung Diseases/metabolism , HumansABSTRACT
Ruptures of hamstring reconstructed anterior cruciate ligaments required additional surgery in five cases over a 4 year period. All transplants were primarily fixed with bioresorbable interference screws close to the joint. The average age was 31 years (range: 18-42), the average interval between primary surgery and rupture of the transplant was 13.2 months (range: 8-24) after an adequate re-trauma. After complete removal of the tibial insertion, a histological investigation was carried out. We stained the tissue-sections following the haematoxylin-eosin, Masson-Goldner and van Gieson protocols. All cases revealed direct healing with grow-over Sharpey-like fibers close to the joint, corresponding to a fibrous tendon insertion and far from the joint the formation of fibrous or cartilage callus.
Subject(s)
Anterior Cruciate Ligament/surgery , Arthroscopy , Knee Joint , Tendons/anatomy & histology , Tendons/transplantation , Tibia , Adolescent , Adult , Anterior Cruciate Ligament Injuries , Bone Screws , Female , Histological Techniques , Humans , Male , Microscopy, Polarization , Recurrence , Reoperation , Rupture , Staining and Labeling , Tibia/surgery , Time Factors , Treatment Outcome , Wound HealingSubject(s)
Diagnostic Imaging , Eye Diseases/diagnosis , Keratomileusis, Laser In Situ , Laser Therapy , Eye Diseases/therapy , Germany , HumansABSTRACT
HISTORY AND CLINICAL FINDINGS: A 72-year-old woman, who suffered from increasing dyspnea and productive cough was admitted to hospital. Clinical examination revealed a reduced respiratory sounds over the left lung and a painless and unmovable tumor in the area of the left hip. CLINICAL AND LABORATORY TESTS: Apart from hypoxemia (pO2 7.81 kPa) the laboratory values did not indicate any pathological findings. The X-ray and CT-scan of the chest showed a few spotty shadows and pleura effusion on the left. No tumor cells were detected in the pleural effusion. In biopsies of the visceral and parietal pleura as well as biopsy within the tumor in the area of the left hip there were clusters of tumor cells of a granular cell tumor. DIAGNOSIS, TREATMENT AND CLINICAL COURSE: Because the same tumor cell type was detected in the visceral and parietal pleura and wihtin the tumor at the left gluteus area, we diagnosed a malignant granular cell tumor. The CT-scan was suspicious of lung metastasis. The primary tumor was located in the area of left hip. The patient was in a poor general condition and she suffered from an extensive metastastic disease; curative treatment was not possible. A pleurodesis was performed. The patient died nine months after initial diagnosis. CONCLUSION: A rare malignant granular cell tumor was discovered by detecting tumor tissue of granular cell tumor in the pleura and within a tumor in the left gluteus area. Another indication of a metastatic disease were multifocal lesions in the lung detected by CT-scan. Curative treatment was not possible.
Subject(s)
Granular Cell Tumor/secondary , Lung Neoplasms/secondary , Muscle Neoplasms/diagnostic imaging , Pleural Neoplasms/secondary , Aged , Biopsy , Buttocks , Diagnosis, Differential , Female , Granular Cell Tumor/diagnostic imaging , Granular Cell Tumor/pathology , Humans , Lung/pathology , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Muscle Neoplasms/pathology , Pleura/pathology , Pleural Neoplasms/diagnostic imaging , Pleural Neoplasms/pathology , Pleurodesis , Thoracoscopy , Tomography, X-Ray ComputedABSTRACT
In order to assess the performance of pulsed Doppler echocardiography and to examine the factors affecting its reliability for the diagnosis of ventricular septal defects, 51 patients, in whom angiographic studies had recently been performed, were investigated before and after operation by this technique. The diagnosis was correct in all cases with left-to-right shunt, when the defect was located either in the upper muscular or in the infracristal portion of the septum, even when pulmonary hypertension or additional cardiac malformations were present. Pulsed Doppler echocardiography did not differentiate between supracristal ventricular septal defects and obstruction of the right ventricular outflow. Apical muscular defects were never observed in our cases. Defects of the inlet portion were not localised by the method. In cases with bidirectional shunt, pulsed Doppler echocardiography failed to provide any diagnostic clue. When a right-to-left shunt was present, only in one case with membranous pseudoaneurysm could pulsed Doppler echocardiography provide an exact description of the haemodynamics before and after operation. In 12 of 22 patients with tetralogy of Fallot, pulsed Doppler echocardiography showed flow tracings possibly related to the septal defect. The site of defect and the extent and direction of intracardiac shunting seem to be the main factors affecting its diagnostic performance in ventricular septal defects.
Subject(s)
Echocardiography/methods , Heart Septal Defects, Ventricular/diagnosis , Doppler Effect , Heart/physiopathology , Heart Septal Defects, Ventricular/physiopathology , Heart Septal Defects, Ventricular/surgery , Hemodynamics , Humans , Postoperative Period , Tetralogy of Fallot/diagnosisABSTRACT
A cardiac pacemaker capable of responding to blood acidosis by change in its stimulation rate allows adjustment to a patient's metabolic needs. The blood pH is sensed by an iridium oxide electrode in the right atrium. During exercise, the venous pH decreases and the paced ventricular rate increases. If acidosis persists, the paced rate gradually returns to baseline and reaches it after about 70 minutes. A pH-triggered pacemaker has been implanted in a 72-year-old male. The pacemaker remained responsive one year after implant, increasing rate during exercise, cold pressor stress, ischemia of the arms and emotional stress.
