[Subacute lower back pain and acute kidney failure in a 47-year old man]. / Subakute lumbale Rückenschmerzen und akute Niereninsuffizienz bei einem 47-jährigen Mann.

A 47-year-old man presented with subacute, low back pain and increased creatinine levels. A CT scan showed an extrinsic, bilateral compression of the ureters by a retroperitoneal mass with pronounced uptake of 18F-fluorodeoxyglucose in positron emission tomography. Histological findings were consistent with the diagnosis of retroperitoneal fibrosis. Urological decompression was performed. The initiated corticosteroids led to a rapid clinical improvement and regression of the retroperitoneal mass. A relapse occurred after tapering of corticosteroids with a prompt response to increase of the dosage.

[Calcified]. / Verkalkt.

A 73-year-old woman was referred due to an acute and progressive worsening of a previously mildly impaired kidney function of unknown origin. The kidney biopsy showed a phosphate nephropathy. We identified Colophos®, a phosphate-containing purgative as the causing agent, which the patient had received for bowel cleansing for a colonoscopy one day before the detection of the acute kidney failure. During the following months the kidney function initially declined further and then improved. Most cases of phosphate nephropathy are associated with the ingestion of phosphate-containing purgatives. Persons at risk are women, elderly persons, patients with impaired kidney function, hypertension, and dehydration. The consequence is sometimes an irreversible tubulointerstitial injury that can lead to end-stage renal disease in a minority of the cases.

[Uterine leiomyoma as cause of erythrocytosis]. / Uterus myomatosus als Ursache für Erythrozytose.

Myoma-induced erythrocytosis is a rare clinical picture which is probably largely misunderstood. Pre- and postmenopausal women are affected. The characteristics of this syndrome are raised haemoglobin and haematocrit values, erythrocytosis at normal plasma volumes and the fact that these values are promptly and permanently corrected by myomectomy or hysterectomy. Myomatous erythrocytosis syndrome (MES) can be the explanation of normal haematological parameters in patients with myoma-related hypermenorrhoea and menorrhagia.

[Primary hyperthyroidism 1996]. / Primärer Hyperparathyreoidismus 1996.

55 prospectively documented patients aged 20-84 (median 67) years (47 women, 8 males) underwent surgery for primary hyperparathyroidism (pHPT). The most frequent symptoms and associated conditions were nephrolithiasis (42%) and neuropsychiatric symptoms (39%). Only one case of asymptomatic and one case of "normocalcemic" pHPT were found in this series. 47 patients (89%) were cured following initial neck exploration, and 3 further patients (6%) were cured by a second operation. Reoperation also led to cure in 2 patients operated on elsewhere in the first instance. 6 patients (11%) had double adenoma (bilaterally) and 36% of the adenomas had an ectopic location, with an intrathyroidal adenoma in 2 cases. In 2 patients sternotomy was carried out. Persistent pHPT was observed in 3 patients (following initial exploration in 2 cases and reoperation in one). These patients had a supernumerary adenomatous gland with ectopic location in 2 cases and a double adenoma with ectopic position of one adenoma in a further case. One 80-year-old patient died post-operatively from intestinal ischemia. 2 patients had permanent postoperative hypoparathyroidism; in no case was a permanent recurrent laryngeal nerve palsy observed. Bilateral parathyroid exploration with thyroid mobilization by capsular dissection is the procedure of choice for pHPT. In 2 patients with the MEN 2A-syndrome and with medullary thyroid carcinoma thyroidectomy, lymphadenectomy and autotransplantation of normal parathyroids to the arm was performed, with normal parathyroid function in both cases.

Relation of cyclosporine blood levels to adverse effects on lipoproteins.

Hyperlipidemia is common in renal allograft recipients. To elucidate the role of cyclosporine in posttransplant hyperlipidemia, we measured lipids, lipoprotein lipids, and apolipoproteins of thirty-five renal allograft recipients and evaluated their relation to trough cyclosporine blood levels. All patients were on a triple immunosuppressive regimen with equal doses of prednisone and azathioprine, and had stable graft function. Cyclosporine blood levels were significantly correlated to total plasma cholesterol (P = 0.028), low-density lipoprotein cholesterol (P = 0.022), apolipoprotein B (P = 0.017), and the cholesterol/high-density lipoprotein cholesterol ratio (P < 0.002), but not to plasma triglycerides. Significant inverse correlations were found between cyclosporine blood levels and high-density lipoprotein cholesterol (P = 0.034), high-density lipoprotein3 cholesterol (P = 0.025), and apolipoprotein A-1 (P = 0.047), but not high-density lipoprotein2 cholesterol. The independent relation of cyclosporine blood levels to each of the measured lipid parameters was investigated by a stepwise regression model including age, body mass index, interval from transplantation, diabetes mellitus, plasma creatinine, and intake of diuretics and beta-blockers. After correction for these 7 variables, cyclosporine blood levels remained significantly associated with high-density lipoprotein cholesterol, high-density lipoprotein3 cholesterol, apolipoprotein A-1, apolipoprotein B, low-density lipoprotein cholesterol, and the cholesterol/high-density lipoprotein cholesterol ratio. These data suggest that cyclosporine causes atherogenic dyslipidemia.