Pulmonary 15NO uptake in interstitial lung disease.

Because lung nitric oxide (NO) diffusing capacity (DL) represents alveolar-capillary gas diffusion, we queried as to whether disturbances of pulmonary gas exchange in interstitial lung disease (ILD) are appropriately reflected by using NO. In this pilot study, we applied the (15)N-labeled stable isotope (15)NO (relative abundance 0.37% of total NO) in order to ignore the endogenous NO production. In 10 ILD-outpatients, we measured DL (15)NO by performing the single-breath method. Lung function parameters as well as arterial oxygen partial pressure (PaO(2)) were also tested. Values of DL (15)NO ranged within 50-151 ml (15)NO/(mmHg min). Ratios of DL (15)NO/reference were between 43 and 108% of predicted data as taken from our previous work on healthy volunteers [Eur. J. Physiol. 446 (2003) 256]. We found a significant reduction of DL (15)NO/reference in five patients. Additionally, values of PaO(2) were significantly correlated to ratios of DL (15)NO/reference (adjusted R2 +/-SEE=0.407+/-8.051). In conclusion, (15)NO represents an appropriate indicator gas for reflecting an ILD-induced impairment of alveolar-capillary gas exchange.

Pulmonary 15NO uptake in man.

Nitric oxide (NO) is commonly thought to reveal more precise values of pulmonary gas uptake through alveolar-capillary membranes (DL) than the normally used carbon monoxide (CO). Since such measurements are influenced by a significant endogenous NO delivery within human airways, we propose the use of the naturally occurring (15)N-labelled stable nitric oxide isotope (15)NO. It occurs with a relative abundance of 0.37% of the dominating isotope (14)NO. Therefore, the endogenous (15)NO production can be neglected. In the present pilot study we demonstrate the workability of (15)NO in determining DL in healthy individuals. In seven female and 15 male volunteers, averaged values of DL increase with increasing mean alveolar volume as well as individual body height ( P=0.000001). Due to the very high significance level obtained from the multiple regression analysis, we conclude that the application of (15)NO establishes a novel approach to calculate standard values of DL. Such calculations can be employed to predict a reference for patients who suffer from pulmonary diffusion limitation.

[Perianal mucinous adenocarcinoma. A further reason for histological study of anal fistula or anorectal abscess]. / Das perianale mucinöse Adenocarcinom. Ein weiterer Grund für die histologische Untersuchung bei Analfistel oder Anorectalabscess.

A 39-year-old man came to us for surgical treatment of a hidradenitis suppurativa. Upon excision of a perianal abscess, the diagnosis of a rare tumor, a perianal mucinous adenocarcinoma (pT4, pN 1, MO), was made. An abdominoperineal resection was performed, followed by a combination of adjuvant radiation and chemotherapy. A year after the operation, the patient is doing well without any signs of recurrence. This carcinoma probably arises in the anal glands. It often presents as a perirectal abscess and/or an anal fistula. Therefore, the diagnosis is often delayed. At presentation, the tumor is bigger than 5 cm in diameter in 80% of the cases, and the prognosis is poor. It metastasizes mostly to the superficial inguinal or to the retrorectal lymph nodes. There are only case reports and no comparative studies in the literature. In the last 10 years, the carcinoma has mostly been treated by neoadjuvant radiation and chemotherapy, followed by abdominoperineal resection. Since then, the median survival has increased to 3 years. This is the first case report of a combination of a perianal mucinous adenocarcinoma with a hidradenitis suppurativa.

[Hypertensive derailment in marital crisis]. / Hypertensive Entgleisung bei Ehekrise.

A 34-year-old man was admitted because of headache with neck pain, hypertension and tachycardia. The symptoms started 10 days prior to presentation. In the past the patient was treated because of different vegetative symptoms, which were interpreted in relation to excessive private problems. Despite suggestive clinical presentation, the diagnosis phaeochromocytoma was confirmed late. Following removal of the tumor, blood pressure came into the normal range. The operation also abolished all vegetative symptoms and lead to stabilisation of the psychosocial situation.

A clinical and histologic comparison of percutaneous dilational versus conventional surgical tracheostomy.

To directly compare percutaneous dilational tracheostomy (PDT) with conventional surgical tracheostomy, a prospective study was performed in 83 patients requiring tracheostomy for prolonged mechanical ventilation in the intensive care unit or after surgery for a large tumor in the upper respirodigestive tract. Median follow-up was 355 days after PDT and 338 days after conventional tracheostomy. The overall morbidity rate was significantly lower with PDT than with conventional tracheostomy (6.4% vs 36.1%; P < 0.001). Compared with conventional tracheostomy, PDT was also associated with a significantly lower incidence of postoperative bleeding (2.1% vs 13.9%; P < 0.05) and postoperative wound infection (0% vs 22.2%; P < 0.001). There were no clinical signs of laryngotracheal stenosis in either group. In conclusion, PDT is a simple, fast, safe bedside procedure that is associated with significantly lower morbidity than standard surgical tracheostomy.