[Acute mesenterial artery occlusion--an unusual symptom of primary antiphospholipid antibody syndrome]. / Akuter Mesenterialarterienverschluss als seltene Manifestation eines primären Antiphospholipid-Antikörpersyndroms.

BACKGROUND: The antiphospholipid-antibody syndrome (APS) is a thrombophilic disorder, in which venous and arterial thrombosis can occur. We report the rare case of a patient with mesenteric infarction due to primary APS. CASE REPORT: A 46-year-old male patient was admitted to the hospital because of severe abdominal pain. A laparotomy was performed and revealed infarction of a jejunal loop which was resected. At pathohistological examination mesenteric artery infarction was found. Preoperatively prolonged partial thromboplastin time led to coagulation analysis. Lupus anticoagulant and anticardiolipin antibodies were found. TREATMENT: The diagnosis of primary APS was made and the patient was treated with aspirin (100 mg/day) and low molecular weight heparin (2,500 IE/day) permanently. Eighteen months after mesenteric infarction the patient is free of further thromboembolic events.

[Nuclear magnetic resonance tomography for improving the differential diagnosis of pathologic changes in the scrotal contents]. / Kernspintomographie (KST) zur Verbesserung der Differentialdiagnose pathologischer Veränderungen des Skrotalinhalts.

A total of 75 patients with scrotal pathology were examined using magnetic resonance imaging (MRI). The diagnostic results were compared with operative and histological findings and with the sonographic results available. Compared with sonography, MRI showed diagnostic advantages in the detection and characterization of malignant tumors and in the exclusion of non-tumorous testicular pathology (old torsions, periorchitis, old hematomas). No false-negative results were found by MRI. False-positive results were found in 2 out of 75 MRI examinations. The possibility of showing tunica albuginea, of imaging testes in various planes and its diagnostic accuracy of about 88% as well as the lack of ionizing irradiation make MRI the most reliable form of diagnostic imaging in the classification of scrotal pathology. Sonography (51/75) showed high sensitivity in detecting testicular disease (90%), but its specificity (55%) was disappointing and could not be quantified with regards to the differentiation of testicular cancer.

[Cardiac metastasis as cause of therapy-resistant heart failure]. / Herzmetastase als Ursache einer therapierefraktären Herzinsuffizienz.

Ultrasonography revealed a renal tumour (4 x 4 cm) in a 67-year-old man with right-sided lumbar pain and macrohematuria. In addition he had marked nocturnal dyspnoea with dry cough. He had lost about 10 kg in weight. On admission he had atrial fibrillation with an irregular ventricular rate (140 beats/min) and engorgement of the neck veins. Two-dimensional echocardiography, undertaken because of signs of increasing heart failure and a fall of systolic blood pressure to below 100 mm Hg, demonstrated a space-occupying lesion in the right ventricle, 4 x 2 x 1 cm, indicating an intracardiac thrombus or solid tumour. The heart failure continued to worsen, despite treatment with cardiac glycosides, verapamil and diuretics. Hence an exploratory thoracotomy was performed. This revealed an intracardiac tumour which had markedly displaced the right ventricular inflow tract and infiltrated the entire myocardium, but not the tricuspid valve. As much of the tumour as possible was resected, but the patient died postoperatively of heart failure. The intracardiac tumour proved to be a metastasis from the papillary carcinoma of the kidney. This had infiltrated the renal capsule and pelvis and invaded the branches of the right renal vein.

[Magnetic resonance tomography in the differential diagnosis of pathologic changes in scrotal contents--a comparison with computed tomography]. / Kernspintomographie (KST) in der Differentialdiagnose pathologischer Veränderungen des Skrotalinhaltes--ein Vergleich mit der Computertomographie (CT).

48 patients with scrotal pathology were examined by magnetic resonance tomography (MRI) and computed tomography (CT). The diagnostic results were compared to surgical and histological findings. The correct diagnosis could be detected in 81% by CT and in 85% by MR. Another 27 patients were examined only by MR with positive results in 88%. Demonstration of tunica albuginea, imaging of testes in various planes and diagnostic accuracy in about 88% with missing ionising irradiation make MRI the most reliable diagnostic imaging in the classification of scrotal pathology. False negative results were found in 1/48 by CT and none by MRI. False positive results could be found in 2/75 of MRI examinations but none in CT.

[Prognosis of children with congenital tricuspid and pulmonary atresia 1967-83 in comparison with the natural course]. / Prognose der Kinder mit kongenitaler Trikuspidal- und Pulmonalatresie in den Jahren 1967-83 im Vergleich zum natürlichen Verlauf.

46 Children with tricuspid atresia, 56 with pulmonary atresia and ventricular septal defect (VSD) and 33 with pulmonary atresia and intact ventricular septum were diagnosed and treated at the University's Children's Hospital Tübingen between 1967 and 83. Their age distribution and mortality is compared to 91 autopsy-proven cases of tricuspid atresia, 123 cases of pulmonary atresia with VSD and 41 cases without VSD, reported in the time between 1783 and 1945 showing the natural history of these malformations. Inspite of intensive medical and operative therapy, the results of which are reported in detail, mortality continues to be high: 55% of our patients with tricuspid atresia die within the first year of life, 60-62% within the first 2 years (in the bibliographical collective 64% and 73%), 53-61% of patients with pulmonary atresia and VSD die within the first, 61-68% within the first 2 years (in the bibliographical collective 74% and 78%), and 78% of patients with pulmonary atresia without VSD within the first year, 88% within the first 2 years of life (in the bibliographic collective 95% and 97%).