[Value of invasive preoperative imaging in kidney tumors of malignant or uncertain character]. / Stellenwert der invasiven präoperativen Bildgebung bei Nierentumoren maligner oder unklarer Dignität.

Preoperative staging of malignant renal tumors or undetermined dignity is mainly performed noninvasively using CT or MRI. In cases with vascular invasion or a solitary kidney extensive invasive evaluation of the tumor can influence preoperative planning. We report two cases of oncocytoma and renal cell carcinoma with extensive imaging using DSA or helical CT-cavography.

[Hemorrhage-induced rupture of the pancreatic pseudocyst]. / Die blutungsbedingte Ruptur der Pankreaspseudozyste.

Hemorrhage from pseudocyst may be the most serious complication of chronic pancreatitis: the mortality from such hemorrhage approaches 80%. The bleeding arises from a major artery--the artery is eroded by the basic process of autodigestion, and the pseudocyst is converted into a pseudoaneurysm. The wall of the pseudoaneurysm is subjected to arterial pressure and may perforate into the peritoneal cavity, an adjacent segment of the gastrointestinal tract, or the pancreatic ductal system. Clinical signs and indications of complicated pseudocyst are sudden abdominal pain, hypotension, sudden increase in abdominal tenderness, decrease of hematocrit and sudden disappearance of the mass. Sonography, CT and angiography accurately define the bleeding lesion and greatly aid in planning operative strategy. Surgery, angiographic embolisation, or a combination of both may be employed. Transcystic arterial ligation and internal drainage of the pseudocyst or distal pancreatectomy are the operative procedures of choice and give the best results.

[Fatty liver in indirect calorimetry controlled total parenteral nutrition]. / Fettleber unter indirekt-kalorimetrisch gesteuerter totaler parenteraler Ernährung.

The authors have investigated the relationship between total parenteral nutrition (TPN) under indirect calorimetry and the development of fatty infiltrations of the liver in 21 surgical and traumatized patients. TPN was monitored by indirect calorimetry in order to balance lipid and amino acid intake. Glucose intake was adapted only when daily glucose utilization was higher than 150 g. Non protein respiratory quotient (npRQ) and respiratory quotient (RQ) remained below 0.9 during the whole study. The need for lipids was always significantly higher than the lipid intake up to the 5th day after operation or trauma. The need for carbohydrates was significantly lower than the intake of carbohydrates up to the 9th day after operation or trauma. In addition, the utilization of lipids was higher than the utilization of carbohydrates. After 2 weeks of TPN, no fatty infiltration of the liver could be detected by computer tomography and chemical analysis. The calorimetric monitoring of the TPN regimen and the individual adaptation of substrate intake might be responsible for the protection of the liver observed in this study.