[Detection of bone metastases in patients with neuroendocrine gastrointestinal tumors]. / Zur Detektion von Knochenmetastasen bei Patienten mit neuroendokrinen gastrointestinalen Tumoren.

INTRODUCTION: In patients with neuroendocrine gastrointestinal tumors and liver metastases, but without known extrahepatic manifestations, liver transplantation may be indicated as curativ or "long-term-palliativ" therapy. For these patients the absence of bone lesions is mandatory. METHODS: 4 patients with a histologically proven neuroendocrine tumor were examined in order to exclude further metastases. We compared the diagnostic value of somatostatin-receptor-scintigraphy (SRS), X-ray, 99mTc-DPD-scintigraphy, CT and MRI. RESULTS: In all 4 patients bone metastases could be detected using SRS, CT und MRT. In one case MRI proved multiple infiltrations, while SRS showed only a solitary, focal lesion. 99mTc-DPD-scintigraphy was positive in 3 cases, X-ray in 1 case. CONCLUSION: As a diagnostic strategy we initially recommend somatostatin-receptor-scintigraphy. When locating suspect areas in SRS, MRI should be the method of choice for the exact evaluation of malignant bone infiltrations. A CT-guided biopsy is necessary to gain histological information.

[Doppler sonographic monitoring control of perfusion of hepatocellular carcinoma after arterial chemoembolization]. / Dopplersonographische Verlaufskontrolle der Perfusion hepatozellulärer Karzinome nach arterieller Chemoembolisation.

INTRODUCTION: 22 patients with hepato-cellular carcinomas were examined sonographically before and after intra-arterial chemo-embolisation. The aim was to evaluate different techniques for judging tumour morphology and for assessing changes in perfusion. MATERIAL AND METHODS: The morphological appearances and perfusion changes were analysed by means of colour coded duplex sonography and power Doppler sonography before and after intravenous contrast medium. Pulsatility (Pl) and resistance index (RI) were used as quantitative parameters for judging changes in perfusion. RESULTS: In 13 patients intra-tumoral arteries were identified by duplex sonography and in four patients only by the power Doppler procedure. In three patients arterial vessels could only be identified after intravenous contrast. In 9 patients it was possible to document a reduction in arterial perfusion following embolisation. The indices calculated from these findings gave no prognostic indication. DISCUSSION: The methods described give information concerning changes in perfusion of a tumour following chemo-embolisation and, in conjunction with CT and clinical findings, provide indications for further tumour embolisation.

Disseminated herpes simplex virus infection during pregnancy. A case report.

Hepatitis due to herpes simplex virus (HSV) developed in a pregnant women at 38 weeks' gestation. She delivered a live-born infant who had serologically documented HSV 2 infection but did well with acyclovir therapy. The mother, however, died five days postpartum from fulminant hepatic failure despite antiviral treatment, and HSV was demonstrated in the liver. Twenty-three reported cases clearly establish pregnancy as a condition that can predispose to disseminated HSV infection. The majority of cases have been due to HSV 2, and primary infection in the latter part of pregnancy appears to constitute the greatest risk. The major disease manifestations appear to be hepatitis and encephalitis. Historically, maternal and fetal mortality rates have been high, but there is a trend toward improved survival in the acyclovir era.

Fetal echocardiography: indications for referral, prenatal diagnoses, and outcomes.

Three hundred three fetuses were studied with fetal echocardiography and 21 were diagnosed with congenital heart disease (CHD). Indications for study, prenatal findings, and postnatal outcomes were examined in all fetuses studied. The most common indications for referral were previous family history and fetal dysrhythmia. Of 189 fetuses studied for these indications, six had CHD. Indications with the highest proportion of abnormal studies included an abnormal four-chamber view of the heart (50% abnormal), fetal hydrops (30.8% abnormal), and polyhydramnios (25% abnormal). Five of 21 with CHD had chromosomal defects and eight had extracardiac anomalies. Two of the 21 fetuses with CHD survived. Present referral indications led to the diagnosis of the most severe lesions, yet reassurance is provided to many couples with normal fetuses. Fetal echocardiography is important in the care of the fetus at risk for CHD.

Diminished IgG, but not complement C3 or C4 or factor B, precedes nosocomial bacterial sepsis in very low birth weight neonates.

The significance of low serum IgG and complement proteins in very low birth weight (VLBW; less than 1500 g) neonates is not known. Therefore serum IgG, C3, C4 and Factor B were quantitated weekly by rate nephelometry in 15 VLBW neonates who developed proven nosocomial bacterial or candidal sepsis (Group A) and 27 VLBW neonates who did not develop sepsis (Group B). In the first week of life the serum IgG of neonates in Group A was 295 +/- 33 mg/dl (mean +/- SEM) and in Group B it was 440 +/- 21 mg/dl (P less than 0.01). In the second week, the IgG of Group A was 270 +/- 32 mg/dl and that of Group B was 473 +/- 38 mg/dl (P less than 0.01). If the IgG was less than 350 mg/dl in the first week or less than 230 mg/dl in the second week, the relative risk of acquiring sepsis was greater than or equal to 5 (95% confidence interval in the first week, 1.7 to 11.2). The serum IgG was measured before the onset of sepsis in 14 of the 15 neonates in Group A. In the week before sepsis the IgG of the 14 neonates was less than 440 mg/dl (range, 45 to 433 mg/dl) in all cases, was below the mean IgG of Group B in 12 of 14 cases (P = 0.006 vs. Group B) and was greater than 2 SD below the mean IgG of Group B in 4 of 14 cases (P = 0.0003 vs. Group B).(ABSTRACT TRUNCATED AT 250 WORDS)