Thrombolyse des artériopathies des membres

Thrombolytic therapy has been employed for 40 years, by systemic infusion, in the treatment of acute artery occlusions, and since 1971 by local infusion. Several randomised studies published during the 1990's have compared thrombolysis to surgery; they showed the benefits of the thrombolytic therapy, together with, however, the risks and potential complications. The use of thrombolysis combined with endovascular treatment of arterial lesions by recanalisation, thrombo-aspiration, angioplasty with or without endoprosthesis, has allowed defining new therapeutic strategies. The aim of the present chapter is to update one of our previous works by the identification of those new treatment modalities that have been used during the last decade, the presentation of the mechanism of action of standard thrombolytic drugs, streptokinase (SK) and urokinase (UK) utilised by systemic infusion, local fusion, and during per-operative procedures, and finally modern thrombolytic treatments from the plasminogen activator (tPA) to the staphylokinase. A European consensus has allowed to precise indications, contraindications and complications of such treatment (TASC). Recommendation # 59 concludes that there is no more indication for the systemic treatment of acute arterial occlusions with currently available thrombolytic drugs. The contraindications published in 1998 are actually widely known. Current indication remains local thrombolysis. The procedure duration, in addition to the associate risk of complications, is not always compatible with the emergency pattern of the revascularisation necessitated by some acute ischemias. Intra operative treatment is useful in by-pass occlusions. Despite insufficient published data, the combination of surgery and thrombolysis allows reducing both the dose and the duration of the procedure, which can be very important in severe cases of acute ischemia.     

Fermeture des fuites para-prothétiques des TAVI

Literature concerning transcutaneous symptomatic para valvular cardiac leaks closure (PVLC) after trans aortic valve implantation (TAVI) is relatively scarce. Hereby we present 2 clinical cases, one on an Edwards® Sapien 3 valve and the other one on a Medtronic® Evolut R valve. We present also the preliminary results of the 7 PVLC on TAVI included in our prospective FFPP registry during the 2 first years of enrolment (2017–2018), for a total of 158 inclusions for all valves. Seven procedures were performed on 8 leaks, using a majority of vascular plugs (3 Abbott® Amplatzer Vascular Plugs 2 (AVP2), 3 AVP3, 1 AVP4, and 1 muscular Ventricular Septal Defect (VSD) occluder). All procedures were successful without complication. At 1-month follow-up, all patients became asymptomatic. One-year follow-up was already available for 4 patients: 3 of them were symptoms free, and one–who had a second leak not suitable for PVLC-, underwent a « TAVI in TAVI » procedure 2 months after PVLC. This short experience demonstrates the feasibility, the efficacy and the safety of PVLC on TAVI. We expect to be able to offer more in depth information at the end of our prospective ongoing study.     

Manifestations auto-immunes et inflammatoires des hémopathies lymphoïdes

In this literature review, we reported autoimmune and inflammatory disorders associated with lymphoid hematological malignancies, including non-Hodgkin's lymphoma, Hodgkin's lymphoma and chronic lymphocytic leukemia. The different types of systemic involvement are classified by affected organ. We listed in this review the joint diseases, skin, neurologic, hematologic, renal, and vasculitis. We tried to determine whether there is a correlation between each autoimmune manifestation and a specific type of lymphoma or a particular feature that may support a paraneoplastic origin, if there is an impact on the prognosis of the hematological malignancy, and finally, we identified the different therapeutic strategies used in the literature.     

Die Frühdiagnose des Carcinoms des Verdauungstraktes durch P32

Zusammenfassung Mit Radiophosphor ist das Frühstadium eines Krebses leichter zu erfassen als bisher. Durch die Verwendung von kleinsten Geiger-Zählern kann mittels des exakten Nachweises der Strahlenwerte der verschiedenen Gewebe das Carcinom des Oesophagus, Magens und Rectums genau nachgewiesen und lokalisiert werden.Mit 6 Textabbildungen     

Über die Zunahme des Bronchialcarcinoms im Sektionsmaterial des Frankfurter Pathologischen Instituts

Zusammenfassung In einem Zeitraum von 20 Jahren wird an 31770 Sektionen nachgewiesen, daß die Bronchialcarcinome nicht nur zahlenmäßig, sondern auch im Verhältnis zu den Sektionen und den übrigen Carcinomen echt zugenommen haben. Das Bronchialcarcinom wird in den letzten 7 Jahren durchschnittlich 4,0mal so häufig bei Männern gefunden wie bei Frauen. Die steigende Häufigkeit ist sowohl bei den Männern als auch bei den Frauen vorhanden, doch stellt bei letzteren die Zunahme keine echte dar, wegen der großen Fehlerbreite der kleinen Zahl. Veränderungen im Aufbau der Bevölkerung werden für das Zustandekommen des Anstiegs der Bronchialcarcinome in den letzten Jahren ausgeschlossen. Während das Durchschnittsalter der Obduzierten und der Carcinomkranken schlechthin höher geworden ist, ist das Durchschnittsalter der Bronchialcarcinomträger konstant geblieben.Mit 4 Textabbildungen.     

Stellenwert des kontrastverst?rkten Ultraschalls bei der Beurteilung des Morbus Crohn

Ohne Zusammenfassung

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Pr?vention des Schlaganfalls

On the background of aging population an increase of patients suffering from stroke has to be expected during the next years and decades. Strokes are the 3rd leading cause of death and reason for disability in Germany and many other countries. An effective treatment of the modifiable risk factors hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, smoking, alcohol consumption, and adipositas is of enormous impact. Due to the linear relationship between blood pressure and risk of stroke, the treatment of hypertension is the most important and effective one in primary as well as in secondary prevention. Treatment with platelet inhibitors plays an additional important role in secondary prevention. Patients with atrial fibrillation should receive an effective oral anticoagulatory therapy when there are certain risk factors.     

R?ntgenuntersuchung des Thorax

The standard radiographic views of the thorax are the upright posteroanterior (PA) and lateral projections. On a correctly exposed image the lung parenchyma should be visible, as well as the complex structures of the chest wall. This teaching item describes the normal anatomy of the lungs, mediastinum, and diaphragm as demonstrated on plain chest radiographs. Various technical factors, notably the tube voltage, the focus-detector distance, and the anti-scatter grid used, determine the radiation exposure as well as the image quality. Mobile chest radiography of bedbound patients has severe shortcomings such as undesirable magnification, long exposure times, and difficulty aligning the X-ray beam with the anti-scatter grid. In daily practice data acquisition, display, and storage take advantage of the digital technique. In the near future new reconstruction methods will cut the radiation exposure of CT dramatically and broaden the spectrum of clinical applications.     

Über die Bedeutung der freien SH-Gruppen für die Aktivität des Agens des Rous-Sarkoms und des Shope-Papillom-Virus

Summary It is reported on experiments with the Rous-sarcoma and the Shopepapilloma. The agent of the Rous-sarcoma can bei inactivated by the SH-blocker p-Chloromercuribenzoic acid. This inactivation proved to be largely reversible by a overplus of Cysteine as SH-donator.Thereby was showed, that the agent of Rous-sarcoma contains free SH-groups. By the reactivation with Cysteine was proved, that in this loss of activity does not lie before a toxic denaturation by the p-Chloromercuribenzoic acid, but the place of attack are the free Sh-groups.The completeness of the loss of activity shows, that these free SH-groups are necessary for formation of tumor.These resultates tend to show further, that the free SH-groups play a important role in the intracellular binding of the agent. The inactivation of the Rous-agent by oxidation may attack at least in part, if not even exclusively in the free SH-groups.For the virus of Shope-papilloma could not be proved by the employed method free, for activity needed SH-groups.     

Das hepatozellul?re Karzinom aus der Sicht des Internisten und des Chirurgen

Hepatocellular carcinoma (HCC) is the 5th most common cancer in the world and the 3rd cause of cancer-related death. Despite therapeutic advances, the overall survival of patients with HCC has not significantly improved in the last decades. Because in the majority of patients HCCs develop in a cirrhotic liver, the patient’s prognosis depends not only on the tumor stage but also on the liver function. Patients at an early stage with an asymptomatic single HCC with a maximum diameter of 5 cm or up to three nodules each less than 3 cm may benefit from curative therapies, including resection, liver transplantation, and percutaneous ablation. Patients exceeding these limits, but who are free of cancer-related symptoms and vascular invasion or extrahepatic spread, may benefit from palliation with chemoembolization. The advanced stage is characterized by mild cancer-related symptoms and/or vascular invasion or extrahepatic spread. Patients at this stage are eligible for treatment with sorafenib; however, a variety of other new drugs, including small molecules and antibodies, are being tested in randomized controlled trials. The development and evaluation of novel HCC treatment strategies as well as the implementation of existing measures and the development of new ones to prevent HCCs are of utmost importance. A better understanding of the clinical and molecular pathogenesis of HCCs should lead to improved diagnostic, therapeutic, and preventive strategies, with the aim to reduce the incidence of HCC, one of the most devastating malignancies worldwide.