Epidemiologie und molekulare Pathogenese des hepatozellul?ren Karzinoms

Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide which is still associated with a high mortality due to the few therapeutic options available for patients with advanced stage tumors. Viral hepatitis, alcohol and also probably more often in the future non-alcoholic steatohepatitis (NASH) are important risk factors for HCC. The epidemiological associations should allow further improvement in prevention and surveillance strategies for risk patients in the future. A better understanding of the molecular pathogenesis will allow new targeted molecular therapies to be used for HCC.     

Diagnostik und Früherkennung des hepatozellul?ren Karzinoms

The diagnosis of hepatocellular carcinoma (HCC) in patients without liver cirrhosis is based on histopathological and immunohistological findings. When liver cirrhosis is present HCC can be diagnosed based on typical contrast dynamics in cross-sectional imaging. In contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) HCC shows enrichment of contrast agent in the arterial phase and a typical wash out in the portal venous or late phase. Therapeutic options and prognosis depend on tumor stage at the time of diagnosis. Patients with a higher risk of developing HCC, such as patients with chronic liver diseases with advanced fibrosis or cirrhosis or those with chronic hepatitis B (delta) and C virus infections should be enrolled in surveillance programs. Non-alcoholic steatohepatitis (NASH) was recently recognized as an risk factor for HCC development. Already in precirrhotic stages, surveillance should be performed by conventional ultrasound examination every 6 months. As very small hepatic masses <1?cm do not correlate with HCC in most cases, follow-up examinations should be performed promptly. Regular surveillance examinations can significantly reduce HCC-related mortality.     

Auswirkungen des K+-Kanalblockers Tedisamil auf H?modynamik, Myokardisch?mie und neurohumorales System bei Patienten mit stabiler Angina pectoris.?Ein Vergleich mit dem ?-Blocker Atenolol

BACKGROUND: Clinical drawbacks of beta-blocker treatment in stable angina have motivated researchers to provide alternative heart rat lowering agents, such as tedisamil which additionally exerts anti-ischemic and antiarrhythmic effects by blockade of cellular repolarizing K(+) currents. METHODS AND RESULTS: 48 patients with stable angina pectoris were investigated (double-blind, randomized, parallel grouped) comparing the hemodynamic, anti-ischemic, metabolic and neurohumoral effects of tedisamil 100 mg b.i.d and atenolol 50 mg b.i.d. after a single dose and over 6 days of treatment. Tedisamil and atenolol produced a decrease in heart rate both at rest (day 1: -13.6 vs -15.4 bpm; p > 0.05; day 6: -14.8 vs -22.2 bpm; resp.; p > 0.05) and exercise (day 1: -9.1 vs -18.3 bpm; p = 0. 001; day 6: -12.0 vs -24.8 bpm, resp.; p = 0.001), while anginal threshold increased. Cardiac output decreased with tedisamil and atenolol at rest (day 1: -1.01 vs -1.19 l/min; p > 0.05; day 6: -0. 86 vs -1.10 l/min, resp.; p > 0.05) and exercise (day 1: -0.82 vs -1. 28 l/min; p > 0.05; day 6: -0.65 vs -2.68 l/min, resp.; p = 0.03), while stroke volume remained unchanged. Right atrial pressure changed during exercise only: It decreased with tedisamil (-1.7 mm Hg) and increased with atenolol (+3.7 mm Hg). Mean pulmonary capillary wedge pressures decreased at rest (-0.5 mm Hg) and exercise (-6.9 mm Hg) in the tedisamil group, but tended to increase with atenolol on day 6 (rest: +1.7; exercise: +3.7 mm Hg) (p = 0.03). Arterial pressure decreased under atenolol treatment only. Exercise-induced plasma norepinephrine levels were reduced by tedisamil (-93 pg/ml) but elevated by atenolol (+172 pg/ml) (p = 0. 001). As compared to atenolol, tedisamil produced a significant prolongation of QT (c) interval (+31 vs -8 ms) (p = 0.002) at initial values of 0.408 +/- 0.018 s with PQ and QRS remaining unaltered. CONCLUSIONS: In the present study, tedisamil (100 mg b.i.d. ) generated favorable hemodynamic, neurohumoral and anti-ischemic effects in patients with stable angina pectoris. The anti-ischemic efficacy of tedisamil, as measured by ST segment depression and angina threshold, is comparable to that of atenolol (50 mg b.i.d.).     

Ma?geschneiderte L?sung des Verschlusses beider Vv.?subclaviae bei einem 84-j?hrigen CRT-D-Patienten mit defekter ICD-Elektrode

An 84-year-old patient presented with both adequate and inadequate implantable cardioverter defibrillator (ICD) shocks. The patient had received a single chamber ICD 15 years ago after surviving a sudden cardiac arrest. After progression of the underlying ischemic cardiomyopathy an upgrade to CRT-D was executed 3 years before the incident reported here. The interrogation of the device now revealed both oversensing of artefacts in the RV channel and correctly diagnosed VF with subsequent ICD shock terminating the tachyarrhythmia. As battery power was poor it was decided to exchange the generator and to implant an additional pace/sense lead. Due to complete occlusion of both subclavian veins we decided to implant the additional lead using the transfemoral route. This is the first published case of implantation of an extra pace/sense lead via the transfemoral access in a patient with a defective pace/sense component of the ICD lead.     

Klinische Wertigkeit der intraven?sen Kontrastmittelechokardiographie zur Quantifizierung der linksventrikul?ren Volumina und Funktion bei Patienten mit reduzierter echokardiographischer Bildqualit?t

In the present study, we investigated whether the intravenous injection of air-filled albumin microspheres (Infoson) as a contrast medium improves the echocardiographic quantification of left ventricular enddiastolic and endsystolic volumes, stroke volume, ejection fraction, and regional wall motion in patients with suboptimal endocardial border definition on echocardiography. In 30 adult patients, apical two and four chamber views were performed. In comparison to biplane cineventriculography enddiastolic and endsystolic volumes, stroke volume, ejection fraction, and regional wall function were assessed for heart cycles with and without left ventricular contrast.In comparison to biplane cineventriculography echocardiography underestimates enddiastolic (167+/-64 ml, 111+/-43; p<0.0001) and endsystolic volumes (77+/-63 ml, 54+/-40 ml; p<0.0002), stroke volume (90+/-25 ml, 57+/-17 ml; p<0.0001), and ejection fraction (58+/-16%, 55+/-14%; p<0.03). By contrast echocardiography ejection fraction (58+/-16%) agreed with the angiocardiographically measured ejection fraction. Furthermore, after contrast injection correlations improved between cineventriculography and echocardiography for the assessment of left ventricular enddiastolic volumes (without contrast r = 0.90, SEE = 19 ml; with contrast r = 0.93, SEE = 19 ml), endsystolic volumes (without contrast r = 0.94, SEE = 14 ml; with contrast r = 0.95, SEE = 15 ml), stroke volume (without contrast r = 0.63, SEE = 14 ml; with contrast r = 0.67, SEE = 14 ml), ejection fraction (without contrast r = 0.84, SEE = 8%; with contrast r = 0.88, SEE = 7%), regional wall motion (p<0.01) and its reproducibility (p<0.02). In adult patients with suboptimal endocardial border delineation intravenous contrast echocardiography improves the assessment of left ventricular ejection fraction, regional wall motion, and its reproducibility without severe side effects.     

Die Ver?nderung des Mittels durch das Wachstum normaler und neoplasischer Zellen. Studien mit Kulturen in vitro

Ohne Zusammenfassung     

Beinvenenthrombose mit fulminanter Lungenembolie und Vorhofthrombus des rechten Herzens Thrombolyse oder Embolektomie? Thrombolyse oder Embolektomie?

Bei dem 35 j?hrigen Patienten kam es 10 Tage nach eingeschr?nkter Immobilisierung wegen einer rechtsseitigen Sprunggelenksdistorsion zum Auftreten einer im Verlauf zunehmenden Luftnot unter Belastung. Am 14. Tag erfolgte die Einweisung in die Klinik wegen einer progredienten respiratorischen Insuffizienz unter der Verdachtsdiagnose einer Lungenembolie.