Ergebnisse des seletiven venösen Etagenkatheters (SVK) beim okkulten C-Zell-Karzinom der Schilddrüse

Background: Medullary thyroid carcinoma (MTC) can — even in recurrent cases — only be treated surgically. Therefore, preoperative localization of the tumor is essential.Methods: From April 1986 through April 1997, 137 patients with MTC were operated on at our clinic. In 22 patients with recurrent tumor which had not been radiologically localized, 28 selective venous catheterizations (SVC) with determination of calcitonin levels were carried out.Results: In 23 examinations a suspected tumor could be identified (nine cervical unilateral, seven mediastinal, four cervical unilateral and mediastinal, one cervical bilateral and mediastinal, one liver, one cervical unilateral and liver). In 18 cases surgery was performed for recurrence (nine cervical revisions, one mediastinal dissection, six cervicomediastinal dissections, two laparotomies). In 15 of 18 cases, tumor tissue was found in the previously suspected area. In ten cases serum calcitonin levels dropped postoperatively by 6%–75%. A normalization of the hormone level was achieved only once by yet another operation. During further follow-up, five of the reoperated patients died from their disease. The other 17 patients are being followed up, whereby calcitonin levels are elevated but there is no clinical or radiological evidence of tumor.Conclusions: Although in the patient cohort presented a normalization of serum calcitonin could be achieved only once, the authors consider SVC useful because it is the only means of localization of tumor tissue in cases of negative radiologic studies and therefore allows a planned approach to the operation procedure in these cases.     

Evidence for multiple xenogenous origins of plastids: comparison of psbA-genes with a xanthophyte sequence

Summary When only plastidic features are considered, it is difficult to distinguish between monophyletic and polyphyletic xenogenous origins of plastids. We suggest that a direct comparison of nuclear and plastidic sequence-similarity pattern will help to solve this problem. The D1 amino acid sequence of six major groups of photosynthetic eukaryotes and of the two groups of photosynthetic prokaryotes are now available, including the psbA-gene product from Bumilleriopsis filiformis, which is the first molecular sequence reported for a xanthophycean alga. Evidence is provided for an independent and polyphyletic origin of plastids from five out of the six major taxa of photosynthetic eukaryotes. This conclusion is reached by comparing a plastid-based pattern of D1 similarity with a nucleus-based similarity pattern published recently. Furthermore, the availability of D1 sequences from five eukaryotic algae led to a re-evaluation of the taxonomic position of Prochlorothrix.     

Oesophageal atresia: caudo-thoracic epidural anaesthesia reduces the need for post-operative ventilatory support

The mortality of neonates with oesophageal atresia in the Third World remains high because of delays in presentation and diagnosis. Lack of appropriate intensive care facilities is a further contributing factor. Caudothoracic epidural anaesthesia was used during surgical repair of oesophageal atresia in 35 patients in an attempt to minimise the need for post-operative ventionally support. This group was compared with 36 patients whose surgery was performed under general anaesthesia. The age at the time of referral, sex ratio, and weight were comparable in both groups. Using the Waterson classification, a greater number of poorer prognostic patients were seen in the epidural group (P <0.02). In all Waterson risk categories fewer patients required ventionally support post-operatively, which was statistically significant (P <0.01) when all categories were combined. We are encouraged by our results and believe this technique has a rôle in the management of neonates undergoing major surgery, both where neonatal intensive care exist or is deficient as in many parts of the Third World.     

Lupus vulgaris in a patient with systemic lupus erythematosus and persistent IgG deficiency

We present the case of a patient with juvenile onset systemic lupus erythematosus (SLE) who developed a persistent, acquired hypogammaglobulinaemia with IgG deficiency. The hypogammaglobulinaemia was probably a complication of high dose corticosteroid treatment. The serum IgG level remained subnormal despite intravenous immunoglobulin therapy. Lupus vulgaris, which developed on the nasal cartilage in this patient with SLE, is not an expected finding. This patient is probably the first reported case of SLE associated with lupus vulgaris.     

Risk factors for capillary leakage syndrome after bone marrow transplantation

 Age, hematopoietic growth factors, cyclosporin A, mode of bone marrow transplantation (BMT) (autologous, allogeneic-related, unrelated), and underlying disease were assessed as potential risk factors for capillary leakage syndrome (CLS) in 96 patients after BMT. CLS was defined as unexplained weight gain of >3% within 24 h and nonresponsiveness to furosemide. CLS occurred in 9/21 patients after unrelated compared with 2/33 after allogeneic-related BMT (p=0.0017) for hematopoietic disorders (n=54) and in 6/7 patients after allogeneic-related compared with 3/35 after autologous BMT (p=0.0001) for solid tumors (n=42). Hematopoietic growth factors and cyclosporin A were no signficant risk factors on their own. We conclude that unrelated BMTs or high-intensity conditioning regimens used in combination with allogeneic-related BMT are the main risk factors for CLS. Received: 6 January 1997 / Accepted: 10 March 1997     

Zytopathologie der Prostata

Zusammenfassung Die transrektale, palpatorisch kontrollierte FNAB der Prostata ist eine preiswerte und schnelle Methode zur Diagnostik palpabler und nichpalpabler Raumforderungen mit hoher Sensitivit?t (ca. 95%) und niedriger Komplikationsrate ( <1%). Ihre Spezifit?t betr?gt >97%. Der Mangel an geübten Punkteuren und zytologisch erfahrenen Pathologen schr?nkt jedoch bisher die klinische Anwendung der Methode ein. Neben diversen Formen der Prostatis k?nnen 5 verschiedene Prim?rtumortypen differenziert werden. W?hrend PIN I zytologisch nicht diagnostizierbar ist, mu? man bei PIN-II/III-L?sionen mit falsch-positiven zytologischen Karzinomdiagnosen rechnen. Das zytologische Malignit?tsgrading ist prognostisch relevant und eng mit dem histologischen korreliert. Die pr?operative, radiologisch kontrollierte FNAB pelviner und paraaortaler Lymphknoten tr?gt mit einer Sensitivit?t von ca. 86% und einer Spezifit?t von ca. 100% zur Vermeidung wegen Lymphknotenmetastasierung nicht indizierter Prostatektomien bei. Die diagnostische DNA-Zytometrie erkennt in den konstant und repr?sentativ diploiden und tetraploiden Prostatakarzinomen diejenigen, welche nicht nur ein sehr geringes Progressionsrisiko aufweisen, sondern die auch unbehandelt gegenüber gleichalten gesunden Patienten kein erh?htes Sterberisiko mit sich bringen. DNA-tetraploide Prostatakarzinome zeigen unter Hormontherapie wahrscheinlich eine Verschlechterung der Prognose. DNA-aneuploide Prostatakarzinome dürfen nicht abwartend therapiert werden; sie sprechen auch auf eine Hormontherapie nicht an.