112. Was Leistet die Computertomographie bei der Lokalisationsdiagnostik des primären Hyperparathyreoidismus?

Langenbeck's Archives of Surgery -     

Buchbesprechungen

Ohne Zusammenfassung     

Nitroglycerin and isosorbide dinitrate in pulmonary hypertension of chronic obstructive pulmonary disease

The effects of sublingual isosorbide dinitrate (ISDN; 10 mg) or nitroglycerin (NTG; 1 mg) on pulmonary hemodynamics, gas exchange and pulmonary function were studied during right heart catheterization in two series of 27 patients with COPD. An immediate significant decrease of pulmonary arterial pressure, cardiac output and work of the right ventricle was obtained with both drugs, but NTG only was able to reduce the pulmonary vascular resistance. Arterial oxygen tension did not decrease, but venous O2 tension did, with no change in blood lactate. NTG had also a slight bronchodilating effect. After chronic use, no improvement of pulmonary function or gas exchange was observed but NTG lowered pulmonary vascular resistances significantly. The effects observed during the acute study were reproduced after six weeks with the same doses of both drugs. NTG appears effective in reducing pulmonary arterial hypertension mainly by vasodilation while the ISDN effect seems due only to the decreased cardiac output.     

Pattern of soluble TNF receptors I and II in sepsis

Summary The serum levels of soluble TNF receptors I (sTNFR I) and sTNFR II were measured frequently in 14 patients with sepsis to evaluate the pattern of these TNF antagonists in relation to TNF alpha, Soluble TNFR I and II could be detected in all samples with significantly higher levels (p<0.001) compared to healthy controls. The concentration of sTNFR I as well as sTNFR II was significantly higher in nonsurvivors compared to survivors during the first 36 h of sepsis (p<0.001). Levels remained elevated throughout the evaluation with maximal values in patients who died. A positive correlation exists between both receptors and between soluble receptors and simultaneously obtained sepsis score (p<0.01) while TNF immunoreactivity detected in 80% of all samples did not correlate to soluble receptor levels or sepsis score. Soluble receptors were constantly found in the circulation representing the inflammatory state throughout the evaluation even when TNF activity was undetectable.

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Kinetik der löslichen TNF-Rezeptoren I und II bei Sepsis

Zusammenfassung Die Serumspiegel der löslichen TNF-Rezeptoren I (sTNFR I) und II (sTNFR II) wurden in kurzen Zeitabständen bei 14 Patienten mit der Diagnose einer Sepsis bestimmt, um die Kinetik der natürlich vorkommenden TNF-Antagonisten in Relation zu TNF alpha zu untersuchen. Die sTNFR I und II waren signifikant gegenüber gesunden Kontrollprobanden erhöht (p<0,001). Die Serumkonzentrationen sowohl des sTNFR I als auch des sTNFR II waren während der ersten 36 Stunden der Sepsis bei den Patienten, die verstarben, signifikant höher als bei den Überlebenden (p<0,001). Die Konzentrationen blieben während der weiteren Messungen erhöht und zeigten maximale Werte bei Patienten mit einem letalen Ausgang. Eine positive Korrelation bestand zwischen den beiden löslichen Rezeptoren sowie den Rezeptoren und dem gleichzeitig bestimmten Sepsis Score (p<0,01), während die Immunreaktivität von TNF alpha, die in 80% aller Proben gemessen wurde, keine positive Korrelation zu den löslichen TNF-Rezeptoren oder dem Sepsis Score aufwies. Die löslichen TNF-Rezeptoren I und II können während der Sepsis zu jedem Zeitpunkt und auch dann nachgewiesen werden, wenn keine meßbare TNF-Aktivität vorliegt.

     

Bilio-duodenal jejunum interposition as a technical alternative to Roux-Y reconstruction following reconstruction of cancer of the fork of the hepatic duct

The inability to predict preoperatively whether resection will result in tumorfree or at least tumorinfiltrated margins, represents one essential problem in surgical treatment of central bile duct carcinoma. In a certain number of cases the operation ends with a tumorinfiltrated biliodigestive anastomosis usually performed in a Roux-en-Y-technique. In those cases early tumor recurrence is predictable, but any follow-up and treatment by endoscopic methods (laser resection, pigtail drainage) are inhibited by the long jejunal limb of the Roux-en-Y-reconstruction. Therefore we changed our operative procedure in patients with central bile duct carcinomas performing the reconstruction of intestinal bile drainage by a cholangio-duodenal interposition of a 25 cm jejunal segment. This technique now allows endoscopic reintervention in cases of recurrent tumors or benign strictures of the anastomosis which is demonstrated.     

Species identification of mycobacteria in paraffin-embedded tissues: frequent detection of nontuberculous mycobacteria.

Diagnosis of infections caused by mycobacteria, especially nontuberculous mycobacteria still represents a difficult task both in microbiology and pathology. The aim of this study was to determine the frequency of mycobacterial DNA detectable by PCR in formalin-fixed paraffin-embedded tissues showing suspicious granulomatous lesions. A total of 190 archival specimens were analyzed, using a nested PCR protocol, which amplifies a fragment of the mycobacterial 65-kDa heat-shock protein gene. Restriction fragment-length polymorphisms and sequencing were utilized to further analyze the obtained PCR products. Corresponding microbiological culture results were available for 41 cases. We detected mycobacterial DNA in 119 cases (63%), of which 71 (60%) were positive for Mycobacterium tuberculosis complex DNA and 41 (34%) for DNA of nontuberculous mycobacteria. Seven cases (6%) could not be subtyped for technical reasons. The largest group of nontuberculous mycobacteria comprised 29 cases (25% of the 119 positive cases), which were assigned to Mycobacterium fortuitum complex. Mycobacterium avium-intracellulare complex was detected in eight (7%) cases, Mycobacterium gordonae in three (2.5%) and Mycobacterium rhodesiae in a single case (0.8%). All cases of Mycobacterium tuberculosis were unequivocally identified by restriction fragment-length polymorphism analysis. In contrast, sequencing provided a gain of information over restriction fragment-length polymorphism analysis in 37% of the nontuberculous mycobacteria cases (15 of 41). Alignment studies on DNA of nontuberculous mycobacteria showed frequent sequence variations, supporting the existence of sequevars. Comparison of molecular data to available results of microbiological culture assays showed a good concordance of 83%. In conclusion, amplification and sequencing of the mycobacterial 65-kDa heat-shock protein gene is an excellent tool for species identification of mycobacteria, especially nontuberculous mycobacteria, in formalin-fixed paraffin-embedded tissues.     

Preliminary results of cytotoxic monoclonal antibody treatment in pancreatic adenocarcinomas and biliary tract carcinomas

Fifteen patients with biliopancreatic carcinoma were treated by monoclonal antibodies (12 pancreatic adenocarcinomas, 3 bile duct carcinomas). In 7 cases, a tumor resection was associated with immunotherapy: 5 partial pancreatic resections for stage III and IV disease, according to Hermreck's classification, and 2 biliary resections (Whipple resection for distal duct tumor, biliary and liver resection for proximal bile duct tumor). We use the 17-1.A antibody, an IgG-2a murine monoclonal antibody, either isolated (6 cases) or in association with other monoclonal antibodies (4 cases) or gamma IFN (5 cases). All of these patients underwent leukapheresis. Response to 17-1.A therapy was evaluated by laboratory tests (CA 19-9) and by morphological investigations (US, CT, radioimmunolocalization scanning). The median survival of patients with unresectable pancreatic carcinoma (7 cases), was 7.4 months. For pancreatic adenocarcinoma, treated by resection associated with immunotherapy (5 cases), the median survival was 21 months. Monoclonal antibody therapy was effective in a third of evaluated pancreatic adenocarcinomas (4 clear objective responses) but only transiently except in one patient still alive after 57 months. The low rate of therapeutic responses may been attributed to inadequate doses and the development of human anti-murine antibodies.