A voluminous vascular leiomyoma of the pancreas treated by personal technique of resection of the pancreatic head without duodenectomy

A new technique variation of complete resection of the pancreatic head with preservation of the duodenum is described. The steps of this intervention are the partial mobilization of the duodenum, the mobilization of the gastric antrum, the section of the pancreatic neck and the complete resection of the pancreatic head with a meticulous dissection/section of the small blood vessels connecting the duodenum and the head of the pancreas. The terminal part of choledochus is removed with the specimen of the pancreas. The intervention is completed with cholecystectomy, end-to-side pancreaticojejunostomy, end-to-side choledocho-jejunostomy and side-to-side jejunojejunal anastomosis. The authors carried out this intervention on a 74-year old woman with a voluminous vascular leiomyoma of the pancreatic head. The patient, two years after the operation, is well with a normal clinical and laboratory follow-up.     

Nasal inflammation and chronic ear disease in Australian Aboriginal children

Objective : Chronic middle ear disease is common in Aboriginal children, and may be linked to nasal inflammation and Eustachian tube dysfunction. The pattern of nasal inflammation is unknown. The study reported here was performed to define the role of allergy and infection in causing nasal inflammation in Aboriginal children with chronic middle ear disease.
Methodology : Thirty-one Aboriginal children aged between 3 and 7 years underwent clinical assessment, audiometry and allergy skin tests. Nasal swabs for bacterial culture and cytology were performed during the winter and again in spring to identify any seasonal variation. A randomized trial of nasal beclomethasone for 8 weeks was conducted in children with abnormal tympanometry to identify the effect of therapy upon nasal cytology.
Results : Twenty-six of the 31 children had abnormal tympanograms. Average hearing levels were reduced in nine children. Pathogenic organisms were isolated from most children: Streptococcus pneumoniae (82%), Haemophilus influenzae (79%), Moraxella catarrhalis (39%) and Staphylococcus aureus (29%). Eight of the 31 children (26%) were atopic. Nasal cytology disclosed a marked neutrophil infiltrate (80% of cells) during the winter, which fell significantly in spring to 52% of cells. Only two subjects had nasal eosinophilia of >10%. There was no effect of beclomethasone on nasal cytology.
Conclusions : Chronic ear disease in Aboriginal children is associated with nasal inflammation, neutrophil infiltration and the presence of bacteria. These features suggest respiratory infection as the main cause of chronic nasal inflammation in Aboriginal children with middle ear disease. There is a seasonal variation in the severity of the nasal infiltrate, consistent with increased infections during winter. Despite a high prevalence of atopy, allergic nasal disease was uncommon.     

Multiple myeloma associated with systemic lupus erythematosus

A case of systemic lupus erythematosus (SLE) complicated by multiple myeloma is presented; the lupus diagnosis was put together with the diagnosis of myeloma but the symptoms had commenced a few years before. The putative mechanisms underlying this unusual combination are discussed.     

Treatment of Behçet's disease--an update

OBJECTIVES: To report the experience of the investigators and review the major treatment trials conducted for Beh?et's disease (BD). METHODS: A MEDLINE literature review from 1970 to date was performed on the drugs prescribed for the treatment of BD. Open and controlled clinical studies and indications for the treatment of affected organs are analyzed. RESULTS: Glucocorticoids are indicated for the treatment of BD, although no controlled studies have been reported. The combination of corticosteroids and immunosuppressant drugs is used when vital organs are involved. Nonsteroidal anti-inflammatory drugs are of little value in arthritis. In controlled trials, colchicine was efficacious for erythema nodosum and arthritis, particularly in women. Cyclosporine A has a rapid action and when combined with azathioprine is effective in patients with severe uveitis and extraocular manifestations. Chlorambucil is indicated for uveitis and meningoencephalitis. In controlled studies, azathioprine prevented unilateral uveitis from becoming bilateral and improved extraocular symptoms. Pulse cyclophosphamide combined with corticosteroids improves severe systemic vasculitis. Interferon alpha benefits ocular and extraocular manifestations, but controlled studies are lacking. Methotrexate is indicated for uveitis and arthritis, and sulfasalazine improves gastrointestinal vasculitis. In controlled trials, thalidomide was effective for mucocutaneous manifestations, but on its discontinuation the disease exacerbated. Orogenital manifestations are treated with local application of corticosteroids or other medications. CONCLUSIONS: Combination therapy is not always efficacious in controlling inflammation. The goal of management is to treat early to avoid recurrences and irreversible damage to the vital organs. With proper management of BD, loss of useful vision was reduced from 75% to 20% of the affected eyes. However, less favorable results are seen for central nervous system and large artery and vein involvement.     

垂全催乳素瘤的诊断和治疗指南

3.男性:高催乳素血症通常导致阳痿、不孕和性功能低下.男性患者通常为大腺瘤,有神经系统症状.其原因可能是对症状认识的延误或者肿瘤生物学行为的差异.     

Kooperationsverträge zwischen Krankenhäusern und Vertragsärzten – Schnittstellenoptimierung oder Zuweisungsprovision?

Abstrakt  1. Eine Vereinbarung zwischen einem Krankenhaustr?ger und niedergelassenen ?rzten als potentiellen Zuweisern, die diesen ein Entgelt für Leistungen verspricht, die sie ohnehin im Rahmen ihrer (vertrags?rztlichen) Versorgung erbringen würden, ist rechts- und wettbewerbswidrig. 2. Eine in der Sache unzutreffende Bezeichnung dieser Zusammenarbeit als “sektorübergreifend” oder “pr?-/post” ?ndert an dieser Bewertung nichts, sondern verst?rkt eher den Verschleierungscharakter derartiger Vertr?ge. 3. Derartige Vertr?ge leisten in verantwortungsloser Weise sachwidrigen Erw?gungen bei der Wahl des geeigneten Arztes oder Krankenhauses Vorschub. (Leits?tze des Bearbeiters)