Biomedical subjects
Publications and source records attributed to A Guthoff.
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We report our first case of symptomatic traumatic neuroma in the liver hilum after orthotopic liver transplantation. Compression of the hepatic artery caused extraluminal obstruction and resulted in perfusion damage to the graft. Moreover, intimal hyperplasia of the hepatic artery was present. Retransplantation was necessary because the hepatic artery was not salvageable. Potential pathophysiological mechanisms for these findings are discussed.
A 41-year-old man with type II diabetes for the past five years had for three weeks been suffering from high fever (up to 40 degrees), feeling of pressure in the upper abdomen, loss of weight, lack of appetite and increasing weakness. Ultrasound examination as an out-patient was suspicious of diffuse liver metastases from an unknown primary tumour. Ultrasonography and computed tomography after hospitalization suggested multiple liver abscesses. Fine-needle biopsy grew Yersinia enterocolitica. In addition, there was evidence of an asymptomatic intestinal Yersinia infection without septicaemia. After intravenous treatment with three times daily 5 g mezlocillin and three times daily 80 mg tobramycin the fever at first subsided, but the liver abscesses remained unchanged. When fever recurred a week later, cefotaxim, three times daily 2 g, was started. This led to complete regression of the abscesses within three weeks, and the patient has been free of symptoms since.
Between November 1988 and February 1990, a total of 180 patients (76 men and 104 women; mean age 59 [17-79] years), suspected of having sustained a deep-vein or pelvic thrombosis were examined by colour Doppler ultrasound, the results being compared with those obtained by conventional phlebography. For 154 phlebographically confirmed acute venous thromboses (demonstrated by colour Doppler ultrasound in 153), four older thromboses (colour Doppler ultrasound: 7), and 22 without significant venous disease (colour Doppler ultrasound: 20), the specificity for colour Doppler ultrasound was 99%, its sensitivity 94%. In 49 patients with confirmed venous thrombosis thrombolytic treatment was started with 250,000 IU urokinase, followed by 62,500 IU hourly, the results being assessed by colour Doppler ultrasound and phlebography. This gave a specificity, compared with phlebography, of 99%, and a sensitivity of 97%. These data indicate that, in the diagnosis of venous thrombosis of the legs, colour Doppler ultrasound noninvasively provides information at least as reliable as phlebography. It may even be superior to phlebography in the demonstration of residual flow in partly thrombosed veins.
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Knowledge of common complications of central venous catheters is completed by a case of bacterial tricuspid endocarditis with recurrent pulmonary infarction. This rare, life threatening complication should be considered in differential diagnosis, when in case of central venous catheter sepsis, changing pulmonary infiltrations with pleural effusion as well as different auscultatory findings above the tricuspid valve do occur. The diagnosis can be supported by echocardiographic demonstration of tricuspid vegetations.
Primidone (PRIM) is metabolized into phenobarbital (PB) and phenylethylmalonamide (PEMA). During anticonvulsant therapy with PRIM under normal conditions PB represents by fat the largest portion of the total concentration of all three components (PRIM + PB + PEMA). In combined therapy with diphenylhydantoin (DPH), and during chronic PRIM overdosage, the relative concentration of PB is even higher. A case of renal insufficiency while on PRIM therapy and a case of acute PRIM intoxication are presented. In both cases PRIM and PEMA are elevated while PB is relatively low. The mechanisms involved in this phenomenon are discussed. Excluding young children with chronic PRIM overdosage, and the endogenous and exogenous intoxication described here, a relative PB concentration below 40% indicates a lack of patient compliance if a steady treatment schedule has been maintained for at least 3 weeks.