Biomedical subjects
H Pippert
Publications and source records attributed to H Pippert.
[Hemorrhagic pseudocysts and pseudoaneurysms in pancreatitis. Diagnosis and therapy].
Acute hemorrhage from pseudocysts and pseudoaneurysms is a threatening complication of chronic pancreatitis. Whilst surgical intervention still has high perioperative mortality (16.8%), transcatheter arterial embolization is becoming more frequently used for suitable cases and appears to have lower mortality (6.1%). We report on six patients treated in our unit. Four of them underwent primary surgical treatment, the other two were treated by embolisation. One of the latter patients subsequently required laparotomy for further treatment. All six patients survived. Comparing the literature covering the periods between 1951 and 1981 and between 1982 and 1996, transcatheter embolisation seems to be valuable in controlling this type of bleeding, thereby reducing mortality.
[Ectopic thyroid tissue: an unusual differential diagnosis of space-occupying mediastinal lesions].
The differential diagnosis of soft tissue masses of the anterior mediastinum includes cervical goiter extending into the mediastinum, germ-cell tumors, masses originating from the thymus, lymphoma and sternal tumors. A rare cause is ectopic mediastinal goiter without a link to the cervical thyroid. We report the case of a 36-year-old female patient with accidental chest X-ray finding of a large mass ([symbol: see text] 7 cm) in the anterior mediastinum. CT showed a hypodense mass with homogeneous enhancement and calcifications. There was no evidence of invasion in other organs. CT-guided biopsy revealed thyroid tissue. The cervical thyroid was normal in CT, ultrasound and 123I-scintigraphy; no link to the mediastinal goiter was detectable. Radionuclide uptake in the latter was homogeneous. Since malignancy could not be ruled out definitively, the mass was removed by thoracotomy and a vascular pedicle originating from the mediastinum was found. Pathologic evaluation confirmed the preoperative diagnosis of ectopic mediastinal goiter.
Vertebral osteomyelitis caused by group B streptococci (Streptococcus agalactiae) secondary to urinary tract infection.
Infections due to group B streptococci usually occur in the peri- and neonatal setting or in adults with chronic underlying diseases. A case of pyogenic vertebral osteomyelitis caused by Streptococcus agalactiae in a 54-year-old man suffering from phimosis with urinary retention and urinary tract infection is reported. This case adds to the few existing reports of vertebral osteomyelitis caused by group B streptococci.
Acute median nerve compression at the distal forearm caused by a thrombosed aneurysm of an epineural vessel: case report.
The case of a patient with a 2-day history of symptoms suggesting acute carpal tunnel syndrome is presented. However, an urgent electroneurographic examination revealed median nerve compression at the forearm and magnetic resonance imaging confirmed compression by a mass proximal to the carpal tunnel. Surgical exploration showed a recently thrombosed aneurysm of an epineural vessel. Histological and, later, general and angiological investigations could not reveal the underlying cause of this aneurysm. Preoperative electrodiagnostic examination is recommended in acute peripheral nerve compression to prevent decompression at an incorrect site. If atypical nerve compression is suspected, magnetic resonance imaging may be indicated to detect localized nerve compression and its underlying cause.
[Portal venous thrombosis following splenectomy in portal hypertension: risks and management].
Splenectomy intended to treat hypersplenism can, in the presence of portal hypertension (PTH), lead to extrahepatic portal and mesenteric vein thrombosis. The management of possible variceal bleeding in patients with extrahepatic portal vein occlusion following splenectomy in portal hypertension is a problematic and challenging undertaking. We report on the management of variceal bleeding in 2 noncirrhotic patients with PTH who developed portal vein thrombosis following ill-advised splenectomy. It must be stressed again that splenectomy alone intended to control hypersplenism in portal hypertension is to be avoided at all costs. Options for the treatment of portal and mesenteric vein thrombosis and variceal bleeding are proposed.
[Aortobronchial fistulae as late complications following the surgical correction of aortic isthmus stenosis].
Three patients (2 men, aged 39 and 52 years, one woman, aged 47 years) developed hemoptysis 3-19 years after surgical resection of coarctation of the aorta. Digital subtraction angiography in the two men was suspicious of an aortobronchial fistula. An emergency thoracotomy revealed the diagnosis in the woman: she died during the operation of intractable arterial bleeding, the initial operation having been atypical (insertion of a graft extending across the isthmus to the ascending aorta). The 52-year-old man died of left heart failure after pneumonectomy (for massive bleeding into the left lung). An aneurysm sack at the aortic isthmus was resected and a vascular graft implanted in the 39-year-old man. There have been no further hemoptyses. These cases emphasize the need for including aortobronchial fistula as a cause of hemoptysis.
[A rare constellation of findings: bile duct cancer, ulcerative colitis, deep venous thrombosis of the leg].
A case of a 28-year-old patient with long-standing chronic ulcerative colitis is presented, in whom cholangiocarcinoma was diagnosed by CT and ultrasound guided liver biopsy. This association is well known, because the incidence of bile duct carcinoma in patients with chronic ulcerative colitis is increased. A possible precursor of the disease is thought to be primary sclerosing cholangitis which also more frequently occurs in patients with ulcerative colitis. Our patient was initially hospitalized for deep venous thrombosis, which in retrospect had to be interpreted as a paraneoplastic syndrome.
[Life threatening aortobronchial fistula as a late complication following surgical correction of aortic isthmus stenosis].
An aortobronchial fistula is a rare cause of hemoptysis and most commonly occurs in patients with thoracic aneurysms. If undiagnosed, this entity is uniformly fatal. However, with early recognition and surgery, the survival rate exceeds 80%. We present history and outcome of 3 patients with fistulas due to previous surgery of coarctation of the aorta and discuss the value of different diagnostic procedures.
[Hemolytic anemia as a result of hemodynamically-insignificant paravalvular dehiscence of St. Jude-Medical aortic valve prosthesis].
The course of a patient with aortic valve replacement is reported in whom increased intravascular hemolysis and auscultatory findings were suspicious of paravalvular dehiscence although other non-invasive examinations did not reveal pathological findings. Heart catheterization showed nearly normal pressures and angiocardiography minimal diastolic transaortic regurgitation. Nevertheless the patient had to be reoperated due to severe hemolytic anemia. Successful closure of the periprosthetic leakage resulted in prompt normalisation of laboratory findings of hemolysis.
[Benefits of endocarditis prevention in patients with prosthetic heart valves].
The beneficial effect of prophylaxis for IE was studied in 229 patients with prosthetic heart valves in whom 287 diagnostic or therapeutic interventions were performed. The prevention used was similar to that recommended by the American Heart Association. Prosthetic valve endocarditis was not observed in any of these patients. This result was compared with that of 304 patients with prosthetic heart valves, in whom without any prevention 390 similar interventions were performed during the same observation period. The incidence of prosthetic valve endocarditis occurring within 14 days after the intervention was 1.5/100 interventions (n = 6). All patients had to be reoperated. One patient died perioperatively. Two more patients developed prosthetic valve endocarditis 8 and 13 weeks, respectively, after the initial intervention. This retrospective study documents the benefit of the prophylaxis for IE used.