Biomedical subjects
K Mathias
Publications and source records attributed to K Mathias.
[Acute kidney failure in a recurrence of sarcoidosis at the height of summer].
HISTORY AND FINDINGS: A 35-year-old woman with sarcoidosis, successfully treated 3 years previously, developed fatigue, nausea and loss of weight during a summer holiday in Italy where she was exposed to much bright sun. There had been no previous recurrence of the sarcoidosis. On return she was found to be in renal failure with marked hypercalcaemia. Physical examination merely revealed peasized non-tender submandibular and cervical lymph nodes, but was otherwise unremarkable. INVESTIGATIONS: Serum creatinine and calcium concentrations (3.8 mg/dl and 3.6 mmol/l) were markedly elevated. Computed tomography showed an enlarged submandibular lymph node, but no other organ abnormality. Biopsy of the salivary gland demonstrated recurrent sarcoidosis. TREATMENT AND COURSE: Calcium concentration became normal (2.4 mmol/l) within two weeks of treatment with methylprednisolone (100 mg daily for 3 days, followed by gradual reduction to 30 mg daily for 3 months, until discontinued slowly). Creatinine concentration, which had fallen to 1.5 mg/dl, was at the upper limit of normal (1.1 mg/dl) after 4 months and 0.8 mg/dl after 8 months. CONCLUSION: Marked exposure to UV light should be avoided in patients with a history of recent sarcoidosis, because it increases the formation of vitamin D3 precursors: In the case of recurrent sarcoidosis, these precursors are converted to 1,25 dihydroxyvitamin D3 in the sarcoidosis granulomas. This can lead to severe complications, such as hypercalcaemia and renal failure.
[Semiquantitative detection of pain and heat sensations in evaluation of contrast media in pelvic/leg angiography. Intraindividual double-blind study with iomeprol 350 and iopentol 350].
The effect on pain and heat sensation of monomere non-ionic contrast media with different osmolality was assessed in a randomized double-blind study. Peripheral angiography was performed in 29 patients who suffered from chronic occlusive vessel disease. The two non-ionic contrast media iomeprol and iopentol were applied intraindividually. The contrast media with an iodine concentration of 350 mg/ml had an osmolality of 618 or 810 mosm/kg. A contrast medium volume of 80 or 90 ml was injected in the abdominal aorta. The mean flow was 13.9 ml/s. The two contrast medium injections were separated by an interval of 10 min. No analgesic premedication was given. The pain and heat intensity was semiquantatively measured using a visual analogue scale ranging from 0 (no heat/pain) to 100 (intractable heat/pain). The median after the first injection was calculated as 40 for iomeprol and 70 for iopentol. The comparison of heat and pain sensations after the second injection showed a less distinct difference with a scale rating of 60 for iomeprol and of 65 for iopentol. The statistical variance was highly significant (p < 0.01) in favor of iomeprol.
Gastric leiomyosarcoma in a child.
Gastric leiomyosarcoma is a rare tumor in pediatric patients. The histological differentiation between leiomyoma and leiomyosarcoma is difficult. Computed tomography may allow the presumptive diagnosis of leiomyosarcoma to be made preoperatively and the surgical treatment can be planned in advance. We report a case of gastric leiomyosarcoma in a 2-year old boy. Ultrasonography and computed tomography demonstrated an inhomogeneous mass with areas of tumor necrosis and calcifications in the left upper quadrant.
[Complications of an idiopathic rhabdomyolysis (Meyer-Betz syndrome) after physical exertion].
A few hours after a 15 km march a 19-year-old man developed a fever of 40 degrees C, accompanied by hemoptysis, tarry stools and pain in the thigh. On physical examination there was tenderness and swelling over the shoulders, upper arms and thighs as well as petechiae, bruises, hepatomegaly, pain on percussion over the kidney region and signs of hypovolaemia. There was leukocytosis (18,800/microliters) and increased creatinase activity (3900 U/l, rising to 66,300 U/l after 24 h). The platelet count fell from 147,000 to 11,000/microliters, the fibrinogen level to 0.25 milligrams. On the second day serum creatinine was 4.1 mg/dl, urine volume 50 ml/24 h, urinary myoglobin concentration 120,000 micrograms/l. The Quick value dropped to under 3%, while liver enzymes and bilirubin concentration rose. The rhabdomyolysis caused acute respiratory failure, despite symptomatic treatment of the acute renal failure and consumption coagulopathy, but after 8 weeks of intensive treatment the patient was discharged without symptoms. No cause other than the preceding physical exertion was found for the rhabdomyolysis. Muscle biopsy revealed unspecific changes 4 1/2 months after discharge.
The boneless neonate: a severe form of achondrogenesis type I.
We report a case of a severe form of achondrogenesis type I. Prenatal ultrasonography showed a micromelic fetus; bony structures could not be identified. Postnatal radiographs revealed some foci of ossification in the ossa ilia, the clavicles, the upper and the lower jaw and the base of the skull. The long bones, the vertebral column and the ribs were not visible. The diagnosis was established by histologic examination of the growth plates.
Lead dislodgment of a permanent pacemaker due to removal of a temporary pacing electrode.
A 63-year-old male received a transvenous temporary pacemaker for bradyarrhythmia following mitral valve replacement and tricuspid valve annuloplasty. A transvenous permanent pacemaker was implanted the following day due to persistence of the bradyarrythmia and pacemaker dependency of the patient. Later the same day during removal of the temporary pacing electrode the permanent pacing lead was dislodged and had to be operatively repositioned. To avoid this complication, the position of pacemaker leads should be checked postoperatively with a frontal and lateral chest radiograph, and fluoroscopy should be used during removal of a temporary lead.
[Pain in the left iliosacral region. Plasmacytoma of the ilium].
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[Contrast medium intolerance in computerized tomography].
An adverse reaction to a contrast medium with swelling of the nasal mucosa was incidentally documented during a computer tomographic examination of the skull, showing how fast liberation of mediator substances can cause mucosal edema.
[The radiological findings in adamantinoma of the long tubular bones].
The radiological findings of adamantinomas of long bones are described in 22 patients. The diagnosis was confirmed by a team of experts (pathologist, radiologist, orthopaedic surgeon) of the "Bone tumour study group" at the German Cancer Research Center. There were 12 male and 10 female patients aged 5 to 67 years (most commonly in the second and third decade). In 21 patients the tibia was involved and in one patient the fibula. The tumour was nearly always in the diaphysis (20 cases). The most striking radiological feature was a diaphyseal lesion confined to the bone showing multicentric translucencies. The latter showed surrounding or central ring shaped or focal areas of increased density. The lesions tended to be longitudinal, averaging 11 cm (between 3 and 25 cm). All lesions showed a sclerotic margin separating it from normal bone, at least over part of the lesion. Expanding lesions were mostly separated from the soft tissues by a bony rim (18 cases).
[Diagnostic and therapeutic strategies in locally recurrent rectal cancer].
Following curative operation for rectal cancer, 14-44% of the patients develop a local recurrence, in most instances situated in the operative bed. Differentiation of recurrent tumor, scar tissue and inflammation is not always possible by computerized tomography and magnetic resonance imaging. Recurrent tumor in these patients is diagnosed by percutaneous biopsy and histological analysis. In 24 patients in whom operation was impossible and a maximum irradiation dose was also applied, chemotherapy was administered in the form of regional perfusions. The internal iliac arteries were perfused with folinic acid and 5-fluorouracil in these patients. This procedure reduced the intensity of pain or achieved a pain-free interval of 9 days to 8 months.
Local thrombolysis for salvage of occluded bypass grafts.
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[Grand mal seizure. Laminar heterotopy of the gray substance].
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[Cardiac arrhythmias. Amiodarone liver].
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[Cancer of the colon? Chronic intestinal pseudo-obstruction].
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[Diagnostic imaging of thalamic infarcts].
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[Cerebral calcification in idiopathic hypoparathyroidism].
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[Nonsurgical treatment of a massive macrohematuria following kidney biopsy].
In the treatment of massive hematuria after renal biopsy, selective percutaneous vaso-occlusion with detachable balloons is an effective alternative to urological surgery, as demonstrated in the case of a 39-year-old man. A review of the literature, which records success rate of more than 90% in nonmalignant renal hemorrhage, confirms the therapeutic value of the various parenchyma-sparing embolization techniques.