Biomedical subjects
Publications and source records attributed to P Röttger.
The unusual case of a 10-month-old infant with an ectopic refluxing ureter entering into a seminal vesical cyst associated with ipsilateral renal dysplasia is described. The embryology, differential diagnosis, and therapy are discussed.
Five cases of sclerosing lipogranulomas of the external genitalia after previous injection of vaseline are presented. The public should be informed about the disastrous effects of paraffin injections and the importance of a radical but organ-preserving surgical treatment.
A case of malignant mesothelioma of the tunica vaginalis testis is reported in a 77-year-old male patient. There was no history of asbestos exposure. Recurrent right hydrocele with a papillar inguinal mass was the main clinical feature. An inguinal radical orchiectomy with en bloc resection of the surrounding tissue was performed. The therapeutic options for this rare, but aggressive neoplasm are discussed. Because of the disappointing results of antineoplastic chemotherapy or radiation therapy, the importance of initial radical surgical treatment with complete excision is emphasized.
A 71-year-old patient had been suffering from pain-free obstructive jaundice for 8 weeks. Ultrasonography and computed tomography revealed an inhomogeneous mass (diameter 7 x 6 cm) in the head of the pancreas. In combination with a CA 19-9 of 329 U/l, the findings were highly suggestive of a pancreatic carcinoma. Endoscopic implantation of a pigtail drain into the dilated choledochal duct was performed. A partial duodenopancreatectomy (Whipple's procedure) became necessary because of continuous bleeding with hemodynamic disorders after endoscopic papillotomy. In the histopathological examination a low-grade malignant non-Hodgkin lymphoma of the pancreas (follicular centroblastic-centrocytic) was diagnosed. The differential diagnosis of primary pancreatic lymphoma from pancreatic carcinoma is usually impossible. Neither clinical nor laboratory nor imaging methods indicate to the correct diagnosis. In cases of relatively large pancreatic tumor masses and impression of the pancreatic duct without infiltration, a primary pancreatic lymphoma should be considered and a histological diagnosis by biopsy should be performed.
A verrucous carcinoma of the urinary bladder (pT4N0M0, G1) developed in a 66-year-old woman who had been suffering from interstitial cystitis with Hunner's ulcer for 10 years. Up to now, only 7 cases of verrucous carcinoma of the urinary bladder unassociated with bilharzial cystitis have been reported. Although the development of a verrucous carcinoma as a complication of interstitial cystitis has not been reported so far, the authors regard the chronic irritation of the bladder to be the most important etiologic factor for the malignant transformation. After conservative management had failed, a radical cystectomy with supravesical urinary diversion was performed. The characteristics of interstitial cystitis, verrucous carcinoma and surgical management are discussed.
Annular pancreas is rare congenital malformation of the pancreas. In about 50% of the cases the malformation is asymptomatic until the third to fifth decade. We report on a 52-year-old male patient who presented with subtotal duodenal and gastric outlet stenosis. Duodenohemipancreatectomy (Whipple's procedure) was performed. The histological examination showed an annular pancreas with complicating inflammatory reactions (tryptic sialadenitis) of the pancreatic head causing additional obstruction. Annular pancreas should be taken into account as a possible cause of adult duodenal obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) is the diagnostic modality of choice, and in combination with computed tomography the diagnosis can be obtained preoperatively in many patients. However, there are still patients in whom the diagnosis can finally be obtained only intraoperatively especially in cases where inflammatory pseudotumors or subtotal duodenal stenosis make ERCP impossible.
For 3 months, a 70-year-old woman had been affected by painless, symmetrical swellings in the limbs, spreading proximally, causing hardening of the skin and impaired joint movements, but no fever. Her general condition and findings on physical examination were according to age. ESR was 22/42 mm and there was a thrombocytosis (533,000/microliters) and eosinophilia (16%, absolute 2,140/microliters). Radiological and ultrasound examinations were normal. Skin biopsy revealed marked oedema of the connective tissue septa and perivascular lymphohistiocytic infiltrations, which--together with the other findings--suggested eosinophilic fasciitis. She was treated with prednisone, 100 mg daily, reduced gradually to 8 mg daily, as well as cimetidine, 800 mg daily, as immunomodulator, and intensive physiotherapy. The swellings and eosinophilia regressed within 8 weeks, but the hardening and impaired mobility persisted. Maintenance glucocorticoids are being continued.
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We present a case of thrombosis of a St. Jude Medical valve in mitral position at the time of manifestation of an acute malignant lymphoma. Since valve thrombosis and the onset of acute malignant lymphoma appeared simultaneously, we conclude that the malignant lymphoma may have been the cause of valve thrombosis. In our case report we discuss the genesis and prophylaxis of valve thrombosis during malignant disease.
A case of fatal intracranial hemorrhage is reported in an eleven year old girl with acute idiopathic thrombocytopenic purpura following a viral infection. The patient was randomized to the IgG-arm of the ITP therapy study. Immunoglobulin administration was not followed by a raise of the thrombocyte count. Neither the IgG therapy nor intensive therapeutic measurements were able to prevent the fatal course of cerebral hemorrhage in this case. Pathological and immunological findings indicate that our patient suffered from a fulminant ITP which must be considered as a part of a still active viral disease.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The results of clinical and morphologic studies performed in 41 patients with chronic, renal failure and secondary hyperparathyroidism, who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. In five cases, 7--33 months after autotransplantation we found transplantation tumors developing in the forearm. Explanted grafts showed invasive growth of parathyroid tissue in the adjacent structures, into the musculature and blood vessels. The increased incidence of mitosis otherwise seen as evidence of malignant neoplasia of parathyroid tumors, indicated atypical focal proliferation of the transplanted tissue. This is justification for not performing transplantations any more in the treatment of renal osteodystrophy.
The 24 endocrine pancreatic tumors and 14 carcinoids were examined immunohistochemically for cholecystokinin, insulin, gastrin, GIP, glucagon, sercretin, VIP, motilin, neurotensin, pancreatic polypeptide (PP), somatostatin, and ACTH. In 12 tumors of the pancreas more than one peptide-containing cell type was observed. The clinical symptoms showed hypersecretion of only one of the hormones, however. The midgut carcinoids (jejunum, appendix) represented the classical view of the carcinoid as an argentaffin cell tumor secreting 5-hydroxytryptamine. Tumors originating in the foregut (bronchus, stomach, duodenum) and hindgut carcinoids (rectum) were nonargentaffine, containing and secreting various polypeptide hormones. We conclude that light microscopic immunohistochemical methods are useful in distinguishing endocrine from nonendocrine tumors and multihormonal syndromes (MEA) in the classification of predominant hormone-secreting tumors.
Thymusaplastic mutants of mice (nu/nu) and rats (rnu/rnu) were used as recipients for tissue of one aldosteronoma of a 21-year-old male patient with Conn's syndrome and for tissue of one adenoma of a 28-year-old female patient with Cushing's syndrome. In this animal experimental study we succeeded in demonstrating that congenitally athymic rodents are ideal recipients for xenotransplantation of adrenal cortical tissue. The graft viability was demonstrated by obtaining light and electron micrographs of the biopsied transplants and its endocrine function documented by the measurements of plasma renin, cortisol, and urinary excretion of aldosterone, cortisol, and corticosterone. Fifteen patients are presented who were surgically treated for Cushing's disease. Fourteen patients with adrenocortical hyperplasia underwent total adrenalectomy and two had after adrenalectomy autotransplantation of adrenal tissue in the forearm muscle. One patient was treated with a transsphenoidal, partial hypophysectomy. Our clinical experience with Cushing's disease showed that the initial surgical procedure may be directed to the pituitary and only in unsuccessful surgery to the adrenals. Adrenal autotransplantation after total adrenalectomy is an obsolete procedure.
The increased incidence of neoplasia in the chronic use of immunosuppressive agents has been linked to a variety of factors including age, dose, agent, and frequency of administration. In this study azathioprine (az) and ifosfamide (ifo) were given both daily and weekly to female (NZB X NZW) mice over a period of 14 or 16 months in various dose regimens. Daily treatment with both agents prolonged survival time significantly but induced an apparently dose-related increase in tumor frequency. Intermittent ifo therapy produced neoplasia and survival results comparable to daily treatment, whereas intermittent az failed to extend longevity or produce malignancies. Varying the age of the mice (180 vs. 120 days) at the outset of treatment did not materially affect results in any respect. Ifo is less toxic than az in doses prolonging survival.
The age of (NZB x NZW) mice treated with immunosuppressive agents has been associated with an increased incidence of neoplastic disease in certain experimental situations. In this study, azathioprine administered daily over a period of 7 to 8 months significantly increased the occurrence of malignancies in animals aged 6 to 12 weeks at the start of treatment. No such increase was observed for ifosfamide. The resulting lesions observed in azathioprine and ifosfamide treated hybrids were predominantly lymphomas (60 to 80%) and could be classified according to two histologic types: Type I and II. The lymphomas in the ifosfamide groups could not be distinguished histologically from those in the azathioprine groups.