Embolization therapy in patients with severe arterial bleeding after hysterectomy

The case history of a patient aged 41 years, who suffered recurrent hemorrhages following vaginal hysterectomy is reported. After several surgical interventions complete hemostasis was finally achieved by selective embolization of the internal iliacal artery. The application of this procedure is recommended in case of recurrent bleeding complications caused by pelvic surgery or neoplasms.

Intestinal neuronal degeneration in a patient with chronic idiopathic intestinal pseudoobstruction

Neuropathological examination of the gut in a patient with chronic idiopathic intestinal pseudoobstruction and temporal lobe epilepsy showed a degeneration of Auerbach's and of Meissner's plexus. The extent of generative changes increased in an aboral to oral direction. Neuronal degeneration was characterized by ballooning of the cytoplasm of the ganglial cells, by a hyperargyrophilia, a shortening and dilation of cell processes, and a progressive fragmentation and loss of axons. In rectal biopsies, a PAS-positive granular material was detected in the cytoplasm of ballooned ganglial cells. A severe peripheral neuropathy with fiber degeneration in the posterior columns and axonal lesions within ventral nerve roots and a more recent fiber degeneration in the lateral columns corresponding to the picture of subacute combined degeneration of the spinal cord and a symmetrical Ammon's horn sclerosis was present. This case of progressive intestinal neuronal degeneration of unknown origin is a newly described condition leading to chronic idiopathic intestinal pseudoobstruction.

[Botfly larva skin infestation in a donkey]

In January 1987 7 larvae of Hypoderma diana were found in a donkey. The infection probably took place on a horse pasture in Fürstenwalde, Frankfurt (O.) region, grazed also by roes, the main hosts of H. diana.

A Chinese hamster cell cycle mutant arrested at G2 phase has a temperature-sensitive ubiquitin-activating enzyme, E1

The effect of restrictive temperature on ubiquitin conjugation activity has been studied in cells of ts20, a temperature-sensitive cell cycle mutant of the Chinese hamster cell line E36. Ts20 is arrested in early G2 phase at nonpermissive temperature. Immunoblotting with antibodies to ubiquitin conjugates shows that conjugates disappear rapidly at restrictive temperatures in ts20 mutant but not in wild type E36 cells. The incorporation of 125I-ubiquitin into permeabilized ts20 cells is temperature-sensitive. Addition of extracts of another G2 phase mutant, FM3A ts85, with a temperature-sensitive ubiquitin activation enzyme (E1), to permeabilized ts20 cells at restrictive temperatures fails to complement their ubiquitin ligation activity. This indicates that the lesions in the two mutants are similar. Purified E1 from reticulocytes restores the conjugation activity of heat-inactivated permeabilized ts20 cells. Ubiquitin conjugation activity of cell-free extracts of ts20 cells was temperature-sensitive and could be restored by adding purified reticulocyte E1. Purified reticulocyte E2 or E3, on the other hand, did not restore the ubiquitin conjugation activity of heat-treated ts20 extracts. These results are consistent with the conclusion that ts20 has temperature-sensitive ubiquitin-activating enzyme (E1). The fact that two E1 mutants (ts20 and ts85) derived from different cell lines are arrested at the S/G2 boundary at restrictive temperatures strongly indicates that ubiquitin ligation is necessary for passage through this part of the cell cycle. The temperature thresholds of heat shock protein synthesis of ts20 and wild type E36 cells were identical. The implications of these findings with respect to a suggested role of ubiquitin in coupling between protein denaturation and the heat shock response are discussed.

Determination of amino acids in biological, pharmaceutical, plant and food samples by automated precolumn derivatization and high-performance liquid chromatography

An easy, rapid and sensitive method for the simultaneous determination of primary and secondary amino acids in different matrices, e.g. protein hydrolysates, pharmaceutical formulations, plant extracts, food samples and physiological fluids, is described. After minimum sample preparation amino acids were derivatized with two different reagents, o-phthalaldehyde-3-mercaptopropionic acid for primary and 9-fluorenylmethylchloroformate for secondary amino acids, by an automated precolumn derivatization technique. With minor adjustments of separation parameters this method can also be used to determine amino acids in different matrices. Analysis time including reaction, separation and reconditioning ranged from 20 min for hydrolysates to 60 min for physiological fluids. The separation was done on a reversed-phase column with a gradient of acetate buffer-acetonitrile as the mobile phase. The precision for peak areas of the individual amino acids was within a relative standard deviation of 2% for the hydrolysate assay and 2-5% for the physiological assay, and for retention times better than 0.7%. The detection limit with the diode array detector (ultraviolet-visible) was ca. 2-5 pmol, measured at 338 nm for primary and 266 nm for secondary amino acids; with the fluorescence detector 20-50 fmol were detectable at excitation and emission wavelengths of 230 and 455 nm for primary and 266 and 310 nm for secondary amino acids, respectively.

[The parasite fauna of East Germany. 9. The helminth fauna of Lutra lutra]

Alimentary tract, liver, kidneys and lungs of 25 otters, died of several causes during 1982-1987 in GDR were included in helminthological investigations. Parasites were detected in 8 animals. One cestode: Taenia martis and 3 trematodes: Isthmiophora melis, Opisthorchis felineus and Pseudamphistomum truncatum are regarded to be certain parasites of this host. Other findings like Ligula intestinalis, Azygia luccii and Piscicola geometra and the fragment of a pseudophyllidean enter the alimentary tract with the food and pass through it.

[Seasonal occurrence of Dicrocoelium dendriticum in intermediate hosts]

Epizootiological questions were studied on a permanent pasture of a farm situated in one of the dicrocoeliasis areas in the GDR during the 1986 grazing season. Helicella obvia snails and Formica fusca ants were found to be first and second intermediate hosts respectively. A total of 1,121 snails and 70 ants were dissected. The infestation rate with Dicrocoelium dendriticum stages in snails decreased in summer after the high spring peak and increased again in autumn. Paralysed ants were found only at temperatures below 20 degrees C. Parthenogenetic stages in snails were identified morphologically according to the structure of cercariae; the metacercariae isolated from the ants' body cavity were determined in animal experiments.

Interrelations between glycolysis and the hexose monophosphate shunt in erythrocytes as studied on the basis of a mathematical model

A mathematical model is presented which comprises the reactions of glycolysis, the hexose monophosphate shunt (HMS) and the glutathione system in erythrocytes. The model is used to calculate stationary and time-dependent metabolic states of the cell in vitro and in vivo. The model properly accounts for the following metabolic features observed in vitro: (a) stimulation of the oxidative pentose pathway after addition of pyruvate due to a NADP-dependent lactate dehydrogenase as coupling enzyme between glycolysis and the oxidative pentose pathway, (b) relative share of the oxidative pentose pathway in the total consumption of glucose amounting to approximately 10% in the normal case and to approximately 90% under conditions of oxidative stress excreted by methylene blue. From the application of the model to in vivo conditions it is predicted that (c) under normal conditions glycolysis and the HMS are independently regulated by the energetic and oxidative load, respectively, (d) under conditions of enhanced energetic or oxidative load both glycolysis and the HMS are mainly controlled by the hexokinase; in this situation the highest possible values of the energetic and oxidative load which are compatible with cell integrity are strongly coupled and considerably restricted in comparison with the normal case, (e) the stationary states possess bifurcation points at high and low values of the energetic load.

Cooperative social coordination and aggression in male laboratory rats: effects of housing and testosterone

A cooperative behavior, coordinated shuttling by pairs of laboratory rats in a rectangular chamber, can be influenced strongly by an interaction between housing and sex. Males and females learn readily when housed together socially, but individual housing ("isolation") causes severe deficits selectively in males. The aim of the present study was to examine the role of testosterone in the differential effects of housing on cooperation learning. Males of a Sprague-Dawley derived strain were housed socially or individually and treated daily in one of three ways (six groups, n = 6 per group): (1) castrated, injected with oil vehicle (without testosterone); (2) castrated, injected with 500 micrograms testosterone propionate (exogenous TP); and (3) sham operated, injected with oil (intact, endogenous testosterone). Socially housed pairs learned readily in all treatment groups, using strategies of coordination in which stereotyped contact or aggressive interactions were interpolated. Individual housing was associated with a deficit, but only in the TP-treated and intact groups in which some pairs either did not learn or performed poorly. The deficit was associated with violent fighting and extreme and stable differentiation into dominants and subordinates, the latter exhibiting prolonged freezing. Oil-treated castrates, when housed individually, were unimpaired and actually surpassed their socially housed counterparts on some measures. Their success was associated with an increase only in low-level aggression. The housing-hormone interaction in male rats suggests that testosterone influences the capacity to develop cooperative behavior by modulating both aggression and its consequences for the relationship between partners. The use of social interaction models, including cooperation, for the study of behavior-hormone interactions was also discussed.

[Budd-Chiari syndrome as a late complication following closure of an atrial septal defect]

A case of a Budd-Chiari syndrome in a 19-year-old female patient is reported who had undergone surgical closure of a secundum atrial septal defect 13 years before. 8 months before the development of the Budd-Chiari syndrome she started to take oral contraceptives. The clinical picture of the Budd-Chiari syndrome developed within several days. The inferior vena cava did not fill with contrast dye when an angiography was performed using the right vena iliaca approach. The contrast dye disappeared through collateral veins (vena azygos, vena hemiazygos). After 4 days of treatment with systemic streptokinase she underwent open-heart surgery. The orifice of the inferior vena cava was occluded to a diameter of 6 mm. No thrombi were found. The lesion was corrected with two patches, one in the right atrium and the other in the inferior vena cava. This case report demonstrates that a Budd-Chiari syndrome is a possible late complication after closure of an atrial septal defect which should be treated by surgery.

[Parasites in East Germany. 8. Helminths of Ondatra zibethica]

In 1984/85 80 muskrats have been investigated by helminthological autopsy. Helminth infection was established in 72 animals. Altogether 4 trematodes, 7 cestodes and 2 nematodes were found. 2 cestodes were detected for the first time in the muskrat. Relations between parasite fauna and biotope are recognizable.

[Radiologic alternatives of splenectomy]

Partial peripheral splenic embolization can be performed in case of incurable thrombocytopenia due to hypersplenism without following splenectomy. A combined proximal and peripheral splenic embolization should only be carried out immediately prior to splenectomy if complications of hemorrhage due to extreme splenomegaly are to be expected. An only proximally performed occlusion can be by-bassed by collaterals. Anatomic blood vessel variations, techniques and complications are discussed in 6 cases.

[Echinostoma echinatum, Notocotylus noyeri and Quinqueserialis quinqueserialis as unusual parasites of Rattus norvegicus]

The trematodes Echinostoma echinatum, Notocotylus noyeri and Quinqueserialis quinqueserialis hare been found in the intestine of a Norway rat caught quite near water. These are the first natural findings of the two last mentioned parasites in this host.

Bilateral virilizing adrenal tumor in a 17 year old woman

We report on a 17 year old female patient with amenorrhea, hirsutism and slight acne. Hormonal blood analyses showed markedly increased levels for dehydroepiandrosteronesulfate, testosterone and androstenedione. Ultrasound investigation revealed a large tumor above the left kidney and a small area above the right kidney, suspicious for a tumor on the contralateral side. This was confirmed by angiography. During surgery, bilateral tumors were removed. Pathological diagnosis was made as bilateral adenomas of the adrenal cortex. Postoperatively, an impressive normalization was observed, accompanied by a rapid decrease of the elevated hormone concentrations. This case is the first report of a bilateral occurrence of a virilizing tumor of the adrenal cortex.

Chemical-shift-selective magnetic-resonance imaging of avascular necrosis of the femoral head

Chemical-shift-selective (CHESS) nuclear-magnetic-resonance (NMR) imaging is a new method for separating "water" and "fat" (CH2) resonances in proton NMR imaging. Its major advantage over conventional composite NMR imaging is the contrast enhancement, which in particular allows the detection of small water-containing structures, such as vessels or joint surfaces, normally obscured by fat signals. First clinical findings in the femoral head with avascular necrosis are reported.

Hepatic artery embolization for treatment of endocrine gastrointestinal tumors with liver metastases

We report about six patients with endocrine gastrointestinal tumors and liver metastases (four insulinomas, one carcinoidtumor, one paraganglioma), who were treated with a transluminal embolization of the hepatic artery when cytostatic therapy was ineffective. In two patients a second embolization was necessary after recurrence of clinical symptoms. All patients tolerated the procedure without severe side-effects and improved clinically. Serum insulin levels and HIAA-secretion rapidly decreased. Survival lasted from 3 to 32 months (median 15 months). Five additional patients with metastatic endocrine gastrointestinal tumors, observed during the same time period, were regarded as not suitable for hepatic artery embolization. In selected patients, hepatic artery embolization may become an effective therapy for treatment of metastasing endocrine gastrointestinal tumors when conventional medication with cytostatic drugs has become ineffective.

[Is routine bone scanning justified during the after-care for breast cancer?]

In a retrospective study of 254 women with carcinoma of the breast (mean age 55.4 years) the occurrence of bone pain was compared with results of skeletal scanning, skeletal X-ray examinations and routine biochemical findings. Typical signs of skeletal metastases were found in bone scans of 119 patients, 88 (74%) of whom had bone pain. Alkaline phosphatase was elevated in 54 (45%), LDH in 32 (27%), and gamma-GT in 69 patients (58%). There was a statistical correlation between the number of affected skeletal parts and the absolute level of alkaline phosphatase (P less than 0.001) and of LDH (P less than 0.05). Skeletal scans gave no evidence of bone metastases in 36 patients who had bone pains. In this group of patients alkaline phosphatase was elevated in 4, LDH in 1 and gamma-GT in 12 patients. Routine scanning of 254 patients revealed skeletal metastases in 12% without any clinical symptoms. Bone pain and (or) increased activity of alkaline phosphatase occurred in 91% of patients with skeletal metastases. In our view, bone scan in the postoperative control of breast cancer is justified only after onset of clinical symptoms and (or) if there is an abnormally raised alkaline phosphatase activity.

Diagnostic and Statistical Manual-III: a perspective from family court

The third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III) is evaluated from the standpoint of forensic science experience in a family court setting. The importance of diagnosis in developing pertinent recommendations within an adversarial system is discussed, with particular emphasis on difficulties in coordinating the Manual with the mental disorders frequently found in such a population. The limitations of the current criteria of the developmental disabilities are noted, and problems of reconciling incest and child abuse with the nomenclature are investigated. Some inconsistencies in the conceptualization of the conduct disorders and antisocial personality disorder are explored in terms of the needs of the juvenile justice system. An additional coding procedure is proposed for DSM-III, in order to identify more easily prodromal or emerging disorders of clinical significance.

[Mitoxantrone in the primary treatment of metastasizing breast cancer]

25 females (57.7 +/- 11.1 years) and 1 male (71 years) with histologically verified metastasizing breast cancer were submitted to mitoxantrone therapy. Secondary tumours were found in following organ systems: bone: 19 cases; lung: 13 cases; liver: 6 cases; skin: 5 cases; locoregional and nodal: 5 cases; brain: 1 case. All patients showed normal bone marrow and heart function before commencement of treatment. Mitoxantrone was given in form of a 30-minute infusion at a dosage of 14 mg/m2. In 4 patients dosage was increased to 20 mg/m2. Treatment cycles were repeated every 3 weeks according to peripheral blood counts. All patients were cardiologically monitored throughout the study by means of electrocardiogram, systolic time interval measurement and radionuclide angiography. The mean observation period was 169 +/- 98 days. The response of the patients was as follows: 1 complete remission, 5 partial remissions, 4 unchanged disease and 16 progressive disease. Side effects were normally mild; only nausea, leucopenia and moderate hair loss were of clinical relevance. Cardiac decompensation was not observed. No significant electrocardiographic alterations were found throughout the study. Results of systolic time interval measurements (PEPI, PEP:LVET) and radionuclide angiography (LVEF) gave evidence of moderate depression of heart function. In view of the optimal benefit/risk ratio of mitoxantrone this drug could be used in combined modality treatment schedules in metastasizing breast cancer.

[Determination of left atrial size. Comparison between echocardiographic and radiological determination]

The size of the left atrium was determined echocardiographically and radiologically in 66 patients with mitral valve disease, grade I-IV (New York Heart Association classification). Angiocardiography served as the reference. The echocardiographic determination was both by M-mode and two-dimensional, the radiological one was from the postero-anterior films (after Higgins), as well as from the lateral pictures. There was good agreement between the two echocardiographic methods and a good correlation of the two with cine-angiographic measurements (r = 0.82-0.99; P less than 0.001). But there was a poorer, although still statistically significant correlation of the radiologically determined atrial size with the echocardiographic and angiocardiographic measurements (r = 0.47-0.56; P less than 0.001). Thus M-mode and two-dimensional echocardiography is the more sensitive method for determining the size of the left atrium.

[Significance of laboratory chemical parameters for the detection of metastases in breast cancer]

The diagnostic value of 7 laboratory parameters for the detection of metastases was investigated in 136 patients with verified breast carcinoma after mastectomy. The post-operative interval was 6 to 80 months (means = 27.5). 61 patients had multiple metastases as determined by physical examination, X-rays, computertomography, sonographic and scan procedures, while the other 75 patients had no evidence of metastases. Carcinoembryonic antigen (CEA), alkaline phosphatase (AP) and lactate dehydrogenase (LDH) proved to be reliable parameters for the presence of metastases; the combination of these 3 parameters had a sensitivity of 73.0% and a specificity of 94.7% in the detection of metastases. The additional determination of gamma-glutamyltranspeptidase (gamma-GT), blood sedimentation rate (BSR), C-reactive protein (CRP) and serum iron (Fe) increased the sensitivity of metastases detection to 83.8%, but the specificity decreased to 46.2%.

[Primary aspergillosis of the lung in leukoses]

The course, radiological features and pathological changes of primary aspergillosis in four patients with acute lymphatic leukaemia are described. Two patients died despite antimycotic therapy. Breakdown of the infiltrate could not be established radiologically, nor pathologically. In a further two patients, a 'primary aspergilloma' developed during the course of several days. Both patients survived. The radiological demonstration of a fungus ball and of an air crescent in a typical aspergilloma can be regarded as a good prognostic sign.

Intra-arterial perfusion therapy with 5-fluorouracil in patients with metastatic colorectal carcinoma and intractable pelvic pain

In a phase-II trial, 18 patients with intractable pelvic and perineal pain caused by local recurrent and/or metastatic colorectal carcinoma resistant to combinations of analgesics, systemic cytostatic chemotherapy and/or radiation were treated with intra-arterial perfusion therapy using 15-30 mg 5-FU/kg body wt./day for 1-5 days. Of 18 patients, ten achieved complete pain relief for 3-32 weeks (mean, 15.7 weeks); after the perfusion therapy eight used less than 50% of the amount of analgesics required before treatment; one patient had only a minor response; two patients were treated unsuccessfully. Side effects were mild and controllable. One patient died subsequent to arterial embolism in the leg where the catheter was placed; pelvic perfusion therefore appears risky in patients with severe arteriosclerosis.

[Adenine nucleotides and metabolites of glycolysis in the liver in auxiliary transplantation]

The metabolic state of the liver during preservation as well as in and after auxiliary transplantation was investigated in dogs. The biopsy was carried out by means of TRU-CUT biopsy needle. - The ATP concentration, the storage of energy, the amount of the adenine nucleotides, and the ATP/ADP quotient decrease in the preserved liver. The AMP concentration, the concentration of the hexosemonophosphates and the mass-effective quotient of the phosphofructokinase increase simultaneously. The energy supply is the glycolysis exclusively. A lactate accumulation is avoided by continuous perfusion. - The changeover of the anaerobic to the aerobic energy preparation took place by degrees after the recovery of the liver circulation. The ATP concentration, the ATP/ADP quotient, the storage of energy, and the amount of the adenine nucleotides increase in the transplanted liver. - An irreversible ischemic damage of the liver appears in the metabolic state of the organ by a massive decrease of the ATP concentration below 0.7 mmol/kg, the amount of the adenine nucleotides below 1.8 mmol/kg, and AMP concentration.

[Value of phlebography in the diagnosis of edema of the leg]

In the diagnosis of leg edema, important phlebographic procedures are explained in terms of their technique and the information they provide. Ascending phlebography is the most important procedure for diagnosis of phlebothromboses, post-thrombotic syndromes, occlusions of the deep veins of other genesis, perforans insufficiency as well as vessel malformations. Additional administrations of selective contrast medium, intraoperative techniques as well as transosseous contrast medium administration are mentioned as rare supplementary methods. Peripheral open measurement of venous pressure constitutes an important additional documentation of vein function. The limits of the information provided are explained with reference to the normal phlebogram as well as to findings of venous reflux disturbances in the region of the deep veins, especially in acute thrombosis and occlusion of deep veins.

[Criteria for diagnostic and therapeutic methods of vascular embolization (kidneys, spleen, liver) (author's transl)]

Basing on the findings in patients with extensive carcinomas of the kidneys, the article reports on the various possibilities of application of occlusion spirals (Gianturco's method), of injectable occlusion materials and a combinations of both methods. In the authors' own experience, the spiral technique has mostly proved successful in achieving embolization of the arteries of the kidney 24 hours before surgery. Both the spiral technique as well as the use of injectable emblizates and a combination of both are used in the treatment of macrohaematurias in non-operable kidney tumours. The article reports on the technical conditions, indication and methodical limitations of embolization of the splenic artery, basing on three actual cases. The conditions and technique of embolization of branches of the hepatic artery are discussed by means of the findings obtained in two patients with liver metastases of an insulinoma.

An investigation of the intellectual capabilities of juvenile offenders

One hundred two cases were drawn randomly from the Bronx Family Court Mental Health Clinic's active files. Clients were given a Wechsler Intelligence Scale for Children--Revised, Bender Gestalt, and Wide-Range Achievement Test Reading. Results indicated that approximately one third were functioning the mentally defective range, one third in the borderline mentally retarded range, and one third in the low average to average range. Almost half showed perceptual deficits correlated with minimal brain dysfunction. Results were highly significant, suggesting that delinquents apprehended and seen in our clinic are likely to be of borderline intelligence or below, showing evidence of minimal brain dysfunction. Hypotheses are discussed, as is the need for appropriate treatment facilities.

[Immunoglobulins after experimental liver transplantation in pig]

During a period of 14 days after porcine liver transplantation immunoglobulins IgA, IgG, and IgM were investigated. IgA and IgG were slightly elevated at the end of investigation. The increase in IgM was higher and significant. This rise in immunoglobulin-level is thought to be a result of immunisation by parenchymatous insults after liver transplantation.

[X-ray diagnosis of Crohn's disease in the intestine (author's transl)]

The article describes the essential roentgenologic findings associated with Crohn's disease in the intestine, manifested as stenoses, thickening of the walls, fistula formation and pseudodiverticula or appearance of Bodart's intermediary segment, on the basis of characteristic findings, followed by valuation in respect of the exclusive possibility of diagnosis via radiology. The article goes into details in respect of differential diagnosis criteria, particularly within the frame of tumour diagnosis. Differentiation can be effected with the help of findings in peritoneal carcinosis and intestinal changes induced by radiation.