Zur diätetisch induzierten und postoperativen Thromboseneigung

Sludged blood ist weder gleichbedeutend mit Thrombose, noch besagt sein Vorkommen, daß eine Thrombose besteht. Im Einzelfall ist daraus auch keine Voraussage abzuleiten, daß eine Thrombose entstehen wird.

Es kann aber nicht bezweifelt werden, daß dies Instabilitätsphänomen mit einer zunächst reversiblen Ballung von Blutelementen eine bedeutende Thrombosedisposition bewirkt, wenn andere Faktoren (Verhalten der Thrombozyten, Gerinnungsfähigkeit des Blutes, Verhalten der Gefäßwand und -lichtung u. a.) im gleichen Sinne wirken. Blutviskositätssteigerung, Strömungsverlangsamung, intravasale Blutsenkung mit Bildung von adhaerenten Massen an der klebrig veränderten Gefäßwand, Gefäßverschlüsse, Kombination mit Thrombo- und Leukozytenaggregation und gleichzeitige gesteigerte Gerinnbarkeit sind Teilaspekte des thrombogenetischen Mechanismus durch sludged blood. Diese Instabilität der Blutzusammensetzung ordnet sich also bezüglich ihrer thrombogenetischen Bedeutung unter die Rubrik „veränderte Blutbeschaffenheit” ein und steht mit den beiden anderen klassischen Bedingungen zur Thrombusbildung (behinderte Blutströmung und Gefäßwandschädigung) in pathogenetischer Wechselwirkung. An der ersten Anlage eines Thrombus können also auch Erythrozyten wesentlich beteiligt sein. Diese Thromboseanlage manifestiert sich im Blut durch zirkulierende Blutpfröpfe. Die Beobachtung des Blutes in den Bindehautgefäßen kann demnach, mit Kritik angewandt, einen zusätzlichen Indikator für eine Thromboseneigung liefern.

Late enhanced computed tomography in Hypertrophic Cardiomyopathy enables accurate left-ventricular volumetry

OBJECTIVES

Late enhancement (LE) multi-slice computed tomography (leMDCT) was introduced for the visualization of (intra-) myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM). LE is associated with adverse cardiac events. This analysis focuses on leMDCT derived LV muscle mass (LV-MM) which may be related to LE resulting in LE proportion for potential risk stratification in HCM.

METHODS

N=26 HCM-patients underwent leMDCT (64-slice-CT) and cardiovascular magnetic resonance (CMR). In leMDCT iodine contrast (Iopromid, 350 mg/mL; 150mL) was injected 7 minutes before imaging. Reconstructed short cardiac axis views served for planimetry. The study group was divided into three groups of varying LV-contrast. LeMDCT was correlated with CMR.

RESULTS

The mean age was 64.2 ± 14 years. The groups of varying contrast differed in weight and body mass index (p < 0.05). In the group with good LV-contrast assessment of LV-MM resulted in 147.4 ± 64.8 g in leMDCT vs. 147.1 ± 65.9 in CMR (p > 0.05). In the group with sufficient contrast LV-MM appeared with 172 ± 30.8 g in leMDCT vs. 165.9 ± 37.8 in CMR (p > 0.05). Overall intra-/inter-observer variability of semiautomatic assessment of LV-MM showed an accuracy of 0.9 ± 8.6 g and 0.8 ± 9.2 g in leMDCT. All leMDCT-measures correlated well with CMR (r > 0.9).

CONCLUSIONS

LeMDCT primarily performed for LE-visualization in HCM allows for accurate LV-volumetry including LV-MM in > 90% of the cases.

KEY POINTS

• LeMDCT of relatively low contrast allows for LV planimetry in HCM. • The correlation of leMDCT-based LV volumetry with gold-standard CMR was excellent (r > 0.9). • LeMDCT requires approximately 2.0mL/kgBW of dye to achieve acceptable contrast.

[The problem of diagnosis of biliary calculi in acute pancreatitis by means of laboratory methods]

In order to assess the validity of a biochemical prediction of gallstones early in the course of acute pancreatitis by simple biochemical values (SGOT greater than or equal to 60 U/l, bilirubin greater than or equal to 1.6 mg/dl, alkaline phosphatase greater than or equal to 100 U/l) 297 patients with alcoholic, idiopathic and biliary pancreatitis were reinvestigated in a retrospective manner. The present study shows that a valid prediction by these values is not possible since 1) only about 40% of attacks of acute gallstone pancreatitis were associated with elevated SGOT, bilirubin and alkaline phosphatase concentrations and 2) there was a considerable overlap with the other etiological groups especially with idiopathic pancreatitis.

[Quantitative determination and phenotyping of ceruloplasmin in morbus Wilson (author's transl)]

Sera of 17 patients with Wilson's disease and of 48 relatives were investigated as to a possible correlation between ceruloplasmin phenotypes and Wilson's disease. The control group included 727 healthy subjects. The results of the quantitative determination of ceruloplasmin confirmed the overlapping in the groups of so-called heterozygotes and controls known from the literature. The ceruloplasmin phenotypes in starch gel electrophoresis we observed were of the most common phenotype Cp BB in the patients as well as in the controls. Therefore, patients with Wilson's disease also show the normal Cp-phenotypes.

[Unusual clinical forms of pseudo-LE syndrome: an induced immune-complex disease? (author's transl)]

Two of nine patients with pseudo-LE syndrome had previously undescribed organ manifestations. In one there was the full-blown picture of cutaneous lupus erythematodes, with renal and CNS involvement, ending fatally. Immunohistologically there was severe vasculitis and nephritis, histologically generalised necrotizing angitis. It is possible that the dramatic clinical picture was due to alpha-methyldopa. In the second case lymphadenopathy with bihilar involvement and splenomegaly predominated. Histologically there was no evidence of Boeck's sarcoid. Further studies revealed systemic involvement with immune-complex nephritis, electron-dense deposits in the glomerular basal membrane, and the typical changes of lupus erythematodes in the marrow. In a third case there were similar changes in kidney and marrow. These findings support the view of an immune-complex disease which can be fatal. An unusual feature in seven of the nine patients was the proven intake of Venopyronum¿ coated tablets in temporal relationship to the manifestation of the disease. It is possible that the described cases of pseudo-LE syndrome were drug-induced. The immunological mechanism of the disease would, in that case, be analogous to penicillamine nephropathy.