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De Dyn S, Demirci I, Prescher A, Kopp A, Klosterhalfen B, Janßen H. Mechanical ileus of the small bowel due to an inflamed Meckel's diverticulum with an enterolith - a case report with literature review. Acta Chir Belg 2023; 123:699-706. [PMID: 36259265 DOI: 10.1080/00015458.2022.2136047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Meckel's diverticula result from incomplete obliteration and regression of the omphaloenteric duct and are the most common congenital intestinal malformations. Many Meckel's diverticula remain asymptomatic and are discovered as incidental findings. They present a diagnostic challenge. METHODS We report the case of a 35-year-old man who presented with an acute abdomen and ileus. Computed tomography of the abdomen showed a mechanical small bowel ileus. There was a calibre jump in the terminal ileum with a round endoluminal definable hyperdense structure of almost 2 cm in diameter. RESULTS An exploratory laparoscopy was performed revealing an inflamed Meckel's diverticulum with impacted enterolith as the cause of the intestinal obstruction. CONCLUSION In symptomatic Meckel's diverticula, haemorrhage and obstruction are the most common complications. The development of ileus due to a Meckel's diverticulum with an enterolith is considered extremely rare but should be taken into account.
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Affiliation(s)
- Stephan De Dyn
- Department of General, Abdominal, Vascular and Thoracic Surgery, Krankenhaus Düren, Düren, Germany
| | - Ilhan Demirci
- Department of Vascular Surgery, Marienhospital Aachen, Aachen, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen, Aachen, Germany
| | - Andreas Kopp
- Department of Diagnostic and Interventional Radiology, Krankenhaus Düren, Düren, Germany
| | | | - Hermann Janßen
- Department of General, Abdominal, Vascular and Thoracic Surgery, Krankenhaus Düren, Düren, Germany
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Demirci I, Kinkel H, Antoine D, Szynaka M, Klosterhalfen B, Herold S, Janßen H. Sclerosing angiomatoid nodular transformation of the spleen mimicking metastasis of melanoma: a case report and review of the literature. J Med Case Rep 2017; 11:251. [PMID: 28865487 PMCID: PMC5581926 DOI: 10.1186/s13256-017-1400-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/20/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sclerosing angiomatoid nodular transformation is a benign disorder of splenic tissue and is often mistaken as a potentially malignant entity in the diagnostic process. To the best of our knowledge, this is the first report of sclerosing angiomatoid nodular transformation mimicking metastasis of melanoma in the literature. CASE PRESENTATION A 43-year-old white man presented with a newly found splenic mass 4 years ago to our Department of Gastroenterology. He was diagnosed as having a superficial spreading malignant melanoma localized at his left instep 7 years ago and was successfully treated with radical local resection. Several diagnostic procedures were conducted. Ultrasound showed a hypoechoic lesion in the inferior pole of his spleen with a diameter of 2 cm, blurred boundaries, and inhomogeneous interior pattern. Contrast-enhanced ultrasound was inconclusive and showed only discrete contrast enhancement of the lesion with accentuated nodule-like enrichment of the boundaries in the arterial phase. Computed tomography and magnetic resonance imaging scans showed two splenic lesions which were highly suspicious of metastasis. Magnetic resonance imaging of his head was inconspicuous. Bone scintigraphy showed no abnormal results. Fine-needle aspiration indicated metastasis of the above-mentioned malignant melanoma. We conducted a laparoscopic splenectomy. His intraoperative and postoperative course were uneventful. In contrast to the result of the fine-needle aspiration, the presence of metastasis of melanoma could not be confirmed. Histological analysis revealed nodule-like arrangement of fibroblasts with low cell density and a predominance of dilated capillaries, indicating sclerosing angiomatoid nodular transformation of the spleen. CONCLUSIONS There are no preoperative diagnostic imaging procedures which can definitely differentiate sclerosing angiomatoid nodular transformation from malignancies in cases of morphological and immunophenotypic variations of the specimen. Morphological and immunophenotypic variations of the specimen represent a diagnostic challenge and can mimic malignoma. As reported in our case, the specimen obtained by ultrasound-guided fine-needle aspiration led to the diagnosis of metastasis of melanoma. Splenectomy is often conducted due to a splenic mass suspicious of malignoma as described in our case or with unknown valency in different diagnostic imaging procedures.
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Affiliation(s)
- Ilhan Demirci
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Düren, Düren, Germany
| | - Horst Kinkel
- Department of Gastroenterology, Hepatology and Diabetology, Hospital of Düren, Düren, Germany
| | - Dirk Antoine
- Department of General, Visceral and Thoracic Surgery, Hospital of Leverkusen, Leverkusen, Germany
| | - Marc Szynaka
- Department of Radiology, Hospital of Düren, Düren, Germany
| | | | - Susanne Herold
- Department of Internal Medicine II, University of Gießen Lung Center, Gießen, Germany
| | - Hermann Janßen
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Düren, Düren, Germany
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Janßen H. Kontrollierte Fallsteuerung als Methodik im Versorgungsablauf chronisch Erkrankter – eine empirische Analyse. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H Janßen
- Hochschule Bremen – University of Applied Sciences, Institut für Gesundheits- und Pflegeökonomie IGP, Bremen
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Janßen H, Köhler L. Untersuchung zu Struktur-, Prozess- und Ergebnisqualität der mobilen geriatrischen Rehabilitation in stationären Pflegeeinrichungen. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H Janßen
- Hochschule Bremen – University of Applied Sciences, Institut für Gesundheits- und Pflegeökonomie IGP, Bremen
| | - L Köhler
- Hochschule Bremen – University of Applied Sciences, Institut für Gesundheits- und Pflegeökonomie IGP, Bremen
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Behrens J, Schmidt-Ohlemann M, Martin N, Grune K, Janßen H, Köhler L, Siegert R, Warnach M, Kraft JW, Naumann F, Pflug M, Thiel S, Wolf M. RCT und (Selbst-)Auswahlbias: Die Wirksamkeit von Rehabilitation am Beispiel Mobiler geriatrischer Rehabilitation von Bewohnerinnen stationärer Pflegeeinrichtungen. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Behrens J, Schmidt-Ohlemann M, Martin N, Grune K, Janßen H, Köhler L, Siegert R, Warnach M, Kraft JW, Naumann F, Pflug M, Thiel S, Wolf M. Die Verwechslung von Zielen und Mitteln: Kein Assessment misst das Erreichen des gesetzlichen Rehazieles, oder? Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kossert K, Nähle O, Janßen H. Activity determination of 229Th by means of liquid scintillation counting. Appl Radiat Isot 2014; 87:274-81. [PMID: 24345524 DOI: 10.1016/j.apradiso.2013.11.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 11/17/2013] [Indexed: 11/26/2022]
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Aguilar-Rodriguez R, Milea SL, Demirci I, Herold S, Flasshove M, Klosterhalfen B, Kinkel H, Janßen H. Localized retroperitoneal Castleman's disease: a case report and review of the literature. J Med Case Rep 2014; 8:93. [PMID: 24612848 PMCID: PMC3977947 DOI: 10.1186/1752-1947-8-93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/11/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction Castleman’s disease, also known as angiofollicular lymph node hyperplasia, is a rare disease with two known expansion types, unicentric and multicentric, which play a major role in determining therapy. We focus here on the unicentric type, which can be treated and cured by surgery. To date, approximately 1000 cases of Castleman’s disease have been reported in the literature. Case presentation A 50-year-old Caucasian woman presented to our Department of Hematology and Internal Oncology with increasing fatigue as her sole symptom. Diagnostic investigations including laboratory studies, ultrasound, computed tomography and magnetic resonance imaging were performed. These revealed an interaortocaval, retroperitoneal tumor mass in her upper abdomen as the only manifestation of the disease. No enlarged lymph nodes were detected. We conducted a laparotomy with radical extirpation of the tumor mass (10×9×5.7cm). Complete tumor resection with clear margins was achieved. A pathological analysis of the resected sample showed atypical lymphoid tissue of small to medium cells with some clearly visible nucleoli, enlarged sinusoidal vessels, pleomorphic calcifications and focally preserved germinal-center-like structures. Histological and immunohistochemical analysis confirmed the diagnosis of Castleman’s disease: staining for CD3, CD5, CD10, CD20, CD23, CD79 and Ki-67 was strongly positive in the germinal-center-like structures. Histological findings clearly showed the disease to be the hyaline vascular subtype. Staining for cyclin D1 and CD30 was negative. Expression of CD15 was positive in the enlarged sinusoidal vessels. A supplementary clonality analysis was without pathological findings. Tests for human immunodeficiency virus and human herpes virus 8 were negative and results from a bone marrow biopsy were normal. Our patient recovered well from surgery and was discharged from our hospital. To date, no recurrence of the disease has been detected. Conclusion Castleman’s disease is a rare disorder that remains a diagnostic challenge. Radical surgical resection is considered to be the gold standard for treating the unicentric variant of this disease.
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Affiliation(s)
| | | | - Ilhan Demirci
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Düren, Düren, Germany.
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Janßen H, Augustin CB, Hinrichsen HH, Kube S. Impact of secondary hard substrate on the distribution and abundance of Aurelia aurita in the western Baltic Sea. Mar Pollut Bull 2013; 75:224-234. [PMID: 23987093 DOI: 10.1016/j.marpolbul.2013.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/09/2013] [Accepted: 07/12/2013] [Indexed: 06/02/2023]
Abstract
This study assessed the impact of secondary hard substrate, as being introduced into marine ecosystems by the establishment of wind farm pillars, on the occurrence and distribution of the moon jelly Aurelia aurita in the southwestern Baltic Sea. A two-year data sampling was conducted with removable settlement plates to assess the distribution and population development of the scyphozoan polyps. The data collected from these samples were used to set up a model with Lagrangian particle technique. The results confirm that anthropogenic created hard substrate (e.g. offshore wind farms) has the potential to increase the abundance of the A. aurita population. The distribution of wind farm borne jellyfish along Danish, German and Polish coasts indicates conflicts with further sectors, mainly energy and tourism.
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Affiliation(s)
- H Janßen
- Leibniz Institute for Baltic Sea Research Warnemuende (IOW), Seestrasse 15, 18119 Rostock-Warnemuende, Germany.
| | - C B Augustin
- Leibniz Institute for Baltic Sea Research Warnemuende (IOW), Seestrasse 15, 18119 Rostock-Warnemuende, Germany; University of Rostock, Aquaculture and Sea-Ranching, Faculty of Agricultural and Environmental Sciences, Justus-von-Liebig-Weg 6, 18059 Rostock, Germany
| | - H H Hinrichsen
- GEOMAR - Helmholtz Center for Ocean Research Kiel, Düsternbrooker Weg 20, 24105 Kiel, Germany
| | - S Kube
- University of Rostock, Institute of Biosciences, Aquatic Ecology, Albert-Einstein-Str. 3, 18059 Rostock, Germany
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Unkel B, Hoegner K, Clausen BE, Lewe-Schlosser P, Bodner J, Gattenloehner S, Janßen H, Seeger W, Lohmeyer J, Herold S. Alveolar epithelial cells orchestrate DC function in murine viral pneumonia. J Clin Invest 2012; 122:3652-64. [PMID: 22996662 DOI: 10.1172/jci62139] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 07/19/2012] [Indexed: 12/23/2022] Open
Abstract
Influenza viruses (IVs) cause pneumonia in humans with progression to lung failure. Pulmonary DCs are key players in the antiviral immune response, which is crucial to restore alveolar barrier function. The mechanisms of expansion and activation of pulmonary DC populations in lung infection remain widely elusive. Using mouse BM chimeric and cell-specific depletion approaches, we demonstrated that alveolar epithelial cell (AEC) GM-CSF mediates recovery from IV-induced injury by affecting lung DC function. Epithelial GM-CSF induced the recruitment of CD11b+ and monocyte-derived DCs. GM-CSF was also required for the presence of CD103+ DCs in the lung parenchyma at baseline and for their sufficient activation and migration to the draining mediastinal lymph nodes (MLNs) during IV infection. These activated CD103+ DCs were indispensable for sufficient clearance of IVs by CD8+ T cells and for recovery from IV-induced lung injury. Moreover, GM-CSF applied intratracheally activated CD103+ DCs, inducing increased migration to MLNs, enhanced viral clearance, and attenuated lung injury. Together, our data reveal that GM-CSF-dependent cross-talk between IV-infected AECs and CD103+ DCs is crucial for effective viral clearance and recovery from injury, which has potential implications for GM-CSF treatment in severe IV pneumonia.
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Affiliation(s)
- Barbara Unkel
- Department of Internal Medicine II, University of Giessen and Marburg Lung Center, Giessen, Germany
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Demirci I, Herold S, Kopp A, Flaßhove M, Klosterhalfen B, Janßen H. Overdiagnosis of a typical carcinoid tumor as an adenocarcinoma of the lung: a case report and review of the literature. World J Surg Oncol 2012; 10:19. [PMID: 22269186 PMCID: PMC3317839 DOI: 10.1186/1477-7819-10-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/23/2012] [Indexed: 12/17/2022] Open
Abstract
Background Overdiagnosis of bronchopulmonary carcinoid tumors together with overtreatment can cause serious postoperative consequences for the patient. We report of a patient with a typical bronchopulmonary carcinoid tumor, which was initially misdiagnosed and treated as an adenocarcinoma of the lung. GnrH receptors and the associated Raf-1/MEK/ERK-1/2-pathway are potential targets for analogs in cancer treatment. We suspected a correlation between the lack of tumor growth, application of leuprolide and the Raf-1/MEK/ERK-1/2-pathway. Therefore, we examined GnrH receptor status in the examined specimen. Case presentation In 2010 a 77 year-old male patient was shown to have a tumor mass of about 1.7 cm diameter in the inferior lobe of the left lung. Since 2005, this tumor had hitherto been known and showed no progression in size. The patient suffered from prostate cancer 4 years ago and was treated with TUR-P, radiation therapy and the application of leuprolide. We conducted an explorative thoracotomy with atypical segment resection. The first histological diagnosis was a metastasis of prostate cancer with lymphangiosis carcinomatosa. After several immunohistochemical stainings, the diagnosis was changed to adenocarcinoma of the lung. We conducted a re-thoracotomy with lobectomy and systematic lymphadenectomy 12 days later. The tumor stage was pT1 N0 MX G2 L1 V0 R0. Further immunohistochemical studies were performed. We received the results 15 days after the last operation. The diagnosis was ultimately changed to typical carcinoid tumor without any signs of lymphatic vessel invasion. The patient recovered well from surgery, but still suffers from dyspnea and lack of physical performance. Lung function testing revealed no evidence of impairment. Conclusion The use of several immunohistochemical markers, careful evaluation of hematoxylin-eosin sections and the Ki-67 labelling index are important tools in discriminating between carcinoids and other bronchopulmonary carcinomas. Although we could not detect GnrH-receptors in the examined specimen, there may be individual differences in expression. GnrH receptor profiles in typical and atypical carcinoids should be scrutinized. This could lead to new therapeutical options, since the GnrH receptor has already been described on atypical carcinoids. Clinically tested drugs such as leuprolide could come to use.
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Affiliation(s)
- Ilhan Demirci
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Düren.
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Herold S, Shafiei Tabar T, Janßen H, Högner K, Seeger W, Steinmüller M, Lohmeyer J. Exudate macrophages attenuate lung injury by the release of IL-1 receptor antagonist in gram-negative pneumonia. Pneumologie 2011. [DOI: 10.1055/s-0031-1272254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Janßen H. Kosten-Nutzen-Analyse in der orthopädischen Chirurgie. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Becker R, Janßen H. Untersuchung der Lebensqualität chronischer Wundpatienten im Rahmen Integrierter Versorgung – Eine Verlaufsanalyse. Gesundheitswesen 2008. [DOI: 10.1055/s-0028-1086433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schwandner T, Kramm J, Janßen H, Padberg W. Kavernöses Hämangiom des Rektums vom diffus expansiven Typ. Zentralbl Chir 2006. [DOI: 10.1055/s-2006-944361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Raudonus J, Bernard J, Janßen H, Kowalczyk J, Carle R. Effect of oligomeric or polymeric additives on glass transition, viscosity and crystallization of amorphous isomalt. Food Res Int 2000. [DOI: 10.1016/s0963-9969(00)00022-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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