[Sonographic representation of the normal and acute inflamed appendix--in patients wi right-sided abdominal pain]

The detectability, vascularization and size of the normal and inflamed appendix were investigated in the study. 148 patients under suspicion of appendicitis or with lower right abdominal pain were studied over a period of five months beginning in January 1998. An ultrasound-transducer was employed at a wave length of 3.5 MHz to 10 MHz. Vascularization was measured using 'Duplex' and 'Color Angio'. The results were compared with operative evidence, histology and patient history. The appendix was detected in about 30% of the cases (47/148). But of the presumably normal appendices only 12% (13/109) were detected. 27 appendices sonographically diagnosed as acutely inflamed were confirmed by operation and phlegmonic. The acute appendicitis was sonographically diagnosed with a sensitivity of 82% and a specificity of 95%. The diameter of the normal appendices was an average of 5.5 mm, that of the acute was 12.2 mm whereby 21 of 25 organs were at least 9 mm. The measurement of the organ size seems to be more helpful than the detection of vascularization. Both methods alone cannot detect the acute phlegmonic appendicitis. The normal appendix was less frequently detected than described in current literature. Patients with pain present difficulties in ultra-sound examination because both the cooperation and the time for the correct diagnosis are limited.

Malignant fibrous histiocytoma of the epididymis. Case report and review of the literature

A 54-year-old patient was found to have a painless ca. 1.5 cm diameter tumor in the region of the right epipidymis. The right testis was exposed from a scrotal incision. The final pathology surprisingly showed malignant fibrous histiocytoma (MFH) of the epipidymis and the patient subsequently underwent radical inguinal orchiectomy. Complete metastatic screening was normal. Postoperatively, 60 Gy external beam radiation was administered. At the least follow-up (6 years), there were no recurrences or metastases. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.

[Primary paraurethral malignant mixed tumor (carcinosarcoma) of the vagina. A case report]

In total malignant mixed tumors (carcinosarcomas) represent a very rare gynecological neoplasm. In accordance with the embryological genesis primary localizations are with descending probability the uterus, the ovarians and finally the tubes. We report on a 55 year old female patient, with a paraurethral mass, which was primarily diagnosed in 1994. Histopathological evaluation of a transvaginal biopsy did not demonstrate evidence of malignancy at that time. After painful enlargement the paraurethral mass was resected surgically and histopathological evaluation revealed a primary paraurethral malignant mixed tumor (carcinosarcoma). Postoperatively, the patient underwent percutaneous (46.4 Gy) and intracavitary (2 x 6 Gy) radiation. Twelve months postoperatively there is no evidence of disease.

[Ultrasound diagnosis of acute appendicitis--possibilities and limits of the method--results of prospective and retrospective clinical studies]

AIM

In the diagnosis of appendicitis high-resolution ultrasound has become "gold standard" among the imaging methods. The ranking of the method and its dependence on the experience of the examiner, the quality of different ultrasound machines and the time of the examination, were examined in a trial during a 7-year period.

METHOD

In 905 patients examination by the surgeon was followed by ultrasound. The results were compared with clinical or histological diagnosis.

RESULTS

In a prospective study we examined sonographical 367 patients with the diagnosis of "appendicitis" at admission. The sensitivity was 75.3%, the specificity 96.2%. In a retrospective analysis of 538 patients with appendectomy, the sensitivity was 50.5% and the specificity 95.4% in pre-operative diagnosis. If the examination was done by a less experienced examiner (less than 500 ultrasound examinations/year) the sensitivity was 45.1% and specificity 93.6%; an experienced doctor (500-1000 ultrasound examinations/year) achieved 57.9 and 92.9% and a highly qualified investigator (more than 1000 ultrasound examinations/year) a sensitivity of 73.9% and a specificity of 97%. If the examination was realised with high frequency ultrasonic scanning (10 MHz), sensitivity (73.9%) and specificity (96.3%) could be increased. Essential for an exact diagnosis was a short-term period between ultrasound examination and intra-abdominal diagnosis.

CONCLUSION

Optimal sonographical appendicitis diagnosis must be based on a combination of a qualified examiner, high-resolution ultrasound and short-term follow-up.

Recurrent gain of chromosome arm 7q in low-grade astrocytic tumors studied by comparative genomic hybridization

Consistent tumor-specific chromosomal aberrations have not been described in low-grade astrocytic tumors. The most frequent genetic alterations are mutations of the TP53 tumor suppressor gene and/or loss of heterozygosity (LOH) on 17p that occur in about 30% of the cases in adult patients but that are uncommon in childhood tumors. We used comparative genomic hybridization (CGH) to map DNA copy number alterations in 18 primary low-grade astrocytic tumors (ten adult patients and eight children). A gain of chromosome arm 7q was the most frequent event detected in five of ten astrocytomas (50%) from adult patients, followed by DNA amplification on chromosome arm 8q and gain on 12p (two cases). Loss of chromosomal regions on 1p, 4q, and the X chromosome was observed in two of ten cases [including one patient afflicted with Turner syndrome (45,X)]. In contrast, no consistent changes were observed in low-grade astrocytomas in children. A loss of the X chromosome was the sole aberration detected in two of eight cases using DNA extracted from the normal brain tissue. The findings suggest that a gain of 7q is an early event in the initiation of astrocytomas in adult patients. The discrepant findings in low-grade astrocytic tumors in adults compared to tumors in children support the the hypothesis that there might be different mechanisms responsible for tumor development.

[The layers of the gallbladder wall: an ultrasound-anatomic comparative study]

In a sonographic-histological comparative test, operatively withdrawn gallbladders in native and formol-fixed states were examined. The thickness of the gallbladder wall and of its layers was measured sonographically. Afterwards the gallbladders were reexamined microscopically in the sonographic sectional plane and the measurement was repeated. By removal of the single layers of the wall and by repeated sonographic measuring, sonographic and microscopic measurements of the parietal layers could be correlated. Both gallbladder wall thickness and thickness of the single anatomic layers can be evaluated sonographically. The correlation between sonographic and histological measurements is fairly to highly significant. The sonographically measurable layers can be related to the following anatomical layers (when measuring from outwards to inwards): 1. echogenic layer = initial echo and subserosa; 2. echo-poor layer = muscularis; 3. echogenic layer = lamina propria; 4. echo-poor layer = mucosal epithelium; 5. echogenic layer = exit echo.

[Report of 2 cases of isolated, primary amyloidosis of the male urethra and urinary bladder of a female]

Primary localized amyloidosis of the bladder and urethra is a rare condition. Two cases of isolated primary amyloidosis, of the urethra in a man and of the bladder in a woman, are reported. The clinical specificity of the location and the specific therapy are discussed. We draw attention to the extended, palette of diagnostic investigations now available and the new classification made possible by the introduction of immunohistochemistry and immunoelectron microscopy.

"Angiodysgenetic necrotizing encephalopathy" and its different manifestations. Survey of age-related forms and clinico-pathological appearances

Various observations of diffuse meningo-cerebral angiomatoses, which cannot be satisfactorily classified with the common phakomatoses, have been reported. They may occur at any age, with familial accumulation or sporadically. Divry and van Bogaert were the first to draw attention to such conditions in adults, where meningo-cerebral angiomatoses seemed to be combined with sudanophilic leukodystrophy. However, subsequently the latter was considered to be due to hypoxic damage to the white matter. In other observations, the severe damage to the grey matter was more evidently of hypoxic origin. Observations on two newborn individuals, sporadic examples of diffuse meningo-cerebral angiomatosis and with severe necrotic changes in the grey and white matter, are reported and discussed. Published reports on the various age-related forms are summarized and a general designation is suggested, which includes the various observations under a general heading. A parallel will be drawn between the meningo-cerebral angiomatosis and Foix-Alajouanin's disease.

Estrogens influence antibody coating in experimental urinary tract infection

Female rats were infected with E. coli 0.25 by intravesical instillation. After 4 weeks, significantly higher bacterial counts (bladder puncture and renal homogenates) were found in estradiol treated rats (0.5 mg/kg/week) than in solvent controls, but the proportion of antibody-coated bacteria was significantly (P less than 0.01) lower in bladder urine and renal homogenates. There was no influence of estrogens on renal histology or ureteral width. The results are compatible with an effect of estrogens on local immune response in the urinary tract.

Acute abdominal rhabdomyolysis after body building exercise: is there a "rectus abdominus syndrome?"

Report of a 19-year-old man who was admitted to the hospital after vigorous exercise with signs of the "acute abdomen" syndrome. Since intestinal reasons for the complaints were excluded, a myocardial infarction was considered. However, the excessively increased serum CK levels indicated a disorder of the voluntary muscles. A biopsy taken from the rectus abdominis revealed typical features of acute rhabdomyolysis, which was obviously restricted to the rectus abdominis. Together with a somewhat later observed autopsy case of a young male with acute abdominal rhabdomyolysis, also restricted to the rectus abdominis, this case gives rise to discuss, whether there exists a "rectus abdominis syndrome" analogous to the anterior tibial syndrome.

High-resolution sonography in experimentally induced scrotal pathology

Benign and malignant extra- and intratesticular lesions were experimentally induced in the testes of Wistar rats so as to evaluate the significance of high-resolution ultrasonography for the early detection of intratesticular malignancy. The animals were studied using high-resolution sonography (mean frequency = 8 MHz) over 6 weeks. Walker carcinomas could be induced in the testicle in 50% of the cases; 8 of 17 showed a locally limited growth. Tumors over 2 mm in diameter showed a typical change in the normal sonographic pattern of the testes. The overall sensitivity of high-resolution sonography for intratesticular lesions was 88%, the specificity 91%. The detection of small intratesticular lesions has made high-resolution sonography superior to conventional sonographic techniques and may therefore prove to be of major clinical significance.

Antibody coating of bacteria in experimental infection of the urinary bladder

We studied antibody coating of urinary bacteria in experimental cystitis of the rat both in the absence and presence of a foreign body (polyacrylamide sphere). In the absence of a foreign body, inoculation of the bladder urine resulted in generally transient bacteriuria with no significant antibody coating or defects in the bladder uroepithelium, lymphocytic infiltration of bladder mucosa, or plasma cells in the bladder mucosa. Inoculation in the presence of a foreign body resulted in protracted bacteriuria with significant antibody coating of urinary bacteria, defects in the bladder mucosa surface, lymphocytic infiltration of the bladder mucosa, and numerous plasma cells. We conclude that the bladder mucosa is capable of mounting a local immune response against bacterial invasion which leads to antibody coating of urinary bacteria.

[A histologically insured bilateral osteochondrosis of the head of the first metatarsal (author's transl)]

A case of bilateral osteochondrosis of the head of the first metatarsal shows two interesting aspects: 1. The second time in literature a histological verification is gained. 2. A combination with one-sided epiphyseal undergrowth of the proximal phalanx I inspires new associations to hallux rigidus and similar diseases.

The effect of in situ isolated perfusion of experimental renal tumors with cytotoxic agents in high concentration

In animal experiments the possibility of increasing the dosage of anticancer drugs by isolated in situ tumor perfusion without incurring systemic toxicity was studied. Isolated perfusion of normal kidneys with tris-ethylenimino-benzochinon (triaziquon, Trenimon) and amethopterin (Methotrexate) demonstrated that the kidney tolerates far higher antitumor drug concentrations than are achieved by systemic anticancer chemotherapy. Renal function, which was evaluated before and after cytotoxic perfusion by means of renal functional scintigraphy, decreased by less than 15%. Each kidney was examined histologically after perfusion. Isolated cytotoxic perfusion of renal tumors (Walker carcinosarcoma 256) using the combination of Trenimon (0.034 microgram/ml) and Methotrexate (0.034 mg/ml) led to complete tumor regression. Tumor perfusion without cytotoxic agents and systemic intravenous administration of the LD50 of the anticancer drugs did not achieve tumor control.

[Persistence of the primitive aortic conus in normal positioning of the great vessels of the heart. A contribution to the formal independence of bulbar contraction inhibition]

A hitherto undescribed cardiac malformation, characterized by persistence of the primitive aortic conus and normal positioning of the great vessels, is reported and used to discuss the theory of bulbar resorption and the hypothesis of conal growth. The persistence of the primitive aortic conus is explained by the absence of bulbar contraction. The present selective inhibition of bulbar involution in normal positioning of the great vessels shows it to be a phenomenon formally independent of the transposition. Thus, the concept explaining the formal genesis of transposition is explained by arrest of torsion of the bulbar truncus is reconfirmed.

[The effects of extreme cold on major blood vessels. An experimental study (author's transl)]

In 10 beagles cryogenic experiments were performed to study the effects of freezing the iliac artery and vein. The histological tissue reaction after cold exposure in major pelvic vessels was early inflammation and followed by a rapidly progressing reparative process. Long-term microscopic changes were proliferations of the vessel intima and focal splitting on the elastic membrane. No evidence of thrombosis, aneurysm fomation and rupture of the vessel was found. Vascular function as a blood conduit was undisturbed.