In Western industrialised countries the prevalence of neoplastic colonic lesions and diverticular disease markedly increases with age. In contrast, the coincident occurrence of both diseases seems to fall below their individual epidemiologic estimates. Because directly comparing data are rare, this retrospective study evaluates the coincidence of neoplastic lesions and diverticular disease.

BACKGROUND:The development of hypertensive pulmonary vascular disease (HPVD) is considered a risk factor in the long-term course of patients with secundum atrial septal defects (ASD). The aim of this study was to assess the prevalence and histologic degree of HPVD and pulmonary hypertension in relation to preoperative clinical and hemodynamic data, intraoperative findings, and operative outcome in adults.METHODS:Lung biopsies of 75 patients, mean age 44 +/- 14 years (18-71 years), with secundum ASD or sinus venosus defect including ten patients with partial anomalous pulmonary venous return were analyzed in accordance with preoperative and intraoperative findings as well as operative outcome. Lung biopsy was performed at the time of defect closure and was classified according to Heath and Edwards.RESULTS:Structural changes of the pulmonary vasculature were found in 59% of patients; grade 3 and higher changes were present in 19%. There were no statistically significant relations between histologic findings and preoperative clinical and hemodynamic data, intraoperative findings, and operative outcome. The prevalence of moderate (32-50 mm Hg) and severe (> 50 mm Hg) systolic pulmonary hypertension was 27% and 17%, respectively. Increased systolic pulmonary arterial pressure was associated with increased pulmonary vascular resistance (p < 0.000) and patients' age (p = 0.001). Patients with a lower functional capacity had a higher prevalence of pulmonary hypertension (p = 0.011).CONCLUSIONS:The prevalence of HPVD and pulmonary hypertension in adult patients with secundum ASD or sinus venosus defect is considerable. Preoperative hemodynamic data do not predict the degree of HPVD in lung biopsy. Closure is generally advised to prevent increasing pulmonary arterial pressure and decreasing functional capacity over time.

Background— Current heart valve prostheses are constructed mimicking the native aortic valve. Special hemodynamic characteristics of the mitral valve such as a nonaxial central inflow with creation of a left ventricular vortex have so far not been taken into account. A new polycarbonaturethane (PCU) bileaflet heart valve prosthesis with special design for the mitral position is introduced, and results of animal testing are presented. Methods and Results— After in vitro testing, 7 PCU-prostheses and 7 commercial bioprostheses (Perimount, n=4; Mosaic, n=3) were implanted in mitral position into growing Jersey calves (age 3–5 months, weight 60–97 kg) for 20 weeks. 2-Dimensional echocardiography was performed after implantation and before sacrification. Autopsy included histologic, radiographic, and electron microscopic examination of the valves. In vitro durability was proven for >15 years. After implantation 2-dimensional-echocardiography showed no relevant gradient or regurgitation of any prosthesis. Clinical course of the animals with PCU valves was excellent. In contrast, 5 of 7 calves with bioprostheses were sacrificed after 1–9 weeks because of congestive heart failure. 2-Dimensional echocardiography of the PCU valves after 20 weeks showed mild leaflet thickening with trivial regurgitation; mean gradient was 8.1±5.0 mm Hg (weight: 160–170 kg). The explanted PCU prostheses revealed mild calcification and no structural degeneration. All of the Perimount bioprostheses were severely calcified and degenerated after 11±7 weeks. One Mosaic bioprosthesis was thrombosed after 1 week, and 2 showed severe and mild-to-moderate degeneration after 4 and 22 weeks, respectively. Conclusions— Polycarbonaturethane valve prostheses with special design for mitral position show excellent hemodynamic performance and durability in vivo. Calcification and structural changes are mild compared with bioprostheses. Controlled clinical studies are planned.

OBJECTIVE:Current prosthetic heart valves necessitate permanent anticoagulation or have limited durability and impaired hemodynamic performance compared with natural valves. We report in vivo and in vitro results with new polymeric valve prostheses that have a special design for the mitral and aortic positions. The aims are improved durability and elimination of the need for permanent anticoagulation.METHODS:The mitral and aortic prostheses (Adiam Life Science, Erkelenz, Germany) are made entirely of polycarbonate urethane (PCU). The bileaflet asymmetric mitral valve mimics natural, nonaxial inflow, which creates a left ventricular vortex, saving energy for systolic ejection of blood. The trileaflet aortic prosthesis has diminished pressure loss and reduced stress and strain peaks at the commissures. The valves were subjected to long-term in vitro testing and in vivo testing in a growing calf model (20 weeks; 7 mitral and 7 aortic valves) with comparison with 2 commercial bioprostheses (7 mitral, 2 aortic). Two-dimensional echocardiography was performed after implantation and prior to sacrifice with autopsy and valve examination.RESULTS:In vitro durability of the PCU valves was proved up to 20 years. In vivo durability and hemodynamics were superior to those of all bioprostheses. Survival of PCU valves versus bioprostheses was 7 versus 2 mitral valves and 5 versus 0 aortic valves, respectively. Two animals with PCU aortic valves died of pannus overgrowth that caused severe left ventricular outflow tract obstruction without changes in the valves. Degeneration and calcification were mild (mitral) and moderate (aortic) in PCU valves but were severe in biological valves. There was no increased thrombogenicity of the PCU valves compared with bioprostheses.CONCLUSION:The new flexible polymeric aortic and mitral valve prostheses were superior to current bioprostheses in animal testing.

The classification of cystic kidney diseases according to the pathologic-anatomic potter classification may be difficult. New molecular genetic findings are important to understand the underlying pathogenesis, but less useful to classify the hereditary diseases. An exact classification of polycystic kidney disease in fetus and children is very important for the human genetic consultation. Therefore, the investigation of pathological anatomy of kidney and liver, as well as the evaluation of additional malformations and family history is necessary. For clinical use the mode of inheritance (autosomal dominant and autosomal recessive) is used to differentiate hereditary polycystic kidney diseases.

We report a case of gall bladder tuberculosis in a 64-year-old male. The gall bladder is an extremely rare localization of an infectious disease seen frequently worldwide--tuberculosis. The reason for this special resistance against the mycobacteria is not clear and is controversial. In imaging, the disease can mimic acute or chronic cholecystitis or carcinoma of the gall bladder. It is important to consider tuberculous cholecystitis in differential diagnosis and to do tuberculin skin tests in case of suspicion. This test is technically easy and cost-effective. Since 1968, isolated tuberculosis of the gall bladder has not been reported in western civilization. This case study was done because of the rareness of the disease,and we review the literature on this topic.

Zusammenfassung Es wird über einen Fall von Gallenblasentuberkulose bei einem 64-jährigen Mann berichtet. Die Gallenblase ist eine extrem seltene Lokalisation einer weltweit sehr häufigen Infektionskrankheit – der Tuberkulose.Der Grund für diese spezielle Resistenz der Gallenblase gegenüber dem Erreger aus der Gattung Mycobacterium ist unklar und wird kontrovers diskutiert. Die Erkrankung kann bildmorphologisch eine akute oder chronische Cholezystitis oder ein Gallenblasenkarzinom imitieren.Wichtig ist, differenzialdiagnostisch auch an eine Cholezystitis tuberculosa zu denken und bei Verdacht einen Tuberkulintest durchzuführen. Diese Untersuchung ist technisch einfach und kostengünstig durchführbar.Seit 1968 wurde über keinen Fall von isolierter Gallenblasentuberkulose in der westlichen Welt mehr berichtet. Die Publikation erfolgt aufgrund der Seltenheit des Krankheitsbildes. Es wird anhand eines Fallberichtes ein Überblick über die Literatur zum Thema gegeben.

Background: To evaluate the biocompatibility of surgical mesh, explanted mesh samples were collected and analysed.

Die diagnostische Typisierung zystischer Nierenerkrankungen kann im Einzelfall Schwierigkeiten bereiten, da die nach Potter benannten pathologisch-anatomisch definierten Typen oft keine eindeutige Klassifikation erlauben. Die molekulargenetischen Erkenntnisse haben neue Einsichten geschaffen, tragen in der Praxis jedoch nur wenig zur Einteilung bei. Da eine präzise Klassifikation vor allem kindlicher, aber auch fetaler Zystennieren für die humangenetische Beratung betroffener Familien von großer Bedeutung ist, sollte neben einer präzisen pathoanatomischen Beschreibung von Veränderungen der Nieren und der Leber, sowie eventuell weiterer Fehlbildungen, immer auch die Familienanamnese berücksichtigt werden. In der klinischen Praxis werden für die erblichen polyzystischen Nierenerkrankungen die genetischen Begriffe (autosomal-dominant und autosomal-rezessiv) bevorzugt.

Fragestellung: Die Induktion einer ausgeprägten Angiogenese ist Voraussetzung für das schnelle Wachstum maligner Tumore. Wir untersuchten den Angiogeneseprozess von Ovarialkarzinom-Gewebe auf der Hühner-CAM (Chorio-Allantois Membran). Aus der großen Anzahl angiogenese-relevanter Faktoren konzentrierten wir uns auf das VEGF (Vascular Endothelial Growth Factor) und korrelierten die mRNA-Expression mit den Ergebnissen der Immunhistochemie und der Gefäßdichte.

OBJECTIVES:To analyze the biocompatibility of multifilament polyester (PET) meshes used for the implantation of auditory brainstem implants in a standardized Wistar rat model (n=29).METHODS:The physical properties of the meshes were examined during surgery. Using a modified plastic embedding, the local tissue reaction and the stability of mesh position in the region of the fourth ventricle were evaluated in section series from day 3 to 64. The cellular reaction was further differentiated using transmission and scanning electron microscopy.RESULTS:PET meshes were stable for handling. However, sharp edges inevitably led to brainstem and cerebellar penetration in some cases. The meshes were preserved in situ in all section series. Positioning was stable with one exception. A sufficient fibroblast and collagen fiber encasement was reached after 14 days. In all cases, no further change was observed through day 64. The host-defense reaction was persistent and characterized by numerous macrophages and foreign-body giant cells. Bacterial infection occurred in three cases.CONCLUSIONS:PET meshes proved to have an acceptable biocompatibility regarding local-tissue reaction in the brain. Modified polymer structures should be developed to reduce risk of injury. Anti-inflammatory surface treatments and monofilament meshes could reduce the infection rate.

Background: The aim was to study the long-term tissue response to polypropylene mesh.Methods: This was a retrieval study that investigated 76 polypropylene meshes with a median implantation interval of 18 (range 2-180) months. Mesh was explanted following hernia recurrence, infection or pain. The median implantation interval was 20 (range 4-180) months in the recurrence group, 30 (range 5-48) months in the pain group and 10 (range 2-56) months in the infection group (P < 0.05, infection versus pain or recurrence). The inflammatory response was determined by immunohistochemistry of macrophages (CD68), polymorphonuclear granulocytes (CD15) and T and B lymphocytes (CD3 and CD20). The cell turnover within the interface mesh fibre-recipient tissue was measured by TUNEL for apoptosis or DNA strand breaks, Ki67 for cell proliferation and heat-shock protein (HSP) 70 for cell stress.Results: With the exception of HSP-70, levels of all variables decreased over time. Sex, age, type of previous operation or location of the mesh did not have a significant influence.Conclusion: Long-term incorporated polypropylene mesh in humans has a more favourable tissue response with increasing implantation interval.

Freeman-Sheldon syndrome is defined as a combination of microstomia, deep set eyes, small palpebral fissures, arthrogryposis with ulnar deviation of the hand, talipes equinovarus and generalized muscular hypertension. Respiratory and swallowing problems are frequently encountered in these patients due to small orifices of mouth and nose. Obstruction of the upper airway tract resulting in tracheostomy has only been described twice. The described child manifested the typical dysmorphic features of Freeman-Sheldon syndrome and suffered from serious respiratory distress and swallowing difficulties from birth. The boy died at the age of 7 months after accidental decannulation of the tracheostoma during sleep. He did not show anatomical or histopathological abnormalities in the pharyngeal, laryngeal or tracheal regions. We assume that the only explanation of the repeated obstructive episodes is a functional muscular obstruction.

INTRODUCTION:Angiosarcomas are uncommon neoplasias, normally located in the skin, liver or heart. Primary angiosarcoma of the lung is rare.CASE REPORT:We report on a 41-year-old patient who presented increasing dyspnea. A 10-cm-angiosarcoma of the inferior lobe of the left lung was detected. After preoperative chemo- and radiotherapy the patient was referred to our clinic for surgical intervention. Resection of the inferior lobe of the lung, resection of part of the diaphragm, lymphadenectomy and replacement with a Vypro-II mesh was performed. Histological examination showed a mesenchymal neoplasia with myxoid tumor tissue, variable cell density and small proliferations of vessels. The immunohistochemical analysis confirmed the diagnosis of an angiosarcoma. The patient was discharged in a good general state for further ambulatory radiochemotherapy.DISCUSSION:Angiosarcoma of the lung must always be included in the differential diagnosis of lung nodules and diffuse infiltrates despite its rare occurrence. Success with neoadjuvant therapy has been reported, but radical resection is recommended due to the cumulative bad prognosis.

Einleitung: Angiosarkome sind seltene Neoplasien mit bevorzugt kutaner, hepatischer oder kardialer Lokalisation; das primäre Angiosarkom der Lunge stellt dagegen eine Rarität dar. Fallbericht: Wir berichten über einen 41 jährigen Patienten, bei dem aufgrund einer progredienten Dyspnoe ein 10 cm großes Angiosarkom des linken Lungenunterlappens diagnostiziert wurde. Nach präoperativer Chemo- und Radiotherapie wurde der Patient zur operativen Intervention in unserer Klinik vorgestellt. Es erfolgte eine En-bloc-Unterlappen-, Zwerchfellteilresektion, Lymphadenektomie und Ersatzplastik mittels Vypro-II® Mesh. Die histologische Untersuchung zeigte eine mesenchymale Neoplasie mit myxoidem Tumorgewebe unterschiedlicher Zelldichte und zahlreichen Gefäßproliferaten. Die Immunhistochemie konnte die Diagnose eines Angiosarkoms bestätigen. Der Patient wurde in gutem Allgemeinzustand in die weitere ambulante Radiotherapie entlassen. Diskussion: Das Angiosarkom der Lunge ist trotz seines seltenen Auftretens in die Differentialdiagnose pulmonaler Rundherde und diffuser Infiltrate einzubeziehen. Trotz der Erfolge neoadjuvanter Therapiemodalitäten ist eine radikale chirurgische Resektion aufgrund der kumulativ schlechten Prognose dringend zu empfehlen.

OBJECTIVES The goal of this study was to test the hypothesis that moderate hypothermia during cardiopulmonary bypass (CPB) provides myocardial protection by enhancing intramyocardial anti-inflammatory cytokine balance.BACKGROUND Moderate hypothermia during experimental CPB stimulates production of interleukin-10 (IL10) and blunts release of tumor necrosis factor-alpha (TNF Phi).METHODS Twelve young pigs were assigned to a temperature (T degrees) regimen during CPB: moderate hypothermia (T degrees: 28 degreesC; n = 6) and normothermia (T degrees: 37 degreesC; n = 6). Intra-myocardial TNF alpha- and IL10-messenger RNA were detected by competitive reverse transcriptase polymerase chain reaction and quantification of cytokine synthesis by Western blot. Levels of cardiac troponin I (cTnI) in cardiac lymph and in arterial and coronary venous blood were examined during and after CPB. Myocardial cell damage was assessed by histologic and ultrastructural anomalies of tissue probes taken 6 h after CPB.RESULTS Synthesis of IL10 was significantly higher, while that of TNF alpha was significantly lower, m pigs that were in moderate hypothermia during surgery than in the others. In contrast with normothermia, moderate hypothermia was also associated with significantly lower cumulative cardiac lymphatic flow during and after CPB, significantly lower lymphatic cTnI concentrations after CPB, significantly lower percentages of myocardial cell necrosis and a significantly lower score of ultrastructural anomalies of myocardial cells. While die percentage of apoptotic cells was not different between groups, the apoptosis/necrosis ratio tended to be higher in animals that were in moderate hypothermia during surgery. In all animals, TNF alpha synthesis correlated positively while IL10 production correlated negatively with necrosis and total cell death, respectively.CONCLUSIONS Our results suggest that moderate hypothermia. during CPB provides myocardial protection by enhancing intra-myocardial anti-inflammatory cytokine balance. (C) 2001 by the American College of Cardiology.

Introduction:Cardiomyocytes respond to stress with the expression of various heat shock proteins (HSPs).Expression of mitochondrial HSP60 is known to be induced by various stress factors, including ischaemia and reperfusion.The aim of the study was to investigate the induction of HSP60 in human myocardium during cardiac surgery. Method:From eight patients undergoing elective coronary artery bypass grafting or valve replacement, samples of right atrium were harvested before and after extracorporeal circulation (ECC).Two patients had atrial fibrillation and six were in sinus rhythm.The myocardial samples were excised and immediately immersed in liquid nitrogen.The HSP60 protein level was determined using sodium dodecyl sulphate-polyacryl-amide gel electrophoresis, Western blot, and subsequent ECL technique.The amount of HSP60 protein was quantified by optical densitometry, according to the immunoreactive bands of actin.Results: In all samples HSP60 was detected before and after ECC.We could not find any difference in HSP60 expression before and during cardiac surgery.There was no correlation with duration of cardiopulmonary bypass or reperfusion time. Conclusion:We could not demonstrate a cytoprotective upregulation of HSP60 after an obligatory period of ischaemia, cardioplegic arrest and reperfusion.This might reflect effective cardioprotection during ECC.

Toxoplasma gondii infections in heart transplant recipients emerge in most cases as newly acquired infections of the immunocompromised sero-negative patient from an exogenous source, usually the donor organ. We report on a 64-year-old heart transplant recipient who developed pneumonitis, myocarditis, and hyperacute encephalitis three weeks after transplantation. Histopathological examination of an endomyocardial biopsy revealed fulminant T. gondii infection. Although appropriate chemotherapy was administered immediately, the patient died the next day. Our case demonstrates that if a histological diagnosis is not rendered in time, fulminant toxoplasmosis may lead to a fatal outcome. In conclusion, a general screening of the donors and recipients for opportunistic infections, including toxoplasmosis, and an appropriate prophylaxis should always be considered.