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Eye lens radiation exposure during radiologically-guided endoscopic procedures may result in radiation-induced cataracts; therefore, we investigated the ocular radiation exposure during ureteroscopy on a phantom model.Using an Alderson phantom model and eye lens dosimeters, we measured the ocular radiation exposure depending on the number of X-ray images and on the duration of fluoroscopic imaging. The measurements were done with and without using a face protection shield.We could demonstrate that a significant ocular radiation exposure can occur, depending on the number of X-ray images and on the duration time of fluoroscopy. Eye lens doses up to 0.025 mSv were recorded even using modern digital X-ray systems. Using face protection shields this ocular radiation exposure can be reduced to a minimum.The International Commission on Radiological Protection (ICRP) recommendations of a mean eye lens dosage of 20 mSv/year may be exceeded during repeated ureteroscopy by a high volume surgeon. Using a face protection shield, the eye lens dose during ureteroscopy could be reduced to a minimum in a phantom model. Further investigations will show whether these results can be transferred to real life ureteroscopic procedures.

The overwhelming postsplenectomy infection syndrome (OPSI) is a fulminant sepsis that is mainly caused by Streptococcus pneumoniae and is characterized by a particular high mortality. Patients whose spleen was removed due to a hematological disease are at special risk. Even after the recommended immunization against Streptococcus pneumoniae 20-30 % of these patients do not develop an adequate level of antibody response. Therefore, this particular group of patients must be trained how to behave in case of fever and need to obtain immediate specific sepsis therapy with antibiotic prophylaxis.

Placental site trophoblastic tumor (PSTT) is a rare, mostly benign tumor, which in 10-15% of cases shows a malignant behavior. The case of a 35 year old woman with pulmonary metastasis of a PSTT is reported. This finding was incidental in an atypical lung-resection due to pneumothorax. The literature on this rare tumor entity is reviewed especially in terms of differential diagnosis, biological behavior and association with a pneumothorax.

Annular pancreas is a rare congenital malformation of the pancreas. In about 50 % of the cases the malformation is asymptomatic until the second to fifth decade. We report on a 75-year-old male patient with an extremely rare localization of annular pancreas - namely at the pars horicontalis duodeni - who presented with recurrent vomiting and loss of weight. An end-to-side Roux-Y duodenojejunostomy was performed. After that procedure we discharged the patient on day eleven after surgery in good physical health condition. In a patient presenting signs of duodenal obstruction annular pancreas should be taken into account as a possibility.

We describe the third case world-wide of a chorangiocarcinoma, a tumour with an abnormal trophoblast proliferation in combination with a hypervascular chorangiosis of the villous stroma. The lesion was an incidential finding by a healthy 31-year-old woman, gravida 1, para 1 when the pregnancy was terminated at 34 weeks gestation because of fetal distress and intrauterine growth restriction. Hormonal levels were within the normal range. Mother and infant had an uneventful postpartum course. Immunohistochemical studies of the abnormal trophoblasts demonstrated strong immunoreactivity for HCG and in 80% for Ki 67. The semiquantitative expression of angiogenic growth factors (VEGF, bFGF, Ang-1 und Ang-2, PDGF) in the tumour trophoblasts was similar to that seen in the normal villi. The pathogenesis of this tumour with a villous vascular response is curious and unclear. Possibilities include the occurrence of a variant of a chorion carcinoma, the occurrence of a new tumour entity or of two separate lesions, a chorangioma and incidential chorion carcinoma, present together as a "collision" tumour. Another possibility is a composition tumour or a reactive lesion of trophoblasts and the villous vascular tree.

Intoxicated states can be induced not only by the typical narcotic drugs, but also by other psychotropic substances, such as the thorn-apple and angel's trumpet. In recent times there has been an increase in the reported number of cases of such intoxications. Clinical symptoms, toxicological analysis and possible forms of treatment are discussed.

A patient with cervical myelopathy caused by marked degenerative alterations of the cervical spinal column at the level of cervical vertebrae 3/4 and relative spinal canal stenosis in the area of cervical vertebrae 5-7 was treated in the department of neurosurgery because of progressive myatrophy and paresis of muscles innervated from cervical nerves 5-7. The operation was performed with vertebrectomy of cervical vertebra 6, implantation of a Harms titanium cage with autograft and a plate and spongy bone screw fixation system. There exists an unusual--and not often publicized--complication during this surgical procedure in the area of the cervical spine, namely penetrating injury of the vertebral artery caused by the treatment with a plate and spongy bone screw fixation system. We describe such an injury of the left vertebral artery. The vertebral artery was intraoperatively embolized using mechanical embolization coils.

We report about our experiences obtained with the Vitek system (bioMerieux, Nürtingen) for identification of 1160 clinical Candida isolates. The Vitek system correctly identified 1005 (86.6%) Candida isolates (probabilityor = 85%): 776 (66.9%) strains were identified after 24 h of incubation, 229 (19.7%) required 48 h of incubation. In 4.4% (n = 51) we found results with a lower probability (85%). After 24 h of incubation 38 (14.6%) of the 260 C. tropicalis isolates tested were misidentified as C. parapsilosis; we obtained the correct results after 48 h of incubation. 104 (9%) isolates were wrongly identified after 48 h of incubation. The majority of these strains (n = 82) were biochemically minimally reactive Candida species. Overall, the Yeast Biochemical Card system provides a reliable method for the rapid, automated identification of medically important Candida species.

The investigation of susceptibility of Candida species to fluconazole was performed in microdilution to a supplemented HR-medium. The sufficient reproducibility of the test was verified using special control isolates and isolates of patients. The excellent applicability of the method in routine diagnostics was evaluated by in vitro testing of susceptibility of 279 Candida isolates from patients being colonised or suffering from endomycoses. The Candida species showed different susceptibility against fluconazole: 96% of the C. albicans isolates were sensitive, 55% of the C. glabrata isolates had a reduced sensitivity, and 26% were resistant against fluconazole (MIC25 micrograms/ml). C. krusei isolates were highly resistant (9 of 11 strains).

The case of a 68-year-old man with leiomyosarcoma of the spermatic cord is reported. Radical orchiectomy with high ligature of the cord was performed. Pathological examination including immunohistochemistry demonstrated a leiomyosarcoma which seemed to arise from a spermatic cord vessel.

To our knowledge this is the first reported case of a primary extracranial meningioma located in the palatine tonsil. Immunohistochemical investigation of the tumour showed coexpression of vimentin and neuron-specific enolase (NSE). No staining was found with antibodies against cytokeratins KL1, 13/10, 8 and 18, epithelial membrane antigen EMA and melanoma protein (HMB-45). It seems justifiable to classify this tumour as an atypical meningioma because of the local increased mitotic activity.

The risk profile and the macro-vascular complications of patients with type II diabetes mellitus (NIDDM) was investigated in general practice patients for the first time in the FRG. It was the aim of the study to evaluate the efficacy of the therapy and possible improvements after detailed instructions in a random sample of well defined NIDDM in the greater Munich area. 290 NIDDM (187 female, 103 male) out of a total of 1500 patients treated by 22 general practitioners were randomly recruited for the study. First results indicated an excess morbidity of the NIDDM, e.g. 43.5% with HbA1c greater than 8%, hypertension in 73.8%, hypertriglyceridemia in 75%, hypercholesterolemia in 36.3% adipositas in 78%, and a micro/macro-albuminuria in 44.5%. A similar risk profile could be determined in cases with recently diagnosed NIDDM. The remarkable risk profile documents itself in the incidence of macro-vascular complications: 40.8% of the male and 43.2% of the female showed a peripheral arterial disease (pAVD), in 8% of all patients a carotid artery stenoses could be detected by means of doppler ultrasound technique; 46.6% of the male and 59.3% of the female patients showed symptoms of CHD. With the exception of the incidence of CHD in patients less than 64 years the duration of NIDDM had no influence on the macro-vascular complications as demonstrated in previous studies. The age however always had a significant influence on all three vascular regions examined. Albuminuria correlated as such with a number of risk factors showed a significant correlation with the incidence of pAVD and occurred more often in males with carotid artery stenoses. Other correlations established were: Hypercholesterolemia and FVIII ass. Ag respectively, and the incidence of carotid artery stenoses; blood pressure, F VIII ass. Ag and pAVD. In the female a negative correlation could be seen between the pAVD and the HDL-level. In patients with CHD sex specific correlations could be determined to blood pressure, HbA1c, c-peptide and triglyceride levels.

Disturbances of the iron metabolism in patients with chronic alcohol abuse are of very complex genesis. The frequently probable hypersideraemia is caused by an increased intake of iron, by release of depot iron, when an alcohol-conditioned liver damage is present, and by an increased iron balance with disturbed iron use of the bone marrow. Thus the in alcoholics often provable combined megaloblastic-sideroblastic anaemia is in close connection with this.

The clinical and radiological parameters, the laboratory findings as well as the results of the nuclear-medical examination established in 78 patients with an osteomyelofibrosis or osteomyelosclerosis are compared with the data existing in literature and the problems of diagnostics and therapy of these diseases are derived from this.

Changes in all three blood cell systems could be covered in 50 patients treated in hospital for a high consumption of alcohol for years and even decades. There is no symptom which would be pathognomonic for alcoholism in itself. Macrocytosis and macrovoluminity of erythrocytes, hyper-sideraemia and thrombocytopenia were findings frequently encountered and easily to be identified. Megaloblasts, vacuolization, and an increase of sideroblasts could be observed in the bone-marrow. The prompt reversibility of these changes mentioned by simply abstaining from alcohol has a considerable diagnostic utility. The impact of liver damage partly produced by an accompanying spleen enlargement could only be ensured for thrombocyte depression. The increase of methaemoglobin which is unequivocal but without any clinical importance can also be reversed by alcohol deprivation. From a haematological point of view an alcoholic is endangered by a deficient immunological system. Haemorrhagic diatheses due to thrombocytopenia, thromboembolic complications during rebound-thrombocytosis and severe haemolyses can rarely be found.

The composition of free fatty acids of hair lipids from subjects with psoriasis vulgaris (n = 60) and a control group (n = 30) was determine by gas liquid chromatography. The analysis indicates that the percentage composition of longer chain fatty acids was distinctly higher in psoriasis vulgaris. It is suggested that patients with psoriasis vulgaris have either a different air lipid composition and a different microbial activity or different activities of the epidermic esterases.

A retrospective study of 95 follicular thyroid carcinomas was conducted to evaluate the prognostic value of different morphological and clinical features. The biological behaviour of these tumours was primarily influenced by presence or absence of a capsule type of confinement: the frequency of lethal outcome among widely invasive carcinomas was six times higher than among encapsulated neoplasms. Furthermore, dismal prognosis could be demonstrated for tumours occurring in older patients (with a sharp break in the prognosis at the age of 52 years) and for those lesions which displayed oxyphilic metaplasia. The same effect was shown for presence of lymph node metastasis, tumour invasion of the cervical soft tissue and, for the case of encapsulated carcinomas, distant haematogenous spread. Conversely, the degree of differentiation and the patients' sex proved to have no significant influence on prognosis. In 22 carcinomas, cytophotometric and flow-cytometric determinations of DNA values were performed. These procedures revealed to have only limited diagnostic value, since for the majority of the tumours, benignancy or malignancy could not be judged from the DNA histograms. However, DNA measurements proved to contribute valuable information for the prognosis in individual cases of widely invasive follicular carcinomas. The discussion focuses on the diagnostic, therapeutic and prognostic relevance of these findings and on their impact on subclassification of follicular thyroid carcinomas.