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Clinical Relevance of Accessory Spleens Following Elective and Emergency Splenectomies Background: With respect to the various functions of the spleen, a careful risk-benefit analysis must be done before splenectomy. Methods: During 10 years, 211 splenectomies were carried out in our hospital. In 185 of these clinical cases the documents were complete for an analysis. Results: The most frequent indications for surgical treatment were immunothrombocytopenia (22.2%) and lymphogranulomatosis (18.9%) followed by spleen bleedings (24.3%) of traumatically, iatrogenic or spontaneous origin. Postoperative complications such as pulmonary and cardiological disorders, disorders in wound healing, and abscesses could be found in 31.3% of the elective and in 80.4% of the emergency cases. 5.2 and 21.9% of the patients died after elective treatment and emergency surgery, respectively, resulting in an overall mortality of 10.8%. In the latter group death was mostly related to the severe concomitant injuries. The main problem during the postoperative period is the high rate of infections which could be attributed to the loss of an immunologically active organ. Postoperative thrombocytosis was temporary in most cases. A sepsis developed in 4.9% of the patients with a lethal outcome in 2.7% of the cases. 13.5% of the patients showed accessory spleens. In those patients suffering from immunothrombocytopenia and lymphogranulomatosis, they were even found in 22 and 20% of the cases, respectively. 12.1% of the 58 reinspected patients showed accessory spleens; some of them even had multiple accessory spleens. Mostly, solitary accessory spleens were found. They were located in the neighborhood of the spleen or – after splenectomy – in the former spleenic area. The size of accessory spleens ranged between some millimeters and 5 cm with an average length of about 1–2 cm. Accessory spleens were either completely unobtrusive with no function at all, or they can take over some spleenic functions, regardless of their size and location. Especially in combination with immunothrombocytopenia, they may be responsible for the failure of an otherwise successful splenectomy. However, relapses after splenectomy could not generally be attributed to accessory spleens since relapses also occurred after additional exstirpation of accessory spleens. Conclusion: As some accessory spleens take over specialized functions of the spleen while others remain unobtrusive, the benefit of splenectomy for the treatment of blood-related malignancies is hardly foreseeable.

Von Januar 1992 bis Dezember 1996 wurden in der Chirurgischen Universitatsklinik Bonn (Dir. Prof. Dr. A. Hirner) 221 Manner und 79 Frauen wegen Bronchialkarzinomen (n=197), Lungenmetastasen (n=49), sonstigen malignen Lungentumoren (n=48) und Bronchialkarzinoiden (n=8) operiert. Das Durchschnittsalter betrug 63,8 Jahre. Von den mannlichen Patienten waren 51%, von den weiblichen 14,7% an Bronchialkarzinomen erkrankt; bei der histologischen Typisierung der Bronchialkarzinome ergab sich fur Manner und Frauen folgende Verteilung: Plattenepithel-CA 36,7%/8,9%, Adeno-CA 23,1%/40,5%, groszellige CA 6,8%/5,1%, kleinzellige CA 2,7%/1,3% und sonstige maligne Lungentumoren 12,3%/3%; fur Lungenmetastasen 8,7%/7,7% und fur Bronchialkarzinoide 1,7%/1%. Rund 40% der Patienten wiesen anamnestisch Lungenvorerkrankungen auf. Nikotinabusus wurde von 52,4% betrieben; 70,5% der Patienten mit Plattenepithel-CA und 71,4% mit kleinzelligen CA waren Raucher mit einer mittleren Packungsjahr-Belastung von 50 PY. In 26,3% der Falle kam es zu postoperativen Komplikationen, meist Pneumonien und bronchopleuralen Fisteln. Nach einer medianen postoperativen Zeit von 7,1Monaten fanden sich bei 64,9% der Patienten Lokalrezidive u./o. Fernmetastasen. Die durchschnittliche mediane Uberlebenszeit bei Bronchialkarzinomen lag bei 32 Monaten, die 5-Jahres-Uberlebensrate bei 11%; bei den sonstigen malignen Lungentumoren betrug sie 14 Monate und die Uberlebensrate sank nach 41 Monaten auf 0%. Die 5-Jahres-Uberlebensrate bei Lungenmetastasen betrug 60,5% und bei Bronchialkarzinoiden lag die 31/2-Jahres-Uberlebensrate bei 100%.

A scrotal mass as initial manifestation of necrotising pancreatitis is very rare. In addition, the diagnosis is very difficult because diseases that occur more frequently produce similar symptoms. Therefore, it is very important to think about rare entities in the differential diagnosis for testicular pain.

The role of angiotensin in the pathophysiology of mesenteric vasospasm raises the question whether angiotensin-converting enzyme (ACE) inhibitors can influence the sequelae of shock on the mesenteric circulation. The purpose of this study was to investigate the effect of captopril on the metabolic consequences of the nonocclusive mesenteric infarct. Thirty pigs were used. The cardiogenic shock was induced by an infusion of 10% hydroxyethyl starch into the pericardium over 10 min. In all groups, except the control group, the ACE inhibitor captopril was given as a bolus of 0.25 mg/kg and then 10 mg/kg/min continuously up to a total of 50 mg. The positive effect of captopril on the mesenteric circulation was verified by a significantly smaller increase of lactate, lesser pH decrease in the superior mesenteric vein. The shock-induced acidosis in the mesenteric circulation was less profound in therapy groups as compared with the control group. Systemic therapy with ACE inhibitor is more effective than local application. The effect of captopril treatment inherently relies on the timing of initiation.

Thromboembolisch verursachte Milzinfarkte sind eine bekannte Komplikation im Rahmen eines arteriellen embolischen Geschehens. Die hier vorgestellten Falle eines Milzinfarkts sind als Komplikation der endovaskularen Therapie beim infraabdominellen Aortenaneurysma aufgetreten. Diesbezugliche Komplikationen im Zusammenhang mit der konventionellen Chirurgie des Aortenaneurysmas sind in der Literatur nicht beschrieben. Anzunehmen ist, dass durch die endoluminare Manipulation und im Rahmen der Implantation diese Embolie ausgelost wurde. Anhand der Kasuistiken werden die moglichen Ursachen sowie therapeutischen Konsequenzen diskutiert.

The qualitative and quantitative MRI findings in 16 patients with focal nodular hyperplasia (FNH) of the liver are described; nine of these were confirmed histologically. A central scar is typical of FNH and provides a reliable diagnosis. This finding was seen in half the cases. If the scar is not demonstrable, the following features suggest the diagnosis: smooth margins, homogeneous signal distribution, increased signal intensity in T2-weighted spin-echo images and reduced signal intensity in inversion-recovery sequences. The T1 and T2 relaxation times in FNH are increased by about 30% compared with normal liver tissue.

We studied two families with five affected members suffering from ptosis and slowly progressive limb-girdle muscle weakness. All patients had abnormal decremental response on low-frequency nerve stimulation, but there were no repetitive responses to single stimuli. The patients improved on anti-acetylcholinesterase drugs. Intercostal muscle was obtained for special studies from one patient of each family. In vitro microelectrode studies were done in Patient 1. Miniature end-plate potentials were of low amplitude, and the quantal content of the evoked end-plate potentials was normal. Light microscopy revealed a marked type 1 fiber predominance. Acetylcholinesterase reactivity was dispersed over increased length of individual fibers in Patient 2. On morphometry of the end-plate ultrastructure, the number of secondary synaptic clefts per neuromuscular junction and the expansion of the postsynaptic area were markedly reduced. In Patient 1, but not in Patient 2, the envelopment of the nerve terminal by Schwann cell was increased. Acetylcholine-receptor (AChR) density was reduced as judged by the reduced immunoreactivity to antibodies against different receptor subunits. Immunohistochemical analysis of proteins known to be involved in orchestrating the end-plate structure showed deficiency of the AChR-associated protein utrophin. These patients appear to have a defect in the development or maintenance of the postsynaptic clefts; whether this defect results from or causes a reduced expression of utrophin or AChR is unclear.

Congenital esophageal atresia is seen in 1 out of 3000 living births today. The cause of this malformation is a disturbance of the separation of the esophagus, trachea, and lung during their embryonic development. The resulting abnormalities have many different forms but can classified into five major groups as described by Gross-Vogt [1] (Fig. 1). During pregnancy, a hydramnion can frequently be noted, and the postpartum clinical consequences can include choking or coughing. Already during the first hours, the regurgitated gastric juices can pass into the lungs and cause chemical pneumonia and atelectasis. Therefore, an early diagnosis and proper treatment are of vital importance.

A prototype of a measuring device is described, which reads the tube peak voltage and the switch-on time of x-ray units by means of two radiation detectors with different energy dependences due to detector materials (Caesium Iodine and Silicon). With a storage oscilloscope the curves of the tube voltage and the relative absorbed dose rate of intensifying screens can be displayed. The measuring range of the tube peak voltage is 60 kV to 150 kV. It is possible to measure exposure times of radiography equipment above 2 ms wit sufficiently low uncertainty. The tube peak voltage has been read with a relative uncertainty below 5% for almost all dose rates, which arise in practical application of medical x-ray units, and its calibration is made by means of x-ray apparatus with tube voltage reading, which has been compared to a Ge(Li) spectrometer. The stability of tube voltage reading of the measuring device is only effected by radiation damage of the detectors after a long time of utilization. The small diameter of the probe permits the accommodation of other probes, ionization chambers, phantoms, etc. in the radiation field at the same time.

The influence of X-ray Flashes on the germinative faculty of cress seeds has been studied. The experiments show that the radiation damage produced by X-ray flashes (τ < 0,5 μs) is much stronger than the influence of continuous radiation if the absorbed dose is the same. With a dose of about 0.3 Gy, it is possible to reduce ther germinative faculty from 99 % to 85 % while the same dose of continuous radiation shows no significant influence on the growth process. The result indicates that short soft X-ray flashes with high intensity are particularly important in the production of biological defects and should be considered in radiation protection.