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The present article aims at describing a rare case of an RP patient who evolved with heart block and was successfully treated with corticoid pulse therapy, without the need for pacemaker insertion.A systematic research on relapsing polychondritis (RP) and heart block (HB) published in PubMed/MEDLINE, Web of Sciences, LILACS, and Scielo from 1966 to August 2020 was performed.It was found 10 studies on RP associated with HB, and we added a case. Most were male (7/10) with ages 30 to 66 years old. RP disease duration was 1 week-6 years. In most cases (7/10), the RP was active when the HB occurred. A complete HB was observed in 4/7, followed by type II degree block in 3/7, and one patient had a sinus node dysfunction. Most patients received glucocorticoids. A pacemaker was inserted in 4/9 cases. Good outcome was observed in 3/9 patients and mortality in 2/10.We report the first case of an RP patient who had a heart block and was successfully treated with methylprednisolone pulse therapy. The authors suggest that in these RP cases, an attempt with a glucocorticoid pulse therapy may be offered to treat the heart block and prevent the insertion of a pacemaker.

Leseprobe ----- Zusammenfassung Auf der Grundlage umfangreicher Literatur- und Archivstudien werden in „Erziehung als Wissenschaftsaufgabe“ erstmals in 18 Einzelstudien zu ´Grundervatern´ der Politikwissenschaft deren grundlegende Beitrage zur Institutionalisierung und Neuorientierung der politischen Bildung in der Bundesrepublik analysiert. Schlagworter: Politikwissenschaft, Politische Bildung, Bundesrepublik Geschichte, Wolfgang Abendroth, Arnold Bergstraesser, Theodor Eschenburg, Ernst Fraenkel, Otto Heinrich von der Gablentz, Eugen Kogon, Dolf Sternberger, Felix Messerschmid ----- Bibliographie: Behrmann, Gunter C.: Politische Erziehung als Wissenschaftsaufgabe, GWP, 4-2017, S. 599-606. https://doi.org/10.3224/gwp.v66i4.13

Background: Epothilones are a novel class of microtubule-stabilising agents, and sagopilone is a fully synthetic epothilone that has shown marked in vivo and in vitro preclinical activity. Methods: This phase I, open-label study investigated the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of weekly sagopilone. Twenty-three patients with malignancy resistant or refractory to standard treatment were enrolled into this study evaluating sagopilone doses from 0.6 to 7.0 mg m−2. Results: The incidence of drug-related haematological adverse events (AEs) was low, with two grade 3 events observed. Nonhaematological AEs were generally mild and reversible; increased γ-GT was the only grade 4 event and grade 3 events comprised peripheral neuropathy (n=2), diarrhoea (n=1) and fatigue (n=1). Two grade 3 events were DLTs (diarrhoea and peripheral neuropathy at 7.0 mg m−2). The MTD of weekly sagopilone was therefore established as 5.3 mg m−2. Stable disease was the best overall response (n=3). Microtubule bundle formation in peripheral blood mononuclear cells increased post-treatment, peaking after 1 h. Sagopilone disposition was similar across treatment courses and showed rapidly decreasing serum concentrations after infusion end and a long terminal disposition phase with no obvious accumulation in the serum, probably reflecting a fast uptake into tissues followed by a slow release. Conclusion: Weekly administration of sagopilone could represent an alternative to the 3-weekly administration currently evaluated in phase II trials.

Background: Central retinal artery occlusion with persistent amaurosis as the only focal symptom caused by dissection of the internal carotid artery has occasionally been reported. Central retinal artery occlusion due to a common carotid artery dissection has been diagnosed only very rarely. Case Report: We describe a patient presenting with cervical pain, headache and unilateral amaurosis due to a thrombosis of the central retinal artery caused by a common carotid artery dissection, as demonstrated on MR imaging. No other neurological deficits could be detected. The patient underwent an anticoagulative treatment without improvement of his vision, but also without the appearance of further neurological symptoms. Conclusion: In monocular visual loss combined with cervical pain or headache, carotid artery dissection should be considered. Early treatment might be of crucial importance for the prevention of a devastating hemispheric stroke.

Cerebral ischaemia caused by thromboembolism is a possible complication of diagnostic and interventional cardiac catheterization. In this case report we describe the diagnostic steps and successful treatment strategy in the management of a patient who suffered from cerebral ischaemia during cardiac catheterization. Initial CT scanning to exclude cerebral haemorrhage was followed by angiography through the cardiac catheterization sheath in the right femoral artery. Occlusion just before the intracranial bifurcation of the right internal carotid artery was found and local thrombolysis given with a reduced dose of 34 mg rt-PA. The subsequent angiogram showed restored perfusion in the affected vessel after completion of thrombolytic therapy and resolution of neurological symptoms.

The dissection of the internal carotid artery is a rare complication of acceleration traumas of the upper spine. 30% of these dissections are caused by road accidents and again less than 30% of these occur bilateral as shown here. The symptoms are fronto-temporal and periorbital starting headaches spreading out to the occiput and Horner's syndrome. Complete hemiplegia as in our case is an impressive exception but the doctor in attendance should think of the carotid dissection. The exclusion of this complication is obligatory because treatment and outcome depend on it.The dynamic effects of bilateral carotid dissections may, as shown here, lead to relapsing cerebral infarctions with persisting neurologic deficits up to manifest hemiparesis. But restitution can be accomplished if early diagnosed by DSA and/or MRI. Therapy of choice is early prevention of persisting neurologic deficits using effective dosed heparin and depending on the residual lumen of the vessel oral anticoagulants or platelet antagonists for one year.

1965 fand in Kassel die erste »Arbeitstagung« der Deutschen Gesellschaft fur Erziehungswissenschaft statt. Nach verlasslichen Angaben hatte diese kurz zuvor gegrundete Vereinigung der an Universitaten Padagogik lehrenden Hochschullehrerinnen und -lehrer damals 157 Mitglieder (Scheuerl 1987, S. 276). Auch andere Indizien lassen darauf schliesen, dass die Universitatspadagogik noch eine kleine Disziplin innerhalb der Philosophischen Fakultaten war. Schon wenige Jahre spater wurde aus ihr das Massenfach Erziehungswissenschaft, das heute als eigenstandige Fachwissenschaft im Facherspektrum der wissenschaftlichen Hochschulen eine gesicherte Stellung einnimmt. Dass es nicht einmal 50 Jahre alt ist, durfte nur wenigen Studierenden des Fachs bewusst sein. Es wird ihnen in der reichhaltigen Einfuhrungsliteratur auch nur selten verraten.

Purpose To evaluate TOF 3D magnetic resonance angiography (MRA) of the intracranial arteries in patients with vasculitis or vasculitis-like benign angiopathy of the central nervous system (CNS). Method The results of MRA in 20 patients with clinically and radiographically proven vasculitis (17/20) or vasculitis-like benign angiopathy (3/20) of the CNS were retrospectively analysed. Patients with hyperintense lesions of more than 3 mm on T2-weighted MRI images were included in this trial. An inflammatory, embolic, neurodegenerative or metastatic origin of these lesions was excluded by extensive clinical studies. For the MR-examination a TOF 3D FISP sequence was used on a 1.5 T imager. Results MRA showed characteristic changes for vasculitis or angiopathy in 15 of 20 patients (75%). Conclusions In patients suspected of having a vasculitis or vasculitis-like angiopathy, MRA is recommended as a non-invasive modality. If the results of MRI and extensive clinical studies are carefully correlated, MRA may substitute conventional angiography in cases with typical vascular changes.

Ziel: Im Rahmen der internen Qualitatskontrolle sollen die eigenen Ergebnisse von Ballonangioplastien der Becken- und Beingefase bei Patienten mit pAVK hinsichtlich des technischen und klinischen Erfolges kontrolliert werden. Methoden: 197 Ballonangioplastien wurden retrospektiv uber einen Nachuntersuchungszeitraum von 1 - 4 Jahren ausgewertet. Besondere Berucksichtigung fanden klinisches Stadium, Risikofaktoren, die Lokalisationen der Stenosen und Verschlusse sowie nachgeschaltete Strombahnhindernisse. Kriterien fur die Verlaufsbeobachtung waren klinisches Stadium sowie dopplersonographischer Befund. Ergebnisse: Die PTA zeigte einen technischen Erfolg von 95 % bei Stenosen und 80 % bei Verschlussen. Im Langzeitverlauf erreichte die PTA der A. iliaca mit 88 % Erfolg die besten Ergebnisse. Hinsichtlich vorhandener Risikofaktoren zeigte die Kombination Nikotin/Hyperlipidamie (69 %) ein besseres Langzeitergebnis als die Kombination Diabetes/Hypertonie (54 %). Die PTA weiterer, nachgeschalteter Strombahnhindernisse in gleicher Sitzung zeigt bessere Ergebnisse nach einem Jahr (79 %) als die PTA ohne diese Dilatation (73 %). Innerhalb der Abteilung war ein Anstieg der technischen Erfolgsrate von 84 % im Jahr 1995 auf 96 % 1997 und eine Senkung der Komplikationsrate von 8 % auf 0 % zu beobachten. Schlussfolgerung: Die Ballondilatation hat sich durch eine hohe technische Erfolgsrate, gute klinische Langzeitergebnisse und niedrige Komplikationsrate bewahrt. Die PTA weiterer, nachgeschalteter Strombahnhindernisse in gleicher Sitzung ist aufgrund besserer Ergebnisse nach einem Jahr zu diskutieren. Innerhalb der Abteilung konnte die technische Erfolgsrate deutlich gesteigert und die Komplikationsrate gesenkt werden. Purpose: In the context of quality control, the results of balloon angioplasty of iliac and leg vessels in patients with vascular occlusive disease were investigated pertaining to the technical and clinical success. Methods: 197 conventional balloon angioplasties were evaluated regarding their success over a period of 1 - 4 years, retrospectively. The localisations of the primary obstructions and the existence of further obstructions, especially in the lower limb, the risk factors, and the technical and clinical results were compared. The clinical stage and the results of duplex ultrasound during follow-up examinations were recorded over a period of 1 - 4 years. Results: The technical success of PTA was 95 % for stenotic lesions and 80 % for occlusions. In the long-term (up to 4 years) PTA of the iliac arteries achieved the best results with a success rate of 88 %. The long-term results for the combination of the risk factors nicotine/hyperlipidemia (69 %) was better than for the combination of diabetes/hypertonia (54 %). The combined PTA of the main obstruction and of lower limb vascular had better results than the PTA without the dilatation of following stenoses 73 % to 79 % after one year. In our department we achieved a rise in success rate from 84 % in 1995 to 96 % in 1997. The number of complications during PTA was reduced from 8 % in 1995 to 0 % in 1997 and 1998. Conclusions: PTA has a high technical success rate and good clinical long-term results at low complication rates. Combined PTA of the main obstruction and an additional lower limb arterial stenosis or occlusion should be discussed because of the better clinical results after one year. By the quality control we achieved a rising technical success rate and a drop in complication rate.

Background/Aims: Doppler sonography has been used to assess hepatic arterial perfusion in a number of published reports. However, adequate validation studies are available for neither the transcutaneous nor the intravascular Doppler approach. The aim of this comparative study was to assess hepatic arterial perfusion with both methods. Methods: In 15 patients the right hepatic artery was examined with intravascular and transcutaneous Doppler sonography after calibration of Doppler devices in vitro with a thread model. The measurements were performed simultaneously in five and separately within 24 h in 10 patients. Results: In vitro , the correlations between the velocities of the thread and the velocities as determined by intravascular ( r =1.0, p r =1.0, p In vivo , the best correlation was found for systolic peak velocities (intravascular: 58.5±18.1 cm/s, mean±standard deviation, transcutaneous: 58.2±25.2 cm/s, r =0.63, p =0.01). Although lower mean (intravascular: 26.5±7.7 cm/s, transcutaneous: 32.5±14.4 cm/s) and end-diastolic velocities (intravascular: 11.5±4.0 cm/s, transcutaneous: 18.4±8.6 cm/s) were found with intravascular compared to transcutaneous Doppler sonography, significant correlations were demonstrable between results obtained by both methods ( r =0.63, p =0.01 for mean and r =0.57, p =0.025 for diastolic velocities). Similarly, the calculated resistive (intravascular: 0.79±0.07, transcutaneous: 0.68±0.06, r =0.65, p =0.009) and pulsatility indices (intravascular: 1.78±0.47, transcutaneous: 1.26±0.25, r =0.55, p =0.034) were somewhat higher using the intravascular device, but correlated well with the numbers obtained by the transcutaneous approach. Conclusions: The data suggest that with use of different Doppler devices, systolic velocities are the most suitable parameter for Doppler assessment of hepatic arterial perfusion.

□ Hintergrund Der oberen Einflusstauung (Vena-cava-superior-Syndrom) liegt in uber 80% der Falle ein maligner Tumor zugrunde, und nicht selten stellt diese Komplikation das erste Symptom des Malignoms dar.

OBJECTIVE Clinical signs and symptoms sometimes throw suspicion on functional complications and venous thrombosis due to implantable venous access ports. Objective was to determine frequency of these problems using radiologic imaging. METHODS 61 patients were examined by means of fluoroscopy. If indication was given we injected radiopaque (contrast) medium. In the case of suspected vascular thrombosis the radiological finding was verified by sonography, phlebography or by venous magnetic resonance imaging angiography. RESULTS Altogether 46 complications were documented in 37 out of 61 examined patients (61%). Occlusions of port-catheter were proved in 24 cases. It was the radiologically most frequently recorded complication (52%;) and found coincident with other problems in 9 patients (37%;). Pain frequently indicates break of catheters. Implantation of catheters into jugular and axillary veins predisposes to break of catheters just as port-catheters lateral implanted into subclavian veins ("pinch-off-sign"). CONCLUSIONS Functional tests of venous access systems using fluoroscopy and phlebography give information that helps to decide if clinically problematic port-systems should be used furthermore. Directions of catheter which are predestined to complications should be avoided.

Am Beispiel von 2 Patientinnen mit klassischer Symptomatik einer chronischen komplexen Visceralarterienischamie werden anatomische sowie pathophysiologische Prinzipien als Voraussetzung fur eine adaquate chirurgische Therapie erlautert. Die anterograde Revascularisation hat theoretisch aus hamodynamischer Sicht Vorteile. Eine Mehrgefasrevascularisation erscheint dem Ein-Gefas-Vorgehen hinsichtlich der Langzeitprognose uberlegen. Innerhalb der Bypassverfahren konnte der aortocoeliacale, mesenteriale Patch-Bypass somit eine ideale Variante darstellen, da er eine anterograde mit einer simultanen Revascularisation von Truncus coeliacus und A. mesenterica superior vereint.

Es werden Besonderheiten der klinischen Symptomatik und des Verlaufes bei einem Patienten mit venoser Angiodysplasie (Klippel-Trenaunay-Syndrom) demonstriert, der vordergrundig eine chronische Veneninsuffizienz mit Aplasie der V. poplitea und ausgedehnte pathologische Refluxe im Bereich des oberflachlichen und tiefen Venensystems aufwies. Klinische, sonographische, plethysmographische und angiographische Befunde wurden zur Objektivierung und differentialdiagnostischen Abklarung herangezogen. Angesichts der schwierigen Befundinterpretation und des komplexen Charakters der Malformation bewahrte sich eine interdisziplinare Kooperation in der spezialisierten Diagnostik und individuellen Therapieplanung. Neue gefasrchirurgische Behandlungsverfahren konnen zur Verbesserung der Langzeitergebnisse auch bei uberwiegend venosen Malformationen beitragen.

In both conditions, post-transplant lymphoproliferative disorder (PTLD) and hemophagocytic lymphohistiocytosis (HLH), infection with Epstein-Barr virus (EBV) is a key mechanism: almost all PTLD in allogeneic stem cell transplantation (alloSCT) is caused by EBV-related neoplastic lymphoproliferation, and secondary HLH is most frequently triggered by EBV infection. Therefore, concomitant EBV-driven PTLD and HLH early after alloSCT require an approach to eliminate EBV and balance immune activation simultaneously. We report on a patient who developed simultaneous PTLD and signs of HLH on day 64 after alloSCT. Treatment was comprised of stopping cyclosporine, short-course dexamethasone, and 3 courses of rituximab. The patient showed full recovery and complete remission of lymphadenopathy. This result indicates that immediate reduction in EBV-carrying B cells by rituximab, suppression of general inflammation, and parallel support of reconstitution of long-term T-cell function, might be an appropriate therapeutic approach in this rare situation.

The dinoflagellate Gonyaulax polyedra was previously shown to undergo asexual encystment in response to decreased temperature (15° instead of 20°C rearing temperature) in combination with short-days, a response which can be mimicked by melatonin and, much more efficiently, by 5-methoxytryptamine (= 5-MT). We demonstrate that these cyst-inducing conditions lead to enormous accumulations of the two methoxyindoleamines. The circadian rhythmicity of melatonin is maintained for the two days usually preceding cyst formation, though, at an elevated level. Transiently, very high concentrations of melatonin can occur, eventually exceeding 1 millimolar. These extreme concentrations decay rapidly; during this decline, 5-MT and 5-methoxytryptophol appear in large amounts. The concentrations of 5-MT which are measured during this process are higher than those required for cyst induction by the exogenous indoleamine.

Head and neck paraganglioma (HNP) represent rare endocrine tumors. Therapy is decided on genetic findings, tumor characteristics (e.g. tumor size, localization and dignity), age of patient and symptoms. In terms of local control radiation therapy is as equally effective as surgery but surgical morbidity rates secondary to cranial nerve injuries remain high.Based on 6 patients with 11 solitary (4 patients) and multiple (2 patients) HNP (8 carotid body tumors, 1 vagal, 1 jugular and 1 jugulotympanic paraganglioma) the specific characteristics of the need for surgery as well as correct choice of treatment in cases of sporadic succinate dehydrogenase (SDH) negative and hereditary SDH positive HNP will be exemplarily demonstrated.A total of 6 carotid body tumors (four sporadic, two hereditary) were resected in 4 patients, five as primary surgery and one as a revision procedure. In one case a preoperative embolization was performed 24 h before surgery. Malignancy could not be proven in any patient. The 30-day mortality was zero. In the patient with bilateral hereditary carotid body tumors, unilateral local recurrent disease occurred. After resection of the recurrent tumor permanent unilateral paralysis of the laryngeal nerve, glossopharyngeal nerve and hypoglossal nerve occurred. All patients were followed-up postoperatively for a mean of 64 months (range 23-78 months) with a local tumor control rate of 100%. The overall survival rate after 5 years was 100%.Given a very strict indication with awareness of surgical risks selective surgery has a key position with low postoperative morbidity in the treatment of HNPs. We prefer surgery for small unilateral paraganglioma, malignant or functioning tumors.

Aquired diverticula of the small bowel (not Meckel?s diverticulum) have a prevalence of 1 to 5 % and are relatively common. They are usually asymptomatic. However, in rare cases they can cause unspecific abdominal symptoms and even critical complications that require surgical intervention. Patients with diverticula of the small bowel were selected from all patients treated at an university hospital of maximal care in a retrospective study covering nine years. In 72 patients with diverticula, 47 % were asymptomatic, 47 % had unspecific abdominal symptoms and 6 % presented acute complications. In 83 % diverticula were localised in the duodenum and proximal jejunum. More distal parts of the small intestine were affected with decreasing frequency. A disseminated affection of the entire small bowel was found in 4 % of all patients. Diagnosis was made by endoscopic techniques in most cases (87 %) and to a smaller extent by CT- and MR-imaging and by other methods. The pattern of complications found is similar to earlier studies. Endoscopic techniques have replaced enteroclysis as the most widespread diagnostic technique in diagnosis of small bowel diverticula.

It has been investigated whether calcium- and verapamil-dependent sensitivities of carotis baroreceptors also exist in man. To answer this question, we pre- and postoperatively measured changes in heart rate during carotid sinus stimulation before and after intravenous administration of 5 mg verapamil in 23 patients with primary hyperparathyroidism. Findings during hypercalcemia were as expected: a more pronounced reduction of heart rate at comparatively low calcium levels. During normocalcemia, we found an opposite effect: a more pronounced reduction at relatively high calcium levels, which was statistically significant. This fact could be explained according to our interpretation. In previous reports, local effects on baroreceptors were examined, whereas we measured the combined effect of several calcium actions. As expected, verapamil attenuated the decrease in heart rate which, however, was not statistically significant.