Medizinische Klinik最新文献_第10页

[Fulminant duodenal bleeding as first manifestation of a neuroendocrine carcinoma of the pancreatic head]. [暴发性十二指肠出血是胰头神经内分泌癌的首要表现]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1043-5

Kerstin Schütte, Jan Bornschein, Doerthe Kuester, Gero Wieners, Peter Malfertheiner

{"title":"[Fulminant duodenal bleeding as first manifestation of a neuroendocrine carcinoma of the pancreatic head].","authors":"Kerstin Schütte, Jan Bornschein, Doerthe Kuester, Gero Wieners, Peter Malfertheiner","doi":"10.1007/s00063-010-1043-5","DOIUrl":"https://doi.org/10.1007/s00063-010-1043-5","url":null,"abstract":"Case report: A 73-year-old male patient presented with upper gastrointestinal bleeding. The reason was an arterial hemorrhage from a duodenal tumor that could only be stopped by an angiographic intervention. In the further staging, there was evidence for a neuroendocrine carcinoma of the pancreatic head with infiltration of the duodenum and hepatic metastases. Due to good differentiation (G1) a systemic biotherapy with octreotide LAR was induced. After recurrent bleeding with arrosion of a branch of the superior mesenteric artery, a duodenum-preserving pancreatic head resection was performed. Afterwards, the systemic therapy was changed to a palliative chemotherapy with streptozotocin and 5-fluorouracil due to local progression of the disease and a Ki-67 index of 4% in the primary tumor.Conclusion: In about 0.7% of patients with neuroendocrine tumors, the lesion is located in the pancreas. At this site these entities are very heterogeneous. The majority are nonfunctional tumors without secretion of bioactive substances and the associated symptoms. About 60% of the patients present with advanced metastasized disease. The therapy depends on the local spread and histological grading as well as symptoms of the patient. The only curative option represents surgical resection. However, even in a palliative situation, there can be benefit for the patient in case of a tumor mass reduction of > 90%. Alternative therapies in the palliative situation are somatostatin analogs, a classic systemic chemotherapy, or locoregional interventional procedures.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1043-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28973554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

[A rare cause of right heart failure]. [右心衰的罕见病因]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1040-8

Rolf Wachter, Gerd Hasenfuss

引用次数: 0

[Jejunocolic fistulae after pylorus-preserving pancreatic head resection: an uncommon cause of chronic diarrhea]. [保留幽门的胰头切除术后空肠结肠瘘:一种罕见的慢性腹泻原因]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1033-7

Thomas Karlas, Matthias Markuske, Katrin Schierle, Joachim Mössner, Michael Bartels, Hans Bödeker

{"title":"[Jejunocolic fistulae after pylorus-preserving pancreatic head resection: an uncommon cause of chronic diarrhea].","authors":"Thomas Karlas, Matthias Markuske, Katrin Schierle, Joachim Mössner, Michael Bartels, Hans Bödeker","doi":"10.1007/s00063-010-1033-7","DOIUrl":"https://doi.org/10.1007/s00063-010-1033-7","url":null,"abstract":"Background: In patients with a history of pancreatic surgery, chronic diarrhea is mainly caused by exocrine pancreatic insufficiency. The authors report, for the first time, a case of jejunocolic fistulae as a cause of diarrhea and weight loss after pancreatic head resection.Case report: A 55-year-old patient presented with chronic diarrhea and cachexia. He had undergone pylorus-preserving pancreatic head resection for chronic pancreatitis 8 years earlier. A recent colonoscopy showed an uncommon anatomy of the colon. Gastroscopy and computed tomography revealed several jejunocolic fistulae as the cause of chronic diarrhea. The patient underwent surgery and the fistula-carrying parts of jejunum and colon were resected. After surgery, his clinical status improved and he gained weight.Conclusion: Interenteric fistulae after pylorus-preserving pancreatic head resection have not been reported so far. Impaired synchronization of gastric emptying and bile secretion could be a possible cause of autodigestion in the anastomosis region.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1033-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28973623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Inflammatory myofibroblastic tumor of the lymph node with paraneoplastic thrombosis and eosinophilia]. [伴有副肿瘤血栓形成和嗜酸性粒细胞增多的淋巴结炎性肌纤维母细胞瘤]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1030-x

Ali Behzad, Andrea Müller, Wolf Rösler, Kerstin Amann, Rainer Linke, Andreas Mackensen

{"title":"[Inflammatory myofibroblastic tumor of the lymph node with paraneoplastic thrombosis and eosinophilia].","authors":"Ali Behzad, Andrea Müller, Wolf Rösler, Kerstin Amann, Rainer Linke, Andreas Mackensen","doi":"10.1007/s00063-010-1030-x","DOIUrl":"https://doi.org/10.1007/s00063-010-1030-x","url":null,"abstract":"Case report: A 52-year-old female patient was admitted to hospital because of progressive thrombosis despite therapeutic anticoagulation as well as leukocytosis with eosinophilia and thrombocytopenia. On examination, the patient presented with dyspnea and swelling oft her left leg and arm. The laboratory findings revealed leukocytosis (31,000/microl) with eosinophilia (54%), thrombocytopenia (58,000/microl), together with an increased C-reactive protein of 247 mg/dl (reference range < 5 mg/dl). Initial computed tomography scans showed pulmonary embolism and a slightly enlarged left inguinal lymph node. Histological examination of the lymph node biopsy revealed in part an epitheloid and spindle cell-like tumorous lesion with slightly increased tissue eosinophilia consistent with an inflammatory myofibroblastic tumor (IMT). Resection of the left inguinal lymph node resulted in an immediate regression of the paraneoplastic eosinophilia and thrombocytopenia. Anti-inflammatory medication with ibuprofen was subsequently initiated. Imaging and clinical examination at 3 months after discharge revealed no relapse and no signs of a paraneoplastic syndrome.Conclusion: The IMT is a rare soft-tissue tumor of intermediate dignity with a low tendency to metastasize. It is consistently accompanied by paraneoplastic syndromes. Therapy of choice is complete resection of the tumor. In nonresectable cases, corticosteroids and nonsteroidal antirheumatics have been shown to be effective. Because of the variable clinical course ranging from spontaneous regression to metastasis, IMTs might be separated into different entities (autoimmune, inflammatory, neoplastic subtype) which thus far cannot be classified on a histopathologic basis. A clinical assessment of the dignity is therefore important until further subclassifications of this rare disease become available.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1030-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28975417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

[Chronic pancreatitis as a risk factor for the development of pancreatic cancer--diagnostic challenges]. 慢性胰腺炎是胰腺癌发展的危险因素——诊断挑战。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1042-6

Tilman Pickartz, Julia Mayerle, Matthias Kraft, Matthias Evert, Katja Evert, Jens-Peter Kühn, Claus-Dieter Heidecke, Markus M Lerch

引用次数: 2

[Anemia and severe thrombocytopenia in celiac disease]. [腹腔疾病的贫血和严重血小板减少症]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1035-5

Maximilian Hatting, Oliver Galm, Martin Meyer, Christian Trautwein, Jens J W Tischendorf

{"title":"[Anemia and severe thrombocytopenia in celiac disease].","authors":"Maximilian Hatting, Oliver Galm, Martin Meyer, Christian Trautwein, Jens J W Tischendorf","doi":"10.1007/s00063-010-1035-5","DOIUrl":"https://doi.org/10.1007/s00063-010-1035-5","url":null,"abstract":"Background: The frequency of diagnosis of celiac disease has increased since the introduction of serologic testing. The number of patients in whom extraintestinal symptoms reflect the initial manifestation is rising. Common symptoms are changes in blood counts, which can arise from changes in all cell lineages. Among these, iron deficiency anemia is very common, but also thrombocytosis and thrombocytopenia have been reported to manifest themselves within the framework of celiac disease.Case report: The authors report on a patient with malnutrition, macrocytic anemia, and pronounced thrombocytopenia. Based on changes of peripheral blood smear and endoscopic result, celiac disease was suspected that could be confirmed by histology of duodenal biopsies. The thrombocytopenia was reversible after initiation of gluten-free diet and folic acid substitution. In addition, clinical symptoms resolved and hematologic reconstitution could be observed.Conclusion: Similar deficiencies have almost exclusively been observed in patients with increased folic acid requirements during pregnancy or intensive care. Celiac disease must be taken into consideration, if changes in blood counts occur associated with gastrointestinal symptoms.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1035-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28973622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

[A 58-year-old hypertensive patient with primary hyperaldosteronism and renal artery stenosis]. [58岁高血压患者原发性醛固酮增多症合并肾动脉狭窄]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1036-4

Michael Nguyen Quang, Bernd Krüger, Christopher D Krüger, Andreas Walberer, Bernhard Schenck, Klaus Kisters, Martin Wenning, Bernhard K Krämer

{"title":"[A 58-year-old hypertensive patient with primary hyperaldosteronism and renal artery stenosis].","authors":"Michael Nguyen Quang, Bernd Krüger, Christopher D Krüger, Andreas Walberer, Bernhard Schenck, Klaus Kisters, Martin Wenning, Bernhard K Krämer","doi":"10.1007/s00063-010-1036-4","DOIUrl":"https://doi.org/10.1007/s00063-010-1036-4","url":null,"abstract":"Background: Secondary hypertension can rarely be caused by different disorders as shown in the present case with simultaneous occurrence of two possible causes.Case report: Magnetic resonance imaging findings of a 58-year-old patient showed an eccentric left renal artery stenosis of 60-70% and an inhomogeneous tumor of the left adrenal gland. After percutaneous transluminal angioplasty, elevated plasma aldosterone concentrations persisted. Adrenal vein sampling in the authors' hospital confirmed a primary hyperaldosteronism due to unilateral adenoma. Subsequently, unilateral laparoscopic adrenalectomy was performed.Conclusion: Atherosclerotic renal artery stenosis stimulates the renin-angiotensin system and thereby causes secondary hypertension. Furthermore, adrenal disorders that lead to abnormal aldosterone secretion, i.e., primary hyperaldosteronism, often result in secondary hypertension. Though the simultaneous occurrence of two potential causes of secondary hypertension is rare, it has to be considered for differential diagnosis and therapy. The presumed pathophysiological relevance should guide the order of therapeutic measures.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1036-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28973628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

[A 37-year-old patient with fever, dyspnea and elevated transaminases after a stay in Mexico]. [37岁患者在墨西哥停留后出现发热、呼吸困难和转氨酶升高]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1045-3

Stephan A Schmid, Gabriele Birkenfeld

引用次数: 2

[Wasp sting, adrenaline injection and acute thoracic pain: an un usual case of stress-induced (tako-tsubo) cardiomyopathy]. [黄蜂蜇伤，肾上腺素注射和急性胸痛:应激性(tako-tsubo)心肌病的罕见病例]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1032-8

Gesa Geppert, Peter W Radke, Volkhard Kurowski, Peter Hunold, Heribert Schunkert

引用次数: 6

[Acute upper gastrointestinal bleeding after coronary intervention in acute myocardial infarction]. [急性心肌梗死冠状动脉介入治疗后急性上消化道出血]。

Medizinische Klinik Pub Date : 2010-04-01 DOI: 10.1007/s00063-010-1044-4

Stefanie Strobl, Ina Zuber-Jerger

{"title":"[Acute upper gastrointestinal bleeding after coronary intervention in acute myocardial infarction].","authors":"Stefanie Strobl, Ina Zuber-Jerger","doi":"10.1007/s00063-010-1044-4","DOIUrl":"https://doi.org/10.1007/s00063-010-1044-4","url":null,"abstract":"History and admission findings: A 73-year-old man with NSTEMI (non-ST segment elevation myocardial infarction) underwent coronary angiography and an in-stent restenosis and thrombosis in ramus circumflexus was found. A drug-eluting stent (DES) was implanted. 12 h after intervention during threefold platelet inhibition the patient presented a gastrointestinal bleeding with melena and the hemoglobin level dropped from 15.3 g/dl to 9.7 g/dl.Investigations: Blood tests revealed a considerable elevation of cardiac enzymes, troponin I, leukocytes and C-reactive protein but normal hemoglobin. In coronary angiography, the stent in ramus circumflexus was found to be occluded. Therefore, a percutaneous coronary intervention with implantation of a DES (Taxus) was performed. In gastroscopy, a 2.5-cm necrotic formation resembling a tumor with an oozing bleeding was identified. The bleeding was stopped after injection of adrenaline. Histological evaluation showed no criteria of malignancy.Treatment and course: With high-dose proton pump blocker therapy, calculated Helicobacter pylori eradication with amoxicillin and clarithromycin, and cessation of NSAID (nonsteroidal anti-inflammatory drugs), the hemoglobin level was stable with 9.7 g/dl. No blood transfusion and no interruption of the dual platelet inhibition were necessary. In control gastroscopy, the initial endoscopically malignancy-suspicious formation presented as a small, superficial, healing ulcer.Conclusion: Bleeding complications after stent implantation create a dilemma situation. The risk of a hemorrhagic shock by continuing platelet inhibition therapy and the risk of an acute stent thrombosis with interruption of the platelet inhibition should be carefully calculated considering individual facts and the guidelines.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1044-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28973555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2