Zusammenfassung

Die Diagnose der dilatativen Kardiomyopathie (DCM) ist in erster Linie eine Ausschlußdiagnose. Sie wird gestellt, wenn eine koronare Herzerkrankung, eine arterielle Hypertonie im großen und kleinen Kreislauf sowie ein Vitium cordis ausgeschlossen sind. Die Ursache der DCM bleibt in aller Regel unklar, wobei am ehesten eine entzündliche oder immunpathologische Ätiologie anzunehmen ist [14, 16].

Zusammenfassung

Bis heute sind nur zwei Viruskrankheiten mit Sicherheit ermittelt worden, in deren Verlauf entzündliche Erscheinungen mit ausgesprochenem Granulomcharakter vorkommen: Chronologisch betrachtet ist das Lymphogranuloma inguinale die älteste, die sog. „Katzen-Kratzkrankheit“ die jüngste (1950). Wahrscheinlich gibt es noch andere, wie das Granuloma annulare z. B., welche allerdings in ätiologischer Hinsicht in keiner Weise genügend erforscht worden sind.

Summary

The management of recurrent acute otitis media and serous otitis media is both challenging and controversial. The efficacy of antimicrobial prophylaxis of children at high risk for recurrent acute otitis media is established, but the indications for such therapy are controversial. Tympanostomy tube insertion also decreases the frequency of recurrent otitis media. High-risk children can be successfully managed with chemoprophylaxis from autumn through to spring. If this fails, then tympanostomy tube insertion should be considered.

Serous otitis media that follows acute otitis media resolves spontaneously in more than 90% of cases. Serous otitis media of unknown onset also has a strong tendency to resolve without treatment. Antihistamines and decongestants, although popular, have no significant effect on the course of serous otitis media. Antimicrobial therapy has a modest effect on the resolution of serous otitis media. Tympanostomy tubes usually improve the conductive hearing loss associated with serous otitis media and should be used when bilateral serous otitis media fails to resolve spontaneously. If repeated tympanostomy tube insertion fails, then adenoidectomy should be considered. With the course of management outlined, most children will have a successful outcome with conservative therapy and the need for surgery will be minimised.

Résumé

La comparaison des cas de tumeurs prévalents avec les cas de décès survenus au cours d'une année permet, sous certaines hypothèses, d'évaluer le degré de couverture d'un Registre. La méthode présentée consiste à répartir les cancers notifiés au décès en 3 catégories, selon qu'ils étaient déjà connus du Registre (I) ou, pour les autres, selon que la date d'apparition de la tumeur — estimée à partir des taux de survie — est antérieure (II) ou postérieure (III) à la création du Registre. Le nombre de cas correspondant Ä la première catégorie, rapporté à la différence entre le nombre total de décès par cancer survenus au cours de l'année et ceux de la catégorie II, donne une évaluation du degré de couverture atteint par le Registre.

Les résultats d'une telle méthode sont présentés pour le Registre Vaudois des Tumeurs sur la base des décès déclarés dans le canton. Les proportions des décès correspondants à des cas de maladie survenus respectivement avant et après la date de création du Registre sont estimés à partir des taux de survie calculés par le Registre Norvégien du Cancer. La discussion porte notamment sur les facteurs permettant d'expliquer la disparité des degrés de couverture obtenus pour les localisations tumorales envisagées.

Patients whose colons were resected for carcinoma were studied in order to determine the relationship between clinical findings — which included development of postoperative delirium — and intramitochondrial inclusion bodies (MI) in the neurons in the colon. Twenty-three patients had MI and 24 patients did not. Preoperative dementia was present in 9 (39.1%) of the 23 patients with MI, and in 7 (29.2%) of the 24 without it. Postoperative delirium developed in 13 (56.3%) of the 23 with MI, and in 5 (20.8%) of the 24 without it (p<0.05). Excluding preoperative dementia, postoperative delirium developed in 5 (35.7%) of the 14 with MI, and in none of the 17 without it. Changes in the neurons in the colon were not related to dementia. The changes may have been related to the functions of the central nervous system, because patients with MI were likely to develop postoperative delirium.

Background

Atraumatic renal pelvis rupture without pre-existing renal or ureteric pathology is an uncommon event. It is reported in the setting of acute urinary tract obstruction, most often secondary to ureteric calculi. Typical symptoms include acute flank pain and nausea, mimicking pyelonephritis or other causes of acute abdomen. Spontaneous rupture occurring bilaterally without identifiable urinary tract obstruction is exceedingly rare, and has yet to be reported in current English literature. Possible contributing pathophysiological mechanisms can be postulated from reported cases of rupture with observed obstruction.

Case presentation

A 58-year-old woman undergoing multiphasic computed tomography (CT) for evaluation of asymptomatic microscopic haematuria developed on-table bilateral renal pelvis rupture seen only after contrast administration, on the delayed phase. There was no significant past medical history of note. The patient remained asymptomatic throughout and after the study, and was managed conservatively. Follow-up radiographical imaging over a month showed resolution of urinoma and no further contrast extravasation. No complications or recurrence was subsequently noted.

Conclusions

Spontaneous rupture of the renal pelvis can be a rare complication of intravenous contrast administration even in cases without identifiable urinary tract obstruction, and it can occur bilaterally. Cases can uncommonly be asymptomatic but typical symptoms should prompt evaluation of the kidneys, particularly when they are not included in the initial study or no delayed phase is protocolled. Interval imaging for resolution of urinoma and contrast extravasation is clinically relevant to monitor for and avoid infective sequelae.

Zusammenfassung

Calcinosis cutis universalis und Poikilodermie wurden nebeneinander bei einer bandförmigen Sklerodermie und bei einer Dermatomyositis gesehen. Es handelt sich um atrophische Endzustände bei verschiedenartigen Krankheiten, nicht um selbständige Krankheitseinheiten.