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BACKGROUND: The origin of extragonadal retroperitoneal germ cell tumors remains controversial. Whether they develop primarily in the retroperitoneum or whether they are metastases of a primary testicular tumor has long been debated. PATIENTS AND METHODS: We retrospectively analyzed 26 patients treated as having primary extragonadal retroperitoneal germ cell tumors based upon the findings of testicular palpation by the referring physician. Testicular evaluation was then extended with ultrasonographical and histological examinations. RESULTS: Biopsy of the extragonadal tumor was performed in 25 patients, confirming diagnosis of extragonadal retroperitoneal germ cell tumor. Prior to treatment patients were clinically evaluated by several physicians and the testes were not considered suspicious for testicular cancer. At urological workup, testes were found to be atrophic and/or indurated in 14 (54%) patients, enlarged in one (4%) and unremarkable in 11 (42%). Ultrasound examination of the testes in 20 patients showed pathological findings in all of them. Histology of the testis was available in 25 of 26 patients and revealed active tumor in three, intratubular germ cell neoplasia in four, scar tissue in 12, sclerosis in three, sclerosis and fibrosis in one, and fibrosis alone in two. CONCLUSIONS: So-called primary extragonadal germ cell tumors in the retroperitoneum are very likely a rare or non-existing entity and should be considered as metastases of a viable or burned-out testicular cancer until proven otherwise. All of our patients with histologically examined testes had pathological finding, 76% of which were either viable tumor or scars.

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The hypothesis was studied whether the chronic administration of nitrite lowers the blood pressure of spontaneously hypertensive rats (SHR) and prevents secondary hypertension-induced organ lesions. For this purpose totally 96 SHR received 50 to 75 mmol/l NaNO2 or equimolar amounts of NaHCO3 in their drinking water during 4, 8 or 12 months. At each point of time arterial blood pressure, determined with the tail cuff method, was significantly lower in the NaNO2-group in comparison to the controls indicating that no significant tolerance towards nitrite had developed. There was also a tendency towards reduced cardiac hypertrophy and renal atrophy in the NaNO2-group, however without reaching the level of significance. Drinking water containing 75 mmol NaNO2/l was not well tolerated by young rats in contrast to 50 mmol/l. Possible beneficial effects of high dietary nitrate/nitrite levels are discussed with respect to the low frequency of hypertension observed in vegetarians.

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Rats received during 3 weeks a Mg-deficient or a Mg-rich diet; Mg-deficient animals revealed hypomagnesemia, cellular K-depletion and Ca-loading. Phrenic nerve-diaphragm preparations were studied; the physiological Tyrode solution contained low or high-Mg concentrations and 0 or 12 mmol lactate/L. Electric stimulation (indirect via the nerve or direct) produced tetanic contractions and increased force at increasing stimulation frequencies. Significantly lower frequencies were needed to elicit these effects when intra- and extracellular Mg levels were low, in comparison to plentiful Mg supply. Comparing unstimulated and stimulated diaphragmatic tissue electrolyte concentrations revealed tissue losses of Mg, K Ca from stimulated tissues which were less pronounced when Mg supply was optimal. These data support the empiric finding that relief from muscle cramps is promptly offered by Mg supplements.

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The lower blood pressure of vegetarians might partly be due to the high dietary load with nitrate which--to a certain extent--is further reduced to nitrite and finally to nitric oxide. To test this hypothesis, spontaneously hypertensive rats received drinking water containing 0, 25, 50 or 100 mmol/l NO2 during 56 days. Food was offered ad libitum or was restricted by 20% (pair-feeding) to simulate the lower energy consumption of vegetarians. Blood pressure, which was monitored at regular intervals, was lowered in a dose-dependent manner by nitrite. This effect was reversible and could not be enhanced by energy restriction. In volunteers plasma nitrate levels increased by a factor of 8 to 32 following the ingestion of a nitrate-rich meal, and mean methemoglobin concentrations increased from 1.2% to 2.4% indicating the endogenous formation of nitrite under these conditions.

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The course of pseudo-aneurysm of the axillary artery, rarely occurring after blunt trauma of the shoulder, is analysed. Own experience is reported, the literature is reviewed. A high index of suspicion is necessary to recognise and repair this serious vascular injury in time in order to avoid permanent brachial plexus deficiency.

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Shoulder dislocations associated with a displaced fracture of the humeral head or glenoid require different treatment than shoulder dislocations without fracture. If the humeral head is fractured, two possible complications must be considered:impairment of the subacromial gliding mechanism and insufficient blood supply to the humeral head. In glenoid fractures, instability may be induced. The degree of instability depends on the size of the fragment. In fractures of the humeral head, in particular of the greater tuberosity, we differentiate between the so-called en bloc fracture and the so-called supra-spinatus avulsion fracture. In "en bloc" fractures, one has to be aware that displacement of the fragment can occur not only in the superior direction but in the posterior direction as well. Posterior displacement is displayed radiologically by the "tangential" view. Both the duration of pain and range of motion depend on the amount of displacement of the fragment. Displacement exceeding 3 min in one direction should be reduced surgically in the active patient. For operative treatment of a displaced "en bloc" fracture, we recommend closed reduction and percutaneous screw fixation performed under regional anesthesia. "Supraspinatus avulsion fractures" ought to be treated like rotator cuff tears because there is no possibility of the small fragments healing due to their placement on the joint cartilage. In fracture dislocations, the blood supply of the humeral head is seriously jeopardized if the fracture is situated in the anatomical neck, whereas this is not the case in a fracture of the surgical neck. The number of displaced fragments allows a prediction concerning the survival of the articular segment of the humeral head.(ABSTRACT TRUNCATED AT 250 WORDS)

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Between 1986 and 1988 67 patients with distal clavicular fracture were treated at the trauma hospital in Innsbruck. Depending on type of fracture conservative treatment (using a spica or other bandages) was performed in those cases without dislocation. Operation was necessary if coracoclavicular ligament was ruptured and dislocation of the distal clavicular end was found in X-rays. The most common practice was the use of K-wires and wire-loops. Plate fixation was necessary in one case of delayed fracture healing. No pseudarthrosis was seen in X-rays, mobility of the shoulder girdle was good and symptoms of pain were rare.

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At the Innsbruck Trauma Department a total of 75 children with closed femoral shaft fractures were reviewed with reference to length discrepancy. The femurs were measured radiologically two times within four years to find out, if overriding of the fragments is useful to prevent overgrowth of the broken limb. In 60 patients conservative treatment and in 15 cases operative treatment was performed. The cases may be divided in two age groups: one ten years of age or younger, the other eleven years to 15 years. Shortening of the fragments shows no evident advantage preventing overgrowth of the broken limb, but in elder children it may provoke a persisting shortening of the limb. As a matter of fact anatomical reduction in conservative treatment of femoral shaft fractures, especially in elder children, should be performed. After operative treatment the children ten years of age to 15 years showed not even more lengthening of the femur than the patients with conservative treatment.

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Between 1969 and 1988 51 polytraumatized patients were treated for rupture of the diaphragm due to blunt trauma. In 39 cases the lesion was in the left hemidiaphragm, in 11 cases on the right side and in one case on both sides. Clinical investigation and posterior-anterior chest X-ray were the most important diagnostic procedures. A high percentage of ruptures was only detected intraoperatively during acute laparotomy/thoracotomy. Early or delayed surgery had no influence on the survival of patients. The prognosis depends on the severity of associated injuries, which are the main causes of death in these patients.

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Increasing doses of nitrite (3.7-14.8 mg/kg BW) were administered via intragastric intubation to 64 spontaneously hypertensive Sprague-Dawley rats. Systemic blood pressure, measured in conscious animals with the tail cuff method, significantly decreased in a dose-related manner 16 and 32 minutes later, and pulse rate slightly increased. Since orally ingested nitrate may be partially converted to nitrite, it seems worthwhile to study correlations between dietary nitrate and blood pressure in experimental animals and man.

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One of each pair of female sister rats aging 1, 4, 7 or 10 months was exposed during 3 months to 31.5 mg/L Cd (as CdCl2) in its drinking water and sacrificed immediately after Cd exposure together with its untreated sister. Concentrations of Cd, Zn and Cu were measured in the kidneys (medulla and cortex), the liver, the duodenum and the uterus. Furthermore, the subcellular distribution of Cd was measured in renal tissue. The accumulation of metal ions, defined as the difference between Cd-treated and untreated rats, was pronounced in all tissues except the uterus and was significantly decreased at increasing age. Multivariate analysis of variance revealed significant interaction with Zn and Cu. Higher Cd accumulation in the tissues of young animals probably depends on the higher consumption of contaminated drinking water per kilogram of body weight. High concentrations of Cd detected in cell nuclei may be due to the similarity between Cd2+ and Ca2+.

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The diagnosis and treatment of shoulder instability require basic differentiation between unidirectional, multidirectional, and voluntary dislocation. Within unidirectional instability primary dislocation, recurrent dislocation, and recurrent subluxation need to be considered separately.--Primary dislocation: In 160 patients with primary dislocation a follow-up was done by questionnaire. In the case of atraumatic primary dislocation the redislocation rate was 100%. Predisposing factors inherent in the bony, cartilaginous, and capsular components of the joint favoured the tendency of primary dislocation. In the case of traumatic primary dislocation the redislocation rate was lower after immobilisation of the joint than without when it had not been immobilised.--Recurrent subluxation: In 52 patients with a clinical diagnosis of recurrent subluxation a tear of the glenoid labrum was found by arthroscopy. In 21 cases the detached labrum was refixed arthroscopically and in 18 cases the repair was done by an open Bankart procedure. Seventy-two percent of the patients who underwent arthroscopic repair showed good to excellent results. In all cases but one in which the Bankart procedure was applied the results were excellent.--Recurrent dislocation: Since 1984 a total of 183 patients were operated on for recurrent shoulder dislocation. All these patients were examined preoperatively by CT scan. The CT findings were used in selection of the appropriate procedure. In 114 patients the Bankart procedure was applied and in 39 cases, a bone-block method. The remaining patients were subjected to various other procedures. Not one of the patients showed postoperative redislocation. (ABSTRACT TRUNCATED AT 250 WORDS)

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Female Sprague-Dawley rats kept on a standard chow or on a magnesium (Mg)-deficient diet during 6 days received s.c. injections of 0, 25, 50, 100 and 200 micrograms of epinephrine (Ep). 1 h before, they were orally treated with 0, 125 or 250 mg of Mg/kg b.w. given as magnesium aspartate hydrochloride. Drug-induced changes were studied by analyzing serum and cardiac tissue samples (Mg, Ca, K, Na and in addition glucose, FFA, cholesterol and creatine kinase in serum) taken at 7 different times (15 to 420 min) after treatment with Ep; effects were evaluated by considering the respective areas under the concentration-time curves (AUC). AUCs were calculated with linear and logarithmic graduation of the time-scale and were also transformed into logarithms. In additional experiments, animals of both diet groups were treated with Mg and Ep as described above and the hearts, excised after 420 min, were prepared for histological examination. Cardiotoxic effects induced by adrenergic overstimulation were aggravated by Mg deficiency. Most pronounced electrolyte alterations and histologically detectable cardiac necroses were observed in the Mg-deficient animals at 420 min following the s. c. injection of 200 micrograms of Ep. On the other hand, oral Mg treatment induced hypermagnesemia and reduced toxic effects of Ep--especially Ca overload of the heart muscle--in controls and in Mg-deficient rats.

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