Many different techniques have been proposed to repair frontobasal dura mater lesions. Because of its low morbidity and high success rate, the endonasal approach has become a preferred route for treating cerebrospinal fluid fistulas of the anterior skull base. This article presents a retrospective evaluation of 136 endonasal duraplasties (126 patients) performed between July 1980 and May 1998 at a tertiary care facility. Follow-up consisted of clinical examinations including nasal endoscopy, objective measures, and telephone interviews. The following measures were used to evaluate the results of these duraplasties: postoperative nasal fluorescein endoscopy in 71 cases, computed tomographic cisternography in 2, nasal fluorescein endoscopy with computed tomographic cistemography in 19, magnetic resonance imaging in 6, and nasal fluorescein endoscopy with magnetic resonance imaging in 1. Tight closure was accomplished in 129 dural lesions (94.9%) on the first attempt. In 3 cases, recurrence of cerebrospinal fluid leakage was treated successfully by 1 endonasal revision, and in 1 case, a tight duraplasty was achieved after 2 endonasal revisions. Its high success rate, low rate of morbidity, and good long-term results recommend endonasal duraplasty as a primary treatment modality for frontobasal dural lesions. For extended frontobasal dural lesions, for which intracranial dural repair is the preferred approach, the endonasal approach should be used to close additional dural leaks of the sphenoid sinus.

Currently available approaches for treating human coronary heart disease aim to relieve symptoms and the risk of myocardial infarction either by reducing myocardial oxygen demand, preventing further disease progression, restoring coronary blood flow pharmacologically or mechanically, or bypassing the stenotic lesions and obstructed coronary artery segments. Gene therapy, especially using angiogenic growth factors, has emerged recently as a potential new treatment for cardiovascular disease. Following extensive experimental research on angiogenic growth factors, the first clinical studies on patients with coronary heart disease and peripheral vascular lesions have been performed. The polypeptides fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF) appear to be particularly effective in initiating neovascularization (neoangiogenesis) in hypoxic or ischemic tissues. The first clinical study on patients with coronary heart disease treated by local intramyocardial injection of FGF-1 showed a 3-fold increase of capillary density mediated by the growth factor. Also, angiogenic growth factor injection intramyocardially as sole therapy for end-stage coronary disease showed an improvement of myocardial perfusion in the target areas as well as a reduction of symptoms and an increase in working capacity. Angiogenic therapy of the human myocardium introduces a new modality of treatment for coronary heart disease in terms of regulation of blood vessel growth. Beyond drug therapy, angioplasty and bypass surgery, this new approach may evolve into a fourth principle of treatment of atherosclerotic cardiovascular disease.

ZusammenfassungDie aktuellen Behandlungsmethoden der koronaren Herzkrankheit zielen auf Minimierung des Infarktrisikos und Reduktion der Symptome durch Senkung des myokardialen Sauerstoffbedarfs, durch Verbesserung der myokardialen Perfusion sowohl medikamentös als auch mechanisch durch PTCA oder Bypasschirurgie und durch Prävention einer weiteren Progression der Erkrankung. Trotz des hohen technischen Standards der interventionellen oder operativen Verfahren der myokardialen Revaskularisation sind diese bei Patienten mit diffuser Arteriosklerose und peripherem Gefäßbefall nicht anwendbar. Die Induktion der Angiogenese durch humane angiogenetische Wachstumsfaktoren entwickelt sich speziell bei dieser Patientengruppe zu einer neuen Therapiemodalität und stellt neben medikamentöser Therapie, PTCA und Bypasschirurgie ein viertes, neuartiges Behandlungsprinzip der koronaren Herzkrankheit dar. »Polypeptide Fibroblast Growth Factor« (FGF) und »Vascular Endothelial Growth Factor« (VEGF) scheinen einen besonders starken Effekt im Hinblick auf die Induktion der Angiogenese im hypoxischen Gewebe auszuüben.

A 77-year-old female presented with a suspected cardiac tumor and thrombosis of both legs diagnosed by phlebography with pulmonary embolism of both sides. In transthoracic echocardiography, transesophageal echocardiography, and CT no intracardial tumor was seen. There was a hiatal hernia which compressed the left atrium from outside. As echocardiographic criteria of hiatal hernia described by D'Cruz we found the left atrium filled with a solid mass and variation of compression of the left atrium depending on breathing. Because of the low incidence of cardiac tumors, differential diagnosis should be done if a cardiac tumor is suspected. A hiatal hernia should always be taken into consideration.