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Biomedical subjects

A Zielke

Publications and source records attributed to A Zielke.

At least 73 records · Page 4Linked to original sources
PubMed1993

Ultrasonography in blunt abdominal trauma: influence of the investigators' experience.

The validity of routine ultrasonography (US) in the evaluation of patients with blunt abdominal trauma (BAT) was investigated in a prospective study. From April 1989 to April 1990, 140 patients with suspected BAT were included in this study. Ultrasonography was performed by 17 surgeons using a standardized technique. The influence of the investigators' experience in US was manifested in the positive predictive value (PPV). Surgeons with a learning period of less than 1 year had a PPV of 60%. Investigators with experience of more than 1 year but less than 3 years had a PPV of 76%. For the most experienced investigators (> 3 years) a PPV of 92% was recorded. The sensitivity for intra-abdominal lesions was 100%, 100%, and 92%, and the specificity 94%, 89%, and 98% for the three levels of experience, respectively. We conclude that US is a suitable test for screening patients with BAT since it is highly sensitive, highly specific, complication free, and easy to learn. The positive findings of surgeons who are learning to use this method should be verified by reinvestigation by an experienced sonographer, by diagnostic peritoneal lavage (DPL), or by a CT scan if the patient is hemodynamically stable.

Abdominal Injuries↗
PubMed1992

[Cystic parathyroid gland adenomas: pathologic-anatomic variants of parathyroid gland adenomas or a separate disease entity?].

Between 01.01.1987 and 31.12.1990 a primary operation was performed on 126 patients in the Dept. of General Surgery, University of Marburg Hospital for primary hyperparathyroidism due to a parathyroid adenoma. Their clinically relevant data were prospectively documented. In 6 patients (4.8%) a total of 7 cystic parathyroid adenomas was found. While there was no difference in age- and sex-distribution, patients with cystic adenomas were found to have markedly higher serum parathormone and alkaline phosphatase levels than patients with solid adenomas. Calcium levels were similar in both groups. Cystic adenomas were much heavier than solid adenomas. A significant number of cystic adenomas was found to be displaced into the posterior mediastinum. The property of cystic parathyroid adenomas to be frequently located away from their usual anatomical position can make the intraoperative search for them difficult.

Adenoma↗
PubMed1992

Carcinoid tumors of Meckel's diverticula. Report of two cases and review of the literature.

Two cases of carcinoid tumors in Meckel's diverticula are reported. Additionally, data of 104 published cases of carcinoids in this rare location are analyzed. The average age of the patients is 56.6 years and corresponds to the age of patients with ileal carcinoids. Carcinoids in Meckel's diverticula also resemble ileal carcinoids in their biological behavior more than they do appendiceal carcinoids. Tumors larger than 5 mm have a marked risk to metastasize. By the time symptoms are present, 77 percent of these tumors have already metastasized. Men are affected by this tumor 2.5 times more often than women. Carcinoids in Meckel's diverticula metastasize twice as often in female as in male patients. More than 70 percent of carcinoids in Meckel's diverticula are found at the tips of the diverticula. An aggressive surgical management of tumors larger than 5 mm is recommended.

Adult↗
PubMed1991

[Chronic purulent, draining, indolent pancreatic head pancreatitis with extrahepatic cholestasis].

Over the period of two weeks a 19-year-old man developed gradually increasing painless jaundice with dark urine and light-coloured soft stools (6-7 times daily), as well as loss of appetite, nausea and nagging itch. Biochemical tests indicated marked cholestasis (alkaline phosphatase 800 U/l, gamma-GT 206 U/l). Abdominal ultrasound examination revealed high-grade stenosis of the distal choledochal duct caused by an enlargement of the head of the pancreas and computed tomography confirmed a tumour in this location. Endoscopic retrograde cholangiopancreatography demonstrated filiform stenosis of the major pancreatic duct and prepapillary stenosis of the choledochal duct. Several needle biopsies failed to establish a definitive diagnosis. A Whipple operation was performed: the stomach was preserved but about 40% of pancreatic tissue resected. Histologically there was chronic suppurative pancreatitis of the head of the pancreas. The patient was symptom-free 6 months after the operation. The case illustrates that it is not always possible in a painless pancreatic tumour to distinguish between pancreatitis and malignant tumour.

Adult↗
PubMed1991

[Ileocolic invagination in adults. The sonographic characteristics].

An 86-year-old man was admitted to hospital because of transitory cramp-like abdominal pain of 6 days' duration. Immediately preceding admission he had suffered a short episode of vomiting and diarrhoea. There was no history of previous abdominal operation. On examination there were signs of incomplete mechanical ileus. Ultrasonography revealed an abnormal cockade with triple ring phenomenon at the ileocaecal junction and the "duck-beak phenomenon" as signs of enterocolic intussusception. Immediate laparotomy demonstrated a submucous lipoma of the terminal ileus as its cause.--If there is clinical suspicion of intussusception, even in the presence of atypical abdominal symptoms, ultrasonography is the procedure of choice to provide rapid diagnosis. In adults treatment is always surgical.

Abdominal Pain↗
PubMed1991

[Ultrasonic diagnosis in suspected acute appendicitis: probable or certain indications for surgery?].

The diagnostic accuracy and the clinical impact of routine ultrasonography performed by 4 surgeons, were prospectively studied in 366 unselected patients admitted for suspected acute appendicitis. Clinical and sonographic findings on admission were correlated with laparotomy findings, pathological outcome and clinical as well as follow-up data. The overall sensitivity, specificity and accuracy of the clinical diagnosis of acute appendicitis were 55.3%, 94.6% and 84.2% respectively (positive predictive value (PPV) 75.8%, negative predictive value (NPV) 87.3%). Ultrasound enabled visualization of the disease in 67 of 85 (prevalence 23.3%) patients with a histologically confirmed acute appendicitis; false positive results were recorded in 7 cases (sensitivity 78.8%, specificity 97.5%, accuracy 93.1%, PPV 90.5%, NPV 93.8%). Ultrasound was particularly useful in patients presenting with equivocal or highly unsuspective signs of acute appendicitis: of 38 patients with an acute appendicitis in this group ultrasonography enabled to make the diagnosis in 26. The combined approach of clinical evaluation and routine ultrasonography markedly improved the diagnostic accuracy (sensitivity 85.9%, specificity 96.4%, accuracy 94%) and substantially reduced the negative laparotomy rate (7.9%) in patients with suspected acute appendicitis. It is concluded, that ultrasonographic evaluation of the patient with suspected acute appendicitis performed by surgeons is of great assistance in surgical practice.

Abdomen, Acute↗
PubMed1990

[Lessons from reoperations in 55 patients with primary hyperparathyroidism].

On the basis of 70 re-operations in 55 patients (34 women, 21 men, median age 58 [43-83] years) suffering from primary hyperparathyroidism the reasons for failure of the first operations were analysed. The main reasons were inadequate exploration of the neck (failure to identify all four glands), failure to recognize multiple gland involvement, or inadequate resection in cases where more than one gland was affected. An abnormally situated gland was a less common cause, as shown by the fact that 41 out of the 73 glands removed at the last re-operation were situated in the normal position or in its immediate vicinity; in 20 cases the surgeon had failed to recognise multiple gland disease. Next in order of importance were anatomical variations in the location (32 out of 73 tumours) or the number of the glands (9 patients with hyperplasia of 5 glands). At the re-operations 89% of the parathyroid tumours were found in the neck region or would have been accessible from the neck at the time of the first operation. Overall, the hypercalcaemia was permanently rectified in 96.6% of the patients. During the last 10 years 94% of patients have been normocalcaemic postoperatively, thanks mainly to the re-implantation of autologous parathyroid tissue, preserved by low-temperature storage. The incidence of permanent unilateral recurrent nerve paresis attributable to the re-operations was 6%.

Adult↗
PubMed1990

[Primary hyperparathyroidism. A disease picture has changed].

Data were retrospectively analysed on 544 consecutive patients (362 females and 182 males, mean age 53.6 [2 weeks and 86 years]) who had been operated on for primary hyperparathyroidism between 1965 and 1989. During this period the rate of renal, bone and intestinal complications decreased from 90% in the first 5 years to 29% in the last 5 years. Organ manifestations and hypercalcaemia were often combined (70% in the early period, 30% now). The proportion of those with an asymptomatic course gradually and continuously rose to 21% now. The patients' average age at diagnosis rose from 46 +/- 10 to 58 +/- 14 years. Serum calcium concentrations in the last few years averaged 3.1 mmol/l, as high during the last few years as at the beginning of the period. Age, serum calcium concentration and parathyroid weight of the asymptomatic patients did not differ from those of the group as a whole.

Adolescent↗
PubMed1989

Direct tubular effect on calcium retention by hydrochlorothiazide.

Previous studies with hydrochlorothiazide revealed a calcium retaining effect of this substance. The mechanism by what this is done is still matter of controverse discussion. Effects of hydrochlorothiazide on vitamin D metabolism have been reported as well as those on parathyroid function. To further clarify the calcium retaining potency of hydrochlorothiazide (HCTZ) we treated 10 healthy young volunteers for four weeks with 2 x 50 mg HCTZ. In all volunteers we observed a marked decrease in urinary calcium excretion as well as in calcium clearance. Furthermore, we found a slight rise in ionized serum calcium (6.7%) and in intact PTH, as well as a 36% drop in 1,25-(OH)2-D3-levels. These effects were reversible after discontinuation of the treatment. No change was observed in urinary cAMP, phosphate excretion, serum anorganic phosphate levels, serum calcitonin and magnesium levels. Data presented here suggest that treatment with HCTZ causes a persistent reduction in calcium excretion through direct tubular effects, inhibits hydroxylation of vitamin D, and does not affect parathyroid function.

Adult↗
PubMed1987

[Physical therapy in degenerative diseases of the joints].

By virtue of their wide spreading and their effects on the social working ability degenerative joint diseases increasingly gain significance. In the concept of therapy of this group of disease apart from pharmacotherapy and operative treatment physiotherapy plays an important role. After having proved that kinetotherapy is a form of treatment which is to be prescribed in the first place, the passive therapeutic methods such as thermotherapy (heat and cold), application of ultrasound, electrotherapeutic procedures, massages promising success in arthrosis are described and questions of dosage are discussed. At the same time the significance of a health resort therapy for this group of diseases in discussed. After a randomized analysis which includes 1,893 patients with arthrosis the ratio of active to passive forms of therapy during a course of treatment in the state health resorts Bad Brambach--Bad Elster in 44 to 56%. Finally it is referred to the particular tasks of the pre- and postoperative physiotherapy in the advanced stages of an arthrosis before and after implantation of artificial joint replacement.

Combined Modality Therapy↗
PubMed1979

[Synovial membrane permeability for plasma proteins and protein syntheses in rheumatic diseases].

1. The permeability of the synovial membrane for proteins is larger in rheumatoid arthritis than in osteoarthrosis, in rheumatoid arthritis with high CRP activity larger than in rheumatoid arthritis with low CRP activity. 2. The diffusion by the synovial membrane in most plasma proteins takes place depending on their molecular weight. Of the 14 proteins tested only haptoglobin and fibrinogen did not follow this regularity. 3. While the non-immune proteins proved in the synovial fluid only come from the blood plasma, the immune globulins IgG, IgA, and IgM as well as lysozyme are partly also locally synthetized and enriched in rheumatoid arthritis. In rheumatoid arthritis lysozyme is present in the synovia not only in free, but in most cases also in cell-bound form.

Arthritis, Rheumatoid↗