Biomedical subjects
E Schmidt
Publications and source records attributed to E Schmidt.
[Work technology in nursing care: correct work technology must be firmly established in all team workers].
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[Creatine kinase: reference values and clinical aspects of the revised standard method (author's transl)].
Reference values for the revised standard method for determining N-acetylcysteine (NAC) activated creatine kinase (CK) activity in serum are presented, based on samples from 432 out-patients and 423 in-patients of either sex. CK activity was not age-related. The suggested range of normal values for serum CK activity, measured by the revised standard method at + 25 degree C, is 10--70U/l for females and 10--80U/l for males. Where an elevation of serum CK activity is of uncertain cause, the CK/GOT ratio had been recommended, additional to the CK-MB isoenzyme, for distinguishing between damage to heart and skeletal muscle. The significance of this ratio was checked with the revised standard CK method and the optimized GOT determination. The point of separation between myocardial and skeletal muscle damage is 10 by this methods. In order to use this ratio, total CK activity must be over 150 U/l and liver disease or secondary liver involvement must have been excluded. The CK/GOT ratio gains in importance through findings which limit the specificity of CK-MB as a purely myocardial (infarct)-specific isoenzyme.
[Hypertrophic cardiomyopathy with obstruction].
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Clinical applications of gut enzymology.
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Creatine kinase (EC-No.2.7.3.2) and creatine kinase isoenzymes during pregnancy and labor and in the cord blood.
Total CK and CK isoenzyme activity in serum was investigated during pregnancy, labor and after delivery as well as in cord blood. Total CK was decreased in the second trimester of pregnancy but increased in late pregnancy. Low CK-MB activity in serum was found in patients with early labor pains. CK-BB activity could never be detected during pregnancy. Total CK and isoenzyme activity increased after delivery. The rise of total CK and CK-MB in maternal serum is directly correlated with the following: type of delivery, duration of labor, parity of the mother, and birth weight. From this it can be deduced that postpartum CK levels depend on skeletal muscle activity as well as on the activity of uterine muscle. Prematures and infants "small for date" have significantly lower total CK and slightly more elevated CK-BB activity in cord blood than children of normal maturity. CK-BB activity is much more pronounced in high risk patients with low Apgar score.
Thiols and hepatic coma.
The plasma concentrations of methane and ethane thiols have been determined during the course of acute liver failure by a gas-chromatographic technique, and a prognostic evaluation is possible using this analysis. Further, the effects of some therapeutic measures, notably hemoperfusion, on the thiol levels have been investigated. It is concluded that these toxins, which are to a large extent covalently protein-bound, are extremely difficult to remove in an extracorporeal liver support system. Since the cause of the pathological thiol concentrations is probably the elevated plasma methionine levels associated with severe liver disease, it is suggested that the most hopeful course of action against the accumulation of thiols in the body might be a preventative therapy involving the normalization of methionine at an early stage of the disease.
Clinical aspects of gut enzymology.
Enzymological alterations in functional disturbances and in diseases of the intestine are reviewed. Examples are given for diagnostic significance (e.g. in Hirschsprung's and Crohn's diseases), for pathogenetic considerations (e.g. in hypolactasia and in celiac disease), and for secondary involvement of the liver (e.g. in intestinal tumors and after bypass surgery) and are discussed in more detail.
Macro-creatine kinase-BB: observations on 6 patients.
From 2000 sera with elevated total creatine kinase (EC 2.7.3.2) activity the sera of 6 patient showed a persistent high and anamnestically inexplicable creatine kinase activity level. The serum isoenzyme pattern was analyzed by four different methods. Electrophoresis revealed an atypical creatine activity band located between creatine kinase-MM and creatine kinase-MB. An adequate estimation of the persistent enzyme activity could only be achieved by immunotitration (immunoprecipitation), which identified the creatine kinase activity as due primarily to the isoenzyme creatine kinase-BB. Other methods (immunoinhibition and column chromatography) may lead to misinterpretations. The atypical serum creatine kinase-BB showed a higher molecular weight (Mr = 250,000) and altered substrate affinity as compared to native creatine kinase-BB. Both properties are attributable to the binding of creatine kinase-BB to immunoglobulins.
[Do compulsory preventive-care (early-diagnosis) examinations of babies and infants actually reach their target groups? (author's transl)].
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[Radioimmunological detection of soluble immune complexes in serum (author's transl)].
Immune complexes could be measured in sera with the use of plastfixed Clq and 125J-labeled anti-Ig-antibody. The sensitivity of the system is 0.1 microgram aggregated human IgG, the working range is between 0.1 and 10 micrograms per 0.5 ml. In 58% of the sera from patients with systemic lupus erythematosus was found an increase in the immune complex content.
[Continent colostomy through free transplantation of autologous colon muscles].
The study is concerned with a problem which is to a great extent still surgically unsolved, namely that of the incontinent hollow organ occlusion. We report on our own experiments on animals and on physiologicofunctional studies, which reveal the suitability of the smooth muscles as an ideal material for sphincter replacements. By histologic research it became obvious that autotransplantations of smooth muscles, carried out for the first time by the Department of Surgery of the University of Würzburg, are possible without significant tissue changes. The transplant is soon supplied by vessels which sprout ubiquitously and completely permeate it so that it can take over its function as sphincter. Meanwhile, the experience gained in experiments on animals has been transferred to surgery on humans. Incontinence and incontinence of the preternatural anus were eliminated in the first operations using autologous autotransplanted sphincteroplasties.
[Advantages of breast feeding of the infant].
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[Correlations between the diminished secretion of export proteins from the liver and the plasmatic activity of liver cell enzymes (author's transl)].
For the evaluation of certain differences in the diminution of export proteins of the liver we examined some exactly defined groups of liver diseases with the aim of further differentiation of the pathogenetic mechanisms. We measured the activity of glutamate-oxalacetate transaminase, glutamate-pyruvate transaminase, glutamate dehydrogenase, lactate dehydrogenase, alkaline phosphatase, cholinesterase and lecithin-cholesterol acyltransferase, the Quick value, the coagulation factors I, II, V, VII, VIII, IX and X. Clotting factors were determined by a Schnitger-Gross Coagulometer. Prothrombin, antithrombin III, plasminogen, factor VIII associated antigen and activated factor XIII were measured by immunoelectrophoresis according to Laurell. Lipoprotein electrophoresis in agarose gel was performed to evaluate changes in lecithin-cholesterol acyltransferase activity. Except of the rising diminution of export proteins in the course of liver disease from acute hepatitis to cirrhosis we found also specific changes of the patterns of the plasma specific enzymes. These proteins were diminished dependent on their half life time and the inflammatory activity--measured as the height of the transaminases. Lecithin cholesterol acyltransferase and factor VIII did not participate in the general diminution of the most export proteins; some details were found to explain this differing behaviour. Results are critically discussed with regard to new aspects in the biochemistry of the damaged liver cell.
[Superselective parathyroid hormone determination--a reliable diagnosis of the location of endocrinological active parathyroid neoplasms].
The importance of superselective catheterization of the small jugular veins for PTH-radioimmunoassay is shown as an improvement of the preoperative localization technique. Since May 1976 in 20 patients the diagnosis of pHPT could be established. Our own experiences with the method of small vein sampling combined with the radioimmunoassay demonstrate that a reliable localization of overactive parathyroid tumours is possible.
[Morphological findings on free intestinal muscle transplants as sphincter replacement].
Using autotransplants of an autonomous intestinal muscle segment a sphincter substitute and consequently a continent colostomy can be produced in humans and dogs. The histological study of the intestinal muscle section resected 1--28 weeks after implantation shows, in dogs, a good healing process and vascularization of the transplant muscle, which explains the clinical success. Even after many weeks only slight atrophy and fibrosis can be observed. Only a few of the intramural nerve plexuses perish. Some of the small intestine sphincters remain incontinent. The specimens show a more or less extensive hemorrhagic necrosis of the transplant with high inflammation. The reason for these complications is thought to be the mucosa glands, which were not completely removed from the vulnerable small intestine of the dog before the transplantation.
[Ureterocystoneostomy using the Politano-Leadbetter procedure in adults].
At the Urology Clinic of the University of Berne during a seven-year period 79 ureterocystoneostomies (UCNS) have been performed with adults suffering from various urologic illness. Technique of operation was a modified Politano-Leadbetter procedure. Over 90% success was achieved in the reflux-only group, acceptable results were obtained with patients suffering from ureteral problems due to gynecologic surgical injury or tuberculosis, while reimplantation of megaureters had a low success rate. Early postoperative complications were rare, and mortality due to the operation was zero.