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Biomedical subjects

F W Reutter

Publications and source records attributed to F W Reutter.

At least 37 records · Page 2Linked to original sources

[Five years' experience with an epimyocardial screw-in electrode in cardiac pacemakers].

197 myocardial sutureless screw-in electrodes were implanted between the years 1973 and 1978. A subxyphoidal transmediastinal route and general anaesthesia were used. All patients had initially good pacing results. In 93% the electrode was placed into the right, in 7% into the left ventricle. The peroperative mortality rate was 0, peroperative complications were seen in 1%. Of the 19% of the complications which needed some kind of a treatment, 7.6% were confined to the lead and 11.4% were other complications. The lead, placed into the right ventricle, had to be replaced in five patients (2.7%) because of exit block or sensing problems. The postpericardiotomy syndrome was the most frequent complication but it did not impair the function of the pacemaker. 4% of the patients died within 30 days after the implantation. In 46 patients the pacemaker was replaced after a mean time of 32,5 months. The measurement of the threshold rose from a mean of 0.8 mAmp to 3.2 mAmp and the mean resistance was 530 Ohms. In 44 patients the electrode could be reused.

Adult

[Effect of 1,25-dihydroxycholecalciferol in renal osteopathy].

9 patients with advanced renal failure and renal osteodystrophy documented by iliac crest biopsy were treated with 1,25-dihydroxycholecalciferol (average dose 0.53 micrograms per day) for 6 months. Under 1,25-DHCC there was a statistically significant increase in serum calcium and decrease in serum alkaline phosphatase and immune parathyroid hormone. Histomorphometric evaluation of posttreatment bone biopsies showed reduction of osteoclastic resorption and endosteal fibrosis. Osteoid volume decreased in most cases. In 3 patients with predominant fibroosteoclasia, bone turnover practically normalized. Bone mineral content of the radius (photoabsorptiometry) did not change with treatment. Transient hypercalcemia occurred in 5 patients and was easily corrected by adjustment of 1,25-DHCC dosage.

Alkaline Phosphatase

Systemic karyomegaly associated with chronic interstitial nephritis. A new disease entity?

In 3 patients, two 26 and one 29 years of age, a nephropathy was accidentally discovered which progressed to end stage renal failure within 4 to 6 years. Renal biopsy revealed an unusually marked karyomegaly particularly of the tubular epithelium. These cytopathological changes were associated with chronic interstitial nephritis. Biopsies of other organs, i.e. liver, colon, bronchus and lungs indicated in 2 patients a systemic distribution of the karyomegaly, particularly in mesenchymal cells. Neither the chronic interstitial nephritis nor the karyomegaly could be ascribed to a recognized etiology. This suggests, therefore, that there is a relationship between these changes. The karyomegaly could be the result of the action of some antimitotic agent such as chemical toxins or virus infections.

Adult

[Lesions of the kidney and the efferent urinary tract due to cantharidine].

5 cases of cantharidin intoxication are reported. 4 patients had used cantharidin as an aphrodisiac and one to induce abortion. All presented with urinary tract symptoms. Four patients had gross hematuria. In one case non-oliguric renal failure occurred, with increase of plasma creatinine to 5.6 mg/100 ml. renal biopsy was performed in 2 cases. On light and electron microscopy glomerula showed only minimal changes such as podocyte swelling. The tubuli were markedly altered, with luminal enlargement, intraluminal cell debris, flattening and shrinking of the epithelial cells and distortion of brush borders. Whereas all 5 patients recovered completely, some deaths due to cantharidin poisoning have been reported in the literature. Since cantharidin is markedly toxic, its use in humans should be strongly discouraged.

Adolescent

[Kurschmann-Steinert myotonic dystrophia and Adams-Stoke attacks. Successful treatment of arrhythmia by means of pacemaker implantation].

The case is reported of a 39-year-old male with Steinert's dystrophia myotonica complicated by cardiac arrhythmias manifested by high-degree a-v block with Stokes-Adams attacks. Implantation of a demand-type cardiac pacemaker brought prompt relief from cardiac symptoms and the patient was able to resume work. The pathologico-anatomical findings in dystrophia myotonica are discussed, together with their possible connection with the type of arrhythmias described.

Adams-Stokes Syndrome

[Complications due to endocardial and epimyocardial electrodes in 171 patients with artificial pacemakers].

On the basis of experience with 171 patients the advantages and disadvantages of a sutureless, corkscrew-like myocardial electrode are compared with those of endocardial electrodes. Electrode complications were significantly less frequent in patients with sutureless myocardial electrodes and never lead to death. However, a benign postpericardiotomy syndrome was frequent (16% of cases). Electrode dislocation was the main complication in patients with endocardial electrodes.

Electrodes, Implanted

[Paralytic ileus in pheochromocytoma. Possible correlation with an attempt at adrenal phlebography].

Following adrenal phlebography, obstruction of the large bowel associated with adrenergic crisis was observed in a 60 year old patient with pheochromocytoma. As in other published cases of ileus associated with pheochromocytoma, high urinary catecholamine concentrations were found in our patient and the tumor resected at surgery was large. As phlebography immediately preceded the onset of ileus and hypertensive crisis, it is postulated that angiography led to massive secretion of catecholamines, which caused the hypertensive crisis as well as the ileus. The possible mechanisms by which phlebography may lead to adrenergic crisis are discussed. It is concluded that in suspected pheochromocytoma all angiographic examinations should be carried out under simultaneous treatment with alpha-blocking agents.

Adrenal Glands

[Late results after zero calorie diet therapy in adiposity].

Patients treated for obesity by total starvation were followed up after a period ranging from 7 to 60 months. Starvation treatment had been carried out 12 times in women and 7 times in men. Weight regain was less than 33% of weight loss in 5 women and 5 men and the regain was 40% in 1 man. Weight increase was higher than 50% of weight loss in 7 women and 1 man. The weight of one of these women exceeded the prestarvation weight. In view of these poor long-term results, therapeutic starvation should be carried out only in selected cases. Our experience indicates a better prognosis for men than for women. There is some indication that long-term results of therapeutic starvation are more favorable in patients with previous myocardial infarction or with somatic conditions which may improve after weight reduction.

Adolescent

[Proceedings: Evaluation of the plasma-phenolred test as a simple kidney function test].

The phenolsulphthalein 60/60 plasma test (PSP 60/60) was evaluated in 30 control subjects (mean value 51 micrograms/100 ml +/- 49 micrograms/100 ml) and 60 patients with chronic renal disease with varying degrees of renal insufficiency. PSP 60/60 proved to be superior to determination of serum creatinine and urea nitrogen. PSP 60/60 correlated well with endogenous creatinine clearance and 131I-iodohippurate clearance in over 80% of cases. Of various exogenous and endogenous factors interfering with the test, drugs influencing renal excretory mechanisms are most important. Due to its technical simplicity, PSP 60/60 is a useful screening test for evaluation of renal function, especially as an office procedure.

Adult

[Proceedings: A mobile coronary care unit at the Cantonal Hospital of St. Gallen].

Cardiac death after a myocardial infarction occurs most frequently within the first hour after onset of symptoms and in nearly 2/3 of cases before transfer to a hospital. Mortality therefore should be influenced by shortening of the prehospital phase. At moderate cost a mobile coronary care unit (Kardiomobil) has been introduced at the Cantonal Hospital, St. Gall. Experience and results of the first year of the service are reported. 82 out of 142 patients transported by Kardiomobil proved to have myocardial infarction. Two patients with ventricular fibrillation were defibrillated, with one longterm success. Sixteen cases of potentially life threatening arrhythmias were successfully treated. The mean period from onset of symptoms to alerting a doctor was 1 h 15 min, while the mean period from onset of infarction to entry into the hospital CCU was 3 hrs.

Arrhythmias, Cardiac

[Hormonal contraceptives and myocardial infarct].

Out of a total of 36,208 admissions during the 21-year period from 1954 to 1974, 514 female patients were hospitalized for acute myocardial infarction. Only 4 of these 514 females were below 40 years of age. In addition to one of the generally accepted risk factors for coronary disease, all 4 patients had been taking hormonal oral contraceptives for a prolonged period. Although there is no direct proof of a connection between the use of oral contraceptives and myocardial infarction, there is increasing evidence that risk factors for coronary disease are potentiated by the use of oral contraceptives. In the presence of risk factors for coronary disease, therefore, oral contraceptives should be taken only on the basis of a strict indication and under regular medical supervision.

Adult