Biomedical subjects
Publications and source records attributed to G Klemm.
A sonographically demonstrated vermicular structure in the region of the gall bladder was suspected to be an ascaris, which is to find in the biliary system occasionally. However under cholecystectomy there was not to detect a worm, only a stone in the cystic duct. In accordance to anamnesis we think it being the caudal part of a ventriculo-peritoneal drain implanted for hydrocephalus therapy.
Peritoneal disturbances in the course of continuous ambulatory peritoneal dialysis (CAPD) are therapeutical relevant. Even calcifications are described in rarely cases. Concerning these cases an experimental model is known being created by Selye and belonging to the calciphylactic concept. In 8 female Wistar rats (weighing 140 to 180 g) this experiment was reproduced and in a similar series an inhibition was achieved by intraperitoneal application of a glucocorticoid. Experiments in this kind give a pathogenetic contribution for peritoneal disturbances and also possible therapeutic hints.
Generally metastases of carcinoid tumours are pseudocystic in nearly 10% of the patients. In our case the guiding diagnostic importance of sonography and computed tomography could be proved. Results have to be completed by histologic findings and hormonal analysis (serotonin, 5-hydroxyindol acetic acid). - Morphological signs especially of the new imaging techniques are often a supposition for the modern therapy, e.g. the application of serotonin antagonists, local perfusion of cytostatic substances and if possible transplantation of the liver.
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After posttraumatic diaphragm ruptures in some cases life threatening haemorrhages from intraabdominal organs (especially from the spleen) into the thorax were found. In general, the diagnosis cannot be established by peritoneal lavage or abdominal sonography. And in case of emergency, there is often not enough time to obtain a computed tomography. It is therefore extremely important for the patient's prognosis that the surgeon initially performing treatment be aware of this cause of bleeding. Correct interpretation of the chest x-ray, for instance in the case of stomach air in a left basal shadow above the diaphragm, can confirm the suspicion, and the urgently required operation can be performed in time.
The puncture of pancreatic pseudocysts with the help of ultrasound is an attempt of treatment without putting too much strain on the patient. In a number of cases a definitive emptying of cysts is successful so that a surgical intervention with application of an interior drainage can be avoided. Of 4 male patients of medium age treated 2 were successfully to be treated. The casuistics of one of the patients is reported. Under the point of view that a sonographically assisted intervention increases the security of the puncture therapy the complex of problems is outlined.
Results of ultrasonical folliculometry during treatment by 5 different stimulation protocols were evaluated in 122 cycles of IVF-patients. Additionally, the structure of follicular population was investigated by measurement of follicular volume which was the basis of a follicular hierarchy. - Number of developing, sonographically detectable and punctured follicles increased significantly from stimulation by Clomiphene to stimulation by Folistiman. Only in stimulation by Clomiphene number of sonographical visible follicles was in accordance with laparoscopically punctured follicles. Development of relationship of the follicular classes during treatment supports hypothesis that exogenous gonadotropins do not increase follicular recruitment in the follicular phase but prevent atresia of follicles recruited earlier. Long lasting action of FSH as in stimulation by gonadotropins stimulates a greater number of follicles more intensively as demonstrated by an increased follicular volume in follicles with high rank numbers in gonadotropin treated patients compared with treatment by Clomiphene and Clomiphene/Anthrogon. Very high FSH-levels probably cause a heterogenous population of follicles with an increased number of small follicles at time of follicular puncture.
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In the pancreas of female rats (180 g body mass) mast cells were seen with histological and histochemical methods in the periductular and perivasal connective tissue in a less number; they were absent in the interacinar region totally. Compared to it they were relatively numerous in the peripancreatic investing tissue. Under calciphylactic conditions (H. Selye) i. e. after sensitization with Vitamin D2 and infiltration of Ferric dextran only calcifies the interstitium of the pancreatic gland, but not the peripancreatic tissue. It is concluded that mast cells in the calciphylactic reaction of the pancreas are of an inferior importance, a mastocalciphylaxis does not exist, but in the sense of a simple calciphylaxis the collagenous connective tissue undergoes a calcifying reaction.
After a pregnancy the 26-year-old patient complained of pain in several joints. Waddling gait and light-grey excrements were conspicuous. Radiologically signs of calcium salt reduction with hank-like bone structures in both forearms. Hypocalcaemia, hyperphosphataemia, parthormone in the serum increased. Villi could not be proved by aspiration biopsy in the small intestine. The bone biopsy spoke for a secondary hyperparathyroidism. By glutene-free nutrition the patient was without pain after several months and was able to go without hindrance after one year.
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A coumarin necrosis of the buttocks skin occurred in a patient with a Klinefelter's syndrome. In the acute stage of the complication the oestrogen activity was increased which is decreased in other persons with this arrangement of chromosomes. It is proposed to analyze the oestrogenes in urine of male patients or of females in the postclimacteric period with coumarine necroses before a treatment with sexual hormones.
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It is reported on the technique of transplantation of a carcinoma on the pancreas of the rat. As to the origin the malignoma used is a tumour induced by Methyl-Yellow and known as solid form of the Zajdela-hepatoma. Out of 50 transplantation experiments 48 were successful (96%). After continuous growth regional formations of metastases were observed. Death took place in the 3rd week after transgression of the borders of the organs under the picture of cachexia.
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