Biomedical subjects
Publications and source records attributed to K E Schenk.
Retrosternal dislocation of the clavicle is an uncommon injury which may affect the mediastinal structures in a life-threatening way. Therefore, computed tomography is mandatory. Manipulation in the acute situation is the treatment of choice. In case of failure or old dislocation, open reduction with stabilization of the joint is required. The literature on this subject has been reviewed and an additional two cases are reported.
Herniation of the abdominal wall is seldom encountered after harvesting cancellous bone from the iliac crest. The case history is presented of a patient with the symptoms, diagnostic work-up and repair of the hernia using a Goretex sheet.
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In the present study we discuss our early results and some technical aspects of a new surgical approach in dealing with high-lying malignant biliary obstruction. After transection of the common bile duct we proceed through a cephalad reflection of its proximal end in a meticulous dissection of the intrahepatic biliary tree. During dissection we follow the intrahepatic course of the right and left portal vein, which leads us to follow the respective course of the main right and left hepatic ducts and to reach the levels of their subsequent consecutive segmental bifurcations. By transecting at high levels, we excise completely or partially the tumor with the confluence of common hepatic duct. We reconstruct the biliary tree by multiple intrahepatic cholangiojejunostomies by use of a Roux-Y jejunal loop and a varied number of segmental hepatic ducts. Transanastomotic tubes were used only temporarily. Fifteen patients underwent operations by the described surgical approach without mortality. All were relieved of their jaundice completely and in all the tumor was either completely (5) or partially (10) removed. All patients had a good quality of postoperative life without being obliged to carry transanastomotic tubes and the complications and problems associated with them.
From September 1983 to December 1985 40 patients from a total of 55 with periampullary and pancreatic head carcinoma underwent resectional surgery in our department. Following a policy of precise evaluation of each patient's operative findings, six patients underwent a Whipple duodenopancreatectomy, 29 patients underwent regional subtotal pancreatectomy, and five underwent regional total pancreatectomy. Five patients underwent vascular reconstruction of their regional vascular structures after transection of the invaded segments of their vessels and eight had positive lymph nodes. Lymph node involvement was confined to the regional area. Patients with distant lymph node involvement (paraaortic) were not considered eligible to resection. Three patients died and 10 required reoperation. Thirty-one had radical resection, one palliative and eight equivocal resection. From the survived patients (n = 37) 33 are alive and doing well at the time of this report (overall mean survival 18 months). The results of this study demonstrate that a radical approach based on a precise evaluation of operative findings of the individual patient might well offer a higher resectability rate and is probably the only chance for radical resection and for a longer survival in patients with periampullary and pancreatic head carcinoma.
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The hemodynamic effects of nitroglycerin and nifedipin and the application of both substances during a long term training program in patients with angina pectoris, myocardial infarction, and myocardial dysfunction (=48) were studied. Cardiac output, heart rate, and arterial blood pressure showed no significant changes after application of nitroglycerin and nifedipin. After nitroglycerin, however, there were significant drops of pulmonary arterial pressure and right atrial pressure during rest and exercise, whereas no changes were seen after nifedipin. With the application of nitroglycerin (but not with nifedipin) prior to the daily physical training program on a bicycle ergometer, all patients with angina pectoris and myocardial dysfunction showed an increasing training effect during the long term program and their angina pectoris improved.
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In 85 patients with myocardial infarction undergoing a physical training on a bicycle ergometer 3 times a week over a period of 18 months beginning 5 weeks after the acute infarction, telemetric and haemodynamic investigations were made. The telemetry was done during ergometer training, dynamic and isometric gymnastics and during work at home. The diastolic pulmonary arterial pressure under exercise was registered in 43 patients before the beginning of the training program; in 16 of these patients a control heart catheterization was made after a training period of 4 months. During the ergometer training program 32% of all patients had ventricular premature beats more than 1:10, 6% had paroxysmal ventricular tachycardias, 1 patient had supraventricular tachycardias and 1 patient died at home after having a tachycardia of unknown origin. During dynamic or isometric gymnastics or under work at home the patients had not more arrhythmias than in the telemetric controls during the ergometer training. Arrhythmias and other complications are very often found in patients with high diastolic pulmonary arterial pressure in the exercise test.
The haemodynamic effects of intravenous injections of furosemide and ethacrynic acid as well as those of peroral administration of nitroglycerin were studied in 32 patients (4-12 weeks after acute myocardial infarction) during rest and exercise. Cardiac output, heart rate and arterial blood pressure showed no significant changes after administration of nitroglycerin, furosemide and ethacrynic acid (fig 3). A few minutes after application of nitroglycerin or furosemide there were significant falls of pulmonary arteria diastolic pressure and right atrial pressure (fig. 1 and 2), whereas no changes were seen after injection of ehtacrynic acid. This initial effect of furosemide as well as the effect of nitroglycerin is primarily of vascular origin, causing an increased peripheral venous capacitance. Ethacrinic acid failed to exhibit any direct vascular effect. Therefore during pulmonary oedema nitroglycerin together with furosemide should be given.
The haemodynamic effects of intravenous injections of furosemide and ethacrynic acid were studied in 12 patients during rest and exercise. Cardiac output, heart rate and arterial blood pressure showed no significant changes after injection of furosemide or ethacrynic acid. Few minutes after injection of furosemide there were significant falls of pulmonary artery diastolic pressure and right atrial pressure, whereas no changes were seen after injection of ethacrynic acid. This initial effect of furosemide apparently is of primarily vascular origin, causing an increased peripheral venous capacitance. Ethacrynic acid failed to exhibit any direct vascular effect.
The mode and extent of the regressions of heart valves, valvular rings, and tendon chords, as well as the size of atria and ventricles in 316 hearts of different age groups (macroscopically normal at autopsy), were studied. With increasing age, the valves showed marked thickening and loss of elasticity. Deposition of lipoids and calcification occur to a variable extent in the valvular tissue and rings; Valve size shows a change of minor degree, but tendon chords and papillary muscles shorten in old age. The diameters of the atria, mitral, tricuspid, pulmonary, and aortic rings increase continuously up to the 9th decade of life. The width and length of the ventricles show minor alterations in size. In old age, heart weight increases.
In a long term experiment, a systematic analysis was made of the cellular reaction of the myocardium and the lymphatic system to application of antigenic substances. Several groups of mice received single or repeated injections of human serum, serum from rabbits with antiheart antibodies, mouse spleen cells immunized to myocardium, and human or mouse cardiac homogenate with and without incomplete or complete Freund's adjuvant. After injection of human and mouse heart homogenate, hypertrophy of myocardial cells was the first alteration seen; then followed focal myocarditis and after 10 months, interstitial fibrosis. Simultaneously, in the lymphorecticular tissue, there was marked proliferation of reticulum cells, lymphocytes, and plasma cells, as well as an enlargement of secondary follicles. All the animals produced antibodies to the injected antigens. Following injection of human serum or serum from rabbits with cardiac specific antibodies or spleen cells, no morphological changes were seen in the hearts.
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