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Biomedical subjects

K Fuchs

Publications and source records attributed to K Fuchs.

At least 109 records · Page 6Linked to original sources
PubMed1981

Stabilization of flail chest by compression osteosynthesis--experimental and clinical results.

It has been demonstrated that the impaired ventilatory parameters can be normalized after early stabilization of flail chest. Most methods for operative fixation, however, have given disappointing results and only plate fixation procedures have been effective. The experimental results of osteosynthesis with dynamic compression plates are presented and demonstrate the superiority of compression osteosynthesis in rib fractures. Compression osteosynthesis resulted in a primary fracture healing with stable fragments after 14 days, whereas conventional plate fixation techniques required a much longer time and showed secondary fracture healing. The benefits of compression osteosynthesis could also be demonstrated in 10 patients with traumatic flail chest. Osteosynthesis resulted in marked pain relief, immediate stabilization of the chest wall, and a shorter time of intubation. Not all fractured ribs need stabilization, dorsal fractures are well fixed by the strong erector muscles, and in the lateral position only ribs III to VII need to be considered. Reasonable stabilization may be achieved with fixation of every second rib. In patients with bilateral rib serial fractures subcutaneous implantation of one or 2 rib struts is recommended--good results were obtained in 12 patients. The indication for operative stabilization of flail chest should be restricted to: 1. Patients with severe ventilatory restriction due to chest wall paradox alone. 2. Flail chest combined with intra-thoracic lesions which require thoracotomy. 3. Flail chest combined with lesions which require a prone position for surgical exploration. 4. Respiratory distress patients when the unstable chest wall interferes with mechanical ventilation or with underlying organs.

Adolescent↗
PubMed1980

Therapy of vaginismus by hypnotic desensitization.

Fear and anxiety are of tremendous importance in the production and maintenance of a symptom. Vaginismus, as a reaction of avoidance of an anxiety-producing situation, is readily amenable to treatment by systematic desensitization. This may proceed mainly in two ways: "in vitro" or "in vivo." In order to strengthen and speed up the densensitization process, we used hypnotic techniques in a dynamic approach. The "in vitro" treatment proceeds with imagery, under hypnosis, of an "anxiety hierarchy" of increasingly erotic and sexually intimate situations which will be reproduced at home with the partner, until sexual intercourse is achieved. In the "in vivo" method the patient learns self-hypnosis and then inserts in the vagina first a finger, and then Hegar dilators of gradually increasing sizes. The partner, the patient, and the physician will then successively proceed to insertion, forming a team-referred work situation. This continues until the "female superior position," practiced first with the largest dilator, is reproduced at home by intercourse. Between 1965 and 1974 we treated 71 women with this method. Good results were obtained in 16 of 18 by the "in vitro" technique and in 53 of 54 by the "in vivo" technique. One patient was referred from the "in vitro" group to the "in vivo" group. In follow-up of 2 to 5 years there was no relapse or symptom substitution.

Adult↗
PubMed1979

[Pneumothorax and haemothorax (author's transl)].

Pneumothorax and haemothorax constitute serious complications of a blunt chest trauma. During 1970-1978 64 persons with pneumothorax and 109 cases of haemothorax were admitted to and treated in the Surgical Unit of the University Hospital, Göttingen. In nearly every case fracture of several ribs had also occurred. The method of choice for treating cases of pneumothorax was by Bülau drainage; surgical closure of the air leakage was rarely necessary. Conservative measures are indicated only if the pneumothorax is narrow or confined to the apical region. It is worth mentioning that in a large number of cases pneumothorax developed during positive pressure ventilation after a chest injury. Complications of Bülau drainage were: damage to the lungs, skin emphysema and bleeding from the intercostal artery. Open application of the Bülau drainage in the 2nd intercostal space is therefore recommended. Treatment of traumatic pleural effusions by Bülau drainage was required in only 14 of 109 cases. Therapy-resistent effusions necessitated thoracotomy and evacuation of the haematoma in 4 persons. If Bülau drainage fails completely to evacuate the haemothorax, it should be promptly followed by thoracotomy to prevent the development of adhesions and the resulting impairment of respiratory function.

Drainage↗
PubMed1978

[Choice of procedure in the surgical treatment of liver injuries].

We give an analysis of liver-rupture cases among our own patients and discuss the problems of diagnosis and surgical therapy. Total lethality is 29%; this is dependent on quick diagnostic procedure, the number and severity of accompanying traumas, and the type of liver rupture. The main diagnostic feature seems to be peritoneal lavage, Operative procedure depends on the type and severity of the liver rupture. We therefore propose a classification of the types of liver ruptures, together with their adequate surgical therapy. Some postoperative complications can also be avoided.

Accidents, Traffic↗
PubMed1975

[Results of operative treatment of chronic pancreatitis, especially exocrine and endocrine functions (author's transl)].

Studies were undertaken in 40 patients with chronic pancreatitis six months to seven and a half years (mean 25 months) after operation, results being compared with pre-operative findings. Measurements included: exercise capacity, absence of pain, body weight, endocrine (36) and exocrine (25) pancreatic function. Almost all patients returned to full or only slightly impaired activity, were free of pain or had less pain and weight increase. Exocrine pancreatic function (secretin-pancreozymin test and faecal fat) was noted in 11 of 25 patients. In another 11 pre-operative progression was arrested. But endocrine function improved in only three of 36 and worsened in 13 (manifestation of subclinical diabetes in eight, worse glucose tolerance in five). The results justify a more active surgical approach in the treatment of chronic pancreatitis in order to save the patients from an often long and painful "burning out" of the disease on purely conservative treatment. Furthermore, exocrine pancreatic function, at least, is maintained or improved.

Adolescent↗
PubMed1975

Serotonin, 5-hiaa, total estrogen and pregnanediol excretion in urine during therapeutic saline abortion.

In 24 patients, who underwent therapeutic abortion for various reasons between the 17th and 26th week of pregnancy, urinary excretion of serotonin, 5-HIAA, total estrogens, and pregnanediol were measured before, during and after the intra-amniotic injection of hypertonic saline. 20% hypertonic saline solution (160-500 ml) was given by transabdominal injection over a period of 5 min. The four hormones or metabolites were measured during six periods: I; 12-24 hrs, and II: 0-12 hrs before saline administration, III: 0-12 hrs after saline administration, IV: 0-12 hrs during aborion, V: 0-12 hrs and VI: 12-24 hrs after abortion. The results point to the active participation of serotonin in the process of fetal expulsion, as serotonin was increased by over 100% (from 20-22 to 43-47 mu-g/12 hrs) during periods III-IV, and its metabolite 5-HIAA, too, increased by nearly 60% (from 2.4-2.5 to 3.3-3.9 mg/12 hrs). They decreased during the post-abortive periods V-VI. On the other hand, total estrogens decreased only slowly, but continuously, during all 6 periods (4.9, 4.3, 3.4, 3.1, 1.8 and 1.4 mg/12 hrs). Pregnanediol, beginning with 12 mg/12 hrs showed a slight increase during periods III-IV (14.5 and 15.6 mg/12 hrs) and a decrease during periods V-VI (8.0 and 5.8 mg/12 hrs). These findings are interpreted as indicating the disruption of feto-placental function affecting estrogens during periods III-VI. They might demonstrate an accelerated hydrogenation of progesterone into pregnanediol during periods III-IV, followed by a sharp decreased in progesterone/pregnanediol production during periods V-VI.

Abortion, Therapeutic↗
PubMed1975

Cell renewal of gastric mucosa in Zollinger-Ellison syndrome.

In Zollinger-Ellison patients the gastric mucosa is characterized histologically by hyperplasia both of the glands and the gastric pits. The fundic gastric mucosa is thickened with a marked increase of the specific glandular cells. In-vitro autoradiographic examination shows a significant increase in proliferation of the stomach epithelial cells in three patients with hypergastrinaemia. The mean generation time was diminished from 72 plus or minus 2 in controls to 45 plus or minus 4 hours in the Zollinger-Ellison patients owing to a reduction of the G-1 phase from 62-63 to 36-37 hours. The labelling index (3-H-index) was increased from 10.0 plus or minus 0.2 to 15.7 plus or minus 1.8%. The DNA synthesis phase, the G-2 phase, and the mitotic time were not altered compared to the controls.

Adult↗