[Relation between serum uric acid and blood pressure in pregnancy].
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Biomedical subjects
Publications and source records attributed to K Jacobitz.
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Examining a 74 year old female patient with a nodular goiter, a tumor of the left thenar eminence with a concurrent radiolucent swelling in the adjoining second metacarpal was found. The diagnosis was a struma nodosa with regressive marginal changes, a hypervascularized monophasic synovial sarcoma of the wrist joint, and an enchondroma of the second metacarpal bone. Following the amputation of the forearm, no radiotherapy or cytotoxic therapy was performed. After a follow-up time of one year no metastases were detected.
Arterial hypoxaemia near critical values may occur during the postoperative period after surgery under general anaesthesia. Mainly alterations of ventilation/perfusion ratio seem to be the cause for this disorder. In this study we examined the effect of low-dose-heparin in improving pulmonary perfusion and consequently reduction of postoperative hypoxaemia. In 22 elderly patients both male and female we found no significant differences in oxygen tension compared to a control group of 19 patients. In both groups duration and degree of postoperative hypoxaemia were equal with minima on the first respectively second postoperative day. As in both groups there were no significant differences in other parameters further influencing oxygen supply--such as haemoglobin, haematocrit, pH and mean arterial blood pressure--we do not believe that disturbances of perfusion caused by microembolism are mainly responsible for postoperative hypoxaemia. Likewise low dose heparin seems to have no effect on postoperative hypoxaemia.
A new method to arrest the unremitting progression of hydrofluoric acid burns, which occurs in the absence of appropriate therapy, is described. The treatment consists of repeated perfusions of calcium gluconate into one of the arteries supplying the affected areas. To date 11 patients have been treated in the described manner, and the therapy brought about recovery in all cases, with little loss of tissue or function.
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The progression of hydrofluoric acid corrosion on the hands, which cannot be arrested by other means and leads to crippling or amputation, can be stopped by one single or several repeated intra-arterial perfusions of 10 ml 20% calcium-gluconate solution in 40 ml normal saline over 4 hours as close to the defect as possible via the brachial artery or one of the forearm arteries. In 4 patients, with corrosion of a severity judged to be between first and third degree, spontaneous healing resulted after this treatment. Based on our experience we advise the use of intra-arterial perfusion and show its advantages over subcutaneous injections or intravenous infusion of calcium.
On the example of the computer-aided basic documentation at the Department of Traumatology Hannover, the necessity of constructive cooperation between the clinic staff and the medical data processors is shown. The system of basic documentation is primarily explained in its conception as far as the clinic is concerned. The fundamental principles, daily routine, and clinical application of this system are described, as are the tasks assigned to the clinical staff within the framework of medical data processing. The necessity of clinical staff quality controls by means of a computer short card is emphasized. The system has been in use for 3 years.
In 85 geriatric premedicated patients haemodynamic effects were investigated following rapid infusion of 500 ml dextrane. The data measured one day preoperative revealed typical age-related changes of the cardiovascular system: decrease of cardiac output, stroke volume and heart rate; increase of peripheral vascular resistance and mean arterial pressure. After infusion of dextran central venous pressure rose by 4.9 mm Hg (mean), mean arterial pressure by 7.5 mm Hg (8.5%) and cardiac output by 1.04 1/min (24.3%). Heart rate alterations were insignificant, but total peripheral resistance decreased significantly by 12.5%. Pulmonary capillary pressure rose to 15.4 +/- 3.4 mm Hg. We conclude that it is possible to increase cardiopulmonary efficiency by extracardiac measures preoperatively even in aged patients. In no case critical left- or right ventricular filling pressure exceeded, so we cannot accept the often expressed warnings against induced hypervolaemia in patients with no cardiac failure except old age.
In 34 elderly male and female patients undergoing upper abdominal surgery under general anaesthesia we investigated duration and degree of postoperative hypoxaemia. In this study only patients with no signs and symptoms of pulmonary or cardiac diseases, verified by normal lung function--vital capacity and FEV1, X-ray and electrocardiographic findings were considered. Postoperative development was free of complications and temperature rises in all cases. The investigations showed occurrence of arterial hypoxaemia during the postoperative period with values near the lower limit where the organism must fall back on cardio-circulatory reserve mechanisms in order to avoid general hypoxydosis. Regarding the restricted pulmonary and cardiac capacity for adaptation and compensation in geriatric patients, we recommend to prolong the practice of O2-application for two or three hours over a period of 24 to 48 hours, especially in patients with postoperative complications such as prolonged gastric atony, temperature, haemorrhage or cardiac and coronary insufficiency. This prolonged application of oxygen by mask or nasal tube should go parallel to other physiotherapeutic measures.
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When starting our surgical out-patient department at the Hannover Medical School we were forced to computerize our medical correspondence as far as possible. In cooperation with the department of biometrics of the Hannover Medical School, a set of three computerized forms was established which in addition to facilitating medical correspondence enabled systematic documentation. The FTSS system generally used in the computer language PL/1 was used for computerization of our forms.
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