Biomedical subjects
Publications and source records attributed to K Riesner.
Painful acute pancreatitis masking pancreatic carcinoma and painless acute pancreatitis with shock or coma as leading symptoms have been described before. We report a first case of almost-painless pancreatitis mimicking pancreatic carcinoma with spontaneous normalization of symptoms and biochemical as well as imaging procedure findings.
Recently, a high incidence of hepatic hematomas following percutaneous liver biopsy was reported. This induced us to undertake this prospective ultrasound examination before, as well as 2 and 24 h after, percutaneous liver biopsy, using a Menghini needle (O 1.4 mm), in 93 patients for diagnostic purposes. Two hours after biopsy a small subcapsular fluid margin was found in one patient (1.1%) which disappeared within 24 h. We conclude that hepatic hematomas are not frequent following percutaneous liver biopsy and that it remains a safe diagnostic procedure to find out the reason for chronically elevated liver enzymes and evaluate suspected diffuse parenchymal lesions of the liver.
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Pulmonary alterations after shock and sepsis, described clinically as shock lung or adult respiratory distress syndrome, are of great importance in intensive care. Pathogenetically an alteration of the surfactant system of the lung is often discussed. Since phospholipids are constituents of lung surfactants, phospholipid metabolism is investigated in experimental peritonitis in rats in our laboratory. 15 hours after inducing a peritonitis, the lung incorporates more oleic acid than that in animals of the reference group. 33 hours after inducing peritonitis, the capacity of the lung to incorporate choline and fatty acids is markedly reduced, histologically the lungs represent morphological equivalents of the so-called shock lung at this time. Therefore we conclude, that an alteration of phospholipid metabolism with a diminished and/or altered synthesis of lung surfactant plays, at least in part, an important role in the pathogenesis of respiratory distress in sepsis and peritonitis.
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Obstructive pulmonary vascular disease and pulmonary hypertension are facts daily encountered by pediatric cardiologists. However longterm thromboembolism, pulmonary vascular obstruction and cor pulmonale are rare conditions in children. The case report of a four years old child treated by a Pudenz ventriculo venous shunt for hydrocephalus is presented. Due to fibrin thromboembolism from the Pudenz shunting tube pulmonary vascular obliteration, pulmonary hypertension and chronic cor pulmonale developed. The autopsy findings are in agreement with the ECG, x-ray, cardiac catheterization data and the angiocardiogram.
Although the pathogenesis of the so-called shock lung is different, from the clinical point of view the syndrome is uniform. Regarding the morphology microcirculation, vascular permeability and surfactant of the lung in shock lung are discussed. The course of the alterations in lung parenchyma is uniform, independent of the different pathogenesis in a single case. Pathology and disturbtion of lung function are conform. The relation of the so-called shock lung to other diseases of lung parenchyma is discussed and finally a definition of the so-called shock-lung recommended.
In arrested and with cardioplegic solutions perfused rabbit hearts the relation of perfusion-pressure and flow rate were examined, showing that edema of the myocardium can be avoided even using erythrocytes-free solutions by two measures. First the solution has to contain colloid active agents and secondly the perfusion pressure has to be significantly below the colloid-osmotic pressure. Furthermore the edema can be avoided by adding 300 mg 6-methyl prednisolone/1. If no attention is paid to these facts the coronary flow decreases constantly due to developing interstitial and interfibrillar edema and degenerative changes of endothelial cells of the capillaries, which even can undergo necrosis. These changes were not seen using steroids. On the contrary here we found by densitometry and increased number of lysosomes. These findings show the effectiveness of corticosteroids in stabilizing the cell membranes.
Considering the functional anatomy of the lung parenchyma the pathomorphological response pattern of the alveolus has been described. Hereby, the fibrosing alveolitis is conceived as an uniform concept of a disease, to which many different aetiological factors are associated. The ultrastructural pathology of early changes in fibrosing alveolitis has been described in the bleomycin lung as an example, which pathogenesis (as a chemically induced pulmonary damage) has a character of a model for the process of fibrosing alveolitis.
A cardiac glomus tumor, first described by Masson, was observed in a 28 year old woman who presented symptoms of cardiac dysfunction. Electron microscopic studies disclose a wide range of differentiation of glomus cells from smooth muscle cells to epitheloid cells. The common feature of both cell types include cytoplasmic microfibrils, fusiform condensations and small vesicles. The endothelial cells also show some structural similarities to these glomus cells. The histogenesis of this cardiac tumor is discussed on the basis of its ultrastructure and its uncommon localization. It is concluded that cardiac glomus tumors arise from primitive mesenchymal cells.
Partial contusion of the lung was performed on 131 albino rats. X-ray and histological findings are comparable with lung contusion in man. Three phases are remarkable. X-ray studies of the thorax do not show impressive changes in spite of histological findings of the lung. This means: X-ray picture of the posttraumatic lung is less eventful than the impressive anatomical histological findings.
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