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Biomedical subjects

K Thon

Publications and source records attributed to K Thon.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Symptomless and complicated peptic ulcer as an extreme clinical form of ulcer disease: consequences for choice between conservative and surgical therapy].

Asymptomatic recurrent ulcers following drugs and surgical therapy are true failures of treatment (Visick IV). Several types of bias at present do not allow any conclusion whether medical treatment and maintenance increase the rate of ulcer complications. The mechanisms of action for medical treatment with cimetidine and operative treatment with SPV are similar, but not identical. Bad compliance and incomplete vagotomies mainly account for success of mutual exchange between the two types of therapy. Using a decision tree with mortality as outcome recommendations are developed for a step-wise therapeutic concept in peptic ulcer patients.

Cimetidine↗
PubMed1985

[Hemorrhaging peptic ulcer--Therapy? When? Which?].

The influence of frequency of surgical interventions and the time of operation on the overall mortality is still a matter of considerable controversy. A close correlation between the risk and incidence of recurrent bleeding and the primary bleeding status during emergency endoscopy let us to design a new concept of a more aggressive surgical strategy. The dominating criteria for choice of treatment based on instant endoscopical classification of bleeding type and activity. The overall mortality was 5.4%. 59 patients (53%) underwent surgery with only two hospital deaths (3.4%). Among the group with conservative treatment there were four additional deaths (7.5%), all patients being above 70 years of age. The results suggest that mortality rates in patients with bleeding gastroduodenal ulcers can be reduced by a more aggressive surgical approach.

Duodenal Ulcer↗
PubMed1984

[Indication and technic of interlocking nailing of the femur].

Between 1973 and 1982 we treated 569 fractures of the femoral shaft by means of osteosynthesis. The internal nailing was performed in 41.6%. We used an interlocking nailing in 170 cases, 116 times statically and 54 times dynamically. An open reposition was performed in 48.2%. With only a very small incision we exposed the area of the fracture to insert the reamer guide under control of the fingers into the distal part of the femoral shaft. By using this technique there is no danger of disposing the fragments in order to achieve stabilisation in the correct position. 52.4% of the patients were younger than 30 years and 25.9% older than 30 years and 25.9% older than 60 years. In all cases we observed an osseous healing, twice a secondary cancellous bone craft was necessary. As complications we had an infection rate of 2.9%, loosening of the bolt in 0.6%, axial malalignment greater than 10 degrees in 0.6%, a rotary malalignment greater than 10 degrees in 1.2%. We did not observe any refracture. Less complications can be observed in interlocking nailing in comparison with plate osteosynthesis. Technique, indication, mistakes, and dangers as well as careful timing of operation are discussed. In open fractures delayed osteosynthesis by means of interlocking nailing is to be preferred to primary plate osteosynthesis. Fractures fixed by interlocking nailing had comparatively less complications in fracture healing and especially no more shortenings and rotation deformities, but the advantage of early full weightbearing. The interlocking nail has a very important value in the management of femoral shaft fractures.

Adolescent↗
PubMed1983

Metabolism and function of gastric histamine in health and disease.

Histamine is not uniformly distributed in the human and animal organisms, but occurs in high concentrations in the gastric mucosa. The enzymes responsible for its metabolism--histidine decarboxylase, histamine N-methyltransferase and diamine oxidase--seem to be less predominantly localized in the stomach. Considerable effort was necessary to detect and measure histamine formation in the gastric mucosa. This was a controversial subject that only was solved recently. Histamine inactivation by histamine methyltransferase occurs in man in the fundic gastric mucosa that has reasonable enzymic activity. However, liver, spleen and intestine show much higher activities indicating less specificity of histamine catabolism in the gastric mucosa. Finally, diamine oxidase activity was once thought to be absent in the corpus mucosa, but more recently, moderate activities of this enzyme were found in several species, including man. Thus, histamine metabolism in the gastric mucosa is by no means unique in mammalian tissues, but the presence of these enzymes may be regarded as an indicator of its physiological function. To some extent enzymic activities involved in histamine formation and inactivation are regulated in the process of acid secretion. Histidine decarboxylase and histamine N-methyltransferase activities are enhanced by gastrin, but are not influenced by vagal stimulation. Hitherto, only histamine methylation was found to be diminished in duodenal ulcer disease. Vagotomy and histamine H2-receptor antagonists modulate histamine catabolism by histamine methyltransferase. The implication of these findings for treatment of duodenal ulcer are discussed.

Amine Oxidase (Copper-Containing)↗
PubMed1983

[Ender nailing of subcapital fractures of the femur neck (Garden I)].

In the period between 1968 and 1982 we observed 441 subcapital fractures of the femoral neck, 55 times a tight impaction in valgus position. Including the year 1976 a conservative treatment was employed (group I); from 1977 onwards operations with the Ender-nailing technique were performed (group II). The patients' average age was 81 to 84 years. In 7 out of 32 cases the conservative functional treatment led to disimpacted fractures between the 5th and 54th day after the accident. Neither a slightly gaping fracture line nor an up to ten-degree antecurvatoral position are a radiologic-morphological criterion for a prognostic assessment. For that reason we performed the Ender-nailing operation in 23 cases from 1977 on. Under immediate postoperative and complete load it was only once we obtained a partial dislocation of fracture which had a compact osseous healing up in varus deformity. A cranial displacement of the nails caused by the operation was observed three times. All patients regained their ability to walk. Until the end of the first year of the accident there was no case of death, nor could we perceive any total necrosis of the femoral head. One pseudarthrosis was found after conservative treatment. The average clinical treatment was 42 respectively 21 days. We transferred 19 out of 32 respectively 7 out of 23 patients to a convalescent hospital. The impacted subcapital fracture of the femoral neck should nowadays be treated operatively. The Ender-nailing technique represents a simple, gentle, and a low-risk procedure for surgical stabilization.

Aged↗
PubMed1983

[Hip dislocation with femur head fracture].

It is talked about the classification, the therapy and the late results of the traumatic dislocation of the hip joint with a fracture of the femoral head. Twelve patients with an average age of 36 years (from 18 to 77 years) were treated between the years 1972 and 1982. The rarer anterior dislocation of the hip including a fracture of the femoral head should be specifically classified, in order not to cause any errors for the therapeutic and prognostic assessment following the Pipkin classification. Type I and II with posterior dislocation justify a closed trial of reposition. The miscarried trial, and a continuing fragmental dislocation with a disturbance of the joint's function, or fragments participating in the load area of the femoral head necessitate an open reposition. Small fragments may be taken away, the larger ones require the screwing osteosynthesis. Smaller fragments from the load area must be sustained in an anterior dislocation ("IIb"). The type III injury gives primarily--in exceptional cases sometimes secondarily--an indication for an alloplastic false hip joint. Injuries of type IV should be restored operatively, respectively, it is necessary to perform a secondary operation to set in an endoprosthetic substitute. With the operative therapy--that is: 5 times extirpation of fragments, 4 times screwing osteosynthesis of the femoral head, twice screwing osteosynthesis of the acetabulum--we obtained good results in injuries of type I, II and IV. We performed 3 times a primary total false hip joint in type III injuries.

Adolescent↗
PubMed1982

Assay and identification of histamine in human gastric aspirate by a fluorometric--fluoroenzymatic technique. Its application in patients with chronic duodenal ulcer.

Histamine assays can be unreliable in individual subjects or samples even though the particular method is in general working very well. Therefore the specificity and accuracy of histamine determination in the gastric aspirate of individual duodenal ulcer patients was thoroughly examined and shown to be satisfactory. Pitfalls of the fluorometric assay were investigated. A native (non-histamine) fluorescence in gastric aspirate which occurs before the addition of OPT was not removed by the original Shore procedure. In the combined assay (Dowex 50 + butanol extraction) this fluorescence no longer interferes with the assay. For the identification of histamine in a single gastric aspirate of an individual duodenal ulcer patient, the reversed blank (3 M HCl added to the reaction mixture before OPT instead after OPT), excitation and fluorescence spectra, the heating test with spectra recorded and the HMT test were found to be reliable. The formaldehyde test and the heating test without recording the spectra were useless since they gave false negative results. Since the HMT test was regarded as a reference method it was thoroughly investigated both by theoretical considerations (enzyme kinetics) and by a series of measurements in a single patient as well as in a group of nine subjects. Samples from the period of peak acid output in response to pentagastrin showed an average histamine concentration of about 8 ng/ml and a histamine output of 1.5 microgram/30 min.

Adult↗
PubMed1981

[Transparent adhesive tape as postoperative dressing. Randomized, clinical study for comparison with a conventional dressing technic].

To evaluate the effect of a thin, transparent, adhesive and elastic polyurethane drape permeable only to gas and water vapor molecules but not to bacteria in comparison to a conventional drape for postoperative dressings, a randomized trial was conducted in 90 male and female patients. 44 patients had the transparent adhesive drape and 46 a conventional dressing. Both groups were reasonably well matched according to age, sex, height, weight and type of operation. There was no difference in healing of skin wounds. But reddening around the stitches was seen more often in patients with the conventional dressing than in those with the polyurethane drape (p less than 0.05). Surprisingly, most of the patients with the transparent drape (42 of 44) accepted it. The transparent adhesive drape was found to be much less expensive than the conventional dressing.

Adult↗
PubMed1981

[Structural and functional alterations of the mucosa of a jejunal segment, interposed isoperistaltically after total gastrectomy according to Longmire-Gütgeman (author's transl)].

Six patients had total gastrectomy because of carcinoma followed by jejunum isoperistaltic interposition according to Longmire. A jejunal biopsy was taken in every case during operation and three and six months later endoscopically for morphometric and functional evaluation of small bowel mucosa. Three months after the operation a rise of L-phenylalanin in vitro uptake, an increase in villus height, surface area and a deepening of the crypts with raised mitotic activity of the crypt cells was found. The ratio of villus height to crypt depth was increased, although not significantly. On the other hand the activity of sucrase was initially decreased. Six months postoperatively all parameters had become normal besides the disaccharidases. These changes may be due to adaptive mucosal hyperplasia after small bowel resection or to luminal mucosal damage followed by compensatory hyperregeneration. Finally a humoral stimulus for mucosal hyperplasia as a postoperative effect is discussed.

Biopsy↗
PubMed1980

[Effect of planned treatment policy in patients with upper gastrointestinal bleeding using endoscopic neodymium-YAG laser therapy (author's transl)].

In a prospective trial with and without laser therapy the outcome on 105 patients was evaluated according to a defined protocol and terminology. Only patients with actively bleeding lesions during early endoscopy had laser therapy. Patients showing evidence of recent bleeding or no bleeding had none. Defects of the laser equipment or impossibility of reaching a bleeding lesion prevented its use in some patients (control group). There was no difference concerning rate of recurrent bleeding or mortality. Controlled trials with defined groups of patients are urgently needed.

Adolescent↗
PubMed1980

[Early or delayed operation in patients with acute cholecystitis. Results of a prospective randomized controlled clinical trial (author's transl)].

In a prospective controlled randomized clinical trial, 60 patients with acute cholecystitis (diagnosed according to well defined criteria) were allocated randomly to early operation (n=28) or conservative treatment followed by delayed operation (n=30). The formed groups were well balanced. Total duration of hospitalization was 12 days for the early and 22 days for the delayed operation group. One case of death in the second group appeared to be due to pancreatic necrosis. From other complications recorded, only stitch sinus seemed to occur more frequently in the early operation group. For the first time the success of the two therapeutic procedures was evaluated by means of a systematic follow-up 6 weeks and 6 months after operation. The outcome was the same in both groups and "very good" and "good" for all patients. From these results early operation as the routine method for acute cholecystitis can be recommended unconditionally.

Acute Disease↗
PubMedDate not supplied

Selection of variables using 'independence Bayes' in computer-aided diagnosis of upper gastrointestinal bleeding.

In this paper two problems of computer-aided diagnosis with 'independence Bayes' were investigated: selection of variables and monotonicity in performance as the number of measurements is increased. Using prospective data from patients with upper gastrointestinal bleeding, the stepwise forward selection approach maximizing the apparent diagnostic accuracy was analysed with respect to different kinds of bias in estimation of the true diagnostic accuracy and to the stability of the number and type of variables selected. The results of this study suggest first that the selection of variables should be evaluated against the estimated true diagnostic accuracy obtained using all variables, and secondly that the results of a single selected sequence may be severely biased.

Bayes Theorem↗