Biomedical subjects
Publications and source records attributed to M Beutner.
This is a report on diagnostics in a patient who anamnestically had three abortions in her history. To look for in search of the cause we found a little submucosal uterine myoma which could not to be removed by curettement. Thus, a gynaecological laparotomy had to be carried out. Paraclinical examinations finally proved the lupus-anticoagulant-factor.
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There is reported on a fifteen-year-old female patient who was operated on under suspicion diagnosis of an ovarian tumour. The internal genital organs were normal, but a retroperitoneal tumour could be found within the pelvis. In this connexion differential diagnostic problems are discussed.
667 cases inclusively 27 twin-births are evaluated in a retrospective study on the anesthesias administered in cesarean section (CS) from 1975 to 1983. The applied induction anesthetics hexobarbital, ketamine (Ketanest), propanidid (Sombrevin), etomidate (Radenarcon) and epidural anesthesia with bupivacaine (Marcaine) have been compared with each other concerning the Apgar scores of the newborns. Significant more depressed newborns have been found both in the hexobarbital group and to a low degree in the ketamine group. This tendency is also preserved when only the primary CS are taken into consideration. Besides the indications for the single anesthetics and methods of anesthesia, respectively, reference is made to the positioning of the mother and the avoidance of aspiration in the introduction of the anesthesia.
An etomidate/fentanyl anesthesia was administered in 112 minor gynecological operations. The endexpiratory percentage CO2-concentration and the expiratory percentage O2-concentration were determined under anesthesia by means of adequate dosage of anesthetics in two groups (group I: 16 women aged between 16 and 54; group II: 10 women aged between 60 and 75). The results reveal that the respiratory depression remains within acceptable limits in both groups. The blood gas values obtained capillarily before and after the operation show a normalisation of these parameters when the patients are transferred to the ward. On account of the minimal side-effects and the short waking-up time this method of anesthesia can be recommended as most favourable short anesthesia at present especially in concomitant cardiac disorders.
Postoperative analgesia was achieved by peridural injection of small doses of piritramide (Dipidolor Gedeon Richter Budapest) to 24 gynaecological and surgical patients. Periods of action were longer than those obtainable from equivalent intramuscular or intravenous injections. Undesirable side effects of the opiates, such as disorders of respiration, vomiting, clouded consciousness, and suppression of cough reflex, were not observed. The method did not affect locomotor and sympathetic nerve fibres and, consequently, proved to be superior to postoperative analgesia by means of local anaesthesia. Repetitive injections can be made by nurses. Peridural opiate analgesia can be recommended for postoperative situations and for other patients with pain.
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Conduction anaesthesia was applied close to the spinal cord of 91 gynaecological patients whose risk in the context of surgery had been found to be increased on account of advanced age or for severe secondary internal diseases. The rate of complications of these patients with regional anaesthesia was compared to that of another group of 91 patients on whom operations were performed under general anaesthesia. The group with anaesthetic block close to the spinal cord exhibited less intra-operative variation in arterial pressure and less postoperative disorders of the respiratory organs. The metabolism of diabetic patients was more easily controlled and managed under regional anaesthesia. Conduction anaesthesia close to the spinal cord is recommended for patients in geriatric condition or with concomitant internal disorders.
1800 cases with interruption of pregnancy are subjected to a computer analysis by means of a data-adjusted medical record for patients with interruption of pregnancy, which is in use in our hospital since 1975. The age distribution reveals a frequency peak between the ages of 35 and 38 years. The striving for a 2-children family is evident. Operating complications occurred in 1.1 per cent of the cases only, 0.4 per cent were perforationes and 0.7 per cent were lacerations of the cervix. This is due to the general application of the vacuum aspiration and the preferred performance of the operations up to the 10th gestational week. The great significance of the application of effective contraceptives is emphasized, since 48 per cent of the women had renounced contraceptives without any reason. Over 40 per cent of the women had employed contraceptives previously, but later on they had abandoned such means, 20 per cent of these women without a special cause. The physician's responsibility for the education of the women is stressed.
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