Biomedical subjects
Publications and source records attributed to M Dürig.
A young man with Weber B fracture had adrenalectomy under the suspicion of pheochromocytoma on the right side. Surprisingly hematoma of the right adrenal gland was found. This case is presented to point out the mechanism of trauma and diagnostic possibilities of the injury.
A prospective, randomized trial has been undertaken to evaluate the prophylactic effects of low molecular weight heparin (LMWH) and dextran-70 in 216 patients with hip fracture during a postoperative period of ten days. Deep vein thrombosis (DVT) was diagnosed using the 125Iodine fibrinogen uptake test, confirmed by ascending venography. 113 patients received LMWH and 103 dextran-70. The frequency of DTV of 14.2% in the LMWH group was significantly lower compared with the 30.1% in the dextran group (p less than 0.003). During the first 10 days postoperative there were no fatal pulmonary embolism (PE). After this period PE occurred in 2 patients (1.8%) in the LMWH group and 1 patient (1.0%) in the dextran group. In each group one patient died from PE. There was no major bleeding in either group. The frequency of local complications was slightly higher in the dextran group (10.7%) compared with the LMWH group (3.5%). The postoperative hemoglobin level was significantly lower in dextran treated patients than in patients receiving LMWH (p less than 0.0001).
The introduction of totally implantable catheter device has provided a simple, permanent and safe access to the vascular system. They have greatly improved the quality of life of the patients involved, whose activities, daily hygiene and bodily attractiveness remain practically unrestricted. To gain the greatest freedom from complications in the use of fully implantable catheter devices, the following requirements are important in to our experience: 1. Experience with only one kind of catheter system, irrespective of whether it is claimed to be the best, the simplest, or the cheapest. Various companies offer a variety of totally implantable catheter devices. Every system has its advantages and its disadvantages. However, each system also requires a considerable degree of surgical experience and experience in postoperative care and management to keep the complication rate as low as possible. Frequent changing to other systems does not enlarge the experience obtained. 2. The experience of the surgical team. In Basel catheter systems are implanted by three surgeons only. We are convinced that this contributes to our relatively low rate of complications. Brothers et al. (1988) also show that the rate of complications is inversely related to the experience of the surgeon involved. 3. The experience, commitment and training of the nursing staff responsible for the care and maintenance of the implanted catheter device. This care and maintenance of the implanted catheter device should start immediately after the surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
A patient with refractory diarrhoea (up to 10 l/d) following colectomy and ileostomy was treated with clonidine, after loperamide, tinctura opii, cholestyramine and somatostatin had failed to reduce stool volume to less than 6 l/d. Under combined treatment with clonidine (1200 micrograms/d) and somatostatin (6 mg/d), which was well tolerated, stool weights were normalised within 24 hours. This case report on the successful anti-diarrhoeic effect of clonidine is completed by experimental data from rat jejunal and duodenal segments. In the presence of the adenylate cyclase-stimulating agent forskolin, clonidine normalised both mucosal cAMP content and cAMP-induced hypersecretion in rat intestine. This suggests that the anti-diarrhoeic effect of clonidine in-vitro results from an alpha 2-receptor mediated inhibition of the stimulated adenylate cyclase. Case report and experimental data therefore support the theory that therapeutical application of clonidine in diarrhoea may be successful.
The extreme lack of renal grafts for transplantation stimulated us to analyze how strict the selection criteria of kidney donors must be. We investigated therefore if preexisting lesions in renal grafts influence initial and late renal function. 147 zero-hour biopsies of 101 donors (mean age 33, from 6-64 years) were examined. By ligh microscopy 38% of biopsies showed no, 44% showed nonspecific and 18% specific lesions. Nonspecific lesions comprised intimal fibrosis of small arteries in 44%, interstitial fibrosis in 8% and an arteriolar hyalinosis in 29%. Out of 102 immunohistologically examined biopsies 74.5% showed nonspecific IgM/C3 deposits in glomeruli and/or arterioles. An age dependent decrease of normal renal biopsies was found which was most evident in donors older than 40 years. Specific findings consisted of glomerulosclerosis (n = 4), glomerulonephritis (n = 11), intravascular coagulation (n = 10) and eclamptic kidney (n = 1). In case of nonspecific immunohistologic findings and in glomerulonephritis rebiopsies showed that antigen deposits usually disappeared within 4 months. Independent of morphologic findings 82% of transplant recipients had a good initial and late renal function. Since donor age, glomerulosclerosis, glomerulonephritis, intravascular coagulation or eclamptic changes seem not to compromise renal function after transplantation a more liberal choice of donors should be considered.
Diagnosis of splenic injury is influenced by both the type of injury and the diagnostic possibilities at the place of evaluation. Noninvasive examination with ultrasonography, computed tomography, or radionuclide scanning detects the injury. If not available diagnostic peritoneal lavage can indicate the necessity of laparotomy. Splenic salvage is the treatment of choice in splenic injury. Selective non-operative treatment of blunt trauma, splenorrhaphy, and partial splenectomy were used successfully to preserve 67% of injured spleens. Clinical and experimental findings indicate that replantation of splenic autologous tissue will not protect the host from septicemia.
In a five-year period (1983-1988) catheters were implanted in 205 patients (118 venous, 31 peritoneal, 29 arterial, 25 epidural and 2 pleural), using the same system (Port-a-Cath). Total implant duration was 88,345 patient days (242 patient years). On average there was one catheter complication per 2000 patients days. The only catheter-system infections occurred with peritoneal catheters. This relatively low complication rate was probably due to the use of only one system, a uniform implantation technique practised by only three surgeons, and strict postoperative supervision by the oncology nursing team.
Primary duodenal carcinoma and duodenal adenoma are rare tumours. Duodenal carcinoma makes up about 0.3% of all malignant tumours of the gastrointestinal tract (Alwmark et al. 1980; Spira et al. 1977). The present paper describes a duodenal carcinoma arising in a mixed tubulo-villous non-Vaterian adenoma in a 68 year old male. Immunocytochemical analysis revealed evidence of neuroendocrine differentiation in both adenoma and carcinoma. In a review of the literature a correlation between the size of adenoma and the probability of concomitant carcinoma is demonstrated. Duodenal adenoma measuring more than 4 cm in diameter should be considered potentially malignant.
A prospective, randomized, double-blind and controlled clinical trial of systemic antibiotic prophylaxis with Cefazolin and Ornidazol (CO) versus Cefazolin and Placebo (CP) was carried out consecutively in 100 patients undergoing elective, colorectal surgery. The incidence of wound infection in the CP-group was 20% (n = 10) and in the CO-group 8% (n = 4) (p less than 0.10 ns). The reduction of anaerobic bacterias from 20% (n = 10) in the CP-group to 0% (n = 0) (CO) was significant (a1 = 0.0139; a2 = 0.0277 s, Fischer's exact test). The time of hospitalization was reduced from 20.3 days (CP) to 16.7 days (CO) (p less than 0.05 s). The agent for antibiotic prophylaxis in elective colorectal surgery is to cover the spectrum of anaerobic bacterias.
17 patients with infectious diseases needed a long-term parenteral antibiotic therapy. Therefore a subcutaneous catheter system (Port-a-Cath) was implanted for intravenous application of the antibiotic drugs. With a total dwelling-time of 952 patient/days no catheter super-infection was observed. Due to postoperative hematoma in an anticoagulated patient one catheter system was not functioning temporarily. One had to be removed on suspicion of a fungous colonization which could not be verified after bacterial examination. Quality of life for all patients was unaltered so that ambulant therapy was possible in almost 20%.
Ruptured appendicitis involves a morbidity rate greater than that of negative exploration, and estimations of morbidity as high as 15% for negative laparotomy have been accepted by various investigators. We undertook a prospective analysis of 450 patients admitted to our hospital with suspected acute appendicitis, to identify those aspects in differentiating diseases that required surgery from those permitting observation. A prompt appendectomy was performed in 265 patients (59%). The appendix was normal in 4% of them. 185 patients were observed clinically and by laboratory investigations. None of them had to be operated on during the following 12 months of out-patient observation. We may conclude that clinical observation by an experienced physician may decrease the rate of negative laparotomies.
Operative treatment of traumatic dislocation of the elbow joint is indicated when there is proved gross instability or osteochondral fractures and loose bodies, or both. We performed a capsule-ligament repair in twenty-eight patients, and no cast was applied postoperatively. Satisfactory results were achieved with an average follow-up of two and one-half months. In all patients postoperative assisted range-of-motion exercise was begun after the operative wound and healed. The functional outcome depended on the osseous lesions involving the articular surface and on the time interval between the accident and the operation.
A case of traumatic hemobilia is reported. After ligation of the left hepatic artery and additional dearterialisation a third bleeding period occured due to a porto-hepatic communication, diagnosed by a transumbilical portography. A left hepatic lobectomy was finally necessary to achieve hemostasis. This case demonstrates that a selective artery ligation for the treatment of hemobilia is only successful if a complete dearterialisation is performed at the first operation. Furthermore a porto-hepatic communication may require partial hepatectomy.
Controlled, randomized and prospective studies were reviewed to evaluate the value of antibiotic prophylaxis in colonic and biliary tract surgery as well as in the treatment of open fractures. --Colorectal surgery: 7 studies using oral and 3 using parenteral antibiotics in addition to extensive bowel preparation have demonstrated the importance of a short term prophylaxis, instituted before surgery and discontinued soon thereafter. Different antibiotics with aerobic or anaerobic spectra reduced the incidence of wound infections significantly; further improvement could be expected from combinations covering both spectra. --Biliary surgery: cefazolin, gentamycin and rifamycin--used in four controlled studies--were effective in reducing infectious complications. No distinction was made between patients of different infectious risks. In low risk gallbladder surgery the real value of antimicrobial prophylaxis is unknown. Short term prophylaxis is recommendable in all high risk patients undergoing surgery and in the low risk case submitted to extensive interventions. --Open fractures: only three authors have submitted their patients to controlled studies. All protocols suffered from some bias. No definite conclusions can be made. The authors' personal recommendations are: no prophylaxis in first degree injuries; early preoperative administration of penicillinase-resistant drugs in second and third degree lesions.
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1. The literature concerning intrathecal herniation of intervertebral discs is briefly reviewed. 2. A case of an intrathecal herniation of a cervical disc with transitory paraplegia and a following Brown-Sequard-Syndrome is reported. 3. Laminectomy disclosed a rotation of the cord and a sequestrated disc embedded in the anterior substance of the cord. 4. A trauma of the cervical spine 8 years ago seem to be responsible for the progredient protrusion of the cervical disc. 5. Adhaesions between the dura mater and posterior longitudinal ligament in this case are regarded as origin of intrathecal herniation.
Nineteen ruptures of the medial head of the gastrocnemius muslce are described. These were caused by sudden overstretching of the muscle though concomitant ankle dorsiflexion and knee extension. Surgical exploration in 12 patients verified rupture of the musculotendinous junction. A 2-year follow-up showed that the surgical approach with suture of the muscle gave better results than conservative treatment, especially in the younger and athletic patients.