[The treatment concept of chylothorax including surgical procedures using fibrin glue].
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Chylothorax↗
Biomedical subjects
N Rohm
Publications and source records attributed to N Rohm.
[Diagnosis and therapy of acute traumatic aortic rupture].
Aortic transection is defined as complete or partial dehiscence of the aortic wall layers. Aortic transections are seen in 16% of all lethal traffic accidents. The quality of the first emergency care outside hospital and the organization of rescue systems result in an increasing number of patients (espec. with life-threatening multiple injuries incl. atypical aortic lesions) reaching a trauma-center. Guide-lines for surgical indications are: 1. emergency-operation in case of symptomatic transection incl. simultaneous surgery of concommitant lesions. 2. Urgent operation following primary hemodynamic stabilisation in cases of isolated or asymptomatic transection. 3. In cases of concommitant lesions with surgical priority, delayed operation of asymptomatic transection. The perioperative letality claims up to 20%. Next of operative complication paraplegia remains the most deleterious problem. Despite different methods of protection on the spinal cord the incidence of paraplegia persists in the range of 5-10%.
Aorta, Thoracic↗
[Traumatic bilateral renal artery occlusion. Case report and review of the literature].
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Adolescent↗
[Reconstruction of the chest wall].
In cases of malignant disease of the chest wall, such as primary tumors or extensive metastases, a particularly large resection is necessary. This leads to great problems in restoring an adequately functional chest wall. In addition to the cosmetic effect one must pay particular consideration to the dynamic parameters of pulmonary function. In a 54 years old male suffering from recurrent malignant schwannoma we performed an extensive chest wall resection. It included the ribs 3-8 on the right. The extension of the defect was 15 X 22 cm. We reconstructed the pleura with Vicryl-mesh. The covering was done with musculus pectoralis major, musculus rectus abdominis and a musculocutaneous obliquus externus abdominis flap. Three months after operation a small restriction of vital capacity is observed. In a 29 years old male partial resection of the right chest wall had to be done for a local extended chondro-sarcoma. The tumor included the ribs 4-9: chest wall defect after resection amounted to 15 X 18 cm. We performed a primary reconstruction using Vicryl-mesh as substitute for the pleura. We covered the pleura with a musculocutaneous latissimus dorsi flap. Three months after successful reconstruction the parameters of pulmonary function reached normal values again. In these and further cases the combination of Vicryl-mesh as a resorbable substitute for the pleura and musculocutaneous flaps for the chest wall has been successful in restoring a good pulmonary function.
Humans↗
Human myocardial beta-adrenoceptors: demonstration of both beta 1- and beta 2-adrenoceptors mediating contractile responses to beta-agonists on the isolated right atrium.
On the isolated electrically driven muscle strip of human right atrial appendages the beta-adrenoceptor subtypes mediating the positive inotropic effects of isoprenaline, dobutamine and procaterol were characterized using the beta 1-selective antagonist bisoprolol and the beta 2-selective antagonist ICI 118,551. The three agonists induced concentration-dependent increases in force of contraction with an order of potency: procaterol (pD2-value: 8.03) greater than isoprenaline (pD2-value: 7.73) greater than dobutamine (pD2-value: 5.44). In saturating concentrations all three agonists produced the same maximum of developed tension. ICI 118,551 (10(-9)--10(-7) mol/l) and bisoprolol (10(-9)--10(-7) mol/l) were nearly equipotent in antagonizing the positive inotropic effects of isoprenaline and dobutamine. However, the slopes of the Schild-plots for both antagonists against both agonists were significantly less than 1.0 indicating interaction with beta 1- and beta 2-adrenoceptors. On the other hand, ICI 118,551 (10(-10)--10(-8) mol/l) was approximately 100 times more potent than bisoprolol (10(-8)--10(-6) mol/l) in antagonizing the positive inotropic effect of the highly selective beta 2-agonist procaterol. In addition, the slopes of the Schild-plots for antagonism of ICI 118,551 and bisoprolol against procaterol were not significantly different from unity indicating interaction with a homogeneous class of beta-adrenoceptors. The pA2-value for ICI 118,551 was 9.49, for bisoprolol it amounted to 6.99.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic beta-Agonists↗
Long-term results following surgical removal of pulmonary metastases in children with malignomas.
Between 1972 and June 1983, 21 children (mean age 9 years, range 20 months to 16.5 years) were operated on for pulmonary metastatic disease. Primary malignant tumors were Wilms-tumor (7 patients), osteogenic sarcoma (7 patients), Ewing's sarcoma (4 patients), hepatoblastoma (2 patients), and rhabdomyosarcoma (1 patient). The surgical intervention was part of a therapeutic pediatric oncological concept with curative purpose including chemotherapy and/or radiation in different combinations. Ten out of these 21 children survived disease-free 3 years and more after pulmonary metastasectomy. An aggressive surgical approach towards pulmonary metastatic disease in children thus appears to be justified.
Adolescent↗