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Biomedical subjects

R Günther

Publications and source records attributed to R Günther.

At least 127 records · Page 7Linked to original sources
PubMed1982

Transrenal ureteral occlusion with a detachable balloon.

Transrenal ureteral occlusion using a detachable balloon was successfully employed to stop urinary flow in seven patients. The balloon was filled with low-viscosity silicone rubber and released in the distal ureter. Percutaneous nephrostomy provided external drainage. Indications were painful dysuria and large urinary fistulas in advanced pelvic malignancy. The method is preferable to ureteral embolization with tissue adhesive.

Embolization, Therapeutic↗
PubMed1982

Percutaneous kidney stone removal.

Percutaneous nephrostomy has proved to be a reliable method to establish access to the collecting system of the kidney. Without adding any significant morbidity, this access can be used for the removal of kidney stones by simple extraction, chemolysis or ultrasound lithotripsy. A nephrostomy channel of the required size is rapidly and atraumatically established with a telescope dilation set. A set of instruments especially developed for intrarenal instrumentation is necessary to guarantee a low residual stone rate. With the use of intrarenal ultrasound disintegration the technique is successful regardless of stone composition and size.

Catheterization↗
PubMed1982

[Is "blind left-pancreatic resection" for insulinoma still indicated?].

One of the main problems encountered in the surgical treatment of insulinoma is that of locating them within the pancreas, since about 10% of these tumors are occult. Modern pre- and intraoperative methods of identifying of hormone-producing pancreatic tumors remove the need for 'blind resection'. Complete exploration of the pancreas, biopsy, intraoperative toluidin-blue-0 staining, glucose monitoring, and especially selective pancreatic venous blood sampling with insulin radioimmunoassay make it possible to locate nearly all tumors. Percutaneous transhepatic portal venography and selective portal blood sample collection for insulin analyses should be done routinely before planning a reintervention when organic hyperinsulinism persists.

Adenoma, Islet Cell↗
PubMed1982

[Rupture, emergency ligature and elective ligature of the carotid artery].

680 patients underwent surgery with radical neck dissection and tumour resection because of malignant diseases of the upper respiratory and digestive tract. Further therapy was pre- and/or postoperative radiation and in some cases preoperative cytostatic therapy. Carotid "blow out" occurred in 18 patients (2,6%) because of fistula formation, bad wound healing and tumour recurrence. Emergency ligation of the common carotid artery or internal carotid artery caused no neurological casualties in 70% of the patients. 4 patients underwent elective carotid ligation. Here, too, no neurological signs were seen. In these patients sufficient collateral perfusion was proved by angiography with balloonocclusion under simultaneous EEG-registration and measurement of the brain perfusion with 133 xenon.

Carotid Arteries↗
PubMed1981

[Percutaneous transhepatic gallstone extraction (author's transl)].

Gall stones 1-3 cm in size were removed in three out of four patients from the common bile duct using a Dormia basket via the percutaneous transhepatic route. This method is indicated in selected cases: inoperable patients or those with a high surgical risk, and calculous obstruction after hepatico-jejunostomy. The method is limited in stones over 1 cm by their hardness.

Aged↗
PubMed1981

[Staging laparotomy for malignant lymphoma: interdisciplinary aspects and results (author's transl)].

Between 1963 and 1979 a total of 357 patients with malignant systemic lymphatic disease underwent splenectomy in the course of exploratory laparotomy. There were three groups: 1. Hodgkin's disease (215 patients), 2. non-Hodgkin's lymphoma (93), and 3. chronic lymphoid leukaemia (49). Comparing pre- and postoperative findings, primary exploratory laparotomy remained the most exact foundation for the differentiated treatment of Hodgkin's disease in stages I-III. Systematic staging laparotomy was of less importance for non-Hodgkin's lymphoma and chronic lymphoid leukaemia because of the much more frequent invasion of bone marrow, spleen and liver. However, it should be considered more often in the management of such cases.

Adult↗
PubMed1981

Renal handling of L-histidine studied by continuous microperfusion and free flow micropuncture in the rat.

Renal tubular reabsorption of L-histidine (His) was measured in vivo et situ by continuous microperfusion and free flow micropuncture of single proximal convoluted tubules of the rat kidney. The reabsorption is shown to be saturable. A permeability coefficient (P) of less than 29 microns 2 . s-1, a maximum reabsorption rate (J max) of 2.75 +/- 1.05 greater than J max greater than 1.97 +/- 0.86 (SEM) nmol . m-1 . s-1 and an affinity constant (Km) of 13.8 +/- 4.2 greater than Km greater than 10.9 +/- 4.0 (SEM) mol . 1-1 (lower values for P = 29 microns 2 . s-1, higher values for P = 0) were calculated from the microperfusion data. Using these constants and taking backflux of His and water reabsorption into account a good fit with the concentration profile of His along the proximal tubule--measured by free flow micropuncture--was obtained. Varying the buffered pH-values of the perfusion fluids (5.0 or 7.4) influenced neither the active reabsorption nor passive permeability of His. This indicates that the charge of the imidazol group of His does not play a significant role in His reabsorption. Further experiments showed that the addition of 20 mmol . 1-1 L-arginine--a strong inhibitor of the reabsorption system for dibasic amino acids--did not have a significant effect on the reabsorption of L-histidine. It is concluded, therefore, that His is reabsorbed by a system for neutral amino acids. Non ionic diffusion does not play an important role for His reabsorption.

Absorption↗
PubMed1981

Percutaneous stone manipulation.

Percutaneous stone manipulation by direct ultrasound disintegration, extraction or chemolysis was done on 34 patients. A total of 15 patients presented with an operatively established nephrostomy, while percutaneous nephrostomy and subsequent dilation of the nephrostomy channel were done in 19. The rate of complete stone clearance was 19 of 20 stones after percutaneous nephrostomy and 8 of 16 stones in the group with an operatively established nephrostomy. The primary goal, to remove obstructing pelvic stones, was achieved in all cases. There were no untoward side effects, such as back pressure damage owing to flushing of the collecting system during ultrasound disintegration, or persistent infection. Complications in 3 patients were managed conservatively.

Aged↗
PubMed1981

[Superselective embolisation in the urogenital tract with tissue adhesives (author's transl)].

The tissue adhesive butyl-2-cyanoacrylate mixed with lipiodol and tantulum powder is an excellent agent for superselective catheter embolisation of small vessels. The mixture is low viscous and can be injected through fine catheters. Occlusion is independent of blood clotting and is permanent. A coaxial catheter technique is recommended or, in cases of difficulty, a ballon catheter can be floated in. Super-selective embolisation was used in 15 patients, in seven for the kidney in eight for the pelvis. Indications were bleeding from the kidney, partial defunctioning of the kidney, tumours in single kidneys and bleeding from carcinomas in the bladder, prostate or cervix.

Adenocarcinoma↗
PubMed1981

[Balloon occlusion test before carotid ligature (author's transl)].

The risk of ligating one carotid artery was tested by balloon occlusion of that vessel for a period of 30 to 60 minutes, during which time contralateral carotid angiography was carried out as well as an EEG and xenon-133 blood flow measurements. The procedure was carried out on seven patients, two showed a reduction in cerebral blood flow without EEG changes. In one patient the contralateral circulation could not be demonstrated by angiography. Carotid ligation was carried out in 5 of 7 patients. Neurological complications were not observed.

Brain Ischemia↗
PubMed1981

[Localization of islet cell tumors using sonography, computed tomography, arteriography and selective transhepatic venous sampling for hormone assay (author's transl)].

Of 29 patients examined operation revealed a malignant tumor in 9 and a benign insulinoma in 18, 2 insulinomas were not found. The problems of preoperative tumor localization were limited to small insulinomas (size 7-35 mm). Ultrasound detected all of 3 insulinomas as low echogenic structures (size 7, 8, 17 mm). Computed tomography demonstrated 4 of 5 insulinomas (size 7, 8, 15, 17 mm) due to contrast enhancement following bolus injection. Arteriography localized 12 of 18 insulinomas preoperatively and 14 of 18 retrospectively. Selective transhepatic venous sampling for insulin assay identified 7 of 8 tumors. Real-time ultrasound and dynamic CT are promising in the diagnostics of insulinomas over 7 mm and should precede arteriography. Selective transhepatic venous sampling as the last diagnostic step is a major procedure and most specific, but not always without problems in interpretation.

Adenoma, Islet Cell↗
PubMed1981

[B-scan sonography of the carotid artery. Technique, results and indications (author's transl)].

Three hundred and forty-six carotid arteries were examined with a two-dimensional 3.5 MHz real time scanner in 173 patients with evidence of cerebral ischaemia; 62 carotid arteries were investigated by selective trans-femoral angiography in 36 of these patients at the same time. Sonography and angiography agreed in 20 (91%) of 22 angiographically normal cases, in all cases (10) with haemodynamically insignificant plaques, in eight (66%) of 12 stenosis of less than 50%, in nine (90%) of ten stenosis of more than 50% and in four (44%) of nine total occlusions. Sensitivity of carotid sonography varied with the severity of the lesion from 44 to 100%. Its specificity was 91%. B-scan sonography of the carotid artery, in the presence of cerebro-vascular lesions (transitory ischaemia, cerebral infarcts) and in the presence of non-specific symptoms and of asymptomatic vascular murmurs, may provide indications for the use of angiography. Its values as a screening procedure remains to be assessed.

Arteriosclerosis↗
PubMed1981

[B-scan sonography for tumour localisation in hyperparathyroidism (author's transl)].

Thirty-four patients with known primary, secondary or tertiary hyperparathyroidism were examined sonographically in order to localise the enlarged glands. Of 40 tumours found at operation, 27 (67%) could be demonstrated sonographically as oval or round structures with low echoes. The smallest tumour diagnosed pre-operatively was 10 x 5 x 4 mm. Sonography is useless for adenomas in the mediastinum. Sonographic localisation is desirable before primary operations for hyperparathyroidism, although it is not indispensable for the experienced surgeon. Sonography is essential before surgery for recurrences and should be performed before CT, arteriography or selective parathormone sampling.

Adenoma↗