Biomedical subjects
Publications and source records attributed to R Günther.
Report of a large, congenital hemangiopericytoma in a male neonate. The classification of these tumours is discussed. This is the first case, to date, of a tumour of this size, found intracranially.
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Biochemical and radiological results, surgical technique and its results were critically analysed in a retrospective study of 154 operations on the adrenals in 127 patients, operated on between 1957 and 1980. There were no complications in 95 patients. In the remaining 32, both intra- and postoperative complication rate was greater after extraperitoneal than transabdominal approach to the adrenals. Postoperative mortality was 6%, but since 1967 only two patients have died in the postoperative period. Thromboembolic phenomena were the main cause of death, patients with Cushing's disease most commonly having this complication.
Temporary pre-operative and post-operative as well as permanent palliative percutaneous biliary-tract drainage was performed in 12 patients with biliary tract obstruction; in three the drainage was internal and in nine external. Main indication of the method is permanent palliative decompression in cases of inoperable malignant tumour with obstructive jaundice. Pre-operatively, percutaneous biliary tract drainage serves as a temporary measure in order to perform an operation after decompression of the biliary tract and improving the patient's general condition. The only serious complication was biliary peritonitis after a drainage catheter had slipped out.
The comparison of transvenous cholangiography (TVC) in 82 patients with percutaneous transhepatic fine needle cholangiography (PTFC) in 84 patients showed that TVC must be considered obsolete due to the complicated procedure with low success rate (56.9%). In one case it led to septicaemia followed by death. The total success rate was 84.5% in PTFC performed with an ultrathin needle (0.5 mm diameter); congested biliary ducts were successfully punctured in 87.9% and noncongested ducts in 72.2%. Severe complications consisted of one case of intraabdominal bleeding and one biliary extravasation. As shown in animal experiments, the superficial parenchymal lesion has not always the shape of a point. High accuracy also in noncongested biliary tracts and low mortality make PTFC superior to TVC and conventional percutaneous transhepatic cholangiography.
Prostaglandin F2 alpha concentrations in cerebrospinal fluid (CSF) from normal human subjects and patients with various pathological disorders of the central nervous system (CNS) were measured by radioimmunoassay. The mean PGF2 alpha level in 54 controls with no evidence of organic CNS disease was 67 pg/ml (range: 25-150 pg/ml). A significant increase of PGF2 alpha levels was demonstrated in most samples from patients with CNS diseases. Extremely high values were found in patients with stroke and subarachnoid hemorrhage when samples were collected shortly after the cerebral attack. With the regression of clinical symptoms and radiological findings a decrease of PGF2 alpha levels was demonstrated in this group of patients. In 32 patients with cerebral transient ischemic attacks a mean PGF2 alpha concentration of 170 pg/ml (range: 35-355 pg/ml) was found. Increased PGF2 alpha levels were found in patients with epilepsy when samples were collected within a few days after a convulsion. PGF2 alpha levels of four patients with slow progredient forms of multiple sclerosis without clinical symptoms at the time of sample collection were not different from normal controls while the mean PGF2 alpha level of all other patients with multiple sclerosis was 152 pg/ml (range: 55-325 pg/ml). Moreover, increased values could be demonstrated in patients with cerebral tumors and inflammatory processes.
Percutaneous transhepatic intubation and drainage of the biliary system were performed in 23 patients, 19 cases preoperatively because of malignant obstructive jaundice. With 12 days the bilirubin serum level went to normal values, and the patients general condition and liver function showed marked improvement. By preoperative PTCD the mortality of palliative procedures in pancreatic carcinoma decreased. Complications occurred in five cases and were easy to manage. Clinical aspects such as indication, optimal period of drainage, and value of other techniques in bile drainage are discussed.
The effect of placebo and ACTH-1-17 (Synchrodyn, Hoechst) upon urinary free cortisol was examined at 5 different circadian stages on 10 men with Steinbrocker Stage II-III rheumatoid arthritis. A mean cosinor analysis of urinary cortisol data from the subjects prior to treatment with either ACTH or placebo revealed a statistically highly-significant rhythm. A circadian variation in a response of urinary free cortisol to a placebo was also seen. Moreover, the response of the midline-estimating statistic of rhythm (rhythm-adjusted circadian average) of urinary free cortisol to ACTH-1-17 by patients with rheumatoid arthritis is circadian rhythmic. This reactivity rhythm is out of phase with the spontaneous rhythm in urinary cortisol acrophases-in the tests limited thus far to midsummer. The further assessment of the circadian component in the context of broader interactions by rhythms with other frequencies in various conditions in health and disease is warranted by the demonstration of rhythms here presented for men with rheumatoid arthritis.
Partial and total trans-catheter embolisation of the spleen with butyl-2-cyanoacrylate-lipiodol in 23 dogs lead to partial necrosis and cicatrisation of the spleen after 3 to 5 weeks. The embolised vessels do not recanalise, but are by-passed by extra- and intra-splenic collaterals. In five animals there was a reduction in the number of erythrocytes; after embolisation there was increase in the number of leucocytes, whereas the thrombocytes were unchanged. The most common complication which occurred in five animals was a 1.5 to 2.5 cm. splenic abscess. The procedure was employed without success in one patient with bleeding oesophageal varices. The procedure was complicated by extensive necrosis of the gastric mucosa. Trans-catheter embolisation of the spleen has significant complications, despite strict asepsis and antibiotic cover. The main indication of the procedure is hypersplenism which cannot be treated surgically.
A new instrument for percutaneous bile duct drainage has been employed on 30 patients with obstructive jaundice. The instrument consists of a 28 cm. long needle of 0.7 mm. diameter placed inside a 15 cm. long Teflon sheath of 1.4 mm. external diameter. This permits fine-needle cholangiography and biliary duct drainage as a single procedure. It causes little trauma and speeds up and simplifies the examination. The instrument is also suitable for transhepatic portal vein puncture.
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Transrenal ureteric embolisation with the tissue adhesive butyl 2-cyano-acrylate mixed with lipiodol and tantalum powder produces rapid and effective occlusion of the ureter. This can be combined with the use of a Gianturco spiral. In an experimental series of eight dogs observed for 54 days, the adhesive disappeared partly in three animals and totally in a further three. Fibrotic ureteric stenosis was observed in three animals. Clinical results were rather better because of the presence of external urinary drainage. Twenty-one ureters in eighteen patients were occluded either unilaterally or bilaterally, and sometimes combined with percutaneous contralateral renal embolisation. After one to four months, the ureter was still occluded in three out of six cases; after five to 17 months, three out of five cases were no longer totally occluded, but in two cases they were still blocked. The procedure is new and suitable for the treatment of otherwise untreatable conditions, such as extensive urinary fistulae, bladder tenesmus and haematuria due to extensive tumours of the minor pelvis.
Internal urinary drainage by antegrade ureteric splinting was successfully performed in 24 patients and the catheter left indwelling in 19. The main indications were postoperative complications leading to ureteric obstruction and urinary extravasation; this could be treated successfully by conservative means in seven out of 15 patients. Temporary splinting in three patients with fibrotic ureteric stenosis, together with dilatation by means of a balloon catheter, did not result in normal urinary flow. In four patients with urinary obstruction due to a tumour, the method became the permanent treatment. Complications of the procedure were dislodgement, obstruction and incrustation of the catheter. The procedure is an alternative to retrograde splinting and percutaneous external urinary diversion.
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Inosine administered into the renal artery improves renal ischemic tolerance. The study was designed to establish the limitations of this measure by comparing its effectiveness with that of regional hypothermia and to test the possibility of combining inosine and hypothermia in prolonged renal hypothermia. In uninephrectomized dogs, the remaining kidney was subjected to 2 h of ischemia under inosine protection; perfusion cooling, or no protection (experiment A), or to 90 min of warm ischemia plus inosine plus 90 min of cold ischemia; 90 min of warm plus 90 min of cold ischemia, or 180 min of cold ischemia (experiment B). Whereas perfusion cooling reliably prevented permanent loss of renal function even after 180 min of ischemia, inosine was clearly inadequate for protection against warm ischemia exceeding 90 min, but effective in shorter periods of ischemia with some unreliability in borderline cases. Inosine protection can be combined with hypothermia in a sequential manner if extended ischemia becomes necessary unexpectedly. For clinical use, however, it seems safer to commence with hypothermia after 60 min of inosine-protected warm ischemia. Simultaneous balloon occlusion of the renal artery and transcatheter perfusion cooling facilitates the clinical applicability of these results.
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