Biomedical subjects
Publications and source records attributed to R Günther.
Preoperative percutaneous transhepatic portal vein catheterization with selective blood sampling from the pancreatic veins and insulin radioimmunoassay is a very successful new procedure for localization of insulinomas. A careful peroperative inspection and bidigital palpation of the whole pancreas helps to avoid the problems of undetected insulinoma.
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Endoscopic sclerotization of esophageal wall has been performed in 48 patients with bleeding of esophageal varices. The mortality rate in the acute bleeding was 29,2%. There was no mortality, if sclerotherapy was done in the non hemorrhagic interval. Of the 48 patients 25 are still alive, 8 more than 2 years without bleeding. In 12 cases we performed transhepatic obliteration of the V. coronaria ventriculi. Only in 3 of them no further hemorrhage occurred within 6 months. Fibrosclerotization seems to be superior to the transhepatic obliteration, because the primary mortality and complications are lower and long term results better.
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Urinary catecholamines and urinary excretion of vanillylmandelic acid confirmed the diagnosis of phaeochromocytoma in ten patients. In two of seven a modified glucagon test significantly aided confirmation of the diagnosis. In all patients the tumour was localised both by catecholamine determination in blood from the vein draining into the inferior vena cava (IVC) and by adrenal phlebography. Site of the adrenal tumour was definitively determined by the high catecholamine level in the adrenal veins and by phlebography. Three extra-adrenal tumours, a thoracic and two abdominal ones, were localised by high catecholamine levels in blood from other veins draining into the IVC. Vanillylmandelic acid determinaion was unreliable in the diagnosis of small phaeochromocytomas.
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.
Cryptands are possibly useful synthetical models for passive ion carriers in biomembranes. Five mainly Na+ and K+ complex forming cryptands were studied in cardiac Purkinje fibres by means of standard microelectrode technique. Even at high concentrations the cryptands 22, 221 and 222 showed no effect. Possibly they are not lipophilic enough to accumulate within the membrane. The more lipophilic cryptands 222B and 222D caused a decrease of overshoot and maximal rate of rise (Vmax), a pronounced loss of plateau and a shortening of the action potential, while the resting potential was only slightly depolarized. 222B made some fibres inexcitable at normal resting potentials; only by increase in stimulation voltage a regular response was obtained. After about 20 min both cryptands (5 x 10(-5) mol/l) depolarized the fibres leading to irreversible inexcitability. The availability of the fast sodium current ("h infinity"-curve) was measured using Weidmann's (1955) technique. With 222B the h infinity-curve-showed a shift in the hyperpolarizing direction, and the maximal Vmax was diminished.
The injection of 200 mg/kg BW maleic acid was found to be a suitable dose for exploring the experimental Fanconi syndrome by micropuncture techniques in rats. In clearance experiments, the fractional excretion of glycine, L-alanine, L-aspartate and taurine was measured. After intraperitoneal administration of maleic acid the excretion of these amino acids was increased in the range between the 20-fold and the 230-fold. Free flow micropuncture experiments showed that the reabsorption of these amino acids is reduced drastically along the whole proximal tubule. Continuous microperfusion experiments lead to the result that, in maleic acid pretreated rats, the reabsorption of 14C-glycine from the proximal convolution was strongly inhibited. It was found, furthermore, that after blocking the saturable glycine transport by L-phenylalanine, the remaining reabsorption of glycine (corresponding to passive diffusion) was exactly the same with and without maleic acid. Microinfusion experiments with 8 mumol.1(-1) L-3H-alanine into the early distal tubule showed a fractional recovery of 103 +/- 4.2% (S.D.) in the control and of 101 +/- 6.5% in presence of maleic acid. It is concluded that maleic acid inhibits the saturable reabsorption mechanism of amino acids along the proximal tubule. Passive permeability of the tubular membrane does not seem to be altered by maleic acid.
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In 68 patients arterial and portal blood flow were measured by angiodensitometry in the course of routine, indirect splenoportography. Results were compared with those already published, with investigations of a model and with animal experiments. It was shown that, given certain underlying conditions, reliable results can be obtained even in the presence of a pulsatile flow and incomplete contrast mixing. Compared with other procedures, the method has the advantage of providing a complete picture of liver haemodynamics in the course of routine splenoportography in a simple way and without affecting the patient further. As a result the indications for performing a shunt and the choice of the shunt technique can be more accurately determined.
Percutaneous nephropyelostomy with a fine needle technique was performed successfully in 20 out of 21 children with urinary tract obstruction. The procedure was of value in assessing the recovery of renal function and for measuring perfusion pressure. As a therapeutic measure the method was used to preoperatively in children who were severly ill, and post-operatively for the treatment of complications after surgery on the urinary tract. A complication seen in two children was repeated dislodgement of the catheter.
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