Biomedical subjects
Publications and source records attributed to R Türk.
A case of squamous cell carcinoma infiltrating the stroma of cystosarcoma phylloides malignum is reported. A short review of prognosis and therapy is given on comparable cases. It is not uncommon to find squamous cell metaplasias in the dilated ducts of cystosarcoma phylloides. The combination of squamous cell carcinoma with this tumour, however, is a rarity.
Due to important improvement in detail resolution and the excellent contrast resolution, in the newest computed tomography (CT) units, normal and pathologic structures of the inner and middle ear can be visualized. The clinical value of CT in comparison to standard X-rays and tomography is prospectively evaluated on the basis of 50 patient examinations. Today CT is unsurpassed in the diagnosis of cholesteatomas and glomus tumors and is superior to all other imaging techniques. Chronic inflammatory diseases of the middle ear can be evaluated in most cases on the basis of standard X-rays and tomography. CT's importance is primarily complementary, except for preoperative cases. Fractures should be visualized first on standard X-rays. If questionable complications are involved (e.g., tympanic or intracranial hematomas), CT should be the next step. Conventional tomograms are not necessary.
There is no clear statement in literature on the problem of indication for surgery in cases of otogenic or rhinogenic meningitis. It is the aim of the present study to determine if and under what conditions conservative therapy alone is efficient and when surgery is absolutely indicated. The cases of 115 patients with endocranial complications, who were treated at our clinic over a period of 22 years, were evaluated; their number per year is significantly continually decreasing. The patients were subdivided into four groups: 1. otogenic/operated, 2. otogenic/non-operated, 3. rhinogenic/operated, 4. rhinogenic/non-operated. The individual groups were then compared in respect of 8 different parameters. The main cause of the disease in Group 1 was the chronic inflammation, in Groups 2 and 3 the acute inflammation and in Group 4 the new trauma. The status localis, the state of consciousness and the number of liquor cells were the most important parameters for establishing the diagnosis "meningitis", while the rigidity of the neck, the body temperature and the x-ray film yielded less reliable findings. On the basis of the results of our study we come to the conclusion that cause and progress of meningitis are decisive factors for the indication for surgery. We consider that immediate surgery (with high doses of antibiotics) is necessary in unconscious patients and in chronic inflammations as the cause of the meningitis. In all other cases treatment should be effected consisting of high doses of antibiotics, with thorough observation of the patients, and the patient should be operated on only if the disease aggravates or fails to improve within the first few days.
In 28 male Wistar rats a standardized lung incision was closed by running suture and in half of the animals by additional application of fibrin adhesive. The animals were sacrificed 30 minutes and 5 days postoperatively. A significantly higher tolerance to increased inflation pressure was found in the fibrin-treated group. Ten patients undergoing pulmonary resection had conventional closure of parenchymatous lesions with additional fibrin gluing. Under positive air way pressure ventilation the sealing effect proved to be better after application of fibrin adhesive to the sutured area.
So far it has not been possible to clearly objectify the success of a specific immunotherapy. The aim of the study is to determine which immunological parameters and which clinically biological observations can be used in order to verify a therapeutic success. In four different groups of patients suffering from grass pollen allergy, different specific immunotherapies were carried out pre-seasonally. Continuous observations of patients symptoms together with continuous measurements of the concentration of pollen in the air, of the usual whereabouts of the respective patients, as well as the determination of specific IgE and IgG antibodies before and after the immunotherapy, and the observation of the IgD titre were used as basis of assessment of the efficacy of the specific immunotherapy. Statistical evaluation showed that only the pollen-exposure measurement as compared to the complaints of the individual patients can yield exact information on the therapeutic success. The immunological parameters, in particular the determination of the specific IgG antibodies, are not statistically related to the actual therapeutic efficacy.
The present study comprises the data of 464 patients referred to the First Otolaryngological Hospital of the University of Vienna between 1960 and 1982. They all suffered from a clearly established sudden hearing loss. The data made it possible to prove that the number of cases suffering from sudden hearing loss increased statistically significantly in the past 20 years. In addition, efforts were made to prove the usefulness of a polypragmatic therapy in cases of sudden hearing loss. For this purpose, two statistically comparable groups subjected to different therapies were juxtaposed: a. One group of patients (1960-1967) treated with various therapies, mainly monotherapies, which are considered to be insufficient according to our present knowledge. b. One group of patients (1977-1981) treated with an uniform polypragmatic therapy. This second group showed significantly better results than the first group. Hence this study proves the effectiveness of a therapeutical method in cases of sudden hearing loss.
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In the introduction, the changes in the clinical features of tuberculosis over the past few decades are analyzed. Despite the reverse trend in incidence, tuberculosis is still one of the major infectious diseases in the world. The essential points in fighting tuberculosis are prophylaxis and early diagnosis, therapy hardly presenting any problems today. A brief survey of the clinical picture of tuberculosis of the ear in general is followed by an analysis of the case findings in patients treated in this department over the past twenty years. Important features are the reverse trend in the incidence of the disease, the predominance of male patients, the history of pulmonary tuberculosis and chronic otitis, and the pathological--and in part highly characteristic--findings concerning the tympanic membrane. The diagnosis of this condition, which is fraught with difficulties, rests with accurate history taking, local inspection and lung X-ray as the most important diagnostic holds. While the therapy of the exudative form of tuberculosis of the ear presents no problem, the proliferating, destructive form is very difficult to treat. A description of several cases helps to show how difficult and time-consuming it may be to establish the diagnosis of ear tuberculosis.
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The effect of the fibrin adhesive on the gas density of pleura-lung-sutures was investigated in 28 male Wistar rats. Standardized pleura-lung-lacerations were closed by additional fibrin adhesive application in combination with fibrinolytic inhibitors. 30 minutes and 5 days after operation the animals were sacrificed and manometric and micromorphological examinations performed. In good histo-compatibility the additional application of the fibrin adhesive proved to be a proper technique in elevating the pressure tolerance of pleura-lung-sutures significantly.
The morbidity of inhalation allergies which was proved to exist on the basis of a screening test involving schoolchildren in a big city (Vienna) in 1979 was compared to that in school children in a rural area (Wiener Neustadt region). The study involved 651 children aged 8, 12 and 15-16 who were examined under the same conditions as the Vienna school children had been examined previously. Case histories were prepared with the help of questionnaires and each child was subjected to a skin test against grass species, pollen and the house-dust mite. If one of the two criteria was positive, blood samples were taken for specific serum-IgE determination by means of RAST and whole-blood IgE-level by means of PRIST. In the group of Wiener Neustadt schoolchildren aged 8, 8% suffered from manifest allergies (7% in Vienna) and 5% from latent allergies (7% in Vienna). In the group of 12 year old children, 11% suffered from manifest allergies (11% in Vienna) and 8.5% from latent allergies (8% in Vienna). A definite conclusion concerning the group of children aged 15-16 cannot be drawn, since the samples were not comparable. Since the results obtained in Wiener Neustadt and Vienna were largely identical, this proves 1. the reliability of the results concerning the percentages of allergic children; 2. that the number of allergies increases with the age of the children; 3. that there is no statistical difference in the allergy distribution between children coming from rural areas or from big cities.
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Ten anesthetized mongrel dogs had a left anterolateral thoracotomy; the left anterior descending coronary artery was then ligated. After 60 min five animals each were treated either with dobutamine (4 microgram/min/kg; for 10 min), or with dobutamine and intraaortic counterpulsation. Combined treatment of cardiogenic shock proved superior. Those five dogs had significantly lower heart rates and dp/dt/p-values. Due to IABP the non-ischemic parts of the left ventricle were better perfused; there was no difference in treatment with regard to ischemic parts. The combined treatment was successfully inaugurated in two patients with cardiogenic shock.
The effects of different doses of pentazocine on circulation and respiration were investigated in 28 patients divided into three groups. The circulatory reactions occurred in two phases. In the first, immediately after the injection, ventilated patients showed vasodilation and therefore a decrease in the peripheral and pulmonary blood pressure due to the reduction in peripheral and pulmonary vascular resistance. In contrast, the second phase is characterized by a vasoconstriction with maximal alterations ten minutes after injection. As a consequence, the peripheral and pulmonary arterial pressure is increased by a raise in peripheral and pulmonary vascular resistance. These circulatory effects were more pronounced in the group receiving the higher dose of pentazocine. In spontaneously breathing patients pentazocine causes ventilatory depression indicated by a decrease in PaO2 and an increase in PaCO2. In these patients pulmonary vascular resistance and pulmonary arterial pressure are increased within the first minute after injection in contrast to the ventilated patients receiving the same dose. These increases are accompanied by the maximum of ventilatory depression. This change can be explained by the pulmonary hypoxic vasoconstriction.
There were 51 deaths following cardiac operation in children under one year of age. Nearly all these children were operated upon without using a cardiopulmonary bypass. The commonest cause of death was intra- or postoperative cardiac arrest usually occurring in patients with complex cardiac anomalies. The second most commonest cause was repiratory deficiency. In children between the ages of 2 and 14 years (91 deaths in 1859 patients, i.e. a mortality of 4.64%), the commonest cause of death was cardio-vascular insufficiency usually caused by the operation. In patients with tetralogy of Fallot (147 deaths amongst 709 patients) one must distinguish between right sided and left sided cardiac insufficiency. Here the next commonest cause of death was bronchopneumonia with septicaemia usually as a result of long term artificial respiration. Other causes of death such as haemorrhages and embolic phenomena are much less important. In order to lower the mortality, better postoperative treatment in an intensive therapy unit especially for children undergoing cardiac operations is suggested.
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