[Occupational health services--new quality criteria after adoption of SGB VII].
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Accidents, Occupational↗
Biomedical subjects
T Riemenschneider
Publications and source records attributed to T Riemenschneider.
Intraarterial hepatic chemotherapy with fluorouracil, fluorodeoxyuridine, mitomycin C, cisplatin or methotrexate as single-agent anticancer drugs for a transplanted experimental liver tumor in rats.
A prospective, controlled and standardized animal experiment was performed to study the influence of various anticancer drugs. The Novikoff hepatoma transplanted into male Sprague-Dawley rats was treated with fluorouracil (FUra), mitomycin C, methotrexate, cisplatin and fluorodeoxyuridine (FdUrd) at equi-effective dosage, in terms of side effects (weight loss), in comparison to a control group (0.9% saline solution) by locoregional application via the hepatic artery. The tumor multiplication factor (TMF = tumor volume day 12/tumor volume day 5) served as the parameter to compare the tumor growth of the various groups. All drugs showed a significant (P < 0.05) effect on the tumor growth. In comparison to the control group (mean TMF 9.66), FdUrd (3.78) and FUra (3.03) only limited the tumor growth, mitomycin C (0.96) produced stable tumor, cisplatin (0.64) and methotrexate (0.15) significantly reduced (P < 0.01) the tumor size. We suggest that, in addition to the established (FUra, FdUrd, mitomycin C) drugs, methotrexate and cisplatin should be considered in further studies of the treatment of primary and secondary liver malignancies.
Angiography↗
[Results of devascularization surgery of the gastroesophageal junction in recurrent hemorrhage of esophageal and fundus varices].
Bleeding esophageal and gastric varices caused by portal hypertension with (group I) or without (group II) liver damage should be treated primarily by sclerotherapy or shunt-operation if there is no indication for liver transplantation. In the case of rebleeding associated with thrombosis of portal-/mesenteric or splenic vein we performed in 17 patients a complete devascularisation of the proximal stomach, cardia and distal esophagus (Hassab's operation 1967) (N = 5--group I; N = 12--group II). In group I, the early postoperative (0-30 days p.o.) course was complicated by one necrosis of the gastric fundus. In group II, postoperative bleeding from gastric varices was noted in four patients, three of which were treated by proximal gastric resection; two of twelve patients died. No serious complications in the long-term follow-up (min. 171--max. 1217 days) occurred in group I. In group II, half of the patients died (1 bleeding episode, 1 liver coma, 1 hepatocellular carcinoma, 2 other causes). The operative risk and the long-term prognosis are essentially influenced by the basic disease and to a much lesser degree by the type of operation. The devascularisation of the esophago-gastric junction is per se a low risk intervention which is always practicable, even in high risk patients.
Adolescent↗
Arterial, portal or combined arterio-portal regional chemotherapy in experimental liver tumours?
The most appropriate route for regional administration of chemotherapeutic drugs to liver tumours was studied in a standardized rodent model: cells of Novikoff hepatoma were transplanted into the central liver lobe of Sprague-Dawley rats. From day 5 to day 12 after transplantation, the liver was continuously perfused with 420 mg/kg 5'-fluoro-2-deoxyuridine by subcutaneous osmotic micropumps via the hepatic artery (n = 20), the portal vein (n = 20) or both vessels together (n = 12). The tumour multiplication factor (TMF) and the vascularization of the tumour were evaluated. Arterial and combined infusion led to a highly significant reduction in TMF, but combined infusion was not more effective than arterial alone. Portal infusion had no significant effect. There was no correlation between vascularization and tumour response in arterial infusion, but a strong correlation in portal infusion. Thus chemotherapy via the portal route may be effective in selected tumours with considerable portal vascularisation.
Animals↗
Isolation of human colonic crypts for study of xenobiotics metabolism.
Methods allowing study of human colonic drug and carcinogen metabolism in intact epithelial preparations in vitro are needed. We describe an isolation method yielding intact colonic crypts with well-maintained ultrastructural integrity and good viability parameters. The crypt preparations obtained with this method were used to study phase I and II drug biotransformation. The colonic crypts demethylated aminopyrine and nitrosodimethylamine slowly, but the colonic carcinogen dimethylhydrazine at a higher rate. The phenolic compounds estrone, 17 beta-estradiol, and 1-naphthol were readily conjugated. In conclusion, the present method yields preparations well suited for further investigation of the role of human colonic biotransformation in carcinogenesis and drug pharmacokinetics.
Adult↗
[Celiac artery compression syndrome].
External compression and kinking of the celiac axis is caused by the enlarged and fibrous median arcuate ligament of the diaphragm. The pathogenetic cause may be a functional ischemia or an irritation of the squeezed celiac ganglion. This painful syndrome is an unusual condition, which occurs at a maximum age of about 40 years and mostly in women. The diagnosis is established by exclusion of all other abdominal sources of pain and lateral aortography. The therapy can often be limited to longitudinal incision of the ligament; reconstructive procedures of the coeliac artery are sometimes necessary.
Arterial Occlusive Diseases↗
Continuous or bolus chemotherapy with 5-fluoro-2'-deoxyuridine in transplanted experimental liver tumors?
The effect of continuous and discontinuous locoregional chemotherapy with Floxuridine (FUdR) was studied in a standardized and controlled animal model, using the transplantable Novikoff hepatoma in Sprague-Dawley rats. The liver was perfused after transplantation with a total of 420 mg/kg FUdR, via a fully implanted osmotic minipump or miniport and catheter in the hepatic artery, either continuously (n = 22) from day 5 to day 12, or discontinuously (n = 28) on days 5 and 8. Viable tumor volume and peritumorous cell infiltration were measured. No reduction in tumor volume was attained using discontinuous therapy, in contrast to a highly significant reduction using continuous therapy (P less than 0.001). Significantly less cell infiltration was found after discontinuous than after continuous therapy. In conclusion, continuous locoregional chemotherapy with FUdR was the superior administration method on measurable tumor effect, when compared to discontinuous infusion.
Animals↗
[Are there differences in prodromal illnesses, symptoms and prognosis for various forms of mesenteric infarct?].
Comparing 105 patients with mesenteric infarction, the typical attributes of the underlying diseases, arterial embolization (aE) (n = 26), arterial thrombosis (aT) (n = 40), venous thrombosis (vT) (n = 32) and combined arterio-venous occlusion (n = 7) could be demonstrated. Present heart disease, diabetes and arterial hypertonia, rapid onset of symptoms, severe abdominal pain and signs of peritonitis, extended gangrene of bowel and a high mortality of about 90% is the typical combination for aE. Over 70 years old patients with higher incidence of arteriosclerosis, more digitalis intake, longer duration of symptoms and with bowel problems in the past have a higher incidence of aT and a slightly better prognosis. Risk of thrombosis, long-standing symptoms and a clearly better prognosis are typical for the vT.
Aged↗
[Microsurgical bile duct anastomosis: animal experiment and clinical study].
In 10 Göttingen-minipigs an end-to-end anastomosis of the normal common bile duct was accomplished under the microscope with 11/0 Polygalactin-sutures. Biliary flow was controlled by serum concentration of alkaline phosphatase, by cholangiography and by dynamic hepato-biliary scintigraphy 2 weeks, and 3 and 6 months after the operation. Anastomoses were judged by macroscopic, microscopic and scanning electronmicroscopic examination 6 or 12 months postoperatively. The anastomoses presented no stenosis at all, only a light periductal fibrosis with intact luminal epithelium. Alkaline phosphatases and cholangiography showed a normal pattern, the scintigraphy presented dyskinesia after 2 weeks and normal flow at the later controls. After a microsurgical operation one patient showed a normal anastomosis after 6 months. A biliary anastomosis should be made by microscope in all patients with a long life span and unchanged bile duct wall in spite of the more difficult operation.
Adult↗
[Secondary reconstruction of intestinal continuity following colectomy for ulcerative colitis].
In 37 patients with a clinically and microscopically confirmed ulcerative colitis the rectum was retained after subtotal (n = 29) or left-sided (n = 8) colectomy. In the following 1.6 years in 25 of the 37 patients the rectal stump was removed; in 9 of these cases a straight ileoanal anastomosis was constructed; after 4 years in 4 of the 8 surviving patients the anastomosis has been removed for various reasons. In 12 of 37 patients the rectum was preserved over 10.8 years only in 4 of these cases with rapidly decreasing protectitis the construction of an ileo-rectal anastomosis was possible.
Adult↗
[Compression syndrome of the celiac trunk].
Compression syndrome of the celiac trunk or Dunbar's syndrome is usually caused by an overly large medial arcuate ligament of the diaphragm. Symptoms are postprandial periumbilical pain, the pathogenesis of which, in spite of abundant collateralization of the celiac trunk, has not yet been clarified. The diagnosis should be established by elimination via lateral aortography. Therapy consists of incision of the ligament, creation of a aorto-celiac bypass, or reinsertion of the celiac trunk. Treatment, however, is successful in only 41% of the operated patients.
Adult↗
[Traumatic bladder perforation in pelvic ring fracture. Case report with differential diagnostic aspects].
In the context to multiple traumata, a 19-year-old man suffered an extraperitoneal bladder rupture due to perforation by a fractured pubic ramus. Because of a rapid shock-induced decrease of hematuria and the misinterpretation of a bruise on the right flank as a renal contusion, the clinical diagnosis was not established. The patient died of head injuries and ruptures of the liver and diaphragm with hemothorax and intra-abdominal bleeding. The impressive bladder perforation was first documented at the postmortem examination. The diagnosis and differential diagnosis of hematuria are discussed.
Adult↗
Morphologic aspects of low-potassium and low-sodium nephropathy.
Renal biopsies from 40 patients with hypokalemia and hyponatremia of an average of 10 years' duration due to abuse of laxatives or diuretics, anorexia nervosa, or chronic vomiting were examined with morphometric methods. Light microscopy revealed the following alterations in the renal cortex as compared with 36 normal kidney: JGC were sometimes slightly and sometimes enormously enlarged (mean, 217%). Smaller glomeruli were found with reduction in the area of the glomerular capillaries and of Bowman's capsule (+/- 7%) but an increase in the area of the mesangial matrix by 25%. The proximal and distal tubules contained nonspecific vacuoles in only 8 of 40 biopsy specimens. Only minor, age-dependent arteriolosclerosis was demonstrable. In 75% of the cases, the interstitial surface area was increased (by 107%) with predominantly focal lymphocytic cellular infiltration. Interstitial fibrosis was more pronounced in emaciated patients. The morphologic-functional correlation between the increase of interstitial surface area and the rise in serum creatinine concentration was highly significant. Typical kaliopenic nephropathy is therefore detectable by light microscopy. GFR impairment correlates with the extent of interstitial fibrosis.
Adult↗
[Q-fever epidemic in an institute of human pathology].
At the Institute of Pathology of Tübingen University 12 members of the staff (nine doctors, one secretary, one cleaner, and one autopsy assistant) fell ill with an influenza-like disease with high fever. In 11 instances there was positive serological evidence of Q-fever. The post-mortem room assistant was not tested serologically, but the disease followed a typical course. All those who fell ill had taken part in post-mortem examinations or a case demonstration at the Institute of Pathology. Seven more doctors fell ill at about the same time. They were working at two different clinic buildings, 1 km apart. They and one medical student had positive serology for Q-fever. No other cases of Q-fever were reported among clinic personnel. All doctors and very likely also a student who fell ill had taken part in the above mentioned case demonstration at the Pathology Institute, 19 days before the mean onset of the disease. No other possible sources of infection were found. In none of the 12 patients who underwent autopsy at the time was there clinical evidence of Q-fever; it was not possible to determine the source of infection retrospectively.
Autopsy↗
[Healing of infected wounds after diathermic and scalpel cuts into the abdominal wall in rabbits (author's transl)].
The course of wound healing and the spreading of infection was investigated through a comparative procedure with 30 rabbits. We performed a laparotomy with diathermy and scalpel, afterward injecting a solution of 6 X 10(10) Staphylococcus aureus in the subcutis. The histological preparation and semiquantitative evaluation of the laparotomy wounds were performed on postoperative days 3, 7, and 14. On day 3, a clear infiltration of macrophages could already be observed in the scalpel wound, while in the diathermy wound more necrosis could be seen. On day 7, the muscle of wounds inflicted by scalpel was infiltrated with granulocytes and monocytes. In those by diathermy, the necrosis was filled with fibroblasts. On postoperative day 14, no histological difference could be seen between the two proceedings: in the subcutis, there is an abscess enveloped in a connective tissue wall; the cutis and the muscle show new scar tissue.
Abdominal Muscles↗
[Duodenal stenosis of the pars horizontalis inferior as a result of an peptic ulcer].
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Adult↗
Morphologic aspects of Goldblatt hypertension in a newborn infant.
Hypertension (210 mm Hg), hyponatremia, hypochloremia, and hypokalemia were observed in an 11-day-old infant. After electrolyte repletion, blood pressure rose to 320 mm Hg in spite of administration of antihypertensive drugs. The child died of a massive cerebral hemorrhage on the 17th day of life. At autopsy, the left renal artery was partially thrombosed and the left kidney partially infarcted. The glomeruli in the preserved cortical areas were of normal size; the juxtaglomerular apparatuses markedly enlarged. The blood vessels were inconspicuous. Enlarged glomeruli, multiple ruptures in the mesangium, ectactic glomerular capillaries, and fragile capillary walls were found in the nonconstricted right kidney. Fibrinoid necrosis with occasional fibrin thrombi in the lumina was present in the arterioles. Pronounced intimal edema with fragmented cells and monocytes embedded in the intima were observed in the interlobular and larger arteries. The histologic findings in the blood vessels of the nonconstricted kidney resembled those found in the hemolytic-uremic syndrome (Gasser's syndrome).
Hemolytic-Uremic Syndrome↗
Spontaneous heterograft aortic valve failure.
Glutaraldehyde-treated porcine aortic valve prostheses have been in clinical use for ten years. The long-term durability of these valves remains unknown although they have functioned well in most large clinical series for more than five years. At the present time, several manufacturers produce bioprostheses mounted on flexible stents. This report concerns the failure of an Edwards porcine xenograft in the aortic position 15 months following implantation. At reoperation, the right and left coronary leaflets of the explanted valve were torn from the aortic wall. The loss of wall integrity suggests that during the process of mounting the xenograft on the flexible stent, the aortic walls of the bioprosthesis may have been thinned beyond a critical point of maintenance of wall strength. The pathological and clinical findings of similar cases are reviewed.
Aortic Valve Stenosis↗