Biomedical subjects
Publications and source records attributed to U Herrmann.
For medical imaging in the pelvic region in female infertility/sterility several methods of investigation are available. Risk/benefit-considerations of the mentioned methods lead to a diagnostic gold-standard: Hysterosalpingography, laparoscopy, laparotomy. Hysteroscopy and sonography can be employed facultatively after hysterosalpingography.
In order to guarantee an equally good development of ileorectostomized pigs (IRA) used for the determination of precaecal protein digestibility and the absorption of amino acids as for intact animals (INT), the supplementation of their rations with easily soluble carbohydrates and minerals is necessary. The effects of these supplements on live weight development, nitrogen balance and N utilization level were the subject of the assessment of 21 rations with 129 and 117 balance measuring resp. with growing IRA and INT pigs. Without any supplementation of the rations the N balances of the IRA pigs showed significantly lower and partly negative N balances and N utilization levels in comparison to the INT pigs. The combined supplement of easily soluble carbohydrates (100 g/kg DM intake) and 300 ... 400 ml electrolyte solution per day (approximately 1 ... 1.3 g additional Na) resulted in N balances almost equal to those of INT pigs. The supplement of both electrolyte solution and NaHCO3 (approximately 2 g Na per animal and day additionally) to a barley + lysine ration resulted in a significant increase of the N balance and N utilization in IRA pigs of a live weight between 120 and 140 kg in contrast to the control period. A supplement of carbohydrates to a ration consisting of barley + fish meal + grass meal and electrolyte supplements of 400 ml per animal and day only resulted in significantly higher N balances and N utilization levels in the live weight range up to 70 kg in comparison to the control periods, which then corresponded to those of INT pigs. There was no essential influence of carbohydrate supplementations on pigs of more than 70 kg live weight. The postileal digestibility of the crude carbohydrates (CC) of 14 rations calculated from the difference between total digestibility (faecal analysis) and precaecal digestibility (analysis of the ileal chyme of IRA pigs) showed that between 40 and 100 g (70 g on average) out of the 780 g CC per kg DM consumed disappear in the large intestine. These studies show that in the testing of concentrates and mixed feed rations the supplementation of 100 g easily soluble carbohydrates/kg DM intake should be sufficient to guarantee a normal development of IRA pigs. In addition, an oral supply of 1 to 2 g sodium in the form of electrolyte solution exceeding the requirement of INT pigs is necessary as this supplementation significantly improves the N retention of IRA pigs even heavier than 100 kg.
Sonographic observation of fetal behavior as a possible indicator for the state of fetal health was quantified with a modified biophysical profile (BPP). The observation time was extended to 40 min, as the fetal rest-activity cycle implies that inactivity may last that long. Gestational age ranged 27-43 weeks. Cardiotocography (CTG) was performed subsequent to an abnormal BPP (ultrasound score 0-4). Reactivity, indicating favorable fetal outcome, was more common in near-term fetuses, suggesting that BPP should be interpreted in relation to gestational age. Therefore, fetuses with an abnormal BPP (n = 29) were each matched and compared with 2 fetuses of same gestational age but normal BPP (ultrasound score 6-8; n = 58). The perinatal mortality and morbidity were significantly higher in infants with abnormal score than in infants with normal score (p less than 0.01). BPP by third trimester sonography helps to diagnose acutely endangered fetuses, and an abnormal fetal movement pattern should lead to further evaluation, i.e. CTG. While BPP scoring, as compared to CTG, is less favorable as a primary surveillance technique and not superior for identifying the hypoxic fetus, additional information is obtained with BPP by diagnosing the growth-retarded and/or malformed fetus.
Although current recommendations for administration of Rh immune globulin have been extended to a variety of reproductive events, residual Rh prophylaxis problems persist. Recent advances in treating Rh-immunized pregnancies include: 1. Fetal blood group determination in first trimester pregnancy by chorionic villus sampling; 2. The severity of fetal haemolysis can be predicted only from invasive procedures, which are recommended, when maternal antibodies exceed 1:8. In the second trimester the only accurate method of assessing the severity of fetal anemia is by fetal blood sampling (cordocentesis). Interpretation of amniotic fluid by the Liley method is still valid for the third trimester of pregnancy; 3. Ultrasonographic evaluation of the fetus is the major adjunct for invasive procedures, but cannot reliably distinct mild from severe fetal disease; 4. Therapy should be initiated before the fetus is hydropic (i.e. Hb less than 5 g%). Survival rates above 90% have been reported by several authors giving transfusions by cordocentesis.
Operative intestinal intubation with Miller-Abbott-tube was performed on 188 patients from 1974 to 1988 in the Surgical Department of Dresden Academy of Medicine. In a retrospective analysis, the advantages and disadvantages of the method in treating the adhesion ileus are described and complications and lethality after predominantly orthograde nasal intestinal intubation are discussed. Exact indications and various operational details may help to reduce complications due to the tube-method to a minimum. The relatively high postoperative lethality (22.3%) was mainly caused by cardiopulmonary illness and peritonitis and does not result from the operative procedure. The fact that no early recurrent bowel obstruction was observed may be stated as an essential result, even though a relaparotomy due to late recurrence had to be made within 1 to 5 years after the first operation in 4% (8 patients) of 188 intestinal intubations.
In digestion trials using pigs fitted with ileo-rectal anastomoses and intact pigs, the influence of two different grinding finenesses (coarse, fine) of vegetable high-protein concentrates (soya bean meal, field bean, lupin) added to cereal diets was examined. It was found that neither the precaecal nor the total nutrient absorption and digestibility were practically injured, when in the concentrates the particle sizes bigger than 2 mm did not amount more than 20% and whole grains hardly occurred. The investigations concerned the crude putrients, watersoluble carbohydrates and starch as well as the indispensable and dispensable amino acids. The apparent and true precaecal absorption values and total digestibility data for soya bean meal (heat treated), field bean (variety 'Fribo' and yellow sweet lupin (variety 'Bornova'--calculated by the different method--are given and discussed.
In digestion trials using pigs fitted with ileo-rectal anastomoses and parallel intact pigs the influence of wheat straw meal (WSM) or grass meal (GM) supplemented on two different levels to a basal diet was examined with regard to nutrient and amino acid digestibility resp. absorption. Both roughages reduced, obviously because of their high cell wall contents, nearly at equal amounts and partly significantly the precaecal as well as the total digestibility of dry matter, organic matter, carbohydrates (= crude fibre + NFE), crude fibre and hemicelluloses (arabinose, xylose). By the roughage supplementations the crude protein digestibility at the terminal ileum was less reduced than at the end of the total digestive tract, the starch digestibility was hardly influenced and that of ether extract mostly increased. In comparison with precaecal glucose and fructose digestibilities it could be shown that the anthrone method is not suitable for determinations of the precaecal digestibility of water soluble carbohydrates. Beside these compounds other substances in the ileum digesta must evidently be dyed by anthrone too. The crude protein digestibility and the amino acid absorption were precaecally hardly or not reduced by WSM supplementations, therefore it can be concluded that it is possible to dilute the energy concentration in diets (e.g. for sows) by addition of WSM without impairing protein digestion and amino acid absorption. The GM supplementations, however, impaired protein digestibility and amino acid absorption of the whole diet, probably caused by the encrusted, possibly heat damaged protein present in the GM itself. When the roughage supplemented diets were fed, the excretion of nitrogen compounds in the faeces was enlarged due to the more intensive bacterial activity in the hind gut and the additional sorption effects to cell wall substances, so that a too low apparent and also true digestibility is made believe. The applicability of the difference method to the calculation of protein and amino acid digestibilities in roughages is very questionable because of their low contents and the missing additivity. The crude fibre and hemicellulose digestibility values calculated by the difference method demonstrate for the both roughages--in spite of high standard deviations--that the precaecal digestibility of crude fibre is about zero and that of the hard lignified hemicellulose fraction in contrast to the predominantly endospermic hemicelluloses of the basal diet is very low. The faecal crude fibre and hemicellulose digestibilities of WSM--especially on the lower supplementation levels--are markedly worse than those of GM.
Selective proximal vagotomy (SPV) with pyloroplasty (n = 39) and without (n = 39) were compared five and eight years after surgery in a randomized clinical study. Pyloroplasty according to Finney had no effect on ulcer recurrence rates after both periods of time (7.9:7.9 or 10.8:8.3 per cent). Additional pyloroplasty, too, had no statistically significant effect on incidence and severity of post-vagotomy syndrome, dumping and diarrhoea, though some trend towards an increase was discernible in wake of pyloroplasty. Occurrence of the lactase deficit syndrome after SPV with pyloroplasty was increased with statistical significance. Lasting loss of senses of appetite and saturation was observed for the first time after SPV, on top of the lactase deficit syndrome. Clinical results recorded after five and eight years did not reveal any significant difference between both groups. These findings are likely to suggest that SPV without pyloroplasty is sufficient for surgical treatment of duodenal ulcer. However, pyloroplasty in combination with SPV has continued to be fully indicated for no-resection therapy of ulcerogenic pyloric stenosis.
Subarachnoid hemorrhage during pregnancy is a rare neurological event which, due to the time of onset and clinical findings, may be mistaken for eclampsia, a purely obstetric complication. Timely specific diagnosis will lead to consultation of the neurosurgeon who, on the basis of non-invasive techniques, determines the optimal timing for surgery to ensure a favourable prognosis for mother and child. The clinical aspects, and the diagnostic and therapeutic procedures are illustrated by three clinical cases at various stages of pregnancy and on the basis of a short review of the literature.
The ultrastructure of the vessels in the normal respiratory and olfactory mucosa of the nasal septum was studied in 15 adult rabbits. Capillaries with continuous and fenestrated endothelia could be observed in both tissues. In the respiratory part, many of the fenestrated capillaries were located subepithelially with their fenestrations facing the adjacent epithelium. Fenestrated capillaries of the olfactory mucosa were found mainly in the deeper parts of the tunica propria and usually revealed only a small number of fenestrations in their endothelial lining. It was also demonstrated that muscularized veins sometimes displayed fenestrated areas in their attenuated endothelia. These results are discussed and compared with the appropriate literature. Our results confirm that there is a link between the morphological peculiarities of the vascular wall and the functional behaviour of the nasal mucosa. These findings also emphasize that endothelial fenestrations seem to be characteristic for a certain segment of the microcirculatory system rather than for a distinct type of capillary vessel.
The activities of various enzymes involved in glycolysis, tricarboxylic acid cycle and fatty acid oxidation were assayed in human myometrium. A gradient of the activities from fundal to cervical myometrium was observed. In contrast to studies performed in rodents, cyclic changes of glycolytic enzymes could not be detected. Hydroxyacyl-CoA-dehydrogenase (HAD) activity was higher in secretory phase myometrium and in cases with cystic hyperplasia of the endometrium than in proliferative phase myometrium. In pregnant myometrium, lactate dehydrogenase (LDH) and glycogen phosphorylase (GLP) were increased and in postmenopausal myometrium the activities of phosphofructokinase (PFK), LDH and succinate dehydrogenase (SDH) were decreased as compared to proliferative phase myometrium. We conclude that in the human myometrium, except for HAD, activities of enzymes involved in fuel metabolism are stable throughout the menstrual cycle and that only prolonged hormonal stimulation leads to alterations of some enzyme activities.
We report on a case in which meconium was detected in the stomach of a foetus at 36 weeks of gestation. This finding, in addition to a pathological biophysical score according to Manning, leads to the diagnosis of foetal hypoxia.
Pigs fitted with ileo-rectal anastomoses (IRA) and in parallel experiments intact (INT) pigs were used to estimate the influence of the different grinding fineness of barley and wheat (coarse, medium, fine) on the apparent and true precaecal and total digestibility resp. absorption of various N free and N containing nutrients, among them crude protein and the indispensable and dispensable amino acids. Coarse grinding (25 ... 50% of the particles greater than 2 mm) resulted in significantly lower digestibility values than medium and fine grinding--with more striking differences in barley than in wheat. Precaecally most nutrients and amino acids are distinctly less digestible than at the end of the total tract. The precaecal lysine absorption determined with IRA pigs is remarkably low. The results are discussed. In order to attain a good utilization of the protein contained in cereals grains should be ground in hammermills with maximal sieve meshes of 3 mm. It is proposed to tabulate crude protein and amino acids in future on the basis of a standardized true precaecal digestibility resp. absorption.
The activities of six enzymes involved in energy metabolism were measured in leiomyoma specimens and in the adjacent normal myometrium from the uterus of 17 patients. In leiomyomas the specific activities of hexokinase, lactate dehydrogenase and hydroxyacyl-CoA dehydrogenase (HAD) were higher than in myometrium. The soluble protein content was lower in leiomyomas. Therefore, most of the differences of specific activities were not found when the enzyme activity was expressed per gram wet weight of tissue, except for HAD activity, which was still higher in leiomyomas (p less than 0.05). This result is compatible with increased fatty acid utilization by leiomyomas, and with the increased growth potential of such tumors.
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The "cavernous" tissue of the nasal mucosa possesses a key function for different physiological and pathological conditions. In the present study we report about our own examinations on the "cavernous" tissue of the rabbit nasal mucosa. The specimen (nasal septum and anterior concha) were fixated by vascular perfusion via the carotid arteries, carefully excised and prepared for light and electron microscopy. Our observations indicate that the tunica propria of the nasal mucosa is covered by large, sinusoidal veins. Most of these vessels possess a rather thin vasvular wall. Some vessels, however, could be identified that had at first been regarded as arteries. A closer inspection, however, revealed the venous character of these muscularised vessels, which may correspond to the so called "Drosselvenen" described by Körner 50 years ago. These veins are supposed to possess a particular anatomical structure in their vascular wall called "sphincter", "muscular thickening", "cushion", or "muscular bolster" by various authors--which enables them to ease or to prevent the loss of fluid from the cavernous tissue. All our morphological findings as well as the functional significance of these peculiar structures are compared and discussed with the appropriate literature.
On the basis of two casuistics is reported on the laser treatment of Buschke-Löwenstein tumours. Hereby the advantages of this method are emphasized and compared with the former treatment techniques.
The vascular system possesses a variety of possibilities to respond to noxious events. Particularly the "morphological reaction" can first be observed in ultrastructural changes of the endothelial cell. In the present study we report on endothelial cell reactions in various carcinomas of the head and neck (carcinoma of the auricle, carcinoma of the maxilla). It is shown that the endothelial cell develops cytoplasmatic processes projecting into the vascular lumen. Occasionally cell edemas can be observed. The use of the scanning electron microscope allows to visualize three-dimensional aspects of the excised specimen. Tumor cells, endothelial cells and erythrocytes are obviously mixed, so that a regular vascular lumen can be found within the tumor tissue only occasionally. The results are compared and discussed, basing on available references.