Biomedical subjects
Publications and source records attributed to U Thiel.
A report is given on 10 years' experience of nephropexy using tissue adhesive. The uncomplicated method of operation is described. Pathological aspects, indications, pre-operative data and post-operative results are dealt with. The method of operation described has proved its worth by acceptable results in practice.
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On principle every vesical tumour should be resected at first transurethrally. The TUTUR allows an exact establishment of the penetration depth of the tumour. The transurethral electro-resection gives representative tissue for the histological examination. For the majority of the superficially infiltrating tumours it represents the method of choice with curative aim. In the treatment of the progressed vesical carcinomas the TUTUR with palliative aim gives immense advantages. Using the developing paravesical inflammation wall the following secondary (and more) resection into the perivesical fatty tissue is possible. The intervention can be repeated at every time it is not mutilating does not cause any stoma problems or metabolic derangements as after discharge of the urine and may be suggested to patients in a general condition which forbids an open surgical intervention. The resection can improve the quality of the patient's life for a long time without great stress and thorough changes of the life habits of old people. However the resection treatment will be successful only then, when it will be performed by an experienced (in transurethral operations) operator with a technically good instrumentarium.
In the period from 1970 to 1978 24 patients after transvesical adenomectomy and 76 patients after TUR of the prostate gland underwent a secondary transurethral surgical intervention. Causes were residual adenomas, stenoses of the vesical neck and recidivations of the adenoma. Explanations are given for the differences in the course of the temporary coordination to the primary intervention. The preoperative situation concerning infections, problems of the operation technique and in the case of the TUR the qualification of the resectionists are mentioned. After the TUR as primary intervention clearly less carcinomas were proved in the electro-resectate in comparison to the transvesical adenomectomy.
In 20 patients with idiopathic hypertrophic obstructive and nonobstructive cardiomyopathy (IHSS), biphasic Thallium-201 myocardial scintigraphy was performed. Regional myocardial Thallium-201 kinetics of these patients were analysed by a semiquantitative computerized method and compared with those of 6 normal subjects. In 12 of 18 with IHSS and no coronary artery disease 26 regions of interest with irreversible and 6 regions of interest with reversible Thallium-201 defects could be detected. Most of the Thallium-201 defects were localized in the interventricular septum. The defects were not related to the age of the patients and there was no relationship between the occurrence of reversible Thallium-201 defects and pathological myocardial lactate extraction rate during maximal atrial pacing measured in 14 patients. The percentage (6.8%) of irreversible defect regions in patients with LV outflow obstruction at rest (n = 13) was more than twice higher compared to those (n = 5, 3.2%) without LV outflow obstruction or no provocative pressure gradient, resp. These data suggest that IHSS is often associated with regional ischemic myocardial fibrosis despite normal coronary arteries. Therefore in these patients Thallium scintigraphy cannot be used as a noninvasive screening method to exclude or prove coronary artery disease.
In order to establish the actual recidivation rate, the patients with partial resections of the kidneys of the years 1965 to 1978 were examined. Of 120 patients treated 106 could be examined for the second time, at a mean time of secondary examination of 6.5 years. 24.5% of the patients had a recidivation at the time of the examination. The annual recidivation rate was calculated depending on the examination. It increases with the duration of the time of the after-examination. The comparison with the recidivation number after pyelolithotomy (26.7%) does not show an evident effect of the partial resection of the kidney on the frequency of recidivations. In the judgment, however, the selection of these patients for this operation technique is to be taken into consideration. The use of the coagulum pyelolithotomy has led to a more stringent indication for the partial resection of the kidney.
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The people become elder in this time, everywhere. The number of patients with adenoma of the prostate is increasing. Most of them have other diseases, too. A retrospective study (2646 cases in 8 years, exactly specially analysed 469 cases from 1975/1976) was done, comparing the results of TUR and open surgery. Well known is the lower risk of TUR, the lower blood loss, the lower discomfort, the lower nursing in the postoperative period ect. There are not news in this study. But it is important, to recall some things, because it's more and more difficult, to classify an old man as an "inoperable case". Nobody knows, where he should stay. The family does not like him at home (his "dripping", his incontinence etc.) In the veterans house it's the same problem, and from the hospital he is removed, because he is an "inoperable case". The situation of this old man is very bad, because he feels there isn't a place for him and nobody likes him. Each man, also if it's the strongest one, will be broken psychically and physically after a short time. Concerning these aspects, must be enlarged the indication of removal the bladder neck obstruction per transurethral resection, more and more.
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After references to definition, anatomic and physiologic foundations the author deals with the pathology of priapism. A clinical systematization of the diseases occurring together with priapism according to causal points of view is no more worth being advocated. It is completely unclarified to which extent the disease actually participates in priapism. After the description of the possibilities of a conservative medical treatment to the heparin and fibrinolysis therapy it is referred to the importance of the continuous drainage of the corpora cavernosa after Grayhack and Quackels. It is reported on two patients operated according to Grayhack. Results of surgical therapy reported in publications of the last time refer to an essential improvement of the prognosis of priapism.
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