Biomedical subjects
Publications and source records attributed to W Burkert.
The case of a male patient with a macroprolactinoma is presented. Within a follow up period of six months the tumor had spontaneously shrunken without any therapy. The causes of this phenomenon are discussed in the following paper.
The authors report a case of a 60-year-old woman with a macroprolactinoma. After radiation therapy of the subtotally excised recurrent tumor, it developed a rapid malignant-destructive growth with invasion into adjacent structures. The causal factors are discussed and the literature is briefly reviewed.
A total of 55 patients with lumbar stenoses which had been existing for a period of 4.5 to 10 years were checked postoperatively. The findings were compared with the preoperative status of the patients. Although in most cases a more extensive decompression was carried out, no cumulated occurrence of spondylolisthesis could be found, nor was a serious and progressive instability of the lumbar spinal cord found in patients with multilevel interventions. On the basis of the clinical-neurological and X-ray checking its was found that the danger of a ventral vertebral sliding due to an extensive decompression is much smaller than the consequences of an insufficient decompression of the neural structures in the stenosed lumbar spinal channel.
Our animal-experimental results obtained in large-area pressure-relieving trepanation after severe craniocerebral traumas with intracranial pressure measuring and oxygen tissue pressure measuring in the brain were compared on the basis of 19 patients operated on in this way. In these operations we followed the achieved principles according to which, if possible at a relatively early time and on large areas, a fronto-temporo-parietal trepanation on both sides should be carried out, in order to make the shifting to the right in the pressure-volume curve sufficiently large, to avoid or remove the squeezing of the brain stem, and to keep the pressure ischaemisation of the cerebral tissue low.
Already in 1905 and 1908 Harvey Cushing carried out decompression operations for the relieving of pressure in inoperable glious tumours and posttraumatic cerebral oedmas. This surgical method of trephination, which later-on was adopted by many other surgeons, was based on the method of the prevention of an incarceration of the mesencephalon in the tentorial slit by an enlargement of the reserve space in the interior of the crane. In case of a posttraumatic cerebral oedema, besides Heppner's work group practically all other authors operated in pronounced late stages of the incarceration. The results obtained were bad. Heppner worked on the basis of a wider indication, operated earlier, and obtained better results. The intervention should be performed on the basis of continuous preoperative measuring of the cerebral pressure. By means of calculations and modelling we were in a position to demonstrate that on both sides very large trephination areas with the relation of the radius of the trephination area to the radius of the head being 2 to 3 are necessary for achieving a sufficient decrease of the pressure by about 20 to 30 torr.
Ultrasonics was used to produce a heavy post-traumatic brain oedema. The oedema that developed rapidly within 6 to 8 hours after the injury expanded intracellularly only without destroying any neurogen structures. Examinations with an electron microscope showed massive swelling of the astroglia, mainly in the area of the astrocytal processus in both of the hemispheres, that means even in the contralateral hemisphere away from the trauma. The intracranial pressure increased rapidly.
In a prospective controlled study 30 parturients provided for elective cesarean section were premedicated either with no specific medication for prophylaxis of aspiration pneumonia or 400 mg cimetidine orally at the evening and 400 mg intramuscularly two hours prior to induction of anesthesia. In the cimetidine treated group only one patient had a gastric pH below 2.5, while in the control group 11 patients had a pH below this limit. The gastric volume in the cimetidine treated group also was significantly reduced. No side effects could be observed in mothers and children. Application of intramuscularly cimetidine seems to be an effective method for prophylaxis of aspiration pneumonia in obstetric anesthesia.
A 41 year old woman had been submitted to a supravaginal uterine amputation in 1978 and to extirpation of the cervical stump in 1981. In 1982 she then developed a tubal pregnancy. - There have been only 30 reports regarding ectopic gestation diagnosed after previous complete hysterectomy in world literature since 1895. In 20 cases conception occurred some time before hysterectomy, in the remaining 10 cases, however, thereafter ("early" or respectively "late" type of extrauterine gestation, with regard to the date of hysterectomy). Probably ectopic pregnancy following complete hysterectomy could be diagnosed more often in the future, provided that the possibility of its manifestation is carefully taken into consideration.
The examination of 2 so-called minipigs and 5 patients with respect to the distribution of intravenously applied Diatrizoate into the cerebrospinal fluid yielded the proof of a high blood-cerebrospinal gradient. After the establishment of the relative flow balance about 60 to 120 minutes after the injection, the concentration of the contrast medium in the cerebrospinal fluid reaches 1.0 to 1.5 per cent the blood level. This dose-dependent value is exceeded in case of a disturbed blood-brain barrier. Thus the neurotoxicity of this contrast medium gains special importance.
Lymphocyte preparations obtained from peripheral blood of 36 healthy pregnancy women during the last 4 weeks of gestation were tested for various cell surface markers (E-, EA- EAC-rosettes, surface Ig positive cells). 29 healthy, non-pregnant age matched women served as controls. The cell surface marker analysis did not show significantly different results in the two groups tested except diminished percentages of EA-rosettes in the pregnancy group. EA-rosettes-forming cells (Fc-receptor positive cells) are known to the effectors of spontaneous and antibody dependent lymphocytotoxicity. Therefore, slightly depressed lymphocytotoxicity may be expected during late pregnancy.
Among the complications after surgical interventions carried out on the Ganglion semilunare because of a trigeminal neuralgia the reason why Keratopathia neuroparalytica plays a role is the fact that it very frequently leads to partial or total blindness of the affected eye. The pathogenesis of the keratopathy is still being disputed. The appraisal of the various surgical methods in trigeminal neuralgia always includes the frequent occurrence of a keratopathy. Among the 171 patients who were operated on in Halle because of trigeminal neuralgia in the last ten years no keratopathy was observed. In 12 cases a reduction or removal of the corneal reflex was brought about. On 8 patients a postganglionic intradural operation was carried out, all others received an electro-coagulation. The co-operation with the ophthalmologist is indispensable both prophylactically and therapeutically.
In 16 cases of brain abscess (1970 to 1976) 10 could be identified to be bacteriologically sterile. However in 5 cases of "sterile" cerebral abscesses, where swabs were taken under anaerobic conditions, it was possible to isolate anaerobic bacteria in every case. It is concluded that in reality thse so-called "sterile" brain abscesses were also contaminated with anaerobes.
Thrombelastography, as a method of rapid registration, is an important addition to the present screening tests of coagulation status. With this method we are able to quickly obtain exact values for clotting and fibrinolysis with more precision than those which can be obtained from the clot observation test. The TEG monitor must however be available in the immediate vicinity of the labour ward and must be ready for use around the clock. Specific therapy for the elimination of failures in hemostasis may then be started without delay, due to prompt determination of coagulation status and early detection of fibrinolysis.
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