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Biomedical subjects

W Teichmann

Publications and source records attributed to W Teichmann.

At least 19 recordsLinked to original sources
PubMed1992

[Case reports of arteriovenous fistulas of coronary vessels in adulthood].

It is reported on the diagnosis and therapy of arteriovenous fistulae of coronary arteries. With the help of 5 casuistic instances external fistulae could be demonstrated by invasive diagnostic procedures. In three cases the fistulae drained from the left coronary into the pulmonary artery, at the second instance from the right coronary artery into the right ventricle, in the fifth instance from the right coronary artery into the right atrium. In addition to this there were coronary stenoses which needed a bypass. In all cases the tentative diagnoses were confirmed intraoperatively. The indication to operative ligatures of the congenital fistulae is discussed and supported depending upon the picture of the complaint.

Adult↗
PubMed1991

Positive phase II study in the treatment of advanced malignant melanoma with fotemustine.

To date, dacarbazine (DTIC) has been the most effective drug in the treatment of advanced metastatic melanoma, achieving response rates of up to 28% (mean, 21%). Multidrug responses were generally no better than those obtained using monotherapy. A quite promising clinical trial was conducted using the new nitrosourea fotemustine. A total of 19 patients presenting with advanced malignant melanoma (clinical stage IV according to the 1987 UICC classification system) underwent treatment involving a more rapid infusion of the drug and a reduction in the rest period from 5 to 3 weeks. This monotherapy with fotemustine yielded two complete responses and seven partial responses; in addition, four patients showed no change and six cases progressed after the induction cycle (median duration of response to date, 7.6 months, including four cases that have not relapsed). Fotemustine was well tolerated by the patients, with the only mild side effects being thrombocytopenia, leukocytopenia and easily controlled nausea/vomiting. Preclinical studies performed previously indicated that fotemustine inhibits enzymes involved in the ribonucleotide reduction pathway (i.e. DNA synthesis), whereby responding patients (n = 3) appeared to favor the thioredoxin reductase/thioredoxin electron transfer to ribonucleotide reductase, whereas non-responders (n = 4) expressed the alternate glutathione reductase/glutaredoxin mechanism. The 47% response rate obtained in these studies vs the 24% reported previously for fotemustine may reflect variations in enzymes in the ribonucleotide reduction pathway in different patients. However, the efficacy of fotemustine against advanced melanoma warrants more extensive trials of this drug, especially since the quality of life of the patients during and after chemotherapy was not severely affected.

Adult↗
PubMed1991

[The effect of continuous thoracic peridural anesthesia on the pulmonary function of patients undergoing colon surgery. Results of a randomized study of 116 patients].

In a prospective randomized clinical investigation, we examined the influence of continuous thoracic epidural analgesia (TEA) on pulmonary function and pathologic chest X-ray findings. METHODS. One hundred sixteen patients having resection and/or anastomosis of the colon participated in this study; 57 were randomly assigned to the epidural group, whereas 59 were given systemic analgesia. Both groups were comparable with regard to ASA classification and pre-existing disease, as well as operative procedures and surgeons. Bupivacaine 0.75% was given to the TEA patients pre- and intraoperatively (epidural catheter T8/9), and postoperatively they received bupivacaine 0.25% continuously by motor pump for 3 days. We aimed to reach an analgesic spread from T5 to L2. In order to maintain sufficient analgesia, we had to increase the dosage from 19.2 mg/h on the evening of the operative day to 22.2 mg on the 3rd postoperative day. However, under these conditions the number of blocked segments decreased from 9.3 postoperatively to 6.6 on the 3rd postoperative day. Balanced anesthesia (isoflurane plus fentanyl) was given to the control group. Postoperatively, these patients received systemic analgesia on request (piritramide i.m., tramadol, or a simple analgesic). Vital capacity and pain score (10-point nominal analog score) were evaluated at 1, 8, 24, 36, 48, 60 and 72 h postoperatively. Blood gas analyses were taken at 1, 8, 24, 48 and 72 h, and chest X-rays were performed on the 1st, 3rd, and 8th postoperative days. Statistically significant results are indicated by "*" (P less than 0.05) and "*" (P less than 0.005) and "***" (P less than 0.001). The standard deviations were shown in cases of statistical significance. RESULTS. There were significantly lower pain scores by 1.0-2.2 points at 1, 8, 24 and 36 h postoperatively in the TEA group. Fourteen patients in group I required adjustments of the postoperative pain treatment regime: 6 had a unilateral epidural block; in 4 the catheter was withdrawn involuntarily. Up to the 2nd postoperative day, patients in the control group received systemic analgesics significantly more often. The vital capacity (percentage of preoperative value) was significantly higher in the TEA group than in the control group after 1 h (58.5% vs 51.7%) and 8 h (63.9% vs 56.7%). From the 1st postoperative day on there was no difference between both groups with regard to arterial blood gases, there was no difference in pCO2 between both groups 1 h postoperatively; it was, however, significantly lower in patients receiving bupivacaine at 8, 24, 48 and 72 h. There was no difference in pO2 at any time. The number of pathologic chest X-ray findings showed no difference between both groups. Looking especially for infiltrates, dystelectasis, atelectasis, and congestion, we also could not demonstrate any difference between the groups. (ABSTRACT TRUNCATED AT 400 WORDS)

Anastomosis, Surgical↗
PubMed1990

[The incidence and localization of colorectal adenomas and carcinomas in 4109 patients].

Findings at coloscopy were analysed retrospectively for 4109 patients (2257 women, 1852 men; mean age 62.3 [5-100] years) who had undergone a high coloscopy between 1982 and 1987. The aim was to determine the site of colorectal adenomas and carcinomas, as well as the relationship between adenoma and carcinoma. Main indications for the coloscopy were polyps at previous ambulatory endoscopy (15.4%), abdominal pain (11.3%) and changed bowel habits (11.2%). In 752 patients 1273 adenomas were detected and in 354 patients there were 374 carcinomas (333 solitary, 21 multiple). 21.6% of the adenomas and 21.4% of the carcinomas were proximal to the right flexure. In 75 of 177 patients (42.4%) with both adenoma and carcinoma both tumours occurred in the same intestinal segment. The severity of the dysplasia increased with increasing size of the adenoma. 52 adenomas (4.1%) already had evidence of malignant degeneration. But 7.7% of the adenocarcinomas were only 5-10 mm in diameter. The increasing incidence of right-sided tumour (right shift) compared with the hitherto known distribution pattern argues for total coloscopy as the primary procedure in the diagnosis of colorectal tumour.

Adenoma↗
PubMed1990

[The treatment of acute heart failure].

Acute cardiac failure is a symptom of a defined heart disease. Therapeutic efforts will only be successful, if the casual disease can be recognized. The clinical picture of cardiac failure is composed of a lot of pathophysiological and pathobiochemical developments. Some of them are still today completely or partly unknown. Each pharmacological intervention influences these regulations and reacts in every situation not only in the desirable but also in an unexpected way. Since we do not know the speed and direction of the developing cardiac failure, patients in NYHA II-III have to be sent to hospital. Starting the efficient treatment in time success can be expected without expensive diagnostics and monitoring techniques. But in some cases highly specialized equipment will be necessary and must be available.

Acute Disease↗
PubMed1990

Epidural analgesia in colonic surgery: results of a randomized prospective study.

Colonic surgery patients were studied to measure: the influence of continuous thoracic epidural analgesia (TEA) on a postoperative pain score, the time till onset of defaecation, blood loss, postoperative temperature elevations, rate of bacterial contamination of wounds and urine, and general surgical complications. Group I patients (n = 57) received general anaesthesia and TEA for the operation, followed by continuous TEA (0.25 per cent bupivacaine) for 72 h. Group II patients (n = 59) received general anaesthesia for the operation, followed by systemic analgesia on request. Significant beneficial effects of TEA in group I were demonstrated by lower pain scores in the first 24 h after surgery and earlier defaecation. However, there were fewer temperature elevations in group II. There was no significant difference between the groups in terms of positive bacteriological cultures, blood loss, need for postoperative mechanical ventilation and complications. However, there was a trend toward a higher rate of rectal anastomotic breakdown, increased blood replacement and intensive care therapy, and longer hospitalization in group I. These results do not suggest any significant beneficial therapeutic effect of continuous TEA in colonic surgery compared with a conventional systemic analgesic regimen. In selected patients (i.e. those with severe pain or those prone to develop postoperative ileus) continuous TEA may be beneficial.

Analgesia, Epidural↗
PubMed1990

[The 25-year existence of the Society of Gastroenterology of East Germany.I. 200 years of gastric intubation--its significance in the development of gastroenterology].

In an overview of the history of gastric intubation, the first use of a stomach tube in 1790 is reported, and the importance of the works of Kussmaul and his assistants as well as of Leube, Ewald, Boas, and Einhorn are specially stressed. With the development of new possibilities of investigation by means of the gastric tube gastroenterology began to emerge as a special field.

Gastroenterology↗
PubMed1990

[The 25th anniversary of the East German Society of Gastroenterology. II. Development of the concept of the gastroenterology subdiscipline].

As like as the introduction of the gastric tube inaugurated new possibilities of investigation, the concept of gastroenterology was rounded up by the study of physiology and pathology of gut, liver, bile-ducts, and pancreas. In form of X-ray examination, topographic gliding palpation, and endoscopy, gastroenterology gained valuable diagnostic methods. The development confirmed Boas' prediction that specialization in the end is for the benefit of total science.

Gastroenterology↗
PubMed1990

[25th anniversary of the Gastroenterology Society of East Germany. III. Organization of the sub-specialty gastroenterology].

The designation of "gastroenterology" was coined in 1896 by Hemmeter. In this article, the foundation of the first gastroenterological societies in the USA, in Japan, and in Poland is reported; the foundation of international societies of this specialty is mentioned too. The establishment of gastroenterological journals in Japan and in France is pointed out. Finally, the arrangement of the governmental acknowledgement of the sub-specialization in gastroenterology in the German Democratic Republic is described.

Gastroenterology↗
PubMed1989

[Effect of glycerol trinitrate on R-amplitude in patients with chronic ischemic heart disease].

In 50 patients with angiographically proven coronary artery disease (CAD) and typical angina pectoris, and in 35 patients with normal angiographic findings the amplitudes of R-waves (sigma R) in 36 precordial ECG leads were measured before and after application of 0.8 mg glycerol trinitrate (GTN). In 21 patients the examination was repeated after coronary bypass surgery. In the CAD-patients decrease of sigma R was shown after sublingual GTN: 19.5 +/- 26.4 mm (p less than 0.05). The control group showed a slight increase of sigma R: 18.7 +/- 16.2 mm (p less than 0.05). After bypass surgery the decrease of sigma R after glycerol trinitrate could no longer be shown. These result support the hypothesis that glycerol trinitrate is capable of reducing enhanced R-amplitudes in resting ECG due to ischemia.

Angina Pectoris↗
PubMed1987

[Effect of ventricular filling volume on the R-amplitude in the ECG].

Among others as cause of the sigma R-amplitude in the ECG changes of the ventricular filling and the stroke volume, respectively, the sympathetic tone and the coronary blood supply are discussed. Patients with absolute arrhythmia in atrial fibrillation as well as patients with extrasystoles represent model examples, in whom of the three factors mentioned above only the stroke volume is changed. Measurements of the sigma R-amplitude as well as of the Einthoven/Goldberger leads as well as of the Wilson leads on the same patient showed higher sigma R-values for the heart beats which were preceded by a short diastolic filling phase (rapid phase of the absolute arrhythmia, interpolated extrasystoles) than in the heart beats with previous long diastolic filling time (slow form of the absolute arrhythmia, extrasystole with compensatory interval). The findings considerably change in their size from patient to patient, however, they are statistically to be ascertained in their tendency. In the practical valuation deviations of the sigma R-amplitude values which do not correspond to this relation should be referred to other determinants of the R-amplitude.

Atrial Fibrillation↗
PubMed1987

[Coronarography findings following systemic short-term lysis of acute myocardial infarct].

In 50 patients with acute infarction who were admitted within 6 hours after the beginning of the complaints randomizedly an intravenous streptokinase short-term lysis or a conventional heparin phenprocoumon treatment was performed and 4 weeks later the results were objectified by coronarography and ventriculography. The patients were subdivided into 3 groups: 1. control group (without fibrinolysis), 2. early lysis (within 4 hours) and 3. late lysis (4-6 hours). Four weeks after the infarction the proportions of the open infarction vessels are approximately of the same size in all three groups, the functional results are best (end-diastolic pressure and kinetics of the cardiac wall) in the group of patients who underwent an early lysis. Successfully lysed patients with remaining residual stenosis must be regarded as particularly threatened by infarction and remain under special control (residual angina, ergometrically objectified exercise tolerance, perhaps coronarography) in the phase of rehabilitation.

Aspirin↗
PubMed1986

Scheduled reoperations (etappenlavage) for diffuse peritonitis.

Etappenlavage, a new concept of scheduled multiple laparotomies with abdominal lavage for diffuse peritonitis, has been in use since 1979. The purpose of etappenlavage is to ensure exclusion of the infected source, promote maximal elimination of toxic necrotic material, and allow prompt recognition of complications to effect immediate repair. Patients with diffuse peritonitis at high risk of developing multiple system organ failure (as assessed by high scores in the Peritonitis Index Altona and Acute Physiology and Chronic Health Evaluation classifications) were routinely reexplored on a daily basis until evidence of improvement or healing was noted. From 1980 to 1984, 61 patients with intra-abdominal sepsis were treated. Thirty-four cases were due to spontaneous perforation of an intestinal viscus, and 27 cases were secondary to postoperative infections. In 51 cases the primary process was present for more than 48 hours. A total of 235 etappenlavages were performed (mean, 3.9 per patient). In ten cases, additional bowel lacerations were noted and repaired at the second laparotomy. In the last 31 patients, closure with a zipper has facilitated reoperation. No drains were used. After definitive closure, primary wound healing was seen in 79% of cases. The overall mortality in this high-risk group was 22.9%.

Adolescent↗
PubMed1985

[Behavior of HDL cholesterol and the apoproteins A1 A2 and B in the central circulation in patients with coronary disease and genetically determined hyperlipoproteinemias].

Seven lipid parameters, including apoproteins A1, A2 and B were determined in blood from different parts of the cardiovascular system in two groups of patients one with and the other without coronary heart disease. In addition, HDL cholesterol levels were compared in patients with coronary heart disease and primary monogenic combined hyperlipoproteinaemia. None of the seven parameters showed significant differences in samples from the pulmonary artery (mixed venous blood) and the hepatic vein of the control and patient groups. The expected significant concentration gradient between the two vascular regions was confirmed in the groups with and without coronary heart disease. HDL components showed a contrary behaviour: the hepatic vein and pulmonary artery exhibited significantly lower values of HDL cholesterol in patients with coronary heart disease than in the controls, but this was not true for HDL apoproteins A1 and A2. Patients with coronary heart disease and primary hyperlipoproteinaemia showed a significant concentration gradient between the two vascular regions for total and HDL cholesterol. These observations reveal the importance of genetic disturbances of lipid metabolism, particularly the implication of various lipid fractions in the pathogenesis of atherosclerosis.

Apoproteins↗
PubMed1985

[Effect of glycerol trinitrate on the R amplitude in patients with chronic ischemic heart disease].

In 46 patients with coronarographically proved stenosing changes of the coronary vessels and typical angina pectoris as well as in 23 patients with coronary system without pathological findings before and after application of 0.8 mg glycerol trinitrate the sum of the R-amplitudes (sigma R) was determined with the help of a precordial mapping system comprising 36 leads. In 10 patients the examinations were repeated after application of an aortocoronary venous bypass. In the coronary patients after glycerol trinitrate a decrease of sigma R was shown. The control group revealed a slight increase of sigma R. The differences between the two groups were statistically significant. After bypass operation the decrease of sigma R under glycerol trinitrate practically disappeared. These results plead with reservation for the thesis that by glycerol trinitrate in coronary patients a reduction of the R-amplitude induced and enlarged by hypoxia may be achieved.

Angina Pectoris↗
PubMed1985

[Early and late results after conventional mitral valvulotomy].

In comparison to the commissurotomy on the open heart the conventional cardiovalvulotomy even nowadays is a recommendable alternative. It is burdened by an insignificant early lethality (1.8%). After 10 years the calculated survival probability is 87.6%. Using the ultrasound cardiography, the image intensifier radioscopy and in exceptional cases the invasive ventriculography to a higher degree those patients can be comprehended preoperatively, in whom a more intensive calcification of the mitral valves or a shrinking of the subvalvular apparatus is present. In these cases primarily the valvulotomy and a substitute of the valve on the open heart, respectively, is to be aspired to.

Adult↗