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Biomedical subjects

A Fritsch

Publications and source records attributed to A Fritsch.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Clinical experiences following the surgical therapy of asymptomatic, oligosymptomatic and symptomatic parathyroid gland hyperfunction].

Depending on their symptomatology 152 cured (i.e., normocalcemic) patients with surgically proven primary hyperparathyroidism (pHPT) showed typical symptoms preoperatively. Besides hypercalcemia and elevated parathyroid hormone levels, 15 patients suffered only from hypertension and/or diffuse osteoporosis and/or complaints caused by the hypercalcemic syndrome (oligosymptomatic patients). Nine patients had no complaints (asymptomatic patients). The long-term clinical course of all patients was analyzed up to 22 years. Although the formation of urinary calculi was stopped in 94% of cases, a deterioration of renal function and hypertension was seen in symptomatic (12.5% and 9.2%, respectively) and oligosymptomatic patients (6.7% and 13.3%, respectively). Renal function and hypertension were unpredictable despite normalization of the hyperactive parathyroid metabolism and were of decisive prognostic significance; 6% died of acute or chronic renal failure, or of the consequences of hypertension. Multiple bone lesions, even large, healed functionally and were of no prognostic significance. In the majority of symptomatic patients gastrointestinal manifestations held postoperatively, but two patients died of acute pancreatitis without gastrointestinal complaints preoperatively. Almost all symptoms of the hypercalcemic syndrome disappeared immediately and permanently in symptomatic and oligosymptomatic patients. No deterioration of renal function and no elevation of blood pressure was observed in cured asymptomatic patients postoperatively. Immediate surgical treatment even in asymptomatic patients may have avoided complications of chronic renal failure or of hypertension. As soon as organic manifestations, even in a mild form, have been established, it seems impossible to predict the course and to prevent an unfavorable clinical outcome.

Bone Diseases, Metabolic↗
PubMed1986

Variations of intramolecular ligation rates allow the detection of protein-induced bends in DNA.

A method requiring minute amounts of DNA and protein is proposed for the detection of DNA bending in solution. Local bending, induced by the binding of a protein at its stereospecific site, must increase the probability of circularization of short DNA fragments and hence the rate of formation of the corresponding minicircles. This effect should be highly sensitive to the location of the protein-binding site on the DNA fragment. Simple controls allow other possible interpretations to be ruled out. The deformation due to the cyclic AMP receptor protein when it interacts with its stereospecific site at the lactose control region is studied by this method. It is shown in this case that untwisting is negligible and bending significant. Further measurements are required to assess the actual value of the radius of curvature of the DNA double helix in this complex.

Base Sequence↗
PubMed1986

Metabolic changes of patients with acute necrotizing pancreatitis.

We carried out metabolic investigations of 26 patients with severe forms of acute pancreatitis which were evaluated by an organ score. We formed six groups from this data: survivors and deceased in the first week, the second week, and after a further two weeks of illness. The amino acid patterns in plasma and muscles deviated considerably from normal at all times in both the surviving and the deceased patients. In particular, changes in the concentrations of branched-chain amino acids and glutamine in the muscle tissue have a prognostic value. In the range two to four (normal range: above 20), the factor glutamine/VAL+LEU+ILE characterizes a prefinal condition in non-survivors. This factor increased in patients recovering from the illness from 6 to values over 20. Non-survivors (NS) had higher plasma levels of glucose and glucagon compared to surviving patients. Plasma glucagon concentrations in NS reached levels up to 4,000 pg/mL at admission, which declined gradually to normal range during the course of the illness.

Acute Disease↗
PubMed1986

Surgical treatment of distant metastases in differentiated thyroid cancer: indication and results.

A total of 45 patients have received surgical treatment for distant metastases in 41 follicular and four papillary carcinomas. Fifty-four metastatic lesions were removed. In the majority of cases (n = 25, 46%), surgical intervention was indicated on the basis of oncologic data (reduced administration of radioiodine). Sixteen patients (30%) underwent surgery to relieve pain, and 13 other patients (24%) had surgical treatment of pathologic fracture. At the time of surgery, 29 patients (64%) had only one resectable metastasis, while 16 patients (36%) had further nonresectable metastases (six in the bone, 10 in the bones and lungs). In the course of 53 operations, metastases were resected from bone in 46 cases, from the lungs and greater omentum in two cases, and from the skin, suprarenal gland, pleura, and intra-abdominal lymph node in one case each. A total of 25 metastases (17 bone, eight soft tissue) could be removed by resection. In 16 patients, the resulting bone defect was filled with bone cement after resection of the metastases. Osteosynthesis was necessary in another six cases, while seven required the implantation of an endoprosthesis. Thirty-eight patients died between 1 and 136 months after surgical treatment. Twenty-six (58%) died of their primary disease after an average 49.3 months, seven (15%) died with their carcinomas of other causes after an average of 12 months, and five (11%) died intercurrently after an average of 16 months. Seven patients (15%) are still alive after 12 to 264 months (average, 99.3 months); four of them are without recurrence and three have metastases. Five of these patients exhibit normal activity, while the activity of the other two is limited by the progress of the carcinoma or as a result of surgical treatment. The estimated cumulative survival rate (Kaplan-Meier) was 44.8 +/- 11.2% for 5 years and 32.7 +/- 11.0% for 10 years after removal of a solitary metastasis. Analysis of these patients shows that the surgical removal of resectable metastases can be a valuable complement to nuclear medical therapy. The complicated surgical treatment of metastases is justified by the favorable effect it has on prognosis and on the patient's quality of life.

Adenocarcinoma↗
PubMed1985

[Regional results of human liver transplantation in Vienna].

21 cases of transplantation of the liver are analysed for indication, anaesthesia, operative management, anhepatic period, immunological therapy and specific post-operative problems (jaundice and rejection episodes). Causes of death are noted and prediction of survival gives a rate of 55%/1st year in the 17 patients operated on since 1982 under a standardised management schedule. The transplantation programme in Vienna provides routine treatment for otherwise untreatable primary (57% cases) and secondary metastatic (14%) tumours of the liver, and, in the second place, for end-stage hepatic cirrhosis (14%) and certain rare liver diseases (14%).

Adult↗
PubMed1985

[Reconstructive operation following duodenopancreatectomy].

Based on 203 operations of our clinic, the most frequent procedures of reconstruction after duodenopancreatectomy are analysed and compared with the results published in the literature. The surgical management of the remaining pancreas carries a high morbidity. An anastomosis should only be attempted with a fibrotic organ. In presence of a soft organ either a ligature of the duct or its open drainage is advisable. A total pancreatectomy for merely technical reasons is unacceptable.

Ampulla of Vater↗
PubMed1985

[Problems of blood replacement in liver transplantation].

Liver transplantation often is accompanied with massive bleeding-blood losses up to 125 I have been reported. A survey of 21 transplantations describes the management for substitution of blood components. After an initial series of 18 patients including 4 cases with blood losses exceeding 100 units of blood, an attempt was made to optimize coagulation in 5 cases with NT-values below 40% by preoperative plasmapheresis. Platelet transfusion was performed in all cases with platelet values below 120 000. These measures led to a significant reduction in blood units substituted during the last 9 transplantations.

Adult↗
PubMed1985

[Liver trauma].

Explore the source record for details and available documents.

Adult↗
PubMed1985

Transsternal operations in thyroid cancer.

Large thyroid carcinomas extending into the anterior mediastinum were removed from six patients by a transsternal surgical approach (partial median sternotomy). Transcervical mediastinal dissection offers obscure exposure and therefore entails the risk of the operation not being radical. The transsternal procedure was used as an alternative to remove affected lymphatic and fatty tissue from an additional nine patients. Sternal metastases were extirpated from 10 patients. Irrespective of the stage of the tumor, the indications for a transsternal approach to onocologically radical extirpation of tumors and mediastinal lymphatic fatty tissue should be more liberal, particularly with differentiated and medullary thyroid carcinomas. The prognosis for differentiated carcinomas is improved by radioiodine treatment, and optimal conditions for this therapy are ensured by the most radical possible removal of the tumor with its affected lymph nodes and sternal metastases. In the case of mixed differentiated/anaplastic and medullary carcinomas, this operative procedure ensures favorable conditions for other adjuvant forms of therapy. Although it was not possible to extend the life expectancy of patients suffering from anaplastic carcinomas, their quality of life was at least improved by the prevention of mechanical dyspnea caused by the mediastinal tumor.

Adult↗
PubMed1984

Proteinases and inhibitors in plasma and peritoneal exudate in acute pancreatitis.

Examination of the peritoneal exudates of 12 patients with acute pancreatitis revealed high activities of pancreatic lipase and amylase. The immunologic levels of the plasma-derived inhibitors alpha 1-antitrypsin, antithrombin III and alpha 2-macroglobulin in the peritoneal exudates were not markedly different from those of the plasma. However, the inhibitory capacity of alpha 2-macroglobulin, the main inhibitor of human pancreatic trypsin in the exudate, was almost completely depleted when measured by an enzymatic method. Furthermore, spontaneous fibrinolysis occurred in 6 out of 13 exudates applied to plasminogen-free fibrin plates, indicating the presence of free proteinase. This fibrinolytic activity might be inhibited by exogenous alpha 2-macroglobulin or aprotinin (Trasylol, Bayer AG).

Acute Disease↗
PubMed1983

[Lack of stimulation of nitrogen retention and plasma protein synthesis due to increased intake of branched-chain amino acids].

In a randomised study the influence of 3 different amino acids (AA) solutions on nitrogen balance, plasma protein synthesis, and plasma and urine AA pattern was investigated in postoperative (p.o.) cancer patients. The patients in group I received a balanced AA solution designed especially for p.o. patients with 10 percent branched chain amino acids (BCAA), those in group II a solution with 60 percent BCAA and those in group III a solution with 67 percent alanine. All patients received the same amount of nitrogen (0.16 g/kg BW/day) and energy (2.p.o. day: 80 kJ/kg BW/day; 3.-5. p.o. day: 160 kJ/kg BW/day) with a 3:1 ratio of carbohydrate to fat calories. No difference was observed between the three groups for mean daily nitrogen balances, however, the cumulative nitrogen balance of group I (-4.5 +/- 3.6 g) was significantly (p less than 0.05) improved compared to group II (-12.2 +/- 4.2 g). The p.o. decreased concentrations of short-life plasma proteins (prealbumin, transferrin, retinol-binding protein) increased until the end of the study period without any statistic differences between the three groups. On the 2nd p.o. day especially the gluconeogenetic AA were decreased in all patients, but were nearly normal in all patients on the 5th p.o. day. In conclusion the increased administration of BCAA neither improved nitrogen retention nor plasma protein synthesis and does not seem advantageous in the postoperative total parenteral nutrition.

Aged↗
PubMed1983

Changing mortality of peptic ulcer disease in Germany.

This study examines mortality of gastric ulcer and duodenal ulcer in the Federal Republic of Germany during the period 1952-1980. The data originate from tabulations of the German Federal Office of Statistics. In women, mortality due to gastric and duodenal ulcer increased; in men, duodenal ulcer mortality remained constant and gastric ulcer mortality declined. Overall mortality of peptic ulcer declined from 7.0 to 6.0 deaths per 100,000 inhabitants and year. Since 1952, the average age at death has increased for both ulcer types and sexes. This was due to an increase of mortality in the older age groups; in men, mortality concomitantly decreased in the younger age groups. Women died of peptic ulcer older than men. In the 1950s none but the group of women gastric ulcer patients died as old as the nonulcer subjects, all other groups of peptide ulcer (female duodenal ulcer, male gastric ulcer and duodenal ulcer) died younger than the nonulcer subjects. In more recent years, both male and female gastric ulcer and duodenal ulcer patients died at the same age or even older than nonulcer subjects. It is concluded that peptic ulcer has changed from a lethal disease of the mid- and old-age groups to a lethal disease predominantly in the old- and very-old-age groups. The time-course of peptic ulcer mortality is different in the Federal Republic of Germany from what has been described in other Western States, especially in the United States and England. This difference suggests that, similar to healing, mortality of peptic ulcer is characterized by geographic variations, and that the time-course observed in one country does not necessarily hold true for other countries.

Adolescent↗
PubMed1983

[The significance of the 5th gland as a cause of primary hyperparathyroidism. Case report and review of the literature].

Of 140 patients surgically treated for primary hyperparathyroidism one patient had persistent hypercalcemia due to an abnormal and ectopic fifth parathyroid gland (0.7%). The possibility of an abnormal fifth gland as the cause of primary hyperparathyroidism should be considered when four glands of normal size and histology have been found in the neck, and of such a gland should be thought in all patients with diffuse hyperplasia after subtotal parathyroidectomy suffering from persistent hyperparathyroidism. The fifth gland is usually found in the lower neck or upper mediastinum, frequently within the thymus. If present, it should be excised by transcervical thymectomy during first operation. In reoperations sternal splitting should be performed.

Adenoma↗