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Biomedical subjects

A Fritsch

Publications and source records attributed to A Fritsch.

At least 73 records · Page 4Linked to original sources
PubMed1982

[Resection of intrathoracic oesophageal cancer by blunt dissection without thoracotomy (author's transl)].

The resection of thoracic oesophageal cancer by blunt finger-dissection and stripping is a further palliative procedure at the disposal of the surgeon. This method represents an alternative to intubation or bypass without resection. The advantages are the better functional results and at least palliative removal of the tumour. This method should be used, however, if there is the possibility of carrying out radical resection from the oncological point of view, with the aim of curing the patient. The technical details are described and the indications and results discussed on the basis of six case reports.

Adenocarcinoma↗
PubMed1982

[Malnutrition and postoperative complication rate in cancer patients (author's transl)].

The nutritional status and skin reactivity of 82 cancer patients were determined before surgery and compared with the postoperative complication rate. The nutritional status of 47 patients was evaluated by weight, height, weight-loss, arm muscle circumference, triceps skin-fold measurements, serum albumin, pre-albumin, retinolbinding protein, tranferrin, and cholinesterase. In 35 patients protein catabolism was assessed by the urea production rate (catabolism greater than 15 g/d). Immunity was assessed by the total lymphocyte count and a skin reactivity test. Using these criteria, 55% of the patients were malnourished. Curative operations could only be carried out in 17.4% of the malnourished, but in 50% of the normally nourished patients (P less than 0.0001). Postoperative complications were increased in malnourished patients (47%) when compared with normally nourished patients (20%, P less than 0.05). In anergic and malnourished cancer patients no curative surgical treatment was possible. Due to the increased postoperative complication rate in malnourished cancer patients, nutritional assessment, including the determination of cellular immunity should be performed after admission.

Body Height↗
PubMed1982

[Esophageal carcinoma: a one-time procedure with stomach transposition as a therapeutic concept (author's transl)].

From December 1979 until October 1981 29 patients with malignant esophageal stenosis were treated in surgical department I of the University of Vienna. The tumor was located in 3 patients in the upper third of the esophagus in 17 cases in the middle, and in 9 in the lower third. The tumor stage permitted curative treatment (exstirpation of the esophagus) in 25 cases; in the remaining 4 patients bypass procedures were performed (retrosternal, antethoracic). In 6 cases the esophagus was excluded by blunt dissection without thoracotomy. For esophageal replacement the stomach was used in all cases in isoperistaltic fashion with cervical anastomosis. Of 13 cervical anastomotic leaks 11 healed spontaneously within 2 weeks. Five patients died, 3 of them because of respiratory failure. Using the stomach for replacement is a safe method with excellent functional results.

Esophageal Neoplasms↗
PubMed1982

Metabolic disorders in severe abdominal sepsis: glutamine deficiency in skeletal muscle.

The metabolic profiles of 14 patients with prolonged abdominal sepsis were analysed on the second day after laparotomy. The profiles of survivors were compared with those of non-survivors who died one to five days after the time of evaluation due to uncontrollable multiple organ failure. In the non-surviving patients plasma glucose and glucagon levels were significantly higher than in surviving patients. The plasma concentrations of phosphoserine, cysteine, valine, phenylalanine, and 3-methylhistidine were found to be significantly increased in non-survivors and their muscle tissue showed significantly decreased concentrations of glutamine, proline and lysine with increases in valine and leucine. A correct classification of non-survivors and survivors could be obtained from the plasma and muscle amino acid concentrations, the highest discriminant power being from muscle glutamine. In severe sepsis metabolic changes correlate with the outcome of the patients, and amino acid metabolism seems to be characterised by low concentrations of muscle glutamine and high levels of the branched chain amino acids possibly indicating an inhibited intracellular glutamine formation in muscle tissue.

Journal Article↗
PubMed1982

[The significance of bilateral diagnostic lymphadenectomy in thyroid cancer. Tactical operative procedure in the 1st intervention].

In 101 patients with differentiated (papillary n = 74, follicular n = 20, or medullary n = 7) thyroid cancer and lymph node metastases a modified radical neck dissection (unilateral or bilateral) had been performed. After the examination of the lymph nodes in several stations the retrospective analysis showed positive nodes within the internal jugular vein (= central reservoir) in 96% of all cases independent of the tumor site. Only tumors in dorsal parts of the thyroid or in the isthmus (4%) showed other modes of lymphatic spread. Therefore during the first exploration the bilateral excision of the lymph nodes of the internal jugular vein (= diagnostic lymphadenectomy) by Kocher' incision is representative whether an extensive lymphatic spread has occurred.

Adenocarcinoma↗
PubMed1981

[Hyperparathyroidism in chronic renal insufficiency new clinical and surgical aspects (author's transl)].

The therapy of secondary hyperparathyroidism in chronic renal disease has been improved by the availability of active 1-alpha-hydroxylated vitamin D derivatives. However, in cases with progressive secondary hyperparathyroidism which have not been brought under control conservatively, surgical intervention is still required. Total parathyroidectomy with autologous transplantation of parathyroid tissue in the forearm has recently been recommended as the optimum surgical approach to secondary hyperparathyroidism. Recent literature is reviewed and personal clinical experience is reported in this paper, followed by a presentation and discussion of the pathophysiology of hyperparathyroidism in chronic renal failure, various means of conservative treatment, indications for parathyroidectomy, surgical aspects and technique of cryopreservation, as well as a standardized therapeutic regimen for pre- and postoperative treatment with calcium and 1-alpha-hydroxylated vitamin D analogues.

Calcium↗
PubMed1981

[Alanine as a nitrogen sparing and gluconeogenetic substrate in the postoperative state (author's transl)].

UNLABELLED: An alanine infusion (90 mg/kg/h) for eight hours was administered to seven patients after cholecystectomy in order to investigate the influence of elevated plasma alanine levels on the postoperative metabolism. The following metabolites and hormone concentrations were analysed in plasma: glucose, urea, free fatty acids, ketone bodies, amino acids, insulin and glucagon. Compared to the pre-infusion values on the 1. postoperative day after an overnight fasting, the following changes were monitored. The plasma glucose concentrations reached a maximum after four hours of infusion (p less than 0.05). Of the amino acids, significant elevated levels were found for alanine (300%, p less than 0.001), glutamine (36%, p less than 0.05), and alpha-aminobutyrate (61%, p less than 0.01). The free fatty acids and ketone bodies concentrations decreased immediately after the onset of the infusion of alanine (p less than 0.05), the increased again during the last four hours of infusion. The secretion of insulin and also the secretion of glucagon were stimulated by the increased alanine levels. The stimulation of insulin reached a maximum after only five minutes, but the glucagon levels increased continuously until the end of the infusion. During the administration of alanine a nitrogen homeostasis was achieved, which was a significant improvement (p less than 0.001) when compared to saline infusions before and after the alanine infusion. CONCLUSIONS: (1) Postoperative increased plasma levels of alanine stimulate gluconeogenesis and reduce the plasma levels of lipolytic metabolites. The induced stimulation of insulin and glucagon is dependent on the duration of the alanine infusion for during extended infusion of alanine the insulin stimulation diminishes while the glucagon secretion continuously increases. (2) Alanine is a potent anabolic substrate in the immediate postoperative situation.

Alanine↗
PubMed1981

[Results of the distal splenorenal Warren shunt (author's transl)].

From May 1st 1977 until the end of December 1980 35 Warren shunts were performed upon unselected patients with portal hypertension and esophageal varices. According to the Child classification they were divided up into nine Child A, 21 Child B and five Child C cases. Five (14.3) postoperative deaths occurred, yet only one due to technical failure; three patients died of hepatic coma and one of a perforated gastric ulcer. As a postoperative complication recurrent bleeding occurred in six cases (17.1%). Not even one case of pancreatitis could be observed. Fifteen patients were examined at least 6 months after operation. The control angiography (n = 15 = 100%) revealed hepatofugal circulation in only one case; splenomegaly was reduced in ten cases. Only one patient showed clinical signs of encephalopathy, fourteen patients were able to return to their normal activities. The late thrombosis rate was very low-only one case; however, the possibility of conversion to a portocaval shunt remains.

Adult↗
PubMed1981

Results following surgical treatment of hyperthyroidism.

In the years 1965-1978 1,222 patients with different types of thyrotoxicosis underwent surgical treatment at the 1st Department of Surgery, University of Vienna. Wherever possible a sparing selective surgical approach was considered preferable: autonomous adenoma (45%) enucleation resection or subtotal uni-lateral resection; multinodular toxic goiter (36%) and Graves disease (5%) uni- or bilateral subtotal resection. The remaining 5% were rather rare types of goiter (recurrent goiter, thyroiditis, adenocarcinoma). Overall mortality due was 0.7%. One-hundred and seven patients (8.76%) were over 70 years old at the time of the operation. Post-operative death occurred in the group of patients with toxic adenomas (2.7%). Four-hundred and ninety-five patients were followed up from 3-13 years postoperatively: the rate of recurrent thyrotoxicosis was 4.4%, 4.8% of the patients with hypothyroidism. In this paper the significance of the rapid effect of surgery in cases of hyperthyroidism is discussed and the results are compared with findings in other studies.

Female↗
PubMed1981

Structure and expression of the hepatitis B virus genome.

By fusion of the hepatitis B virus (HBV) surface antigen (HBsAg) gene to that of the E. coli lac Z gene carried by a phage lambda derivative, expression of HBsAg antigenic determinants was obtained and carried by a 138,000 dalton fusion polypeptide. Such a protein could be ultimately useful for second generation vaccine production. HBsAg gene expression was studied in eukaryotic cells using the mouse L cell (tk-) system. Cotransformation using a plasmid carrying two copies of the HBV genome in a tandem, head-to-tail arrangement (pCP10) and the cloned HSV-1 tk gene resulted in the excretion of 22 nm HBsAg particles in the supernatant. No other HBV markers were detected. These particles possess the same characteristics as the human serum particles (morphology, diameter, density, antigenicity). The purified HBsAg particles from L cells were found to be highly immunogenic in mice. HBV mRNA transcripts from these cells were analysed by Northern blotting. A major species of 2,300 bases was detected. This was mapped on the genome by hybridization with subgenomic fragments and in the L cell system using a series of plasmid derivatives carrying insertions at specific sites in the HBV genome and assaying for HBsAg expression. Thus the HBsAg gene promotor was localized between positions 2,400-2,800. Indeed there is only one TATA like sequence in this region, starting at position 2,776.

Animals↗
PubMed1981

[Reduced levels of free amino acids in plasma and muscle tissue of patients with acute hemorrhagic necrotising pancreatitis (author's transl)].

Levels of free amino acids were analysed in plasma and muscle tissue of nine patients with acute hemorrhagic necrotising pancreatitis and compared with date from healthy volunteers. In the patient group the concentrations of threonine, serine, glutamine (p less than 0.001) and tyrosine (p less than 0.01) in plasma were found to be significantly lower than in the volunteers group, while increased plasma levels were found for 3-met-histidine (p less than 0.05). In muscle tissue the cytoplasmatic levels of glutamate, glutamine and histidine (p less than 0.001) and also of lysine, ornithine and arginine (p less than 0.,01) showed decreased concentrations. However tyrosine and phenylalanine had increased intracellular concentrations (p less than 0.05). It is concluded that (1) the patients in this study had a severely disturbed amino acid metabolism with extremely reduced levels of free glutamine in muscle tissue and (2) that the disturbed amino acid metabolism results from an acute catabolic situation of the patients, in which the reduced levels of free amino acids may indicate an impaired nutritional state.

Acute Disease↗
PubMed1980

[New aspects on diagnosis and therapy of primary hyperparathyroidism (author's transl)].

26, out of them 20 surgically proven cases of primary hyperparathyroidism are presented. The value of different laboratory, radiographic and scintigraphic analysis is examined. The estimation of calcium and phosphate in serum, the iPTH-determination and fine detail hands radiographs were found to be sufficient to establish diagnosis and indication for surgery. The chloride/phosphate-ratio proved valuable in comparative statistical analysis between pHPT and two control groups. Venous sampling at present seems to be the superior method for preoperative localization of parathyroid disease. It should be performed before second surgical intervention in the cervical region, in elderly (more than 60 years old) and risk patients. Early diagnosis and therapy of pHPT is important as pHPT is a chronic disease with many organ complications. The value of calcium-screening in an age group between 40 and 60 years is discussed.

Aged↗
PubMed1980

[The definition of clinical catabolism by the urea production rate and its correlation with cellular immunity].

In 38 preoperative patients the production of urea was estimated and the cell-mediated immunity was measured. 10 patients were catabolic and had negative skin tests, all of them were inoperable. 15 patients were catabolic and had positive skin tests five patients were inoperable. 12 patients were not catabolic and had positive skin tests, two were inoperable. One female patient was not catabolic and had negative skin tests, but was operable. The catabolic state can be assessed by the urea production rate and you can give prognostic and therapeutical references in correlation with the delayed hypersensitivity.

Body Weight↗
PubMed1979

[Surgical treatment of acute and chronic pancreatitis].

The acute haemorrhagically necrotizing pancreatitis demands, as a rule, an operative sanation of the local complications. The partial or total pancreatectomy during the first days for preventing the late local complications is loaded with an operation mortality from 35 to 60%. If the early operation is limited to the removal of recognizable and demarkated necroses, the mortality decreases to 30 or 35%. In principal preference of a retarded date of operation and in consequent sanation of local changes, if necessary in repeated interventions, the mortality is between 20 and 33%. The surgical treatment of the chronic pancreatitis shall concerning indication to operation, tactics and kind of intervention always take into consideration an existing abuse of alcohol. Long-term controls revealed that the most essential life-limiting factor is a further existing alcoholism. The more parenchyma is removed in operation the higher is the late mortality.

Acute Disease↗