[Bronchial rupture and perforation. Diagnosis, treatment, prognosis (16 cases)].
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Biomedical subjects
Publications and source records attributed to A Meyer.
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Implanted synthetic materials have to be included into the differential diagnosis of sepsis. This paper reports on a case of sepsis caused by Staphylococcus epidermidis in connection with a Spitz-Holter shunt. The interval between the implantation and the recognition of the endoplastitis took 4 years. The attempt of an antibiotic sanitation had no results. The fitness for work could be restored by removal of the shunt and reimplantation.
From October 1979 to April 1982 forty two women with previous tubal ligations presented themselves at the Centre for Obstetrics and Gynaecology in Giessen with a high desire of restoration of their fertility. With questionaires and partly structured interviews these women were evaluated at the Centre for Psychosomatic Medicine in Giessen. The results largely confirm previous findings known in the literature regarding the background of tubal ligations in women with desire for restoration of fertility. Most of the patients (N = 37) had the sterilization performed under conditions which are known to have an adverse prognostic effect such as sterilization for medical indications in ten women, sterilization during a marital crisis in eighteen women, and sterilization in conjunction with a therapeutic abortion, confinement or a gynaecological operation in twenty eight women. The psychodynamics of women with a desire for restoration of fertility show two main groups. First: in twenty five women a sterilization and desire for restoration of fertility are an effort to resolve a specific conflict in their marital relationship inasmuch as a new infant should serve as a bonding function and documentation of the new partnership. Second: in sixteen patients sterilization and desire for refertilization are a symptom of an unresolved conflict of the role as woman and mother. The new infant or the restoration of fertility should eliminate the narcistic deficit suffered by the sterilization or restore the self esteem which suffered a female identity blow by the sterilization. Implications of these findings for the counselling practice are discussed.
Previous studies have reported a therapeutic window of 0.8 to 2.0 ng/ml within which clonidine exerts its antihypertensive effect. This study was designed to investigate whether there was any loss of blood pressure control when plasma clonidine concentrations exceeded this window owing to its accumulation in renal insufficiency. The results indicate that clonidine concentrations of up to 30 ng/ml in patients with end-stage renal disease (ESRD) can be associated with a maintenance of blood pressure control. It remains to be learned whether this phenomenon of high concentrations and control of blood pressure in our ESRD patient population may be related to altered (decreased) peripheral alpha-receptor sensitivity and inability to develop vasoconstriction. There is precedence for autonomic imbalance and altered tissue sensitivity in ESRD.
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Alpha-D-Mannosidase (EC 3.2.1.24.) was purified to homogeneity from adult rat brain. The enzyme, of apparent molecular weight 397,000, appears to be formed of subunits of molecular weight 120,000 made of two protomers (62,000) bound by disulfide bridges. Isoelectric focusing gives two bands, of pI 5.40 and 5.15. Both isoenzymes seem to have the same pH curve (a small peak of activity at pH 4.5 and a maximum of activity around pH 6.0). These two isoenzymes are immunologically related.
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In 58 patients among 166 cases of esophageal trauma who developed an intrathoracic complication, the cases are studied of 26 esophageal instrumental perforations, 10 vomiting or effort ruptures, 14 ingestions of foreign bodies (observed in a surgical unit), 5 corrosions by acids or alkalis and 3 esophageal injuries after closed chest trauma. Some complications occurred or were recognized after a delay of 1 to 16 days. In 22 cases treated after the second day, 9 patients survived and in 18 cases treated after 4 days, 6 patients nevertheless survived. The outcome is difficult to assess initially but hope must be entertained even in the most severe cases. The discussion focuses on symptoms and signs, modes of clinical presentation and the different types of fistulas (4 intramural, 31 esophago-mediastinal, 15 esophago-pleural, 5 esophago-tracheal, 1 esophago-aortic, 1 esophago-pericardial). Treatment varies with the delay in diagnosis and is often complex. In cases requiring reoperation the mortality is very high.
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In the first part of the paper supplementary information on Flechsig's personality and his attitude to work is given which had not been sufficiently appreciated in English biographical notices. This is followed by translated excerpts from "Gehirn and Seele", published in 1896, in which Flechsig introduced his myelogenetic localization of the cerebral cortex. The second part is mainly a review of recent advances in neuroanatomical and neurophysiological research within those cortical regions in which Flechsig had been interested. A comparison between recent advances and Flechsig's work demonstrates that Flechsig had definitive ideas on the solution of some of the outstanding problems but had been unable to resolve these with the techniques available at his time.
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