Biomedical subjects
A Neumayr
Publications and source records attributed to A Neumayr.
[The influence of parathormone on blood flow of the hepatic artery after portocaval end to side shunt (author's transl)].
Compensatory increase of hepatic artery blood flow follows protosystemic shunt surgery. Parathormone stimulates significantly blood circulation through the hepatic artery. This stimulating effect is used to test vasodilative capability of the hepatic artery prior to shunt surgery. We report our findings on a additional increase of the hepatic artery blood flow under Parathormone. A portal-caval end-to-lateral shunt surgery caused an increase in blood flow 71 percent on an average compared to the basic value. After administration of Parathormone we observed an additional increase of 13,5 percent. This result indicates, that the hepatic artery will be dilated by Parathormone after a portocaval shunt too.
[Conservative therapy of peptic ulcer].
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[Endoscopic-diagnostic problems in malignant lymphoma of the upper intestinal tract].
A retrospective analysis of 79 patients with malignant lymphoma (ML) of the upper gastrointestinal tract in a series of 842 endoscopically verified malignant tumours is presented. There was a significant difference between carcinomas and ML: in the latter, macrosopic diagnosis was correct in more than 90%, while histologic evaluation of forceps biopsies was false negative in 23.2%. Guided brush cytology provided an unexpected gain of information in 35%. Gastroscopy should be performed even in symptomfree patients with ML. Errors of histologic evaluation can be avoided by wire loop biopsy. Extragastric involvement of ML was successfully demonstrated in 93% by 67-gallium scanning.
[Clinical usefulness of 67 gallium scintigraphy in malignant lymphoma].
The results of 67-gallium scanning in 644 patients with histological confirmation of diagnosis are presented. 67-Ga uptake was recorded in 93.3% of 312 malignant and in 85.8% of 332 benign conditions. In 89.4% 67-Ga was successful in distinguishing between malignant and benign disorders. In 58 of 62 lesions due to malignant lymphoma 67-Ga uptake was seen. 67-Ga scanning is an indispensable tool for early diagnosis of hepatoma (n = 80) and an important non-invasive staging procedure for lymphoma patients which complements exploratory laparotomy.
[Newer knowledge on viral hepatitis (author's transl)].
After the discovery of the "australia antigen" the pioneering pace for the detection of the socalled "Dane-particles" identical with the complete infectious hepatitis-B-virus has been done. These Dane-Particles consist of three different antigens: HBsAg, HBcAg and HBeAg and these specific antigens give valuable diagnostic and prognostic indications predominantly concerning the infectivity of a person suffering from acute or chronic hepatitis B or of a person identified as a chronic carrier. This has impact on blood transfusion services and is of considerable significance for persons being in close contact with a carrier--particularly if he is representing a socalled "core type", whereas the infectivity of the "surface type" carrier is thought to be very low. In the past years important advances could be performed in the study of the hepatitis A. A number of serologic tests have been developed including the determination of the IgM--antibody enabling us a precise diagnosis of the acute period of hepatitis A. Finally the exact differentiation between hepatitis A and hepatitis B revealed the presence of a third type of viral hepatitis, characterized for the present as "Non A non B hepatitis". Just now a radioimmunoassay could be developed for detection of the corresponding antigens of this disease, called now hepatitis C. Meanwhile at least two different clinical entities could be observed. Normal human immunoglobulin may prevent or attenuate an infection with hepatitis A--probably with hepatitis C too. It appears that specific hepatitis B hyperimmunoglobulin with high antibody-titers is useful for post-exposure prophylaxis of single acute exposures. Considerable progress is being made in the development of subunit vaccines against hepatitis B for active prophylaxis, but for general application some scruples still exist.
[Medical treatment of acute pancreatitis (author's transl)].
For medical treatment of acute pancreatitis, only very few effective measures can be recommended. To put the gland to rest, the patient has to be maintained in a fasting state. Additionally, Cimetidine should be administered intravenously. A properly functioning nasogastric tube is an efficacious method of inducing the pancreas to rest. To maintain an adequate blood volume and in protecting the microcirculation of pancreas, the use of intravenous fluids that include colloids, is important. Sufficient replacement of electrolytes evidently seems to be indicated. Drug therapy consists of the administration of analgetics and of an adjuvant use of calcitonine or somatostatine, for reducing the pancreatic flow. Aprotinine given early and in sufficient amounts is to be recommended. Antibiotic prophylaxis should be utilized only when pancreatitis associated with biliary tract disease or postoperative pancreatitis seems to be apparent. Whenever systemic hypotension and shock occurs, plasma or dextran, together with sufficient but controlled amounts of intravenous fluids, must be administered. In acute renal failure dopamine has been used with success. Peritoneal dialysis or hemodialysis as an ultimate measure, has to be considered. In the case of respiratory distress syndrome, oxygen by nasal catheter must be applied.
[Diagnosis of liver and biliary diseases with 99mTc-Hepatobida (author's transl)].
Application of 99mTc-Hepatobida has turned out to be a convenient diagnostic screening method in liver and biliary disease. Side effects are unknown, thus patients with iodine allergy or other forms of allergy, as well as patients harboring autonomous adenomata of the thyroid, and severely ill patients will tolerate this substance well. 99mTc-Hepatobida may be applied even in the presence of highly elevated levels of plasma bilirubin and thus will yield diagnostic results in all forms of hepatic disease if findings are monitored repeatedly. In addition screening with 99mTc-Hepatobida will in some cases suffice to establish the diagnosis and thus forgo more complicated diagnostic procedures.
[Pathogenesis, clinical manifestations and treatment of the "postgastrectomy-syndrome" (author's transl)].
The incidence rate of complications in patients, who underwent stomach resection as surgical treatment procedure is rather high (20%). Postprandial syndromes (dumping syndrome, lactose-intolerance, afferent loop-syndrome), malabsorption syndromes (anemia, osteopathia, steatorrhea, protein deficiency) and late organic manifestations (anastomotic and suture ulcers, retrograde intussusception, gastric-stump carcinoma) were usually summarized as "postgastrectomy syndrome". A review of pathogenesis, symptoms and therapeutic approach for the various postoperative disorders is given. Selective proximal vagotomy as the surgical treatment procedure of choice is emphasized.
[Diagnosis experiences in 188 patients with primary liver cancer].
In Austria primary carcinoma of the liver (plc) is no rare malignancy. From 1973 and 1979, in our department, 188 patients with plc had been registered. By separate evaluation of the results of alpha-1-fetoprotein (AFP)-determination and 67-gallium-liverscintigraphy, a diagnostic accuracy of 81.6%, resp. 78. % could be demonstrated. By combination of both methods, a correct diagnosis of plc was obtained in 95%. Based on the promising results of lobectomies performed in patients with plc, therapeutic nihilism is not longer justifiable.
[The value of gastroscopy in the early diagnosis of stomach neoplasms].
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[Testing the dilatation capacity of the hepatic artery with parathyroid hormone].
In portosystemic shunt surgery, there still is a lack of correlation between various preoperative hemodynamic measurements and the postoperative clinical course of patients. The magnitude of post-shunt increment in hepatic arterial flow was found to be directly related to long term prognosis. To predict the arterial response for selecting patients for shunting, we tried to use a new non invasive method: Arterial and portal components of total liver blood flow were determined quantitatively by "Sequential hepato-splenic scintigraphy". Dilatation capability of the hepatic artery, was tested by means of the hemodynamic action of Parathyroid hormone (PH). PH has been found to induce a large and exclusive augmentation of hepatic arterial blood flow. We were able to document a statistically highly significant increase in hepatic arterial flow following i. v. applications of PH. The extent of arterial increment appears to be dependent upon the degree of entrapment of the hepatic arterioles by the fibrous tissues of cirrhosis.
[Clinical significance of the combined determination of alpha 1 fetoprotein, lipoprotein X, and hepatitis B antigen and antibodies].
In a four-year prospective study 4000 patients of a gastroenterologic and hematologic department were screened for alpha1-fetoprotein (AFP), lipoprotein-X (LPX), and hepatitis-B antigen and antibody (HBsAg, HBsAb). Only histologically confirmed results were used for the evaluation of this study. Liverscintigraphy using 99m-Tc-S-colloid was performed as the morphological examination. 85% of focal liver diseases were seen as space-occupying lesions in the radioscan. The interpretation of their dignity was performed with success by means of 67-galliumcitrate with an overall diagnostic accuracy of 90%. With the methods, presented in this paper, positive results of AFP-LPX-, HBsAg- and HBsAb-determinations mean, without exception, an informational gain. In 1241 of 4000 patients, 1417 positive results were recorded. In combination with two-step radionuclide-scintigraphy as the morphological element of our screening procedure, focal diseases of the liver are no longer a diagnostic problem. Additional information of diagnostic relevance is expected in about 35% of all diffuse hepatocellular diseases.
[The effect of dopamine on the renal function in dogs with chronic ligation of the common bile duct (author's transl)].
The influence of dopamine on glomerular filtration rate (GFR), renal plasma flow (ERPF) and urinary sodium excretion was investigated in dogs before and after a chronic bile duct ligation for a period of 16 days. 1. Dopamine (4 microgram/kg/min.) leads to an increase of GFR, ERPF and urinary sodium excretion. 2. There was no change of GFR and ERPF after bile duct ligation. Urinary sodium excretion was decreased. The decrease was, however, not significant (0.05 less than p less than 0.1). 3. After bile duct ligation dopamine induced increase of GFR and ERPF was of the same order as observed in the preoperative period. Compared with the preoperative values for sodium excretion the dopamine effect was lower (p less than 0.05). The present investigation shows that dopamine is worth trying in cases of obstructive jaundice accompanied by acute renal failure.
Endoscopic treatment of stenosized anastomosis after gastrectomy.
Reflux-induced strictures of anastomoses are well-known complications of total gastrectomys. Since 1974 ten patients with postoperative dysphagia were treated by endoscopy. The enlargement of the obstructed anastomotic ring was done with the unopened diathermy-snare. This simple and uncomplicated method removed the heavy complaints of the patients immediately; no complications were registered until now. Follow-up was 3 to 32 months.
[Value of splenoportography with 99mTc-pertechnetate (author's transl)].
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[Blood perfusion of the liver under physiological and pathological conditions - mechanisms and clinical importance (author's transl)].
It has been shown, that measurement of total hepatic blood flow is not of great diagnostic value: normal functioning of this organ is dependant on blood flow only to a minor degree and diseases of the liver usually go along with only minor changes of total blood flow. There are two reasons for this phenomenon: 1) liver cells are able to extract oxygen from blood exhaustively 2) regulation of hepatic arterial blood flow is almost autonomous and compensates well for changes of portal venous blood flow and changes of extrahepatic arterial circulation. Thus normal hepatic arterial blood flow is the most important factor as far as prognosis of shunt operations is concerned. The manifestation of portal-systemic encephalopathy in addition depends not only upon the amount of portal-venous blood bypassing the liver, but also upon arterial blood flow, since urea synthesis is located primarily in zone 1 of liver microcirculation, which is supplied in the first line by the hepatic arterial system. Reduction of portal venous blood flow plays a rather minor role as compared to reduction of arterial flow; it does mean however a considerable loss of important nutritive and trophic factors for the liver.
[Methods for the demonstration of splanchnic hemodynamics].
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