Biomedical subjects
Publications and source records attributed to B Vogt.
Successful embolectomy of the superior mesenteric artery in a 75-year-old man is reported. The decisive points in early diagnosis are discussed and the specific diagnostic methods for the correct decision are presented. The fulminant evolution of the disease leaves little time in which to decide. Early embolectomy brings about complete cure. It is a life-saving operation and there are no contraindications.
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We used the bovine carotid artery (BCA) as arteriovenous shunt for hemodialysis in 11 patients since December 1975. We discuss our results. For implantations we used two methods: straight and loop grafts. The BCA have many advantages as: good access for punction, anticoagulation not permanently necessary, volume of shunt more than 250 ml/min; the disadvantages are: increased tendence to infection and thrombosis. Thrombosis in BCA can be easier removed than in other grafts. Reduction of the complications incidence is possible with an accurate technique. We think that the BCA is very useful when Cimino-Brescia fistula has failed or is unavailable; we prefer BCA to a saphenous arteriovenous graft in these situations.
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Isoproterenol-activation of the adenylate cyclase system of human fat cell ghosts was markedly inhibited by dihydroergotamine which had no effect on basal and NaF-stimulated enzyme activity. Our results indicate that the antilipolytic action of this substance in human adipose tissue is probably due to inhibition of catecholamine-sensitive adenylate cyclase activity.
The effects of beta-adrenergic agonists such as isoproterenol, norepinephrine and epinephrine upon the adenylate cyclase activity of human fat cell ghosts were tested, each alone and in combination with the beta-blocking agent propranolol. Saturating concentrations of these agents showed a 2-6.5-fold increase of enzyme activity without addition of any artificial cofactors. Isoproterenol was more potent in stimulating the enzyme system than epinephrine and nor-epinephrine. Propranolol caused a dose-dependent rightward shift of the log-dose response curve of these beta-adrenergic agonists. The assay of human fat cell adenylate cyclase in vitro may provide a simple anc convenient assay system for the screening of beta-adrenergic drugs of potential therapeutic importance.
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The effects of chlofibrate on the adenylate cyclase system of human adipocytes were studied. Clofibrate reduced basal as well as hormone-NaF)stimulated adenylate cyclase activities to about the same extent (45% inhibition at 1 mg/ml clofibrate). The relative extent of hormonal stimulation was not altered by this compound. The inhibitory action of clofibrate was non-competitive with respect to the substrate ATP and cofactors (Mg2+-ions). Inhibition of enzyme activity was detectable after 2.5 min. Our results suggest that the antilipolytic activity of clofibrate is mediated via inhibition of the catalytic subunit of the fat cell adenylate cyclase.
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In a series of 18 patients delayed embolectomy of the limb was performed 8-63 days after embolism had occurred. Three patients died (2 of them after amputation), and 7 limbs were amputated after surgery. In 10 instances blood flow was fully restored by the operation. Analysis of the 18 cases leads to the conclusion that the success of delayed embolectomy where neuromuscular function is intact depends primarily on surgical technique. Direct embolectomy by local or regional exposure of the obstructed arterial level is shown to produce better results than conventional (distant) balloon catheter embolectomy by proximal incision. This is thought to be due to increased mural adherence of the embolus, with secondary thrombus formation after a delay of 8 days or more. A plea is therefore made for a more aggressive surgical attitude to delayed arterial embolization. Provided that preoperative arteriography has localized the obstructive level and that the patient's general condition allows major vascular surgery, direct removal of the embolus and secondary thrombi by open exposure of the obstructed artery is recommended.
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In this paper is presented the case of a 27 year old woman in whom a congenital duplication of the distal ileum led to a massive hemorrhage. Heterotopic gastric mucosa was found in the ileal lesion and ulcer formation histologically proven. This case shows that congenital lesions of this sort may not come to the attention of the pediatrician or pediatric surgeon but become the concern of the surgeon in adult life.
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