Biomedical subjects
Publications and source records attributed to C Engelmann.
Successful clinic lung transplantations are an urgent necessity. Till now published 37 transplantations were unsatisfactory in the result. They showed that today the lung transplantation is still an experimental method. This paper analyses the results with the mark to recognize emphasis of the experimental research.
Lung allotransplantation is still an experimental method. Immunologic rejection makes it highly lethal in experimental animals as well as in man. Its present state can in no way be compared with renal transplantation in man.
Differential diagnosis is necessary about chronic affections in the mediastinum. They are classified through appointed criterions in 3 groups. The technical methods of differential diagnosis and the degree of information are described. Operations of mediastinal tumours should be done as early and radically as possible.
A coumarin necrosis of the buttocks skin occurred in a patient with a Klinefelter's syndrome. In the acute stage of the complication the oestrogen activity was increased which is decreased in other persons with this arrangement of chromosomes. It is proposed to analyze the oestrogenes in urine of male patients or of females in the postclimacteric period with coumarine necroses before a treatment with sexual hormones.
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The most important findings of autogenous and allogenous lung transplantations in this article. The balance of clinic lung transplantation so far are not encouraging. However they gave new impulses to the animal experiments while they demonstrated that patients with disseminated pathologic pulmonary alterations principally are an another basis for lung transplantation than pulmonary healthy animals. It is tried to derive the next problems of the experimental lung transplantation from the abundance of open questions. Simultaneous it is pointed to that only in ingenious division of labour between many scientic and medical disciplines it is possible to get decisive results with these the risk of further clinical transplantations can be diminished.
Report on the technical standard of unilateral orthotopic allogenic lung transplantation (allo- or homotransplantation) which has been developed and tried on animals since years at The Institute for Research on Pulmonary Diseases and Tuberculosis in Berlin-Buch. Technical insufficiencies which are crucial for essential alterations of the graft in autogenous lung transplantation (replantation) can not be excluded in allogenic transplantations also. By means of certain direct and indirect criteria the authors examined the development of quality of the technical standard between the years 1973 and 1976. Only based on optimal technique the results from examinations of recipient and graft can be correctly valued. On the other hand, optimal technique is an indispensable presupposition for optimal efficiency of several immunosuppressive methods. Duration of anesthesis, operation, ischemia of the transplantate, and of atrial, arterial, and bronchial anastomosis are considered for the assessment of the quality of technical standard. Thrombosis of pulmonary vein and of atrium was the most frequent complication in 71 allogenic pulmonary graftings. Their frequency decreased with improved technical skill, but some circumstances suggest that their formation is favored also by other factors. The duration of survival after unilateral allogenic lung transplantation is reported, although this is no direct scale for the technical performance.
Undesired effects of nonspecific immunosuppression may be delimited by individual dosage. Early recognition of allograft rejection is the presupposition for that steering. As long as immunologic test methods require a great expense of equipment, personnel, and time, and as other methods (bronchospirometry, lung puncture) after lung transplantation additionally endanger the recipient, clinical routine examinations are particularly important, primarly thorax x-ray examinations. The authors report on serial chest radiographs during the courses after 71 unilateral orthotopic allogenic pulmonary transplantations in dogs with regard to the findings at obduction. Possibilities of differential diagnosis shall be found by that, and the limits of interpreting x-ray films after lung transplantation shall be disclosed. Certain distinctive marks in the x-ray findings indicate the various possible complications; they can not be relied upon, however, when they only extend to the graft (hemorrhage, infection, rejection).
Certain complications after lung resection require rethoracotomy. In such cases it should be done soon to prevent more damage that may be difficult to manage later. The patient tolerates the operation better and recovers more rapidly. Often it is difficult to recognize complications, so it is important to supervise the patient carefully and to interpret all observations correctly. The indication for rethoracotomy among our patients is discussed.
The rare clinical picture of the thrombocytopenia caused by drugs is described using own histories of diseases and data from literature. The questions of diagnostics and therapy are discussed. Despite the as a rule benign course it is referred to the fact to withold the noxa once diagnosed consequently from the patient for prevention of possible complications (cerebral haemorrhage).
In the present paper a description of the notion of the myeloproliferative syndrome and a survey of the clinical pictures belonging to this is given. Here the author enters into the most important diseases, such as polycythaemia rubra vera, osteomyelofibrosis, osteomyelosclerosis and megakaryocytic leukaemia, concerning diagnostics and therapy. On the basis of literature a comphrensive discussion of the problem is give, whereby it is referred to the fact that a differential diagnosis as eact as possible is necessary for the performance of an aimed therapy.
The various forms of combinations of bronchopulmonary and pulmonary vascular abnormalities are classified by their special hemodynamic. They are called "pulmonary malformations with abnormal hemodynamics". 11 cases were observed, operated and analysed.
A reduction of the total leukocytes as well as a significant decrease of heparinocytes and BAI (basophilic age index) can be observed in rheumatoid arthritis in the course of a gold therapy. As some coagulation parameters simultaneously speak in favour of an enhancement of the intravasal coagulation, a partial blocking of the endogenous heparin caused by gold may be supposed. A combined heparin or heparinoid therapy in a low dosage is being recommended for risk patients of the vascular and coagulation system.
Before and after performing a basic therapy with sanocrysin, thromboytic kinetic examinations were carried out in 12 patients suffering from rheumatoid arthritis. The thrombocyte survival time, maximal recovery and thrombocyte turnover were determined. The surface activity values were given in the form of spleen-heart quotients and liver-heart quotients as well as by surplus impulses over these organs. The findings evaluated statistically reveal that even the untreated rheumatoid arthritis will have thrombocytic kinetics deviating from the norm. By influencing RES the gold treatment will lead to an reduction of the enhanced platelet decomposition. The behaviour of single parameters before and after gold therapy are discussed. The examination of thrombocyte kinetic could not identify a damage of thrombopoiesis in the bone-marrow and in the periphery caused by sanocrysin.
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The reduction of prothrombin level below 5% in a patient with intrahepatic cholestasis of pregnancy is reported. The necessity of controlling the Quick level or better factors II, VII, IX and X is discussed. A well-timed Vitamin K therapy in all cases with impaired secretion of bile during pregnancy is recommended.
In a complex examination of clinically healthy persons, with postprandial glucosuria or affected with a hereditary diabetes mellitus differences were found in the dynamics of the insulin secretion in oral and venous glucose tolerance dependent on the character of the glucose tolerance. With the deterioration of the latter the insulinaemia increase and prolongs in oral tolerance, in venous tolerance, however, it will be lower and lower. The through analysis of the results refers to the pathogenetic role of the peripheral resistance to the insulin as well as the disturbed secretory function of the islet apparatus. The established connections allow of the derivation of pathogenetically proved criteria for the differentiation of normal, subnormal and pathologic glucose tolerance. The confronting of the insulinaemia with the adiposity of the persons examined detects the fundamental difference between persons with normal and disturbed carbohydrate tolerance. The increase of weight contributes to the manifestation of the genetic defect. From the prophylactic point of view apart from the significance of the adequate dietetic regimen the attention is also drawn to the effect of biguanides.