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Biomedical subjects

D Steiner

Publications and source records attributed to D Steiner.

70 records · Page 4Linked to original sources
PubMed1978

[Is creatine kinase isoenzyme CK-MB a diagnostic tool for perioperative myocardial infarctions? (author's transl)].

There is still controversy of the validity of elevated CK-MB serum activity in the diagnosis of perioperative myocardial infarction after open heart surgery. CK-MB activity was investigated using myocardial and skeletal muscle biopsies and in sera postoperatively in 192 patients. In biopsies CK-MB fraction of total myocardial CPK was 37%, the total-CPK activity of human skeletal muscles still shows a 5% fraction of CK-MB. There has to be more than 8% CK-MB fraction of total CPK-serum-activity to take this as evidence of myocardial damage. 3 h postoperatively enzymatic-immunologic CK-MB test is no longer interfered by enzymes derived from hemolyzed erythrocytes. In patients without signs of myocardial lesions postoperatively mean CK-MB-activity is 11 to 27 U/1 depending on the operative procedure performed. Activity levels exceeding 50 U/1 are almost evident of myocardial infarction. Elevated CK-MB-serum activity is a sensitive parameter for myocardial lesions overestimating an event of infarction. It is a helpful tool diagnosing perioperative myocardial infarction.

Cardiac Surgical Procedures↗
PubMed1978

Intrauterine device and pelvic inflammatory disease.

Using a retrospective case control design on 101 women with a first episode of acute pelvic inflammatory disease (PID), it was found that 15% were wearing an intrauterine device, as compared to 7% out of a control group of 101 women matched for age, marital status, and interval since their last pregnancy termination. No statistically significant correlation between IUD usage and PID was demonstrated. A significant correlation (P less than 0.01) between previous induced abortion and subsequent PID was found. In the PID group, a significantly higher proportion of previous abdominal and pelvic operations (P less than 0.005) was found as compared to the control group, but the numbers were small. In the absence of a higher frequency of IUD wearers among PID patients as compared with matched controls, we do not believe that there is an increased risk of pelvic inflammatory disease.

Acute Disease↗
PubMed1977

[Prevention of edema during coronary perfusion with cardioplegic solution (author's transl)].

In arrested and with cardioplegic solutions perfused rabbit hearts the relation of perfusion-pressure and flow rate were examined, showing that edema of the myocardium can be avoided even using erythrocytes-free solutions by two measures. First the solution has to contain colloid active agents and secondly the perfusion pressure has to be significantly below the colloid-osmotic pressure. Furthermore the edema can be avoided by adding 300 mg 6-methyl prednisolone/1. If no attention is paid to these facts the coronary flow decreases constantly due to developing interstitial and interfibrillar edema and degenerative changes of endothelial cells of the capillaries, which even can undergo necrosis. These changes were not seen using steroids. On the contrary here we found by densitometry and increased number of lysosomes. These findings show the effectiveness of corticosteroids in stabilizing the cell membranes.

Animals↗
PubMed1976

[Long-term cardiac arrest by cardioplegic coronary perfusion (author's transl)].

UNLABELLED: The Mg++ aspartate-procaine-cardioplegia has been proven in animal experiments as well as from 1970 til 1975 in more than 1000 open-heart-procedures by a myocardial temperature of 32 degrees C and aortic crossclamping time up to 40 minutes superior to all other known procedures of cardiac preservations. To guarantee a safe myocardial protection of the arrested heart for a remarkable longer period of total ischemia, we further developed the cardioplegic technique in the animal lab, and use it now clinically. PRINCIPLE: The arrest is induced by cardioplegia (Mg++ aspartate-procaine), than the arrested heart is cooled down to 15-20 degrees C by cardioplegic coronary perfusion maintaining the oxidative metabolism. The perfusion is stopped. The begin of ischemia is still under normal ATP-levels and continuous cardioplegia. TECHNIQUE: 1. Crossclamping of the aorta; 2. cardioplegic induced cardiac arrest by Mg++ aspartate-procaine (Kirsch); 3. Surface cooling of the heart; 4. Coronary perfusion by hypothermic cardioplegic solution (8-10 min, flow 80-120 ml/min, perfusion pressure maximal 30 mmHg). Perfusate: O2-saturated, erythrocyte free, 6% hydroxyethyl starch solution added 2 mM Mg++ aspartate, 4 mM procaine, 50 mM Na+, 5 mM K+, 0,5 mM Ca++, 25 mM HCO3-, 10 mM glucose, 200 mM mannitol, 250 mg/l 6-methylprednisolone. RESULTS: 84 patients (29 ACVB; 55 valve replacements); crossclamping time: 71 min (SD 22); total time of ischemia: 57 min (SD 18; max 96, min. 27 min); reperfusion time restoring normal excitation-contraction of the heart: 3 min (SD 2); weaning off bypass: 23 min (SD 14). Hemodynamic 12 h postop.: SO2 venous 76% (SD 6). No sympathicomimetics were used. Only 30% of myocardial ATP is splitted after 120 min of cardiac arrest. Electron microscopic findings show only small, reversible alterations of fine structure.

Adenosine Triphosphate↗
PubMedDate not supplied

[Staged diagnosis of septic hip endoprosthesis loosening with laboratory parameters and antigranulocyte scintigraphy].

AIM: The value of serial diagnosis of septic loosening of hip endoprosthesis using laboratory parameters and antigranulocytes scintigraphy was investigated and compared to joint aspiration. METHOD: In 35 patients with intraoperative verification of infection, we calculated sensitivity, specify and prevalence dependent positive and negative predictive values for antigranulocyte scintigraphy, laboratory tests and the most suitable combination of both. We also calculated predictive values of joint aspiration using sensitivity and specify values given in the literature. RESULTS: From negative and positive predictive values, of the sedimetation rate and leukocyte count provided no increase of information. We found the same result for positive predictive values of C-reactive protein. For antigranulocyte scintigraphy alone, we found a distinct but still unsatisfying increase of information. Nevertheless, in both cases infection could be excluded definitely. Therefore, the combination of C-reactive protein and antigranulocyte scintigraphy was suitable and the positive predictive values of this combination were only about 5% lower than those of joint aspiration. But with joint aspiration, infection could not be excluded. CONCLUSION: A positive result in serial diagnosis using C-reactive protein and antigranulocyte scintigraphy leads to an distinct increase in the probability of infection which is comparable to that of joint aspiration. The additional advantages of this procedure are the certain exclusion of infection and the absence of invasiveness.

Aged↗
PubMedDate not supplied

[Surgical therapy and results in rupture of the rotator cuff].

Follow up evaluations of 57 patients with surgically treated rotator cuff tears are presented and valued with regard to the literature. A short anterior exposure and cuff anchorage to the humerus is the method of choice. Anterior acromioplasty should not be a routine. Attention should be paid to adhesions of the sub-coracoidal space, they should be separated if necessary. Patients being of older age, with a short history and a long time interval between operation and final evaluation do have the best results.

Aged↗
PubMedDate not supplied

[Clear cell chondrosarcoma--clinico-pathological report of an additional case].

On account of the rarity and its histologic features, the clear-cell chondrosarcoma is a particular entity. Up to the present, 98 cases have been reported in the literature. In the present report one case located in the proximal femur will be discussed. Approximately 60% of these tumors are situated in the mentioned region. Including one referred case, which will not be described in detail, 100 cases have been recognized. Clear-cell chondrosarcoma is radiographically indistinguishable from benign lesions or chondroblastoma. Therefore the histologic examination is crucial for the diagnosis. The histologic characteristics preclude the diagnosis of chondroblastoma. Clear-cell chondrosarcoma is characterized by regions of chondroid matrix and areas of closely packed, glycogen-rich large tumor cells with distinct boundaries. The centrally located nuclei are large with marked polymorphism, surrounded by abundant clear PAS positive cytoplasm. The chondroid matrix is lacking. Osteoid formation and multinucleated giant cells are present in clear-cell areas. In spite of the low malignancy there is still a metastatic potential. Therefore the type of surgical treatment is very important. En bloc excision with wide margins is the treatment of choice. The knowledge about this tumor is crucial for adequate surgical therapy.

Adult↗
PubMedDate not supplied

[Etiology, diagnosis and therapy of tarsal tunnel syndrome--results of a retrospective study].

Tarsal tunnel syndrome is a rare entrapment neuropathy of the posterior tibial nerve. The compression of the nerve behind the medial ankle should be distinguished from that of the more distal compression syndrome of the plantar nerves, because of different anatomic conditions and pathogenesis. The patient's history is of special diagnostic value. The most impressive clinical finding is tenderness of the nerve. Neurological deficits must be searched for. Decompression by cutting the flexor retinaculum and neurolysis is advised. 77% of the 30 patients having undergone this operation were satisfied with the results.

Adolescent↗
PubMedDate not supplied

Buflomedil hydrochloride attenuates tourniquet-induced microvascular reperfusion injury in striated muscle.

With the use of intravital fluorescence microscopy and the dorsal skinfold chamber model we studied the effect of buflomedil hydrochloride on microvascular reperfusion injury after 4 h of tourniquet-induced ischemia in hamster striated muscle. Animals (n = 15) received 3 mg/kg buflomedil (i.v. bolus) 5 min before onset of reperfusion, and 3 mg/kg buflomedil (continuous i.v. infusion) during the first 20 min of reperfusion. Animals (n = 13) receiving equivalent volumes of saline served as controls. Tourniquet-induced ischemia resulted in (a) a marked decrease of functional capillary density and (b) accumulation and adherence of leukocytes in postcapillary venules after 30 min and 2 h of reperfusion. This was associated with an increased microvascular permeability (leakage of macromolecules), reflecting the alteration of endothelial cell integrity. Treatment with buflomedil significantly reduced both post-ischemic capillary perfusion failure and leukocyte adherence in venules. Concomitantly, the increase of microvascular permeability in postcapillary venules was almost prevented, indicating the beneficial effect of buflomedil on the manifestation of microvascular reperfusion injury following tourniquet ischemia in striated muscle.

Animals↗