Cultural-historical aspects of pain.
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Biomedical subjects
Publications and source records attributed to E Kern.
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Twenty obese patients were either given a caloric restricted diet (300 kcal/d) over 4 weeks alone or underwent an additional ergometer exercise programme for up to 2 hours daily. Combination therapy resulted in an improvement of physical performance by 26% despite weight loss of 11 kg. Blood pressure could be reduced both at rest and on exercise. Blood pressure regulation and heart rate under orthostatic conditions remained unchanged for both therapeutical approaches. The effect on carbohydrate and lipid metabolism was also more favorable in patients on combination therapy than in those given a reduction diet alone. Combination of reduction diet and physical exercise is therefore superior to caloric restriction alone with regard to cardiovascular and metabolic considerations.
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After having presented the actual surgical procedure in cases of severe diffuse peritonitis, the advantage of the so-called 'programmed lavage' is described. The Surgical Department of Würzburg University was encouragingly successful in 64 cases.
Perforated appendicitis has remained to be a common finding of high severity. The causes of difficult diagnosis are discussed in some detail together with the reasons why indication for surgery is too often delayed.
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A programmed peritoneal lavage was done in 20 patients. During this lavage, tissue samples were withdrawn for histological control. During the therapeutical lavage, the morphological signs of inflammation decreased. For the sanitation of peritonitis, the cause of the disease must be eliminated. The morphological signs of healing start during the first three days postoperatively. Peritoneal repair prevails after the second or third postoperative day. Peritonitis will be lethal without focus sanitation and with microorganisms resisting any therapy, although lavage having been done.
The surgical patient is subjected to psychological stress through fear of pain, operation, anesthesia and finally death. The exact definition of psychic stress and the patient's resistance to it is even more problematic than the definition of somatic stress. It is the doctor's task to alleviate the psychic stress of the patient, to instill confidence and to recognise the limits of his resistance and finally to take all this into consideration in planning his treatment.
Some controlled clinical trials have demonstrated that early or immediate operation for acute cholecystitis produces better results than delayed operation or conservative treatment. From 1969 to 1983, 397 patients have been operated for acute cholecystitis at the Surgical University Hospital Würzburg, the results are discussed here.
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Anastomotic dehiscence has become rarer, but as it still occurs in every patient group, it is vital that it be considered. Factors for anastomotic healing are discussed. The submucosa is the most important layer for a patent anastomosis. Single-layer anastomosis using only the submucosa gives excellent results. If precautionary drainage is desired, there should be no direct contact between anastomosis and drain. For treatment of severe peritonitis serial peritoneal lavage has recently been used at the Wuerzburg University Hospital.
Since his early youth Billroth had an extraordinary aptitude for music and actively practised music. Billroth developed to a piano player of high standing. Even as a young professor in ordinary for surgery he worked as a composer of music and wrote critical essays of concerts for journals of music. Later on, a lifelong friendship developed between him and the famous composer Johannes Brahms in Vienna.