Biomedical subjects
Publications and source records attributed to E Schindler.
Based on experience with 166 traumatic vascular lesions in 148 patients, the authors present the diagnostic methods and therapeutic consequences, which are at the moment applied at the Medical Highschool Hannover.
A 20-year-old man suffering from Crohn's disease developed coma and generalized seizures following ileocecal resection. During postoperative parenteral feeding he received xylitol in an unusually high concentration. CT examinations a few days before death showed intense hypodensity and swelling of brainstem and basal ganglia and increasing triventricular dilatation. Autopsy revealed, mainly in the brainstem and cerebellum, a destruction of intracerebral, intracerebellar and leptomeningeal vessel walls by birefringent crystals (probably calcium oxalate), an early inflammatory reaction and severe brain edema with final tonsillar herniation. The same crystalloid deposits were found in the kidneys.
Partial functions of the kidney, i.e. renal blood flow, GFR etc, can be estimated with radionuclide techniques as safe and non-invasive methods. Many methods have been published to distinguish between obstructive and non-obstructive hydronephrosis. A simple and highly relevant technique is the diuretic radionuclide urography which should be done in all patients with questionable urographic or sonographic findings. The evaluation of split renal function is somewhat difficult because tissue absorption will influence uptake determination. In hydronephrosis this absorption cannot be predicted by sonographic measurement of the kidney's depth and mass. A solutions is to calculate the absorption in these patients by stepwise scintigraphy. Continuous quality control of the technique is emphasized.
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The newly developed bioactivated bone cement Palavital is composed of polymethylmethacrylate, glass fibers and bioactive glass ceramic. The superficially located glass ceramic particles offer the possibility of true bonding of the bone cement to the bony implantation bed. Reconstruction of the frontal sinuses and the skull was performed on 9 dogs. The follow up was 14 days to 5 years. The implants were checked by tomography and histology. All implants were tolerated without any inflammatory reaction. The bond between bone and implant was demonstrated. Palavital seems to be an improvement on bone cement on a polymethylmethacrylate base.
Investigation of GFAP in 50 medulloblastomas showed a few GFAP-positive tumour cells in 5 cases only; 17 tumours were negative, and 28 showed a "pseudopositivity", i.e. GFAP-bearing cells were identified as reactive or degenerating astrocytes, intermingled with tumour elements. A high GFAP content was seen in 2 small-cell gliomas of the cerebellum, whereas 3 pineoblastomas, 2 neuroblastomas of CNS, and one medulloepithelioma were negative. GFAP is a very good method for identificating astrocytes, but does not seem to be reliable for identifying the origin of undifferentiated tumours such as medulloblastomas. In these neoplasms glial differentiation is lacking or extremely rare, GFAP-positivity being mostly an artifact. The investigation of small tumour samples or the positivity of a single cell are inadequate data for a correct evaluation of the findings, especially taking in mind that GFAP of degenerated astrocytes can be phagocytised by cells other than glial (e.g., macrophages, epithelial and meningioma cells). The importance of carefully checking the whole structure of the tumour is stressed, GFAP positivity or negativity being not a sufficient criterion for its nosological classification.
Both isotope clearance studies in dog and man and morphometric findings in the rabbit demonstrate that compensatory changes in the remaining kidney start immediately after contralateral nephrectomy and are completed no more than 3 months later. In the meantime, there is a transitorily exceeding rise of ERPF, GFR, glomerular capillary diameter and volume of the glomerulus, evidence of a "reactive hyperemia". 8-12 weeks after unilateral nephrectomy, clearance values of both men and dogs have fallen to a constant level corresponding to 70 per cent of the value of two organs. Loss of function in one kidney is compensated by the contralateral organ in the presence of the damaged partner. The removal of a non-functioning kidney usually will not result in a rise of function in the remaining organ.
Since the cyclic nucleotides (CN) adenosine 3',5'-monophosphate (cAMP) and guanoside 3',5'-monophosphate (cGMP) are involved in the regulation of cell proliferation and tumor growth in vitro, a study was made of the levels of these compounds in the lumbar cerebrospinal fluid (CSF) of 20 patients with intracranial and spinal tumors. In the presence of benign or malignant intracranial tumors there was a slight and not significant decrease of cAMP as well as cGMP levels in the CSF, as compared to control patients. While there was no significant correlation between the levels of the two CN in controls, there was a positive correlation in tumor patients. Total protein content and cAMP were negatively correlated in malignant intracranial tumors. Possible influences of tumor growth and intracranial pressure increases on CN levels are discussed. In spinal tumor patients normal CN levels were observed. However, in a patient with meningeal sarcoma an extremely marked elevation of cAMP occurred in parallel with the extension of the tumor to the spinal meningeal space, suggesting massive secretion of cAMP from the tumor cells.
The penetration depth of mitomycin into the normal urinary bladder wall and tumor was determined in 21 bladder tumor patients. Either 20 mg mitomycin/20 ml distilled water or 40 mg/40 ml distilled water was locally instilled into the bladder with a catheter after emptying it and was left for about 25-l20 min. The individual concentrations of mitomycin within the various bladder layers (epithelial, lamina propria, up to the middle of the musculature) were determined with a thin-layer cup method specially modified for these investigations. The results show a high scatter of resorption from 2 up to 442 micrograms of mitomycin/g dry weight. With this method, mitomycin could be determined in the bladder musculature.
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Criteria defining the value of any diagnostic modality are referred to computed tomography in order to determine the importance of computed tomography in otorhinolaryngology. The accuracy of computed tomography to solve diagnostic problems in otorhinolaryngology is demonstrated by some findings shown by computed tomography of the facial regions, of the ear, and of the neck. The diagnostic limitations of computed tomography are pointed out. The value of computed tomography in the otorhinolaryngologic diagnostics is emphasized.
32 patients with lesions of the parotid region underwent CT-sialography; 7 of these cases were selected to demonstrate the clinical usefulness of this diagnostic method. CT sialography allows to differentiate deep-lobe parotid tumors and parapharyngeal tumors. CT is also very good for estimation of the tumor size, which contributes to therapy planning. Basing on CT findings the operability of malignant tumors can be determined. CT sialography provides valuable information in cases with special diagnostic problems.
Intravenous urography remains the most decisive investigative method in the management of blunt renal trauma. Even minor urographical changes would merit scintiscan and ultrasound examination in order to visualize or rule out parenchymal lesions, intra- or extrarenal hematomas and urine extravasation as well as assess respirational excursions of the kidney. Follow-up studies may be performed without hesitation. Major lesions (primarily a urinoma) and alarming clinical findings necessitate further diagnostic procedures (angiography, possibly after computer tomography). In case of a surgical intervention, angiography cannot be replaced by any other diagnostic method to date. There are no comparative studies of patients with similar injuries managed alternatively with immediate operation or a conservative approach. However, based on our diagnostic possibilities and therapeutical results, we are in favor of a more expectant management of major renal trauma.
After review of the principles of the simple and multiple Z-plasty the authors demonstrate clinical cases of primary facial wound closure and correction of large cervical scars.
It is not possible to completely exclude the possibility of errors in clinical and urographic suspicion of renal agenesia/dysgenesia, using sonography, computerised tomography or arteriography. Phlebography yields the most unequivocal findings; in fact, this method is particularly applicable in case of desired withdrawal of venous blood for the purpose of determination of renin. Attention must be paid to variation in venous drainage on both sides, especially, however, on the left side. Dysplastic pelvic kidneys are probably detected most safely by means of computerised tomography.
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A 6-year-old European boy with a tumour in the head and neck region died 86 days after the first occurrence of symptoms despite chemo- and radiotherapy. An epipharyngeal biopsy at the beginning of the disease and a cytological investigation of biopsy and autopsy material showed non-Hodgkin lymphoma with a high degree of malignancy of the Burkitt type. High antibody titres against Epstein-Barr virus (EBV)-specific virus capsid antigen, nuclear antigen and the R component of the EBV-early-antigen-complex as well as the approximately 27 EBV genome equivalents per tumour cell, demonstrated by DNA-DNA hybridisation, characterised the tumour as true Burkitt lymphoma which is observed extremely seldom outside Africa.
Established cell cultures derived from mouse, rat, hamster, cat, and man were examined for the in vitro activities of UDP-glucuronosyl-, phenol sulfo-, and glutathione-S-transferases. The relative activities of the conjugation reactions differed considerably between the various cell lines: Glutathione-S-transferase activities were present in all cell lines with wide variation between different transferase forms. Phenol sulfotransferase was not detectable at all in most of the cell lines tested or was present at very low levels. In contrast, UDP-glucuronosyltransferase activity was expressed in the majority of cultures. Established cultures containing specific combinations of the various types of conjugases should be useful in examining their role in the inactivation and activation of potentially toxic chemicals.