Biomedical subjects
Publications and source records attributed to E Steiner.
The authors report an observation of isolated hypertension during pregnancy; this hypertension has revealed a cancer of kidney. As hypertension has regressed after ablation of the tumor, the authors evoke physiopathological hypothesis. They insist about X Ray of kidney after pregnancy, for hypertensive pregnancy. It seems to be the best exam to discover an uropathy.
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In 13 rabbits the rectus femoris muscle was freely transplanted from the left to the right side using microneurovascular anastomoses. About 7 months after surgery the muscle transplants were assessed functionally by force measurements. On the average, the transplanted muscles regained 55 percent of the maximal tetanic tension of unoperated, normal rectus femoris muscles, expressed as force per gram of muscle weight even 68 percent. After functional assessment, the muscles were weighed and then used for histologic, histochemical, planimetric, and biochemical evaluation. H&E-stained cross sections showed a high content of healthy muscle fibers; only some small atrophic and single fat cells were scattered over the cross sections. Good reinnervation over the sutured muscle nerve was confirmed by the type-grouping of muscle fibers in the NADH and myofibrillar ATPase staining. There was an excellent correlation between the functional results and the histologic picture as well as the content of choline acetyltransferase (CAT). A certain parallelism was found between the function of the transplants and the content of hexokinase, but none for the other estimated muscle enzymes, such as malate dehydrogenase (MDH), creatine kinase (CK), and lactic dehydrogenase (LDH). All enzyme levels were lower than in normal muscles. The results of this experimental series underline the utility of muscle transplantation with microneurovascular anastomoses to restore lost muscle function, even in the extremities, when strong forces are needed.
This case, however, confirms our hypothesis that intraperitoneal positioning of a segmental pancreatic graft into the Douglas' pouch and an end to side arterial anastomosis bring several advantages as far as venous thrombosis and tryptic lesions are concerned.
The authors compare six personal cases of ovarian pregnancy with those in the literature. They point out that there is no specific clinical sign which makes it possible to tell whether one is dealing with an ovarian or a tubal pregnancy. They show the value of laparoscopy and especially of laparotomy and the histo-pathology of the specimen. Finally they show that although ectopic pregnancy rarely occurs in this site it is easy to treat and nearly always can be treated conservatively.
The surgical technique in clinical pancreas transplantation is still not standardized. Animal experimentation should allow a reproducible and reliable model by choosing the cervical region in dogs as the site of segmental grafting. A goal of the experiments was to determine the influence of preservation, operation technique, duct occlusion, immunosuppression, and gastrointestinal hormones (Somatostatin, Cyclosporin A). 50 grafts have been transplanted. It could be clearly demonstrated that in 54% the vascularization of the left lobe of the canine pancreas differs extremely from man. Successful results are to expect being aware of the anatomical variations. The varieties of the arterial blood supply indicate which technique has to be performed to avoid ischemic grafts due to inadequate preservation.
We have reported about three patients with extensive destruction of the anorectal sphincter apparatus which were treated at the I. Surgical Clinic of Innsbruck University, Austria, between 1964 and 1981. Diagnostical methods and therapy are explained. Special emphasis is layed on exact anamnestic, clinical, radiological and neurological diagnosis of the sphincter before the closing of the protective colostomy.
Glucuronidation of harmol in microsomal preparations and sulphate conjugation in hepatic 105,000 g supernatant fractions were studied comparatively in human fetal and adult liver subcellular preparations. The formation of harmol sulphate in the fetal liver was slightly lower than in the adult liver and considerably lower than in rat liver. No glucuronidation of harmol was found in fetal liver, while the activity in adult liver was 30-80 nmol glucuronide formed/2 mg/20 min. In an ontogenic perspective, our in vitro findings are consistent with drug metabolic studies in the human neonate in whom negligible glucuronidation but well-developed sulphate conjugation of paracetamol has been demonstrated.
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100 kidney-transplantations had been performed in Innsbruck between January 22, 1974 and August 28, 1980. Following a period of 10 months after the hundredth transplantation, 78% of the patients had survived, and 65% of the grafts were functioning. 165 cases of rejection had taken place during the above mentioned period of observation. 112 cases of bacterial infection, 14 cases of viral infection, and 36 cases of fungal infection had been diagnosed and treated. The rate of surgical complications was extremely low. Further complications included gastrointestinal complaints, hypertensive crises, and thrombosis of the pelvic veins.
The authors describe a case of high venous thrombosis with floating clots at the 37th week of pregnancy. The problem of diagnosis was solved by urgent Doppler examination and by phlebograms of the legs. It is necessary to have a team of many disciplines that can be brought together at any time. These consist of: -an anaesthesist who can resuscitate with heparin and give obstetrical anaesthesia, -an obstetrician who can carry out caesarean sections, -a vascular surgeon who can carry out a partial block of the inferior vena cava. This would appear only to be possible in a special centre.
The charts and routine preoperative roentgenograms of 350 children admitted for elective pediatric surgery were analyzed to evaluate the clinical importance of routine preoperative chest roentgenograms. This analysis, and a review of the literature, should indicate that routine preoperative roentgenograms for elective pediatric surgery are unnecessary. Indications for selected preoperative roentgenograms based on patients' history and clinical findings are enumerated.
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Closed tube thoracostomy is a common and very useful procedure in therapy of acute thoracic injury. However, it is not without risk. With aggressive use of this procedure in the emergency department, the incidence of technical complications was 1 percent. Our review suggests that complications can be further diminished by the routine use of large thoracostomy tubes that are placed well up on the chest after confirmation of an open pleural space, by avoiding the use of a trocar for tube placement, and by the use of a high volume, low pressure suction system. Empyema was the most common complication associated with tube thoracostomy after trauma. It occurred in 2.4 percent of the patients. Its exact causes is not known, and the role of prophylactic antibiotics needs to be established.
On the basis of 42 patients the problems of diagnostics, indication for operation and the operative technique of diverticula of the duodenum are described and discussed. It must be emphasized, that in most cases these diverticula do not cause any symptoms. Precondition for successful surgery is adequate experience in surgery.
As several authors stated within the last few years and according to our experience as well cadaveric kidneys of young children are suitable for transplantation. Considering the shortage of transplantable organs en-bloc-transplantation should not be performed, even if this provides the opportunity to remove one kidney in case of surgical complications. On the other hand by transplanting a single organ one donor may help two recipients. Since it is known that kidneys of babies under 18 months do not guarantee sufficient function in adults, it should be a rule that kidneys of children under 18 months have to be transplanted en-bloc, whereas kidneys of older children can be transplanted solitarily without hesitation. Long term results with baby kidneys do in no way differ from kidneys of adults.
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