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Biomedical subjects

F Schulz

Publications and source records attributed to F Schulz.

At least 73 records · Page 4Linked to original sources
PubMed1988

[Validation study of the Mannheim Peritonitis Index].

113 patients suffering from purulent peritonitis entered this retrospective study for evaluation of the prognostic value of the Mannheim Peritonitis-Index. There was no lethality below an index x = 21, between x = 21 and x = 29, it was 29% and lethality increased to 100% in patients with an index x greater than or equal to 30. Statistical validation showed that prognosis was correct in 93% for the index x = 27, with a sensitivity and specificity of also 93%. Between x = 21 and x = 29 prognosis of the MPI was correct in at least 65%. The MPI is shown as a prognostic index for peritonitis with high accuracy in individual prognosis, that could be easy routinely documented.

Adolescent↗
PubMed1987

Seasonal changes in circulating levels of thyroid hormones are not dependent on the age in Djungarian hamsters Phodopus sungorus.

1. Plasma levels of total and free thyroxine (T4; FT4) and triiodothyronine (T3; FT3) were measured by radioimmunoassay in adult and senescent Djungarian hamsters at different times of the year. 2. Seasonal changes of both hormones were found in adult and senescent hamsters. 3. However, except for total thyroxine, the patterns were different in both groups of hamsters. 4. These results suggest, that in Djungarian hamsters age-related changes of thyroid function do not affect the secretory activity of the thyroid gland rather than the phase of the seasonal cycle.

Acclimatization↗
PubMed1987

Progress in reconstruction after resection of the head of the pancreas.

Fistulas of the pancreas due to dehiscence of pancreaticojejunostomy after partial pancreaticoduodenectomy caused severe postoperative complications. Whereas various methods with and without anastomosis of the pancreas are recommended to deal with the pancreatic stump, mortality rates of 20 to 75 per cent have been reported. These different results prompted us to start a prospective, nonrandomized study in which three methods of reconstructing the remnant of the pancreas involving anastomosis were compared with pancreaticocutaneous drainage without anastomosis. One hundred and thirty-one patients with partial pancreaticoduodenectomy entered this trial, 54 female and 77 male patients with an average age of 55.9 years. The indications included: 42 instances of chronic pancreatitis, 44 instances of carcinoma of the pancreas and 45, periampullary carcinoma. We performed 33 end to side pancreaticojejunostomy procedures (four fistulas of the pancreas, a mortality rate of 15.0 per cent), 31 end to end anastomoses (three fistulas of the pancreas, a mortality rate of 6.5 per cent) and 48 double loops with anastomoses of the pancreatic and hepatic duct to separate jejunal loops (nine fistulas of the pancreas, a mortality rate of 2 per cent). Nineteen patients were operated upon using external drainage of the pancreatic stump by means of Penrose drains (five fistulas of the pancreas, a mortality rate of zero per cent). To reduce the fatal risks caused by combined fistulas of the pancreas and biliary tract, the use of separate intestinal loops for anastomoses of the pancreas and biliary tract offers the best solution, since no fatal complications of the pancreaticojejunostomy were observed. In contrast, pancreaticocutaneous drainage was performed upon patients with endangered pancreatic anastomoses due to local morphologic conditions, such as tender pancreatic parenchyma or thin pancreatic ducts. The total loss of exocrine function and the high morbidity rate of 37 per cent is justified in spite of the mortality rate of zero per cent. Total pancreaticoduodenectomy, for technical reasons, represents no acceptable alternative in view of higher mortality rates.

Adult↗
PubMed1986

[Significance of emergency endoscopy in severe upper gastrointestinal hemorrhage].

312 of a total of 543 emergency endoscopies were carried out in patients with severe haemorrhage of the upper gastrointestinal tract. This was defined as a haemorrhage of such severity that at least 2 of the following 3 criteria were present: a shock index greater than 1, an erythrocyte count of less than 3 million/mm3, and a transfusion requirement of three or more 500 ml bags of blood. The source of the bleeding was exactly located in 247 endoscopies, and accurate diagnoses were established in 94.4% of the cases examined. The most frequent source of bleeding was oesophageal varices, followed by duodenal ulcers. In 20.2% of these cases, further sources of potential haemorrhage were found in the upper gastrointestinal tract. Endoscopic diagnosis resulted in immediate, specific therapy in 286 cases. Treatment was given within the first 24 hours in every case. 24.7% of our patients had to undergo laparotomy immediately after endoscopy. 30.4% were given H2 receptor inhibitors, and 35.6% underwent endoscopic haemostasis. The mortality rate in these patients was 29.5%. These results indicate that emergency endoscopy is an important aid to decision-making in cases of severe haemorrhage of the upper gastrointestinal tract.

Acute Disease↗
PubMed1986

[Determination of TSH receptor antibodies--clinical value].

In 223 patients suffering from Graves' disease, TSH receptor autoantibodies in serum were measured using the commercially available TRAK assay (Henning, Berlin). Of 53 patients examined before treatment, 50 (94%) were TRAK-positive. During drug therapy the number of positive titers decreased. Of 38 patients examined after a therapy course for the first time, only two (5.3%) were positive. Evaluation of antibody status after all three forms of treatment (drugs, surgery, radioiodine) in 146 patients showed that of 33 patients with persistently positive titers only nine relapsed. Of the 24 patients out of this group without relapse, 15 had operative or radioiodine treatment. The 113 patients becoming or remaining TRAK-negative after treatment showed 12 relapses, in all these cases relapse was accompanied or announced by conversion to positive TRAK values. The high sensitivity and specificity of the assay (in a control group of 40 patients with autonomous adenoma no positive TRAK was seen) allow to use the test for discrimination between Graves' disease and disseminated autonomy of the thyroid in patients presenting with diffuse hyperthyroidism. Thus, by helping to establish an exact diagnosis, TRAK could become important for therapy planning. Concerning relapse prediction, our data are less promising since only 39% of patients with persistently positive TRAK titers relapsed. TRAK is not a reliable indicator of relapse risk especially in patients operated or treated with radioiodine. On the other hand, 10% of patients showing negative titers after treatment also relapsed, all turning to positive TRAK values at the same time.

Autoantibodies↗
PubMed1986

Cholesterol: an antidiarrheal agent in rats with short-bowel syndrome fed elemental diets.

Studies show that bile acids and long-chain fatty acids are responsible for diarrhea in certain malabsorption syndromes. Recent reports indicate that substances such as dietary cholesterol, when moderately consumed, can reduce bile-induced excessive mucosal fluid and electrolyte output. This study explores the antidiarrheal effect and dosage of dietary cholesterol in rats following massive bowel resection, co-fed elemental diet. Thirty-five male Sprague-Dawley rats weighing 248-253 g underwent 75% resection of the small bowel and were fed ad libitum for 21 days with 1 of 5 diets (n = 7) of Vivonex HN, supplemented by 0, 2.5, 5, 10 or 15 mM cholesterol/1,000 g of the powdered elemental diet. Parameters measured included daily food and water consumption, daily changes in weight, volume of excrement and stool consistency graded by the same individual (water, semiformed or formed). It was found that 5 mM dietary cholesterol in 1,000 g of the elemental diet produced the most formed stool and significantly improved weight gain in rats with short-bowel syndrome.

Animals↗
PubMed1985

[Tumors of the small intestine--diagnosis, therapy and prognosis].

Between 1965 and 1983 91 patients suffering from primary tumors of the small intestine underwent surgical treatment. These patients comprise 1.24% of the total number having gastrointestinal tumors in that period. In 33% exact preoperative diagnosis was set. The delay in establishing diagnosis (6.3 months) was due to nonspecific symptoms. The majority of patients underwent operation because of vital indication without former specific investigation. Benign tumors could be resected radically without lethality. Curative resection could be performed in 62.5% and palliative resection in 37.5% of malignant lesions. Surgical lethality was 17.8%. The most common histologic type were the adenocarcinoma at one side and the adenoma at the other. The 5-year-survival-rate for curatively resected patients ranged from 60% for carcinoids, 25% for carcinomas up to 20% for lymphomas. The mean survival rate for patients who underwent curative resection was 44.12 months, for those with palliative treatment 13.37 months. 18 patients, 51.4% of the curatively treated group, are still alive, mean follow-up time being 5 years. Rareness, challenge in diagnosis, surgical procedures, postoperative complications, reoperation frequency and long-term prognosis seen from various points of view are discussed. Our study emphasizes the importance of thorough gastroenterologic investigation of patients with tumor-suspective abdominal symptoms and the eminence of explorative laparotomy as final diagnostic and therapeutic step as well as the postulation for ultimate surgical radicality.

Age Factors↗
PubMed1985

[Nitroblue tetrazolium (NBT) test as a potential diagnostic aid in the preoperative detection of patients at risk for infection].

The clinical application of a simple quantitative NBT-test to investigate the "killing function" of granulocytes in surgical patients with various underlying diseases is described. In this test preoperative patients showing a decreased NBT-reduction in their leucocytes always developed infectious complications after surgery. Taken together, these results indicate that the NBT-test could be used as a "simple indicator" of the granulocyte function in respect to the predictability for patients with high risk of infection.

Aged↗
PubMed1985

Amino acid concentrations in plasma and skeletal muscle of patients with acute hemorrhagic necrotizing pancreatitis.

We measured amino acid concentrations in plasma and skeletal muscle of three groups of patients with acute hemorrhagic pancreatitis: (a) patients without secondary organ lesions, (b) patients also suffering from kidney damage, and (c) patients in whom the pancreatitis was accompanied by sepsis and multiple organ failure. In all three groups, especially the third group, the amino acid concentrations in both plasma and muscle were below normal. Glutamine was only 14% of normal in muscle tissue of the third group. Onset of renal insufficiency was indicated by increasing values for 3-methylhistidine and cystathionine; multiple organ failure, by increased concentrations of methionine and phenylalanine in plasma. The low amino acid concentrations of patients with acute pancreatitis can be explained as a combined effect of semistarvation and hypercatabolism. Changes in the plasma concentrations of amino acids did not reflect necessarily the concentrations in muscle tissue.

Acute Disease↗
PubMed1985

[Variability of the arteries of the nose].

Arriving current, width and course of the arteries of the outer nose were investigated at 40 headhalves. We defined 4 groups of vessel patterns. Also 6 types of variations were described and right-left-differences were determined. The results are discussed in detail with the dates of former scientists.

Arteries↗
PubMed1985

[Conservative therapy of iatrogenic esophageal perforation].

During 7336 diagnostic and therapeutic endoscopies of the upper gastrointestinal tract 10 perforations of the esophagus were seen (0.14%). After diagnostic X-ray 5 patients were operated and 5 treated conservatively. The precondition for conservative treatment were immediate diagnosis and a covered perforation of the intrathoracal esophagus without communication to pleura or trachea. Treatment consisted in alimentary restriction, parenteral nutrition and high antibiotic therapy. One patient with a esophagotracheal fistula died under conservative treatment. He could not be operated because of advanced tumour disease. The others had an uncomplicated course and, after healing of the perforation, between the 5. and 15. day oral nutrition could be started. It is proved, that the conservative treatment of iatrogenic perforation of the esophagus is a minimal stressing and very successful therapy, if the above-mentioned conditions are followed exactly.

Adolescent↗
PubMed1984

[Relaparotomy following stomach operations].

From 1977-1982, 1.442 operations of the stomach were performed. In 82 cases a relaparotomy was necessary. In 27 cases the cause was peritonitis with anastomotic insufficiency. 7 patients had generalized peritonitis without anastomotic leakage. 14 had to be reopened because of localized abscesses. 11 patients had a bowel obstruction, 7 patients massive postoperative bleeding. 6 cases developed severe pancreatitis with peritonitis and 5 others developed bile leakage. The rest had several other complications. 47.6% of the reoperated patients died, most of them because of surgical complications. Therefore immediate reoperation should be performed before severe complications occur.

Gastrectomy↗