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Biomedical subjects

F Schulz

Publications and source records attributed to F Schulz.

155 records · Page 9Linked to original sources
PubMedDate not supplied

Laparoscopic versus open treatment of patients with acute cholecystitis.

BACKGROUND/AIMS: The studies published so far mention a high rate of complication and conversion in laparoscopic surgical treatment of acute cholecystitis. Considering the relatively high conversion rate in cases of acute cholecystitis, it is necessary to pre-operatively estimate the chance of successful laparoscopic cholecystectomy. One of the aims of this study was to determine the factors that influence the chance of success of this technique. Another aim was to define possible advantages of the method. METHODOLOGY: From 1991 through to 1995, a total of 295 patients in whom acute cholecystitis had been diagnosed on the basis of clinical examination, laboratory data, ultrasonography and pathohistological examination, underwent operative therapy. The laparoscopic approach was attempted in 49 of these patients. Since the patients who underwent primary open surgery were markedly handicapped with regard to severity of inflammation and co-morbid factors, we identified a sub-group of these patients who were comparable to those who underwent laparoscopic cholecystectomy in accordance of the above-mentioned criteria. RESULTS: The rate of conversion (44.9%) correlated with the severity of inflammation, which was determined on the basis of leukocytosis > 10 x 10(9)/l (p = 0.004) and the pathohistological diagnosis (p = 0.005). Hence, the rate of conversion was 71.4% in cases of empyema of the gallbladder but only 29.2% in cases of edematous cholecystitis. In patients whose leukocyte count decreased within 4 days of conservative treatment, a successful laparoscopic cholecystectomy (LC) was performed in 91.7% (11/12) of cases, while 8 patients whose leukocyte count increased or showed no reduction during this time required conversion to open cholecystectomy (p = 0.0001). In cases of acute cholecystitis, the complication rate after LC is lesser in respect of wound infection (p = 0.07) and pneumonia (p = 0.04). In all patients, obesity was a risk factor for wound infection (p = 0.04). Injury to the small intestine was registered in 1 case but in no case was LC associated with injury to the bile duct. CONCLUSIONS: The degree of inflammation and its response to conservative treatment, which are determined on the basis of leukocytosis and clinical improvement, are clear indications of the chance of successful delayed laparoscopic cholecystectomy within the first week. Hence, all patients whose leukocyte count does not decrease after antibiotic treatment should be treated with open cholecystectomy (OC). The complication rate following LC is less than that following OC. Although no injury to the bile duct has been observed in cases of acute cholecystitis, major complications are possible and should not be excluded.

Acute Disease↗
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[Differential diagnostic aspects of forensically relevant findings in the brain stem].

Because of the extreme dense accumulation of vital structures (compared with other regions of the central nervous system), in the brainstem even small lesions may cause serious clinical symptoms. Judging the forensic relevance of macroscopically visible lesions requires the knowledge of the respective possible diagnosis. As shown in three case reports (67 years, teleangiectasis; 35 years, cavernoma; 49 years, secondary hemorrhage following trauma) this demands apart from the knowledge of the normal and pathological anatomy of the brainstem always the use of histological methods.

Accidents↗
PubMedDate not supplied

Diagnosis and treatment of bleeding colonic diverticula.

BACKGROUND/AIMS: Colonic diverticula are the most frequent cause of major lower intestinal bleeding and pose a diagnostic and therapeutic challenge to the attending physician. Emergency surgical resection is associated with a high mortality and morbidity and patients who will stop bleeding spontaneously cannot be distinguished from those who will continue to bleed. Our aim was to evaluate the efficacy of barium enema as a sole less invasive treatment option for severe diverticular bleeding. METHODOLOGY: We evaluated 102 patients admitted with colonic diverticular bleeding, from 1993 to 1997, who needed transfusion of 2 or more units of blood. We compared the clinical efficacy of surgical resection, conservative treatment, and therapeutic barium enema with regard to the cessation of bleeding, morbidity, mortality, and rebleeding rate. The therapeutic strategies used after further episodes of bleeding were also registered. RESULTS: Transfusion requirements were highest in patients who underwent surgical treatment, while the least amount of blood was required by the barium enema group (6.9 +/- 3.1 vs. 3.6 +/- 1.5 units of blood). However, the quantity of transfused blood did not correlate with the initial hemoglobin level, which was highest in the conservative treatment group and lowest in the operative group (9.0 +/- 1.2 vs. 8.1 +/- 1.3 g/dL). These data support the fact that the most severe bleeding would necessitate surgical resection and that therapeutic barium enema may be considered more effective than conservative treatments. With regard to the outcome of treatment, conservative treatment led to a rebleeding rate of 43.3%, which differed significantly from a 15.9% rebleeding rate after therapeutic barium enema (P = 0.009). No rebleeding was registered in surgically treated patients. Sixty percent of patients in whom therapeutic barium enema failed were treated by colonic resection without mortality, while 77% of patients who had rebleeding after conservative treatment were successfully treated with barium enema. Overall, barium enema was the most frequently applied second-line treatment (56.5%). The mortality after surgery was significantly higher than that after other treatment modalities (33% vs. 1%; P = 0.0001). CONCLUSIONS: If diverticular bleeding is clinically suspected as the cause of major lower intestinal hemorrhage, barium enema is a more promising alternative than conservative treatment because of diagnostic and therapeutic importance in the long-term. In the event of urgent secondary surgery following the failure of barium enema to stop bleeding, we recommend a sigmoidoscopy and, optionally, an angiography before surgery in order to first localize the bleeding. We conclude that therapeutic barium enema is the treatment of choice for the first bleeding episode, while surgical resection should be performed if rebleeding occurs.

Aged↗
PubMedDate not supplied

[Self-mutilation in men--injury pattern and motivation].

6 cases of self-inflicted injuries in male individuals are reported. The age of the affected men was between 15 and 46 years whereas the younger age predominated. Alleged incidents were robberies in 3 cases, rape in one case, violation in custody in one case and an assault originating in personal motives in one case. In 4 cases, the typical injury pattern of self-infliction was present showing parallel course and superficiality of the wounds in areas accessable by the persons's own hands. In 2 cases, atypical injuries (i.e. deep cuts and massive signs of strangulation respectively) were found. However, in most cases, the underlying motive was to gain affection. An autoerotic accident was tried to be disguised in one case. Profit was the leading motive in another case.

Adolescent↗
PubMedDate not supplied

[Unusual fatalities caused by glass splinter injury].

In the case of a thorax stab wound and an intrapulmonal position of the glass fragment (fall from a ladder into a glass door) an extrathoracic cardiac massage had been carried out. The result of which, an extremely unusual "reanimationtrauma" and the problems connected with it are discussed. In another case of a stab wound of the right iliacal vessels and the position of the glass fragment in the minor pelvis (jump through a thermopane glass of a door, followed by a fight) investigations were first conducted because of the suspicion of manslaughter. The autopsy, however, completely excluded death through fault of another. Further an unusual figured glass cut wound on the left side of the head (fall into a glass brick wall) led to death through gradual bleeding. The question arose whether death was caused by failure to give assistance.

Accidents, Home↗
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[Growth and development kinetics of Bacillus thuringiensis in batch culture].

The kinetics of Bacillus thuringiensis growth and its assimilation of nutrient substances were studied under the conditions of batch cultivation in a complex medium containing yeast extract and in a chemically defined medium with amino acids. The growth of B. thuringiensis can be divided into five phases: exponential growth; decelerated growth; stationary phase when protein crystals are formed; stationary phase when spores are formed; lysis of sporangia releasing spores. The first phase may in turn be subdivided into three stages according to changes in the specific growth rate and substrate assimilation: a high specific growth rate and no glucose assimilation; an abrupt drop in mu and the beginning of intensive glucose assimilation from the medium; a new rise in the specific growth rate. As follows from the results of studying the kinetics of B. thuringiensis growth in a chemically defined medium, the above changes in the exponential growth phase are due to the fact that the culture assimilates yeast extract components in the complex medium or amino acids in the chemically defined medium during this phase, and then starts to assimilate glucose and ammonium in the following phases of growth.

Amino Acids↗
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[Myxoma of the left atrium as the cause of sudden death? An unusual fatality].

Case report of a 67-year-old woman who was found under mysterious circumstances 3 weeks after she had died. Main result of the autopsy was a myxoma of considerable size in the left atrium. Epidemiology, pathology and clinical aspects are presented. The myxoma's possible meaning as cause of death is examined in a fatality where the inquiry was restricted because of the corpse being putrefied and partly eaten away by maggots.

Aged↗
PubMedDate not supplied

[Confusing muscular hemorrhage in a drowned cadaver. A contribution to differentiation between vital and postmortem changes].

The autopsy on an body recovered from the water showed evidence of drowning and, in addition, the occurrence of extensive intramuscular bleeding on the neck, in the area of the shoulder girdle and the upper arms. There was a suspicion that criminal violence had been used, and the police carried out extensive investigations; these were inconclusive. The subsequent histological examination of the affected musculature revealed "reactive" changes throughout which corresponded to post mortem damage. The case presented here serves to illustrate the usefulness of muscle histology for differentiating between the occurrence of intramuscular bleeding before and after death; the corresponding histological criteria are outlined.

Aged↗
PubMedDate not supplied

[Vitality and possible causes of punctate hemorrhages in the lower brain stem of a burned corpse].

The case under discussion of a burn victim with dot haemorrhages into the caudal brain stem confirms other observations which have only rarely been published that these dot haemorrhages are not necessarily the sequelae of an intra vitam trauma. A reliable assessment of such cases demands a comprehensive pathologic and if possible neuropathologic autopsy including follow-up investigation considering police inquiry.

Brain Stem↗
PubMedDate not supplied

[Expert assessment of coital injuries from the forensic medicine viewpoint].

A 38-year-old woman was transmitted to hospital with profuse vaginal bleeding. The origin of the vaginal injuries (resulting from "normal" sexual intercourse vs. use of instruments for manipulation in the vagina) was obscure. The wound pattern is presented and the literature on the subject is reviewed with special reference to predisposing factors and genesis of coital injuries. Concerning the wound pattern, reflecting a blunt trauma, a manipulation with a (so far unknown) instrument, but also with finger or hand could not be proved with the required certainty. In the presented case the origin of the vaginal injuries from "normal" sexual intercourse as described by the accused man could not be excluded.

Adult↗