Biomedical subjects
Publications and source records attributed to G Pilz.
We report the case of a four year old female patient who underwent an unsuccessful puncture of the subclavian vein in another department with an adult subclavian catheter. Unilateral haematothorax with massive bleeding from the right Art. thoracica interna occurred as a sequel of this attempt and was successfully treated in our department.
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Two cases of late recurrence (31 and 33 years after radical surgery) of an ameloblastoma induced us to explain our operative approach on the basis of experience with 37 patients operated on for ameloblastoma at our clinic. With special consideration of the biology, clinic and histopathology of this tumour, we have tried to establish operative guidelines with regard to radical surgery. We arrived at the conclusion that ameloblastomas regarded as malignant should be treated by radical surgery; and those considered to be benign, by conservative surgery, individual decisions being imperative. Our clinical observations and analyses are compared with the results of other authors.
On the basis of observations in 90 patients with odontogenic maxillary sinusitis who had been re-examined clinically and radiologically, the authors deal with the optimal utilization of all possibilities of conservative treatment. 74% of the patients were symptom-free, 55% presented a radiologically well pneumatized sinus. The healing quality of inflammatory alterations of the sinusal mucosa is once again confirmed by the observation of the course of the disease.
To illustrate the great variety of wisdom teeth impactions, the authors report a case where a vertically impacted 48 projected with its apex over the mandibular border by almost 2 mm. Possible causes of impaction and their consideration in the surgical removal of such teeth are mentioned.
Of a total of almost 200 patients operated upon by means of the Nasteff-Rosenthal method during the years 1962-1972, 80 could be re-examined. The results obtained show that this operating method stands the comparison with other techniques and that it may be recommended further on for the treatment of great cysts in the mandible as well as in the maxillae.
On the basis of a report of a dentinoma measuring 2 X 2 cm that had rounded the carious tooth and extended far into the antrum, the authors present some fundamental ideas of the pathogeny, clinical picture, therapy and morphology.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
In a multicenter observational study of 163 medical and surgical patients with a total of 173 episodes of sepsis or septic shock (Elebute sepsis score: 19.0 +/- 0.5), the effects of supplemental i.v. immunoglobulin (i.v. IG) treatment (unmodified polyvalent IgG pH 4.25, n = 123; for Pseudomonas sepsis, n = 50, Pseudomonas IgG) on multiple organ failure (MOF) were investigated by means of APACHE II score changes (pretreatment: 23.7 +/- 0.6). In 44% of the cases ("responders"), a prompt improvement in APACHE II score (defined as decrease greater than or equal to 4) was evident from day 0 to day 4 after onset of therapy, thus being in close time relationship to the i.v. IG administration. This improvement, associated with a better prognosis (mortality 24% vs. 55%), was found in all subgroups, most importantly the following: polyvalent IgG vs. Pseudomonas IgG treatment; medical vs. surgical patients; moderate vs. severe MOF; and gram-positive vs. gram-negative septicemia. In a small-sized second comparative nonrandomized control group (n = 27, antibiotic treatment alone) of septic patients (Elebute: 14.7 +/- 1.0) with similar MOF severity (APACHE II: 23.6 +/- 1.4), the response rate (30%) was, though not statistically significant, lower by one-third. The optimal baseline score ranges for patient inclusion into future placebo-controlled randomized i.v. IG trials were found to be 20-35 for the APACHE II score and 12-27 for the Elebute score.
In 40 intensive care patients, tissue oxygen partial pressure distribution within skeletal muscle was measured in order to estimate peripheral oxygen availability. In septic patients with multiple organ failure (n = 20) mean skeletal muscle pO2 was abnormally high (48.8 +/- 8.5 mmHg, p less than 0.001) in contrast to patients with limited infection without sepsis (28.3 +/- 5.9 mmHg, n = 10). Mean muscle pO2 also discriminated between septic and cardiogenic shock (22.6 +/- 6.9 mmHg, p less than 0.001). The characteristic pattern of oxygen availability in septic patients--but not in patients with limited infection--was high skeletal muscle pO2 high whole body oxygen delivery and low whole body oxygen extraction, which was not influenced by the type of pathogenic agent of sepsis. In our patients in severe stage of sepsis, we did not observe local skeletal muscle hypoxia due to microcirculatory disorder. High mean skeletal muscle pO2 suggested reduced oxygen consumption within tissue rather than reduced oxygen transport to tissue in sepsis.
In 47 medical and postoperative ICU patients with 57 episodes of sepsis and septic shock, cardiovascular parameters including systemic vascular resistance (SVR), cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI) as well as six scoring systems (APACHE II, Elebute, Goris, HIS, SAPS and SSS) were studied regarding their usefulness in the assessment of disease progression and evaluation of response to supplemental sepsis therapy (immunoglobulins, plasmapheresis). Among the hemodynamic parameters, only a prompt SVR improvement significantly discriminated between ultimate survivors and nonsurvivors. Thus, an increase in SVR (greater than 160 dyn*cm-5*sec, within days 0 to 4, persisting for greater than 24 hours) can serve as a prognostically validated "response" criterion (responders/non-responders: 26/31; mortality: 27% vs. 77%). Non-invasively, the APACHE II score was best suited (specificity: 88%, sensitivity: 67%) to classify hemodynamically defined responders to supplemental sepsis treatment (score-reduction greater than or equal to 4 on day 4 after onset of therapy).
Multiple hemostatic changes occur in sepsis and multiple organ failure (MOF). To evaluate the role of platelets in patients with sepsis and MOF, we examined changes in surface glycoproteins on circulating platelets of 14 patients with suspected sepsis and MOF. The severity of sepsis and MOF was assessed by the Elebute and APACHE II scoring systems, respectively. Using flow cytometric techniques and platelet specific monoclonal antibodies, platelet surface expression of fibrinogen receptor on GPIIb-IIIa, of von Willebrand Factor receptor GPIb, and of granule glycoproteins (thrombospondin (TSP), GMP-140, GP53) was measured. Plasma membrane expression of GPIIb-IIIa and GPIb on circulating platelets was not affected by sepsis of MOF. Septic patients, however, showed a significantly elevated fibrinogen receptor activity (LIBS1 expression) (p < 0.05) that correlated with severity of disease (r = 0.597, p = 0.043). No significant change in surface expression of granule glycoproteins (TSP, GMP-140, GP53) was noted in septic patients. In contrast, degranulation of granule glycoproteins was significantly elevated in MOF (p < 0.05) which well with severity of MOF (GMP-140, r = 0.611, p = 0.013; TSP, r = 0.643, p = 0.026). We speculate that platelets in sepsis circulate in a hyperaggregable but still reversible state that results in increased risk of microthrombotic events. In the course of the disease, irreversible platelet degranulation of adhesion molecules occurs that may play an important role in the development of MOF.
In 110 patients undergoing elective heart surgery on extracorporeal circulation, various parameters were studied regarding the early assessment of septic complications. In a first step, the Elebute score definition for postoperative sepsis validated in general surgery patients (score > or = 12) could be confirmed in an extended form (> or = 12 on > or = 2 days) for cardiac surgery patients. According to this definition (overall classification accuracy for clinically defined sepsis-related mortality: 94%), septic complications occurred in 16 patients and were associated with a significantly worse prognosis than in non-septic patients (mortality 69% vs. 1%, p < 0.0001). In contrast, SIRS (best classification criterion: positive on > or = 3 days) displayed a lower specificity for clinically defined sepsis-related mortality, at least during the early postoperative course (accuracy: 67%). Based on the Elebute score classification, other more practicable parameters were investigated regarding their usefulness for an early sepsis risk assessment in post cardiac surgical patients. Five additional severity scores (APACHE II, MOF-Goris, HIS, SAPS, SSS) were comparable (ROC area: 0.94 to 0.96) and superior to plasma PMN-elastase and neopterin, haemodynamics and clinical parameters in predicting the risk for septic complications as early as by the first postoperative day.