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Biomedical subjects

G Wolff

Publications and source records attributed to G Wolff.

At least 163 records · Page 9Linked to original sources
PubMed1983

[Benign epithelial neoplasias of Vater's papilla].

Benign epithelial tumours of the papilla of Vater seem to be very rare. Since 1910, 75 cases have been published. 3 own cases were added. Diagnostic and therapeutic problems were discussed. Benign epithelial neoplasms of the papilla of Vater are precanceromatous. Many cases of carcinoma of the papilla may grow from benign adenomas. The treatment of choice is the local exzision of the adenoma, occasionally necessitating the reimplantation of bile and pancreatic ducts. The main problem is the treatment of adenomas with severe epithelial dysplasia. Metastatic deposits are possible but duodenopancreatectomy seems to be too aggressive an operation in such cases. In cases of severe epithelial dysplasia and focal invasion of the stroma duodenopancreatectomy should be performed. In cases of familial adenomatosis coli adenomas of the papilla should be thought of. In cases of adenomas of the papilla of Vater the colon should be examined to exclude a familial polyposis coli.

Adenoma↗
PubMed1983

Cytogenetic studies in couples with multiple spontaneous abortions.

Chromosome studies were performed on a series of 117 couples referred for genetic counseling following two or more spontaneous abortions. Of the 222 individuals karyotyped, in five cases a chromosomal aberration was found. Four cases had a balanced translocation, and one revealed to be a 46,XX/45, X mosaic.

Abortion, Habitual↗
PubMed1982

[Monitoring of respiration: gas exchange and pulmonary hemodynamics].

The quantitative evaluation of pathological CO2 elimination and O2 uptake are discussed. CO2 elimination may be described by the concept of "functional dead space ventilation" (VD/VT) in a manner sufficient for clinical use. For this purpose it is necessary to measure PaCO2 and the concentration of CO2 in the mixed expired gas. For a quantitative definition of oxygen uptake it is necessary to relate PaO2 to inspiratory O2 concentration (F1O2), and this is best achieved using the "intrapulmonary right-to-left shunt". To calculate this ratio, mixed venous oxygen saturation as well as F1O2 and PaO2 have to be measured, which means that a pulmonary artery catheter has to be in place. A new interpretation of the N2 wash-out curve demonstrates that pathological changes of intrapulmonary gas diffusion may be responsible for difficulties in the interpretation of O2 uptake. Monitoring of pulmonary hemodynamics calls not only for a pulmonary artery thermodilution catheter but also monitoring of the course of body weight. However, recent work shows that the measurement of ventricular filling pressures must be related to the individual ventricular volumes in systole and diastole which are measurable today.

Carbon Dioxide↗
PubMed1982

[Catheter epidural analgesia for treatment of postoperative and post-traumatic pain].

Postoperative epidural local anesthetics or opiates provide excellent analgesia but do not reduce the incidence of respiratory complications compared with systemic analgesics. Additional and sometimes lethal side effects reserve the routine use of epidural analgesia for highly selected patients. Thoracic epidural analgesia (TEA) may prevent ventilation in patients with serial rib fractures (SRF) without gross pulmonary parenchymal lesion. TEA results in fewer pulmonary complications, shorter hospital stay, and lower mortality than artificial respiration. Late global pulmonary tests after TEA for treatment of SRF show normal results within comparable groups without rib fractures.

Abdominal Injuries↗
PubMed1982

Nosocomial infections in intensive care wards: a multicenter prospective study.

In a three-year prospective investigation, a total of 6,952 patients were investigated prospectively in nine intensive care wards and their rate of nosocomial infections was analysed. The frequency of the nosocomial infections varied between 3% and 27%. The most frequent nosocomial infections were urinary tract infections, sepsis, infections of the skin and of the subcutaneous tissue, pneumonia and wound infections. The most frequent causes of sepsis were ventilation pneumonia, venous catheters, wound infections and urinary tract infections. The pathogen spectrum was analysed. By specific control of infection with employment of an infection control nurse, the frequency of nosocomial infections on intensive care wards was lowered from 17.2% to 14.3% within one year in one of the hospitals.

Bacterial Infections↗
PubMed1982

Optimal endexpiratory airway pressure for ventilated patients.

In patients ventilated for acute respiratory failure PEEP was changed either by gradual increase and decrease (5 cm H2O/min) or in steps of 5 cm H2O. The effects on gas exchange, pulmonary mechanics and pulmonary and systemic circulation were studied. Total compliance did not change uniformly and cardiac index decreased so much due to PEEP that the increase in PaO2 could not prevent the decrease of arterial oxygen transport. No variable was found helpful to predict the "best PEEP" in a clinical situation.

Blood Circulation↗
PubMed1982

Epidural analgesia or mechanical ventilation for multiple Rib fractures?

A protocol for treating thoracic trauma is proposed. Severe pulmonary lesion with increased venous admixture (e.g. contusio, atelectasis, aspiration) is treated by mechanical ventilation. Rib fractures with minor pulmonary lesion and therefore with only moderately abnormal gas exchange but with remarkably reduced vital capacity (even with flail chest) are controlled by thoracic epidural analgesia following vital capacity, tidal volume and respiratory rate. If both a severe pulmonary lesion and serial rib fractures are present, the patient is ventilated for 2-3 days and then extubated to breath spontaneously with epidural analgesia. The indication for a mechanical ventilation or for spontaneous breathing with thoracic epidural analgesia is therefore deducted more from functional variables than from morphological facts. The course of a consecutive series of 283 patients is presented. 155 patients were treated with primary ventilation and 112 patients with primary epidural analgesia, while 16 patients could be managed with general analgesia. The duration of treatment morbidity and mortality show this protocol to be very useful.

Adult↗
PubMed1982

[Ocular myasthenia in sisters (author's transl)].

The case histories of two sisters with ocular infantile myasthenia are reported. The older girl has been suffering from the disease for 11 years now. Infantile myasthenia is clinically and genetically different from myasthenia gravis which occurs in older patients. The disease is probably due to a number of factors, a special genetical disposition which facilitates the specific effect of environmental factors. It cannot be ruled out, however, that in rare cases as for example in the family with parental consanguinity reported on here there is an autosomal recessive mode of transmission. The clinical and genetic heterogeneity of infantile myasthenia and the heredity of the disease are discussed.

Adolescent↗
PubMed1982

Psychosocial and intellectual development in 12 patients with infantile nephropathic cystinosis.

The psychosocial and intellectual development of 12 children with infantile nephropathic cystinosis was investigated longitudinally by use of biographical data, long-term behavioral observations and psychological assessment. Of the 12 patients, eleven suffered terminal renal failure and 7 of these were followed up after renal transplantation. In spite of the severe illness and the resulting unusual life conditions the patients showed normal intellectual capacity and most of them average school performance. The patients were socially adapted, their behavior was predominantly cooperative, shy and reserved, but depressive at times. After transplantation the children became more active and outgoing. However, growing discrepancies between their physical development and their emotional and social age may lead to adaptational problems at adolescence which may require psychological counselling.

Adolescent↗
PubMed1982

A concept for breath by breath computing of lung compliance in the ventilated patient.

A concept for calculating dynamic lung compliance (CL) by computer in ventilated supine patients is described. The primary signals are gas flow, airway pressure, esophageal pressure (PES) and ECG. Endinspiratory and endexpiratory PES is calculated as a mean value during an R/R interval's time just before the end of inspiration and expiration. Its main advantage is a reduction of the variability in computer calculated CL by reducing the influence of cardiac oscilliations on PES tracings, thus enabling evaluation of special ventilatory settings as intermittent mandatory ventilation or rapidly changing PEEP.

Computers↗
PubMed1981

[Acute heart insufficiency of primarily non-cardiac origin after polytrauma].

UNLABELLED: The following approach is proposed for treatment of the hemodynamics resulting from severe trauma. Blood pressure and pulse frequency are measured whilst volume is added until peripheral circulation returns to normal or until CVP attains 13 mm Hg (under CPPV, PEEP 10 cm H2O). When CVP attains 13 mm Hg a pulmonary-arterial thermodilution catheter is introduced and transfusion continued, possibly up to a PCWP of 17 mm Hg. At this stage, 4 different haemodynamic groups may be distinguished and are described on the basis of the mean values recorded for 3 patients in each group: 1. SVRI increased, LVSWI and PVRI normal. THERAPY: continued slow addition of volume. 2. SVRI and PVRI slightly elevated. LVSWI diminished. CI and VO2 adequate. THERAPY: phentolamine. 3. PVRI slightly elevated, CI and VO2 too low, i.e. left cardiac insufficiency. THERAPY: isuprel. 4. PVRI markedly elevated, CI and VO2 clearly diminished, i.e. biventricular cardiac insufficiency with pulmonary-vascular hypertension. THERAPY: isuprel and phentolamine. Pharmacological therapy can be discontinued after a few days and hemodynamics remain normal. These observations show that "acute cardiac failure in fundamentally normal hearts" can occur after severe trauma and that treatment is possible.

Blood Volume↗
PubMed1981

[Changes in the colloid-osmotic pressure by a foreign colloid (dextran 70)].

In 55 patients undergoing elective surgery (general or urological) the colloid osmotic pressure (COP) of serum was followed up until the sixth postoperative day. The patients were divided into two groups, one receiving intra- and postoperative administration of dextran 70 and the other as a control group with no dextran. COP was measured at an artificial membrane (M = 10000) by a transducer; at the same time the concentrations of total protein, albumin and globulin were determined in order to calculate the COP by the formula of Keys. The dextran group and control group showed no difference in the measured COP. This variable reached the lowest value (which was not below 20 mm Hg) on the first postoperative day. The control patients showed close agreement of measured and calculated COP, while the calculated COP of dextran patients was significantly lower than the measured COP until the sixth postoperative day; the artificial membrane thus registered the action of dextran for this length of time. After each dextran infusion the serum proteins fell to a lower level than in the control group. Three possible explanations are discussed: an increase in intravascular volume, accelerated passage of macromolecules through the capillary wall, and a decrease in albumin synthesis.

Aged↗