Biomedical subjects
Publications and source records attributed to H Fiedler.
Primary treatment of malignant melanoma should be surgical, with due consideration being given to certain peculiarities, including safety distance and radical lymphonodectomy in cases of lymph node metastasation. Adjuvant chemotherapeutic measures have failed to meet expectations in terms of adjuvant or palliative effects on healing. They have simply proved to prolong life with tumour presence.
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Taking into consideration indications and contraindications the coloscopy is a valuable diagnostic method in the programme of the diagnostics of colon diseases after the application of rectoscopy and contrast enema in the colon, which was well tolerated by our patients up to the old age. Decisive for a good evidence are the preparation of the patient to the examination and the experience of the examinator in the overcoming of the anatomical course of the colon.
The optimal utilization of the knowledge and possibilities of pathological and clinical biochemistry presumes a close cooperation between it and the clinical specialties. The common working team of the GDR Society of Internal Medicine and the GDR Society for Clinical Chemistry and Laboratory Diagnostics makes theses of the central points of the cooperation in care, education, further education and postgraduate study and in research a subject for discussion. As essential tasks in the process of medical care are regarded the balance of the examination programme standing at the disposal, the establishment of diagnostic programmes, the establishment of organisational measures, the ascertainment of a use according to indication, the guarantee of the representance of examination material, the control of plausibility and the interpretation of test results. Since the realization of the tasks to a large extent depends on the cooperation of the specialities in education, further education and postgraduate study during the further education the clinician should become acquainted with the possibilities, the limits and the prerequisites for the performance of laboratory diagnostic investigations, the clinical biochemist with the problems of medical care and the value of the laboratory diagnosis in the total process of the treatment. In the field of research the result is a necessary cooperation in the clarification of patho-biochemical mechanisms, in the search for suitable laboratory diagnostic parameters for diagnostics and control of the course as well as in the statement of the validity of laboratory diagnostic parameters and parameter combinations taking into consideration the factors expenses, benefit and risk as well as further diagnostic possibilities.
The effective use of laboratory results is less effected by improvement of the quality of analyses than by standardization and qualification of the pre-analysis as well as by improvement of the diagnostic value (interpretation). The predictive value of a laboratory result of constand sensitivity and specifity is established by the prevalence of the disease in the population group examined. By preceding general examinations (anamnesis, clinical examination) the prevalence and thus the predictive value is increased. Permanent exchange of information and experiences between physicians and laboratory scientists is an essential contribution to the improvement of medical care.
A full-time visit for several weeks of candidates of specialists of internal medicine in laboratories, in which competent specialists of clinical chemistry are working, contributes to the improvement of the interdisciplinary cooperation. By recognition of the pre- and post-analytic errors and by the scientifically proved indication on the basis of diagnostic strategies as well as an effective interpretation the effectiveness of the laboratory diagnostics in the process of medical care can be increased. Practical abilities ready for use are particularly demanded for bed-side methods and in the fields of haematology and haemostaseology.
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We treated 33 patients with a sudden hearing loss with Natrium - Meglumine-diatrizoat (Urografin) when all other standard therapy had failed. Detailed investigations were carried out, and thorough measures were taken against anaphylactic reactions before and during the intravenous administration of Urografin. In 10 cases (30%) an improvement of hearing of at least 20 dB was observed with restitution of almost normal hearing in some cases. The treatment was most successful in those cases where an excessive hearing loss (more than 40 dB) occurred for the first time. Since the drug is only intended for diagnostic use, further use as a therapeutic agent will require legal endorsement.
If blood donor selection were an efficacious means of preventing posttransfusion hepatitis B, three conditions should be fulfilled: 1. the incidence of the disease should decrease immediately after the exclusion of blood donations that contain presumed infectivity markers; 2. the incidence of the disease should likewise decrease when donor blood is completely replaced by autologous blood; 3. retesting of donors implicated in cases of posttransfusion hepatitis B should regularly detect one or more anti-HBc positive individuals per case. Since none of these conditions turned out to be fulfilled when tried in the FRG, it remains an open question whether the transfusion-transmitted part of posttransfusion hepatitis B is significant enough to justify laborious donor screening procedures.
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