Biomedical subjects
Publications and source records attributed to H Konrad.
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The success of a transfusion of thrombocytes is influenced by numerous factors concerning both the preparation of the platelet concentrate and the recipient. In a long-term substitution of thrombocytes on account of the appearance of immunological and unspecific consumption processes the control of the effectiveness is indicated. The determination of the thrombocyte increment and the resonance thrombography are suitable for this purpose. Fever, sepsis, splenomegaly and haemorrhage cause a diminution of the increase of thrombocytes after transfusion. Isoantibodies have the greatest influence on the shortening of the survival time of transfused thrombocytes. The corrected increase of thrombocytes (CI) 1 hour after the transfusion is lowered under 5.0 Gpt/l (m2). Directives are given for the transfusion and statement of the success of thrombocyte concentrate in patients with leukaemia and malignant tumours.
The clinical use of the transfusion of thrombocytes, its indication and problems in the long-term substitution of thrombocytes are explained. Out of the side effects the alloimmunisation against antigens of the HLA-system in the long-term substitution is of greatest importance. A substitution of thrombocytes is indicated in the disturbances of formation. The substitution shall be performed prophylactically in the acute leukaemia and aplasing therapy. When an increased destruction of thrombocytes is existing, other therapy principles are important. Recommendations are given for the prophylactic substitution of thrombocytes. The analysis of the transfusion of 320 concentrates of thrombocytes is reported.
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11 patients with deep pelvic and leg vein thrombosis were treated with ultra-high streptokinase infusion, 1.5. 10(6) IE streptokinase per hour over a six hour period. Opening of the vein occlusion was achieved in four cases completely and in five cases partially. The frequency of complications was lower at short-time thrombolysis with ultra-high streptokinase infusion in contrast to long-time thrombolysis. Bleedings did not occur. Because of the slight side effects ultra-high streptokinase infusion is an alternative in the fibrinolytic treatment of risk patients with pelvic and leg vein thrombosis.
Selective decontamination (SD) is used for prevention of bacterial as well as fungal infection in acute leukemia patients during remission induction therapy. We analyzed 138 treatment periods of 108 patients. The intensified chemotherapy resulted in severe granulocytopenia below 0.1 X 10(9) l for over 25.2 days. In 19 patients there was a suspect of major fungal infection, for which they were given antimycotics (in 15 cases amphotericin B and 5-fluocytosin). Fourteen of them died. Major fungal infections were documented in 5 cases. In 18% of the deceased we found major fungal infection (7 cases of Candida sp., 5 cases of Aspergillus, one case of Candida as well as mucor). There was a correlation between fungal infection, the late stages of the haematological malignancy and the lesions appearing on the oropharyngeal mucosa. However, no correlation appeared to exist in the serological and culture findings between the groups with and without fungal infection. The SD-regime is meant to suppress the Candida cell concentration in the digestive tract but has no influence on Aspergillus in the respiratory tract. The clinical occurrence of major fungal infections published in the E.O.R.T.C.--Gnotobiotic Project Group was 8.2%. According to the literature there is in the eighties a tendency for an increased incidence of aspergillosis. The use of the SD-regime as prophylaxis as well as early antifungal therapy appear to be of great advantage in reducing the frequency of fungal infections in immunocompromised patients.
For evaluating the clinical effectiveness of thrombocyte substitution, the resonance thrombogram was registered before and after thrombocyte substitution in 50 patients with acute leukemia and the increase of thrombocytes (corrected increment) determined. Thrombocyte substitution led to a significant diminution of the platelet amplitude (p less than 0.01) and platelet value. The highest value of these alterations of parameters was reached 1 hour after transfusion, it was somewhat lower after 24 hours, yet the initial value was not reached again. Correlations could be found to exist between the platelet amplitude and the corrected thrombocyte increase 1 hour and 24 hours after transfusion. The resonance thrombography enables the successful control of thrombocyte substitution to be made and it is suitable for monitoring hemostasis in severe thrombocytopenia due to production.
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The serum iron and serum copper level was determined in fifteen patients with lymphogranulomatosis before and during the course of the therapy. While the serum copper was increased in all stages, for the serum iron only in the stages III and IV a tendency to diminution was found. With obtaining the remission a significant increase of the serum iron and a significant decrease of the serum copper developed. The normalization of serum iron and serum copper suggests a remission, the dissociation of the two parameters an activity of the lymphogranulomatosis.
The electrophoretic mobility of lymphocytes is identified in the peripheral blood and from the spleen taken from a patient with hairy cell leukemia. Lymphocytes reveal an unimodal distribution with a low mobility in the histogram. There are no differences between the results obtained by investigating the peripheral blood and those of the spleen. Hairy cells could be delimited from lymphocytes of chronic lymphatic leukemia and immunocytoma by determining EPM.
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Anaemias with multivariate pathogenesis are frequently observed in chronic liver diseases. Among our patients 44.4 per cent (132 of 297) had an anaemia. The hepatogenic anaemia which appeared most frequently in patients with liver cirrhosis and carcinoma of the liver was in most cases normochromic (75 per cent), at a small proportion hypochromic (17.4 per cent) and rarely hyperchromic (7.6 per cent). Initial phases of an anaemia were more frequently registered by means of the counting of erythrocytes than by means of the determination of haemoglobin, which is to be traced back to the frequently existing volume macrocytosis. Leptomacrocytes, target cells and acanthocytes are observed as further forms of macrocytes in liver diseases. Among the possible individual factors the more frequently appearing latent and more rarely existing manifest haemolysis prevailed in 82 per cent of the examined patients. A hypersplenism, however, was present only in 24 per cent of the patients, vitamin B12 and folic acid deficiency as well as signs of the ineffective erythropoiesis relatively more infrequently occurred. Additional occult haemorrhages or an increase of the plasma volume may lead to an anaemia in latent haemolysis. As to the diagnosis a basis programme and an enlarged programme are reported on. The therapy has to take into consideration the treatment of the basic disease and the deficiency conditions or disturbances established.
In the period from 1970-1980 120 patients with NHL were treated. A primary stomach manifestation could be detected in 6.6%. Problems of pre-operative, endoscopic-bioptic diagnostics are discussed and recommendations for a therapeutic proceeding are given. The tumour is surgically removed at stage I and II, which is always followed by polychemotherapy. Primary polychemotherapy is used at stages III and IV. Patients at stage II achieved a complete remission, those at stage IV died within 6 months after diagnosis.
An uncontrollable bleeding of the urinary bladder was successfully treated using a 4% formalin strip tamponade with vesico-ureteral reflux and supportive therapy with thrombocyte concentrates and transfusions of fresh blood. Non-toxic side-effects of oxazaphosphorin derivates and modern methods of prophylaxis using a uroprotectic are presented. Previously the use of formalin together with vesicoureteral reflux was contraindicated; in this case it was successfully applied for the first time via the suprapubic route using a strip tamponade.
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