Chromosome aberrations as a biological dosimeter in thorotrast patients: dosimetric problems.
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Biomedical subjects
Publications and source records attributed to H Muth.
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As a presupposition for estimating the mean tissue dose from intravascularly injected Thorotrast results of investigations on tissue distribution and steady state activity ratios of 232Th and daughters in Thorotrast patients were compiled and are presented as "best estimates". Special emphasis has been given to the non-uniformity of Thorotrast distribution on the organ and cellular level on the basis of results from animal experiments. Moreover, the variation widths of the mean tissue doses were calculated from the individual standard errors of the mean Thorotrast tissue distribution and activity ratios. According to the results of Thorotrast tissue distribution analyses about 97% of intravascularly injected colloidal ThO2 are retained by the organs of the reticulo-endothelial-system (RES) of the average Thorotrast patient (liver: 59%; spleen: 29%; bone marrow: 9%). Only 0.7 and 0.1% are distributed within the lungs and the kidneys, respectively. The fractional retention of 232Th in the marrow-free skeleton proved to be 2% on the average. Considering in addition the results on the steady state activity ratios between 232Th and its daughters and self-absorption of alpha-energy in Thorotrast agglomerates the mean annual tissue doses to the liver, spleen, red bone marrow, lungs (respiratory zone), and cells on bone surface, e.g., from 30 ml intravascularly injected Thorotrast are about 30 (10-70), 80 (30-200), 10 (4-27), 4.5 (1.8-11.3), and 15 (6-38) rad. The variation widths of the mean tissue doses given in brackets are based upon an average individual standard error of the mean Thorotrast tissue distribution and activity ratios of 150%. The data on mean tissue doses, however, do not include variations of the dose due to macroscopic inhomogeneities of Thorotrast distribution on the organ level, which in the liver may go up to a factor of 50. Contrary to the mean tissue dose the local annual dose, i.e., the dose to cells adjacent to the surface of 0.1-50 micron Thorotrast aggregates is between 40 and 40,000 rad.
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In 581 cases of breech presentation during the years 1966--1974 in 90% of cases delivery was possible vaginally. We prefered the method of Lövset und Veit-Smellie. Casarian section was performed in 9,5% of the cases, the mortality of the newborns was 14%. Without the premature newborns (less than 1000 gr), the cases of intrauterine deaths and not viable children with malformations the mortality was 5,6%. The perinatal mortality of the children or more than 2500 gr was merely 0,69%. The general enlargement of the indication for Caesarian section is not recommended.
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Review of 1400 epidural anaesthesias during labour and delivery. The single shot method resulted in complete analgesia in 83.8% of the cases. There were 2.8% failures. With longer duration of albour 13.4% of the epidural anaesthesias had to be repeated. Epidural anaesthesia was tolerated well by the women in labour. Hypotension occurred in 21.6% of the cases and was corrected by intravenous infusion and positioning of the patient on the side. No adverse effects on the fetus were found. The duration of labour and delivery was not prolonged. The caesarean section rate was not increased by epidural anaesthesia. Because of the more difficult bearing down reflux during the second stage of labour, the incidence of vacuum extractions was increased by 1 to 3%. The incidence of forceps deliveries remained stable. There was no significant increase of abnormal vertex positions. Postpartum headaches because of decompression by loss of cerebrospinal fluid was seen in 2.2% of the cases. The headaches subsided on complete bed rest. One case of total spinal anesthesia with respiratory arrest is reported which necessitated immediate intubation. Another dangerous complication was noted in a Para 2 who suffered a complete uterine rupture below the level of the epidural anesthesia without any clinical signs and symptoms. Therefore continual internal fetal monitoring is considered to be essential in all cases with epidural anaesthesias. Previous caesarean sections or uterine operations are no contra-indications to epidural anaesthesia.
Report on the rare event of a complete ischemia of the right arm immediately postpartum. The infant was delivered by Caesarean Section because of cervical dystocia and fetal distress. The umbilical cord was twice around the neck and the ischemia of the right arm appeared to be due to spasm of the axillary artery. Treatment for shock and infusion of vasodilating drugs (Complamin) relieved the arterial spasm.
Between 1966 and 1974, 90% of 581 single breech presentations were delivered vaginally. The incidence of Caesarean Section was 9.5%. The overall perinatal mortality was 14%. After elimination of premature deliveries under 1000 grams, stillbirth prior to labour and non-viable anomalies, the perinatal mortality was 5.6%. The perinatal mortality in infants over 2500 grams was 0.69%.