Biomedical subjects
Publications and source records attributed to H Thieler.
It is reported on a left-atrial myxoma in a 20-year-old patient with atypical symptomatology of the mitral stenosis, unspecific general symptoms and lethally finishing embolisms and on the basis of the course the problems of the differential diagnosis and of the complications are shown.
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By means of a questionnaire the authors checked the views of dialysis teams on ethical and psycho-emotional questions, on on the adaptation of dialysis patients and on dialysis work itself. The results show that psycho-emotional considerations are of considerable importance in the contact with patients over long periods. The staff think about them but are often not able to arrive at a clear opinion. This indicates that psychological training of the staff is necessary in oder to facilitate and encourage the formation of clear points of view.
Report about three patients suffering from psoriasis vulgaris, who were not responsive to common dermatological treatment for many years. After peritoneal dialysis the psoriasis cleared and has not recurred for three to six months. Immunological investigations before and after peritoneal dialysis showed an increasing number of E-rosettes and a decrease of the concentration of soluble immune complexes of the serum.
The blood losses increase to the twofold to threefold by capillary dialysators C-DAK 4 and C-DAK 5 are about 6.8 ml and 26 ml, respectively, in the first use. In repeated use of the C-DAK 4 the blood losses by the C-DAK 5, however, are so high that it is not to be advised to use them manifold under our conditions of dialysis. By an increase of the reperfusion quantity from 150 to 250 ml of electrolyte solution for one C-DAK 4 blood losses may considerably be reduced. In a parallel switching of two C-DAK 4 each exemplar should be perfused individually.
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The author adopts a definite attitude to the prognosis of acute renal failure, based on the experiences of 410 peritoneal dialyses and 168 haemodialyses in 165 patients. In a total lethality of 51% there is no relation between the choice of the technique of dialysis and lethality. The changes of survival are mainly determined by the causal disease and its extrarenal complications. The worst prognosis have patients with a breakdown of other vital functions besides renal failure. The possibility of the alternative treatment haemodialysis/peritoneal dialysis should always be given.
The continuous peritoneal dialysis (CAPD) is with four or five change of 1 1/2-2 l dialysis solution a day a 24 hours/day and 7 days/week dialysis. In 6 patients with terminal renal insufficiency the behaviour of biochemical parameters which serve as acknowledged indicators for the efficiency of a dialysis technique, were pursued under this method more than 4 weeks. At the end of the treatment period the following average values came up: creatinine 9.0 mg/dl, urea-N 65 mg/dl, anorganic phosphate 4.8 mg/dl (without Al-hydroxide), potassium 4.3 mval/l, calcium 4.1 mval/l and a pH-value of 7.35. The results allow the conclusion that with the CAPD a sufficient elimination of retention products is possible and values in the suburaemic region may be achieved similar to the conditions in the intermittent dialytic technique. Conclusions concerning a broad application of the technique in the terminal renal insufficiency may, however, not be made alone from these observations, since the problems of relapsing peritonitis and of the chronic loss of protein known from literature did not yet play a role in our patients in the short observation period.
Ten end-stage renal disease patients treated by continuous peritoneal dialysis were investigated by means of spirography, compliance tests, body plethysmography, and blood oxygen analysis. The ventilatory function was compared with abdomen empty and abdomen filled with 2L of peritoneal dialysis solution. Only a mild ventilatory restriction occurred (vital capacity -3.5%, thoracic gas volume -7.9%) as well as a mild decrease of static absolute compliance (-8.8%) and of dynamic absolute compliance (-6.2%). There was no significant alteration of the specific compliance tests, or of the Tiffeneau test as a parameter of bronchial obstruction, and no reduction of blood oxygen. These results were obtained from probands without bronchopulmonary illnesses. But problems with CAPD and ventilatory function may arise in patients with diseases of the respiratory tract including fluid lung, or in patients with 'space problems' in the abdomen (polycystic renal disease).
51 urologic patients were dialyzed following acute indications during 1968-77. The 47 adults were 31-81 (average 59) years old. Due to the frequency of occurrence the predominant diseases were: Urolithiasis (combined with pyonephrosis, urosepsis, nephrocirrhosis), malignant tumors, and bladder neck adenomas. 18 patients were postoperative cases. 32 patients suffered from severe diseases or complications outside the urogenital tract. According to a differentiation of three risk groups, there were 33 patients belonging to the most severe group III. The patients' admission to the dialysis unit was late in most cases: 13 patients were already in coma or precoma, 18 patients overhydrated, 11 patients' serum potassium was more than 7 mval/1,28 patients' serum creatinine was more than 10 mg/dl. A prophylactic dialysis was possible in 11 cases only. We have accepted all 51 acute urologic patients, admitted to our clinic, for dialysis treatment. Peritoneal dialysis was performed in all 51 patients, only in 6 of them this treatment was followed by haemodialyses. The reasons for prefering peritoneal dialysis were haemorrhages or the danger of haemorrhages, a critical cardiovascular state, or an extreme acotaemia. In 143 peritoneal dialyses with 91 insertions of stilet catheters, one perforation of the small intestine occurred. The patient survived the resulting peritonitis. 13 of 15 patients with this indication got into an operable state in the course of dialysis treatment. Lethality of 61 per cent (31 of the 51 patients died) was related to the severity of the basic urologic disease. 4 of these latter patients could have been admitted to a regular dialysis treatment. In further 6 cases this would have been possible after a special urologic treatment.
In 34 patients without pre-existing infection of the urinary tract mostly a few days after insertion of an indwelling catheter a bacteriuria with 10(5) germs per ml urine developed. In 24 patients from the moment of the first proof of bacteriuria up to the removal of the catheter 1 to 10 days passed away. During this time in 6 patients a cylindruria, in no case, however, an antibody-coat of the bacteria could be established. In 10 patients who carried the catheter for a longer time, the excretion of antibody-coated germs in the urine began 11 to 18 days after the first proof of bacteriuria. A cylindruria was observed in 9 of these patients. Altogether the proof of cylinders in the early phase of the renal infection was more sensitive than that of antibody-coated bacteria in the urine. The probability of a provable participation of the kidneys in catheter-conditioned infections of the urinary tract consequently increases with increasing period of indwelling of the catheter.
This last of three reports on the prevention of hepatitis in dialysis centres deals with the kind and frequency of desinfection measures in the dialysis area, contains advices to the mode of transfer of patients between dialysis centres and makes demands to the tests of hepatitis-B-antigen and antibodies. Finally proposals concerning the frequency of controls for HBs-antigen and anti-HBs and for the passive immunisation with anti-HBs-enriched immunoglobulin are rendered.
On 33 patients who underwent a lung resection under conditions of stress in the majority of cases also after parenchyma-sparing operation a pulmonary hypertension, in about 50% already a slight hypertension in rest could be proved. The increase of the pulmonary pressure correlated with an increase of the resistance of the pulmonary vascular system, of resistance and age and showed tendencies to the increasing postoperative interval.
From the standpoint of prevention of hepatitis in this first report references are given to the construction of dialysis centres, to their apparative equipment with special regard to the artificial kidneys, to the dialysators and to the blood-leading systems. Finally the author deals with the technique of punctures and to the possibilities for avoiding too large blood losses in patients undergoing a chronic dialysis.
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At present 18 of 19 dialysis patients undergo the highly effective short-term dialysis, which is used in the Erfurt centre since November 1974. The therapy is performed by two parallel dialysators C-DAK 4 for 3 to 4 hours (24.4 square metres -- hours/week). During the period of observation of 2 1/2 years altogether 35 patients were treated with the short-term dialysis. There are compared clinical and paraclinical parameters of 12 patients who on an average for 2 years underwent the short-term dialysis. The serum levels of retained substances of protein and albumin as well as the "optimum weight" did not or only unessentially differ from each other. Also the blood pressure values scarcely deviated from each other before and after dialysis. The manifold use of the C-DAK 4 is the cause for an increased substitution of erythrocytes. Insufficient compensation of the circulation and a low body weight are regarded as contraindication to the short-term dialysis.
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8 male patients with chronic dialysis (5 of them with binephrectomy) were thrice a week dialysed in 2 groups alternately 2 months conventionally for 6 hours with a capillary dialysator C-DAK mod. 4 and 2 months for 3 hours with 2 parallel connected C-DAK 4. In a constant square metre-hour-product (23.4 m2h/week), homogeneous criteria of treatment and, as a rule, four times repeated use of the C-DAK 4 clinical parameters, subjective complaints and efficiency of the same patients were compared.