Biomedical subjects
Publications and source records attributed to J Buhr.
Congenital esophago-tracheal and esophago-bronchial fistulae are rare. Symptoms are recurrent pneumonia, cough, dysphagia and pain. The diagnosis is made by bronchoscopy or esophagoscopy. Every time the diagnosis is certain, the fistula has to be exstirpated by means of a thoracotomy and plastic reconstructive flap surgery.
Since January 1990 we have treated 49 patients with spontaneous pneumothorax (35 primary and 14 secondary cases) by thoracoscopic operation. All patients entered a prospective trial. Those with secondary pneumothorax are discussed here. There have been no major complications. Conversion rate however has been high with 4/14 (29%). Three more patients (21%) not suitable for thoracotomy suffered from persistent air leaks. The other 7 patients needed postoperative drainage for less than 6 days in average. VATS could nevertheless be an alternative to thoracotomy for avoiding prolonged suction treatment in patients with secondary pneumothorax as patients showed no complications or disadvantage after conversion to thoracotomy.
Benign mesothelioma of the pleura is a very rare tumor. The cells responsible originate from either the mesothelium or the submesothelium. This is why such tumors are described in the literature as fibroma of the pleura, mesothelial fibroma, localized fibrous mesothelioma and monophasic spindle cell tumor. Their growth, is very slow taking several years or even decades. In contrast to the more common malignant mesothelioma of the pleura, it is not related to asbestos exposure. This report deals with a 47-year-old woman patient with a giant benign mesothelioma of the pleura in the region of the right thorax, which was completely removed by thoracotomy.
We describe a combined tumor and simultaneous transplant model in rats in tended to investigate interactions between tumor growth and graft rejection. To study the influence of tumor growth on graft rejection. Novikoff hepatoma cells were injected subcutaneously into the back of Lewis rats. Eight days later, the grown solid tumor was resected, and allogeneic heart transplantation was performed. Four groups were formed, receiving 5-fluorouracil (5-FU), cyclosporin A (CsA), 5-FU + CsA, and placebo, respectively. In the corresponding groups, tumor injection was omitted. Graft survival was significantly prolonged when CsA was given 5-FU did not abrogate or augment CsA efficiency nor influence graft survival when given alone. In the corresponding control groups, graft survival was similar, thus excluding an immunomodulating effect of the prior tumor growth on graft survival. To study the reverse interaction of allogeneic graft on tumor growth, heart grafting and tumor cell injection were performed on the same day. In different groups, 5-FU, CsA, 5-FU + CsA, and placebo was given. For the control, no transplantation was carried out. The tumor was resected on the 8th postoperative day and examined by immunohistology. A slight decrease of tumor growth by 5-FU, but a marked increase by CsA were found, whereas the graft alone showed no immunomodulation.
In a retrospective analysis, we studied 24 cases of malignant small bowel tumors. Apart from 9 cases of a carcinoid tumor, there occurred 6 cases of leiomyosarcoma and another 7 cases of adenocarcinoma. One case of malignant schwannoma and another case of lymphoma were also seen. Sonography and contrast-study of the GI-tract were the decisive diagnostic tools. Nevertheless, months and even years elapsed before diagnosis was established. Only in 13 patients curative resection could be accomplished. In the remainder of patients, hepatic metastases were found or the tumor could not be resected any more owing to its size. In 6 patients with synchronous and in 7 patients with metachronous liver metastases we carried out palliative regional intraarterial chemotherapy of the liver. The mean survival time of the whole patient group was 19 months. Patients, having submitted themselves to a complete resection of the tumor, had a significantly longer period of survival (mean survival time 25 months) in contrast to patients, having undergone a mere palliative operative procedure (mean survival time 14 months). Mean survival time for leiomyosarcoma was 38 months, for adenocarcinoma 14 months, and for carcinoid tumors 22 months. Owing to difficulties in establishing diagnosis, a tumor of the small intestine should be considered in any patient complaining of abdominal pain.
Traumatic and iatrogenic injuries of the trachea are rare. In case of suspected rupture of the trachea a bronchoscopy remains the 'gold standard' of diagnostic procedures. The injuries should be repaired as soon as possible through a right thoracotomy or a collar incision using resorbable sutures. In case of small lesions a conservative treatment may be discussed. Overall the prognosis of tracheal injuries is good.
Explore the source record for details and available documents.
It was hypothesized that the initial word comprehension of specific-language-impaired children would be enhanced by the insertion of a short pause just before a sentence-final novel word. Three groups of children served as subjects: twenty 5-year-old, specific-language-impaired (SLI) children, and two comparison groups of normally developing children, 20 matched for mean length of utterance (MLU) and 32 matched for chronological age (CA). The children were randomly assigned to two conditions for viewing video programs. The programs were animated stories that featured five novel object words and five novel attribute words, presented in a voice-over narration. The experimental version introduced a pause before the targeted words; the control version was identical except for normal prosody instead of a pause. Counter to the predictions, there was no effect for condition. Insertion of a pause did not improve the SLI children's initial comprehension of novel words. There were group main effects, with the CA matches better than either of the other two groups and no differences between the SLI children and the MLU-matched children.
Explore the source record for details and available documents.
Fifty-nine patients with bronchogenic carcinoma and 21 patients with nonneoplastic lung diseases underwent intraoperative pleural lavage with 300-ml physiologic saline before (Lavage I) and after resection (Lavage II). The presence of tumor cells in the lavage fluid was established cytologically in 29 patients with bronchogenic carcinoma. Twenty-seven had positive findings in Lavage I and 23 of these also in Lavage II. Two patients had positive findings in Lavage II only. All controls were negative. In all 40% of patients with Stage I bronchogenic carcinoma had positive lavage results. The cumulative two-year survival rate of this group is 40%, which differs significantly (P less than 0.01) from the 97% survival rate of the patients with the same tumor stage whose lavage findings were negative. Detection of tumor cells in pleural cavity washings before resection proves that tumor cells have spread into the pleural cavity. Cytologic examination of an intraoperative pleural lavage should be done when assessing the tumor stage.
Pleural lavage with 300 ml physiological saline was undertaken at thoracotomy (before and after resection) in a prospective study of 59 patients (49 males and 10 females; average age 59.7 years, range 41-76 years) with first manifestations of a bronchial carcinoma. The aim was to find out whether, even at an early stage of the tumour, there are tumour deposits in the pleural cavity. The lavage fluid was centrifuged and the sediment then embedded in paraffin and prepared for cytological examination. Tumour cells were demonstrated before resection in 27 patients (45.8%), in 23 of them also after the resection. Among 38 patients, previously classified as being in stage I, the lavage material was positive in 15 (39.5%); tumour cells were demonstrated in 5 of 18 patients in stage pT1. The cumulative two-year survival rate of non-small-cell bronchial carcinoma in stage I (n = 32) was 39.9% if the lavage was positive, 97.4% if negative (P less than 0.01). The results indicate that a positive finding on pleural lavage corresponds to a pT4 stage with a poor life expectancy.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Dispensary care covers all efforts directed towards maintaining health in the sense of physical, mental and social well-being. In view of the purely organ-related standpoint, which is still sometimes encountered, problems may arise in practice which obstruct endeavours towards this aim. Screening was used to identify, among groups with levels of psychoneurological stress higher than the mean yielded by epidemiological surveys and which increase with increasing length of vocational life, subjects whose neurotic symptoms predominated among the totality of pathological findings. Possible conclusions are drawn for the further implementation of an optimized dispensary strategy at the basis.
After a survey of literature the results of an investigation concerning the presence of neurotic evidences in diabetics are demonstrated. Altogether 55.4% of the examined patients gave suspicious references to adequate psychic disturbances. After discussion of the findings possible consequences for the diabetological practice and the basic care are explained.
With the help of a comparative analysis of the cardiovascular risk profile of 150 patients with diabetes mellitus, 62 patients with condition after myocardial infarction and 50 control patients of a rural district with 30,000 inhabitants was established that the spectre of the risk factors widely corresponds. According to a point valuation the diabetics on an average reached 3.36 points and the patients with a condition after myocardial infarction reached 2.66 points. In comparison of the curves a nearly identical course with "a shift to the right" of the patients with diabetes mellitus about the factor of the disturbance of the glucose metabolism could be proved. Concluding from this a general conception of the treatment was described. In this case the aim is a balanced therapy of the factors of risk and a preventive physical conditioning of diabetics with a high risk of infarction. In our investigations was furthermore conspicuous, deviating from literature, a very large proportion of patients with a hyperuricaemia (33.3% of the diabetics, 41.9% of the patients with infarction).