Biomedical subjects
Publications and source records attributed to J Hasse.
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The increasing production and use of asbestos has induced a steadily increasing incidence of malignant mesothelioma. Diagnostic difficulties persist and the disease may remain undiagnosed in spite of multiple fluid aspirations and percutaneous needle biopsies. Thoracic surgery efficiently contributes to the diagnostic yield by thoracoscopy and, with unilateral disease, in functionally operable patients, preferably by diagnostic thoracotomy. In suitable patients this can be extended to either palliative tumour pleurectomy or total pleuro-pneumonectomy en bloc with resection of the pericardium and the diaphragm. The primary mortality of this procedure has dropped from formerly thirty to now well below 10% for both types of resection. Along with any kind of thoracotomy a lung biopsy should be performed for search of asbestos bodies in the parenchyma. This will facilitate not only the differential diagnosis but also the answer to the question of aetiology in support of the patients' and their families' claim for compensation to be paid. Unfortunately, although surgery has advantages compared to chemo- or radiotherapy and improves the quality of life, it fails to achieve cure except in a few favourable cases.
During the last 12 years, 14 patients were subjected to emergency heart valve replacement in acute bacterial endocarditis. Operative mortality was 21% (3/14); significant postoperative periprosthetic regurgitation or reinfection occurred in none of the survivors. Risk factors with unfavourable prognosis are: (1) virulent pathogens ("Non-Viridans"-germs); (2) previously normal heart valves; (3) acute aortic insufficiency with premature closure of the mitral valve; (4) floating vegetations shown by echocardiography. Our results provide further evidence for the efficacy of early surgical intervention in patients with bacterial endocarditis with an unfavourable etiology or a complicated course.
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Two patients with candida infection on prosthetic valves are presented. Both were eventually cured after removal of the prosthesis, sterilization of the prosthetic bed with local iodine solution (Sol. Iodi Aethanolica 6.5%) and insertion of a new prosthesis and the discontinuance of antifungal therapy. This technique has subsequently been applied to 22 patients with bacterial endocarditis with good results.
Ninety-six patients were followed for an average of 45 months after insertion of cloth-covered Starr-Edwards prostheses (SE 2300, 2310, 2320, 2400, 6300, 6320, 6400). Operative mortality was 1%, hospital mortality 5.2% and late mortality (45 months) 13.5%. We observed a high incidence of valve disfunction as evidenced by a removal rate of 23% after six years. Disfunction was most reliably detected by abnormal prosthetic sounds and/or murmurs of incompetence at the prostheses. Thromboembolism occurred in 14% of the patients over 6 years and increased hemolysis was found in 18.8% of patients. It is concluded that the low incidence of thromboembolism does probably not out-weight the high incidence of valve disfunction.
The interpretation of most objective nutrition assessment parameters is affected by liver disease. A subjective global assessment (SGA) tool adapted for assessment of adult liver-transplant candidates was evaluated for interobserver reproducibility. Two dietitians assessed 20 liver-transplant candidates in regard to 25 SGA parameters based on patient history, physical appearance, and existing clinical conditions. Fifteen percent of the patients were found to be well nourished, 70% moderately malnourished, and 15% severely malnourished. Raters agreed on the nutrition status of the patients 80% of the time. Twelve individual parameters showed fair to good interrater reliability (kappa > or = 0.500). Muscle wasting and fat depletion were determined to be the strongest predictors of the final SGA rating (kappa = 0.737, p < 0.0001, kappa = 0.632, p < 0.0001, respectively). The assessment tool itself was determined to be reliable by the Cronbach coefficient alpha-test (0.707). Although this assessment method has limitations, the findings of this study suggest that SGA as an alternative test for assessing the nutrition status of adult liver-transplant candidates has an overall fair to good interobserver reproducibility rate.