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Biomedical subjects

J Sturm

Publications and source records attributed to J Sturm.

At least 19 recordsLinked to original sources

[Leiomyosarcoma of the vena cava. Case report and review of the literature].

The leiomyosarcoma of vascular origin is a very rare tumor which is rarely recovered before the disease has reached an advanced stage because of non-specific and late symptoms. This is a report of 3 cases with leiomyosarcoma of the vena cava and a review of the literature. A high local recurrence rate and high frequency of distant metastases are responsible for the bad long-term prognosis. Early hematogenous tumor spread is favored by intraluminal tumor growth. Only complete surgical resection--if necessary with vascular reconstruction--can improve the bad long-term prognosis.

Aged

Enhanced urinary excretion of leukotriene E4 by patients with multiple trauma with or without adult respiratory distress syndrome.

1. The aim of the present study was to evaluate the systemic synthesis of cysteinyl leukotrienes in patients with multiple trauma. In order to do this, the urinary excretion of leukotriene E4 was assessed in the first 10 days after trauma. 2. Leukotriene E4 was unequivocally identified by g.c.-m.s. in the urine of healthy subjects and patients with multiple trauma after its conversion to 5-hydroxyeicosanoic acid. Leukotriene E4 was routinely isolated from 24 h urine samples by solid-phase extraction followed by reverse-phase h.p.l.c. and was subsequently quantified by r.i.a. 3. Healthy subjects excreted daily 10 +/- 3 nmol of leukotriene E4/mol of creatinine (mean +/- SEM, n = 16) into urine. 4. Patients with multiple trauma who did not develop adult respiratory distress syndrome (n = 7) excreted 76.8 +/- 6.7 nmol of leukotriene E4/mol of creatinine (mean +/- SEM) daily during the first 10 days after trauma, which was significantly (P less than 0.01) more than did healthy subjects. 5. Excretion of leukotriene E4 was even more enhanced in three patients with multiple trauma who developed adult respiratory distress syndrome. Maximal amounts of 593 +/- 185 nmol of leukotriene E4/mol of creatinine (mean +/- SEM) were excreted on day 9 after trauma by these three patients, which corresponds to a 7.7- and a 59-fold increase in excretion of leukotriene E4 compared with patients with multiple trauma who did not develop adult respiratory distress syndrome and healthy subjects, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[Orientation and stretching of DNA chains during pulsed field gel electrophoresis].

The quantitative analysis of the decay of birefringence accompanying gel electrophoresis leads to the characterization of two phenomena respectively attributed to alignment of the tube and to overstretching of the chain in its tube. The major contribution to the molecular orientation is given by the overstretching which relaxes according to a stretched exponential law. The other process, slow, is characterized by a reptation time and a mean orientation factor in good agreement with the biased reptation model without overstretching.

DNA

[The AIDS problem in accident surgery].

In trauma surgery there is a particularly high proportion of patients in the age group most at risk of infection with AIDS. The result of an epidemiological study in our patients (HIV screening of all patients scheduled for surgery at a trauma center over 18 months) showed a prevalence of 0.1%. Specific therapeutic strategies must be developed to deal with the weakened immunity of HIV-infected patients. Fracture treatment in HIV-infected hemophiliacs is a special problem. Homogenous bone transplantation is described with reference to HIV. The particular danger of injury in trauma surgery is also investigated. The chain of infection is illustrated and used to demonstrate the precautions that can be taken against nosocomial HIV infections. Following infection with fluids containing HIV, specific measures must be taken. The legal aspects of HIV-antibody testing in the Federal Republic of Germany are elucidated. Finally, the problems of general preoperative HIV-antibody testing are discussed.

Acquired Immunodeficiency Syndrome

Traumatic shock and head injury: effects of fluid resuscitation on the brain.

UNLABELLED: The effects of resuscitation of traumatic-hemorrhagic shock on the brain are unknown. Traumatic shock in sheep (fracture/crush injury, 2-hr hemorrhage to 40 mm Hg) was followed by resuscitation to baseline mean arterial pressure. Two groups without brain injury were resuscitated with lactated Ringer's (LR1, n = 7) or albumin (ALB1, n = 6). Focal brain injury was added in two further groups (LR2, n = 6; ALB2, n = 6). Hemodynamics, intracranial pressure (ICP), EEG, and colloid osmotic pressure (COP) were followed. Brain water (BW) and cerebral blood volume (CBV) were compared to those of controls (C, n = 7). RESULTS: ICP rose in all groups. Animals without brain injury did not have increased brain water. Below are results for brain-injured animals after resuscitation (mean +/- SEM). (table; see text) Maintaining COP during initial resuscitation does not minimize cerebral edema: the effects of LR and ALB were similar in this setting. Focal brain injury causes edema but does not cause large increases in ICP with initial resuscitation.

Albumins

[Tumor resections in the liver].

Over a 16-year period 54 patients presented with primary malignant liver tumours: 10 (18.5%) were considered inoperable, 44 underwent laparotomy. Nineteen (35%) turned out to be inoperable. A resection with curative intention was performed 25 times (47%) (11 right or extended right and 2 left hemihepatectomies, 12 mono- or bisegmentectomies). Hospital mortality was 8% (n = 2). The median survival time of those who died following resection was 22 months. Four patients have survived for more than 5 years, and three of them are still free of recurrence (5 year survival rate: 17% excl. hospital mortality).

Adenoma, Bile Duct

Opticon flutter.

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Aged

[Risk of lung embolism following preventive intravenous use of heparin in polytraumatized patients].

The risk of thrombo-embolic complications in multiple injured patients is increased due to several pathophysiological factors. The purpose of this study was to analyse the effect of a continuous IV heparin prophylaxis (10000IE/24h) in polytraumatized patients. A post-mortem evaluation of 72 decreased patients out of 373 multiple trauma patients treated during 1984-1985 was performed. In one patient multiple major pulmonary emboli were found to contribute to his death. No deep vein thrombosis as well as no fulminant pulmonary embolism were found in any case.

Adolescent

Thromboxane receptor blockade in an animal model of ARDS.

Manipulation of arachidonic acid metabolism may be important in the prevention and treatment of the adult respiratory distress syndrome. This study evaluated a thromboxane receptor blocker, BM 13.177, in a sheep endotoxin model. Sheep with chronic lung lymph fistulas were pretreated with the blocker before being given endotoxin. The blocker attenuated the early increase in pulmonary artery pressure usually seen after endotoxin (blocker + endotoxin, 31.0 +/- 14.5 mm Hg; endotoxin alone, 42.1 +/- 9.6 mm Hg). There was no effect on lymph flows during the later (permeability) phase (at 6 hours: blocker + endotoxin, 574 +/- 287% baseline; endotoxin alone, 311 +/- 102% baseline). Administration of the blocker alone increased pulmonary artery pressure, arterial pressure, and central venous pressure and decreased heart rate and cardiac index. Thromboxane receptor blockade presumably has little effect on elements of arachidonic acid metabolism other than thromboxane. Thromboxane appears to be important in the early pulmonary hypertension of the sheep endotoxin model but is relatively unimportant in the development of increased pulmonary capillary permeability.

Animals

Doppler frequency spectrum analysis and digital subtraction angiography in carotid artery disease.

The aim of the study was to evaluate the diagnostic accuracy of frequency spectrum analysis complementary to direct Doppler sonography in comparison to conventional biplane arteriography and transvenous digital subtraction angiography in internal carotid artery stenosis. In a group consisting of 229 carotid arteries visualized by conventional biplane arteriography, Doppler frequency spectrum analysis had a specificity of 97% and concerning all stenoses and occlusions, a sensitivity of 89%. In a second group consisting of 198 carotid arteries imaged by transvenous digital subtraction angiography, Doppler sonographic examination had a specificity of 65% only, and concerning all categories of stenoses and occlusions a sensitivity of 85%. These differences concerning specificity are not interpreted as false positive diagnoses in Doppler spectrum analysis but are considered to be due to false negative findings of digital subtraction angiography in stenoses of less than 50% vessel diameter reduction.

Carotid Artery Diseases

Cardiorespiratory and metabolic patterns in multiple trauma patients.

During the last 3 years we have performed a detailed study in 50 patients using the Swan-Ganz catheter to provide prognostic haemodynamic and metabolic values at an early stage. There was a total of 320 severe injuries in these 50 patients with a statistical mean of six to seven. The severity of injuries is documented by the volume replacement necessary within the first 24 hr. On average more than 8 litres of whole blood, albumin and dextran were given intravenously. Out of 50 patients, 28 survived. During the first 2h there was a significant difference between survivor and non-survivor in systolic blood pressure and shock index. From the very beginning the surviving patients demonstrated a higher cardiac index than non-survivors. Pulmonary artery pressure and total pulmonary resistance were also elevated from the very beginning. The right ventricular stroke work index was increased; the left ventricular stroke work index was decreased in the group of non-survivors. The arteriovenous oxygen content difference as well as oxygen extraction ratio was elevated, and the oxygen availability was decreased in the group of the non-surviving patients. Of the metabolic parameters, an increase in the lactate/pyruvate ratio as well as in serum glucose and a decrease in base excess values permit an early prediction of a favourable outcome. There were significant differences in the enzymes SGOT, SGPT, LDH, CHE, as well as bilirubin concentrations between survivors and non-survivors from sixth day on.

Acid-Base Equilibrium

The diagnosis of microscopic carcinoma of the esophagus.

Microscopic squamous cell carcinoma of the esophagus with early submucosal spread was diagnosed in two patients with hiatal hernia and evidence of esophageal reflux. The lesions were not suggestive of malignancy on endoscopic examination. Both patients are known to be alive more than one year after resection and presumably without recurrence. More liberal use of endoscopic brush cytology and biopsy or intubation cytology particularly in the cases at high risk, might substantially improve the chances of very early diagnosis and favorably alter the present grim mortality rate.

Biopsy