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Biomedical subjects

J Zander

Publications and source records attributed to J Zander.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Pharmacokinetic studies of a new 20% fat emulsion containing 70% medium-chain triglycerides].

The aim of the study was to acquire basic knowledge on pharmacokinetic, metabolism and tolerance of a new 20% fatty emulsion with a 70% proportion of medium-chain triglycerides (MCT) and a 30% proportion of long-chain triglycerides (LCT) in the postoperative phase after a trauma of medium severity. - 12 female patients who had an elective rectal amputation and who needed parenteral nutrition postoperatively, were studied. The nutritional regime consisted of 4.8 g/kg/day of glucose and 1 g/kg/day of amino acids. On the second postoperative day the patients were given 0.06 g/kg body weight/h and on the third day 0.12 g/kg body weight/h of new 20% fatty emulsion during a time period of eight hours. Blood samples for the evaluation of triglycerides, free fatty acids, phospholipids, beta-hydroxybutyrate (beta-OHB), acetoacetate, cholesterol, glucose, pyruvate and lactate were taken before and after the fat application. Ketone were measured semiquantitatively. Side effects and complications were not observed. Simultaneously to the administrated triglycerides an increase in serum triglycerides was observed. After four hours fat emulsion was infused under steady state conditions. Under the graphically measured half-life of 17 minutes for the MCT/LCT emulsion, rapid and complete elimination could be seen after the infusion had been stopped. Simultaneously with the high clearance of the infused triglycerides, free fatty acids increased significantly in the plasma without reaching a plateau; 30 minutes after the fat application the laboratory results returned to the initial levels.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Hydroxybutyric Acid↗
PubMed1989

Effect of parenteral glutamine peptide supplements on muscle glutamine loss and nitrogen balance after major surgery.

Twelve patients admitted for elective resection of carcinoma of colon or rectum were allocated at random to experimental and control groups (six in each) and received a total parenteral nutrition regimen providing 230 mg N/kg and 166 KJ/kg daily over the first 5 postoperative days. In the experimental group the parenteral fluid was supplemented with a synthetic glutamine-containing dipeptide, L-alanyl-L-glutamine (54 mg peptide-N/kg per day) and the control group received corresponding amounts of alanine-N and glycine-N. On each postoperative day nitrogen balance was better in the experimental group; mean daily nitrogen balance with alanyl-glutamine was -1.5 (SE 0.4) g N/day and with the control solution -3.6 (0.2) g N/day. The cumulative nitrogen balances on the fifth postoperative day were -7.1 (2.2) and -18.1 (1.7) g N, respectively. With the peptide-containing solution intramuscular glutamine concentration remained close to the preoperative value whereas with the control solution it decreased from 19.7 (SE 0.9) to 12.0 (0.6) mmol/l intracellular water.

Clinical Trials as Topic↗
PubMed1989

Primary squamous cell carcinoma of the neovagina.

Primary carcinomas arising in the neovagina are rare and this is the ninth reported case. Two adenocarcinomas and seven squamous cell carcinomas, including our own case, have been described. The type of carcinoma is related to the transplanted tissue. Although the optimal therapy is unclear, we would recommend surgical treatment rather than radiation therapy. This is based on our own experience and on observations reported in the literature. Regular follow-up of patients with an artificial vagina is mandatory.

Adult↗
PubMed1989

Familial 46,XY pure gonadal dysgenesis and gonadoblastoma/dysgerminoma: case report.

The case reports of two sisters admitted for evaluation of primary amenorrhea are presented. Gynecological and endocrinological investigations and chromosomal analysis led to the diagnosis of familial 46,XY gonadal dysgenesis. Both sisters underwent bilateral salpingo-oophorectomy and hysterectomy. Histological examination revealed dysgenetic gonads with gonadoblastoma and dysgerminoma. Five years after treatment by surgery and irradiation the patients are well and free of recurrence. These cases again confirm the risk of malignancy and the necessity of prophylactic gonadectomy in all patients with gonadal dysgenesis and Y chromosomal material.

Adolescent↗
PubMed1989

[Data from the Bavarian perinatal survey on the problem of the incidence of cesarean section].

Data are presented on caesarean section rates during the first five-year period of the Bavarian Perinatal Study (BPE 1982-1986), comprising 450,000 births. In order to identify long-term trends, statistical studies from the Munich Perinatal Study (MPS) dating back to 1975 were continued in the same Munich hospitals through to 1982-1984. The results may be broken down as follows: 1. The overall rate of caesarean sections has been increasing, steadily, reaching 15% in the 1986 BPE. No clear levelling-off is evident yet. 2. The highest rates of caesarean sections and vaginal operative deliveries were found in university hospitals. Spontaneous deliveries occurred least often in university hospitals (about 70%), and most frequently in the larger country and private hospitals (77-79%). Smaller externally staffed private hospitals had about the same rate of vaginal-operative deliveries as university hospitals. 3. Following caesarean section, postoperative complications prompted a three- to sixfold higher rate of maternal transfer to other hospitals over that following spontaneous delivery. 4. As maternal age increases, so does the rate of caesarean section for primiparae. Nevertheless, recent years have witnessed a levelling-off for women over 34 years of age. No trend toward further increase is evident for this age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Protein oriented peripheral venous nutrition following surgical trauma].

In the postoperative state, hypercaloric parenteral nutrition is not indicated in every patient where enteral nutrition is not feasible. Low caloric protein oriented peripheral venous parenteral feeding might be an alternative nutritional regimen in moderate catabolic postoperative states. In a prospective study, 18 females received a completed nutritional solution during 4 days postoperatively following major colon surgery. The solution contained 80 g Sorbitol, 40 g Xylitol, 70 g amino acids and electrolytes (700 kcal/day). A slightly negative nitrogen balance with daily losses of about 4 g of N were observed. Routine biochemical data did not change compared to preoperative values. Plasma free amino acid homeostasis has been maintained so that conditions for optimal utilisation of the infused nutrients were given. No general side effects could be observed. This protein oriented nutritional solution may be recommended for hypocaloric peripheral venous nutrition in moderate catabolic states.

Amino Acids↗
PubMed1989

[Experiences with a new fat emulsion in surgical intensive care medicine].

As far as energy availability is concerned, it is advantageous to give lipid emulsions to severely catabolic patients, in comparison to lipid-free TPN. It is important to administer essential fatty acids, especially linoleic and linolenic acid, which play a major part in synthesis of membrane phospholipids and prostaglandin metabolism. Lipid emulsions with linoleic acid content and high linoleic-linolenic ratio might be of great value in posttraumatic situations, where the need for linoleic acid might be increased up to 50 g/day. We have examined the safety of a new lipid emulsion with a linoleic-linolenic acid ratio of 16:1 in 14 severely catabolic surgical ICU patients. As a result, neither liver enzyme elevation nor allergic reactions occurred. The limited elevation of triglycerides under lipid infusion and the rapid fall of these values to normal levels account for the satisfactory utilization of the examined lipid emulsion in critically ill patients.

Adult↗
PubMed1989

[Polytrauma as a cause of multiple organ failure].

In recent years progress in anaesthesia and surgery has led to improvements in care for traumatized patients. This progress not only affects emergency treatment, but also critical care. Although today a failure of one organ system can be successfully treated in most cases, the problem of multiple organ failure is still unsolved. Mortality even in young patients remains high (about 30 to 90%). Among the special problems are disturbances of the patients immune system, nosocomial infections with the development of sepsis and its impact on organ functions, hypermetabolism and metabolic failure. The improved insight into the cellular and humoral pathophysiology has led to changes in diagnostic and therapeutic procedures in these patients. Only an aggressive, combined effort of many medical specialties from the beginning and an early recognition and treatment of complications and organ dysfunctions can lead to optimal results.

Critical Care↗
PubMed1988

Comparative morphometric study on the depth of invasion in vulvar carcinoma.

Various studies assess the significance of depth of invasion as an important prognostic factor in squamous cell carcinoma of the vulva. However, methodologic problems exist with regard to the measurement points. While the deepest point of invasion can be measured accurately, the upper reference point is arbitrarily chosen. The goal of the present study was to identify the method of measurement and the threshold value, allowing the clearest prognostic differentiation between groups of patients with vulvar carcinoma. The study involved 124 patients treated between 1971 and 1980, who had received identical treatment (simple vulvectomy followed by local and inguinal irradiation) and identical histopathologic workup (large-scale sections). Beginning with the deepest point of tumor invasion, comparative measurement was carried out with three different points of reference: to the basement of the most superficial dermal papilla (method A), to the surface of the tumor (method B), and to the basement membrane of the deepest rete ridge (method C). The data were used to determine differences in specified end points. The results and conclusions are as follows: (1) The morphometrically determined degree of tumor invasion had prognostic significance. (2) Measurement of tumor thickness (method B) prognostically differentiates patient groups better than measurement of invasion from the most superficially lying epithelial papilla (method A), if classified into tumors up to and over 0.5 cm. (3) Patients with superficial invasive vulvar carcinomas up to 0.5 cm can be further prognostically differentiated into two groups, when measuring depth of invasion from the deepest rete ridge (method C), and classifying into tumors up to and over 0.3 cm.

Adult↗
PubMed1988

Adjuvant radiotherapy in patients undergoing surgical treatment for carcinoma of the cervix.

An analysis was made of the results from operations carried out on 1092 patients with cervical cancer during a co-operative study involving four universities. Standardized surgical procedures and histological processing of the surgical specimens were employed throughout. The indication for post-operative irradiation therapy was different in the University Departments. In order to carry out a realistic comparison of the results obtained, tumour extension, histologically determined on the surgical specimen, was used as a criterion, clinical staging not being used. In cases presenting a continuous tumour growth corresponding to histological Stage Ib, the five-year survival rates achieved were 90.5% and 95.6%, respectively, for patients who had received surgical treatment only and those who had had postoperative irradiation therapy. In cases of continuous tumour growth amounting to histological Stage II, the corresponding five-year survival rates were 79.5% and 83.1%. The difference between the survival rates of patients who had had or who had not had postoperative irradiation was not statistically significant. The further proof of tumour parameters in the formation of twin pairs revealed that the prognosis of patients presenting unfavourable tumour characteristics could not be influenced by postoperative irradiation therapy.

Carcinoma↗
PubMed1988

[Puerperal ovarian vein thrombophlebitis--a rare puerperal complication].

Puerperal ovarian vein thrombosis (POVT) commonly results from purulent necrotic endomyometritis. The incidence is published to be 1 in 600 deliveries, however, according to own data, the incidence is at least 10 times less frequent. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain localized anteriorly to the psoatic muscle and a tender, barrel shaped unilateral tumor. Discrepancy between the grave clinical picture and the insignificant findings on gyn. examination is common. Ultrasound and computed tomography frequently add in the correct diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course. If clinical improvement is delayed despite non-invasive treatment, surgical intervention with resection of the involved veins and all septic foci becomes mandatory. Despite non-invasive and invasive treatment, pulmonary emboli or septic complication refractory to therapy may contribute to mortality. Therefore POVT should always be included in the differential diagnosis of those patients presenting with a variable fever curve or an unexplained septic course following delivery or miscarriage.

Adult↗
PubMed1988

Use of psychiatric referral by family physicians.

The family physician occupies a critical place in the detection and management of mental health problems. Optimal case management requires an awareness of individual limitations and effective use of a psychiatric consultant. The consultant must understand the unique relationship between the patient and the family physician. Several historical biases may impede the physician's use of psychiatric consultation and the patient's acceptance of psychiatric treatment options.

Humans↗
PubMed1987

[Value of palpation and mammography in primary breast cancer. A retrospective study 1973-1982].

The value of palpation findings and mammography in 596 patients with primary breast cancer was investigated. The most frequent symptom (86.1%) was the lump. The primary tentative diagnosis came from the patient in 63.4% of the cases, from the physician in 28.9% of the cases, and only after mammography in 7.7% of the cases. False-negative palpation findings and false-negative mammography findings were observed in 9.9% and 5.0% of cases respectively. There was a clear dependence on the tumor stage. Carcinomas that were first diagnosed by means of mammography manifested a five-year survival rate of 82.6% and a recurrence rate of 15.2%. Carcinomas that were first discovered by the patient or the physician reached a five-year survival rate of 67.7% and 70.6% respectively. Here, too, the recurrence rate was higher, at 26.2% and 22.1% respectively. The data show that the carcinomas that were first suspected mammographically were smaller and manifested lymph node metastases more rarely. In order to reduce the number of false-negative findings the physician performing a mammography or assessing X-ray films should himself submit the breast in question to a thorough palpatory examination.

Adult↗
PubMed1987

[Ca 125 values in inflammatory adnexal disease and endometriosis].

The serum concentration of the tumour marker CA 125 was determined during an inflammatory adnexitis of a young woman of 22 years of age, the measured value being 478 kU/l. After the inflammation had subsided, a malignoma was largely excluded by laparoscopy; the CA 125 value had dropped to 70 kU/l. In a woman of 34 years of age who had an endometriosis that had been identified for the last ten years, as well as an acute suppurative fibrinous peritonitis, the CA 125 value was found to be 205 kU/l. On the fourth postoperative day the value was around 165 kU/l, on the 13th and 26th postoperative day 273 kU/l and 168 kU/l, respectively. There were no signs of an inflammation.

Adult↗