Biomedical subjects
Publications and source records attributed to K Fritz.
Between January and September 1991, the average turnover of outpatient surgical centers in the Palatinate medical district was DM 100,000. A total 14.5% of this amount was costs of operation. Hourly charges are DM 300-600. For economical reasons, operations which do not cover these costs cannot be done.
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The necessary prerequisites for quality assurance are described. An analysis of the frequency and the scope of outpatient operation in the 91 surgical practices in Northern Württemberg, FRG, shows that, for the average practice, its significance is rather low. In contrast to this, the statistics of 41 practices of the "working group of outpatient operation of the BDC" show a clearly higher and more sophisticated capability, due to an annual operation frequency of 683 to 3008 operations. Reference is made to the importance of the out-patient operation for health politics.
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Topical application of 5-fluorouracil (5-FU) has proved effective in the therapy of psoriasis of the nail. Over a period of 6 months, we treated 114 patients with 1% 5-FU liquid and 59 patients with 20% urea plus 1% 5-FU cream twice daily. An improvement of more than 50% of the clinical signs of psoriasis, such as oil spots, subungual hyperkeratosis, and combined signs, was achieved after treatment with urea + 5-FU cream.
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In 42 men suffering from normogonadotropic oligospermia, the response of follicle-stimulating hormone (FSH) to 50 micrograms of intravenously administered gonadotropin-releasing hormone (GnRH) was determined after 15, 30, 60, 90 and 120 minutes. In most patients, the release of FSH rapidly increased during the first 30 minutes following GnRH administration, and there was little change after the maximum level of FSH (FSH max) had been achieved. FSH max was noticed after 30 minutes in 45,2% and after 60 or 90 minutes in other 45.3% of the patients; so every GnRH test should include the determination after 60 minutes. Hypergonadotropic response in GnRH test at normal basal levels of FSH may be diagnosed at sperm densities below 5 mill./ml. We regard a difference between basal and maximum level of FSH of more than 3 mU/ml to be a hypergonadotropic response. The GnRH test should not be confined to hypogonadotropic oligospermia; it may also be applied in endocrinological investigation of severe normogonadotropic oligo- and azoospermia.
The influence of halothane-nitrous oxide anaesthesia and normotensive epidural analgesia (level of sensory block T8-T10), respectively, on the plasma concentrations of adrenocorticotrophic hormone (ACTH), beta-lipotropin (beta-LPH), cortisol, dehydroepiandrosterone (DHA) and aldosterone as well as on the metabolites glucose, lactate and free fatty acids (FFA) was studied in 20 healthy patients who underwent elective orthopaedic procedures on the lower limbs. ACTH and beta-LPH concentrations in plasma rose significantly (P less than 0.001) during halothane-nitrous oxide anaesthesia. DHA secretion closely followed the secretory profile of cortisol. Increased renin levels and increased ACTH release seemed to be responsible for increased aldosterone secretion, intra-operatively. The hormonally induced rise of glycogenolysis and lipolysis did not produce important intra-operative increases in metabolite concentrations in the blood. In normotensive epidural analgesia no significant increase in stress response could be demonstrated, even with low levels of sensory block.
The effects of 0.5% bupivacaine-CO2 and bupivacaine-HCl were tested in a prospective randomised trial on 16 patients who underwent extracorporal shock wave lithotripsy (ESWL) with epidural analgesia. A shorter time of onset of analgesia (3.75 +/- 0.51 min) and a faster distribution of analgesia were noted with bupivacaine-CO2. Hypoalgesic regions were not registered with bupivacaine-CO2 nor with bupivacaine-HCl under shock wave treatment. About thirty minutes after application of either substance a level 1 block according to Bromage was noted, which was not desirable during positioning of the patient on the hydraulic lithotriptor chair. However, toxic blood levels were not reached in either group of patients to any extent.