Science, responsibility, and society.
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Biomedical subjects
Publications and source records attributed to K Heilmann.
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An account is given of unusual course of a hyperthermic crisis in a 23-year-old male who underwent repeated anesthetics. As yet little has been reported about Isoflurane, which we presume to have been the triggering agent. In this case only the surgically untreated lower extremity developed rigor, with which malignant hyperthermia is associated, whereas the surgically treated extremity, where circulation had been stopped with a tourniquet, remained unaffected. Rigor and contracture of the affected extremity were so severe that they led to a compartment syndrome, necessitating fasciotomy. No observation of this kind has been published before. In addition to a discussion of this dissociated effect in malignant hyperthermia, a detailed account of the course of the crisis is given.
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In a sequential observational study efficacy and safety of two dosage regimens of cimetidine for the treatment of reflux-oesophagitis (RE) were examined. 22 office-based specialists took part in the trial. 187 patients received 1600 mg cimetidine (400 mg q.i.d.) daily and 136 patients received 800 mg cimetidine (400 mg b.i.d.) daily, over twelve weeks. The two dosages proved to be equally effective. In the group of patients with RE of stage I at the beginning of the trial, the healing rates were 82% under 1600 mg cimetidine/die and 86% under 800 mg cimetidine/die. In the group of those patients, who entered the study with RE of stage II, in both dosage groups the lesions of 87% of the patients were healed completely or had decreased to stage I. The severity of the mucosal lesions was judged endoscopically, based on a classification scheme modified according to Savary and Miller. The incidence of unwanted symptoms was not significantly different in both dosage groups (1600 mg: 5.3%, 800 mg: 3.4%); none of the symptoms which occurred was judged as definitely caused by cimetidine. The patient collective of the trial was characterized epidemiologically; out of the risk factors examined, only duration of RE history and number of previous RE episodes correlated with the severity of the disease, smoking and alcohol consumption showed no influence.
Cardio respiratory emergencies in which intubation is by any reason not possible are rare. The traditional procedure of emergency tracheotomy can be complicated by tracheal esophageal perforation. There is now available a new emergency cricothyreotomy set "Nu-Trake" which is easy to handle even by the less experienced anaesthesiologist. As shown in our study the risk of tracheo esophageal perforation is very small with the new emergency coniotomy set. We believe the device should be part of the standard equipment of every emergency ambulance, after some improvements by the manufacturer.
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Primary bilateral malignant lymphoma of the breast was diagnosed in these women. All were of the lymphoblastic type of high malignancy. Two patients were pregnant and all died of generalised malignant lymphoma. Survival time between initial or early manifestation in the breast and death was two to four months.
According to the Laurén classification 357 carcinomas of the stomach were reclassified into intestinal and diffuse types. 58.2% were assigned to the intestinal type, 37.5% to the diffuse and 4% to a "mixed" group. There is obvious correlation between the intestinal type, the patients' advancing age and the incidence of chronic, atrophising gastritis with intestinal metaplasia. The diffuse type on the other hand occurs irrespective of gastric changes - mostly in younger persons. The intestinal type of gastric carcinoma frequently is found in risk areas where incidence is "epidemic" in nature; morphology and genetic origin seem to be gastric mucosa changes and intestinal metaplasia or dysplasia. Classifying gastric carcinoma according to Laurén (two groups) is also an appropriate method in our regions as was confirmed by the results we obtained; it is superior to the much more differentiated macro- and microscopic classifications used so far. Because of its simplicity, it is better suited for epidemiological and pathogenetic studies of the gastric carcinoma.
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The basic defect in acrodermatitis enteropathica (A.E.) is zinc deficiency caused by zinc malabsorption. The clinical symptoms disappear and serum zinc levels normalize after oral treatment with zinc. A report is given on two siblings suffering from A.E., both treated with oxyquinolines for a long period with changing clinical success. A permanent clinical remission could be achieved by treatment with zinc-sulphate at doses of 110-220 mg daily. The serum zinc levels normalized. The correlation between the zinc concentration of the hair and the kind of therapy was not very close. As we have shown in our first communication, the Paneth cells of the intestinal mucosa display ultrastructural changes in form of an unhomogeneous structure of the cytoplasm, formation of giant granules, and inclusion bodies. The zinc-therapy led to a complete normalization of the pathological changes in the Paneth cells. Thus, the changes in the Paneth cells in A.E. are the result and not the cause of zinc deficiency.
In the scope of a clinical-experimental study on 12 patients with chronic open-angle glaucoma we proved that a reduction in the individual doses of Acetazolamide (Diamox) brought no reduction in the effect on raised intraocular pressure when the frequency of application was the same. Daily doses of 3 X 125 mg were compared with those of 3-250 mg and 2 X 500 mg (Retardform). A additional trial on 6 patients with a daily dose of 3 X 62.5 mg also showed an obvious effect. The possibilities of long term treatment with acetazolamide are discussed.
The fourth communication on the Ocular Therapeutic System Ocusert (Alza Corp., Palo Alto/Calif.; Federal Republic of Germany: Chemie Grünenthal, Stolberg) deals with experiences of a 24 months follow-up study as well as with the results of an omission test. From the diurnal curves carried out over 24 months, and the regression curves the conclusion can be drawn that the continuous application of pilocarpine has not led either to clinically recognisable changes in morphological structures or to a noticeable decreasing sensitivity to the drug so far. The omission test performed with placebo units shows the effect of intraocular pressure reduction remains reversible.
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Acrodermatitis enteropathica (AE) was diagnosed in 2 siblings, boy and girl, at the age of 10 and 6 weeks. The family history is unremarkable except for consanguinity 5 generations previously. The clinical symptoms of the 2 patients conformed to the known features of AE, the gastrointestinal involvement loosing its significance with increasing age. In one patient in a stage of exacerbation the serum level of oleic acid (18:1) was lowered and of linoleic (18:2) acid slightly increased while that of arachidonic acid was decreased (Fig. 4). In both patients the serum zinc levels were significantly lowered. Under substitution with ZnSO4 the clinical condition improved and the serum zinc levels returned to normal. Histologically the small bowel mucosa was practically normal. Ultrastructural examination of jejunal biopsies revealed rather unspecific changes in the enterocytes in the form of numerous multivesicular bodies. The Paneth cells sometimes contained irregularly formed inhomogeneous structures within their cytoplasm. In addition the secretory granules varied in size and displayed a granular heteromorphic matrix. Frequently they were confluent and formed giant granules.
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Severe combined X-linked immune deficiency ended fatally in a six-month-old male infant after generalized BCG infection. Damage in the cell-bound thymus-dependent immune system is decisive in the development of "BCG histiocytosis". As a result of absent immunocompetent sensitized T-lymphocytes there is insufficient information and stimulation of macrophages to kill the micro-organsims. The disorder of bactericidal properties of macrophages results in an overwhelming infection with BCG bacteria with a characteristic morphological picture.