[Distribution of functions in a general hospital].
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Biomedical subjects
Publications and source records attributed to K Ziegler.
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A report is given on four patients with spontaneous mediastinal and skin emphysema. In three cases younger patients from 14 to 21 years were concerned, in the fourth case a 63-year-old patient was concerned. Two of the younger patients revealed a long lasting malnutrition. As favouring or triggering factor, respectively, for the pathogenesis of the mediastinal emphysema in accordance with Macklin an increase of the intrathoracic pressure by retching, pressing or vomiting is regarded. Apart from this a vasoconstriction of the alveolar vessels (due to decrease of the plasma volume) and nutritional disease might be of importance. In all patients the mediastinal and skin emphysema receded under symptomatic therapeutic measures within some days.
History revealed iatrogenic injury (tracheostomy, intubation, artificial respiration) to be the reason for tracheal stenosis in each of our 32 cases (18 female, 14 male). So far 23 cases have been treated successfully and they live without a cannula; seven are still under treatment, while two patients died (severe heart-attack, spontaneous pneumothorax) and one refused further treatment. We were relatively successful in six cases of sleeve resection. All other 26 cases were treated by creating a tracheal groove, in which tracheal mucosa and skin of the neck were joined and the caudal end mostly kept open by using a pedicle skin flap. Intrathoracic stenoses require a sternotomy. An additional thyroidectomy and lateral traction to the tracheal walls by using loops out of the sternomastoid muscle became necessary in many cases and we obligatorily used tamponades of plastic inlay bolts, the average time of treatment being 8 months.
The human parasitoses, in which a diarrhoea can appear or is the obligatory symptom, occurring in warm countries are discussed in a survey.
Casuistic reports supplement parasitological and epidemiological references to the affection of man with Fasciola hepatica, Clonorchis sinensis and Opisthorchis felineus. Due to the increase of the tourist traffic must be reckoned with a more frequent appearance of these parasitoses little known in Middle Europe.
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