Biomedical subjects
Publications and source records attributed to L Sunder-Plassmann.
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66 patients with suspected bronchial tumors were examined by conventional tomography and by CT. The results were evaluated separately by two radiologists (A and B). All diagnoses were confirmed by bronchoscopy or surgery. In evaluating individual bronchi, conventional tomography had a sensitivity of 88% (A) or 87% (B) and a specificity of 97% (A) or 95% (B); CT had a sensitivity of 95% (A and B) and a specificity of 99% (A and B). If CT is available, our experience indicates that conventional tomography is no longer indicated.
In a prospective trial 33,421 patients receiving a combination of low molecular weight heparin and dihydroergotamine (LMWH/DHE; Embolex NM) as a routine antithrombotic agent were observed. The patients were recruited from surgical, traumatological, orthopedic, gynecological and urological departments. During the observation period 17 patients suffered from myocardial infarction leading to death in 7 cases. In 63 patients pulmonary embolism occurred, causing death in 12 cases. No irreversible vasospastic reaction due to DHE was seen. In one case a reversible ischaemic reaction in a lower limb was described which might have possibly been due to DHE. The low rate of complications suggests that LMWH/DHE is a safe and highly effective combination with a low risk of vasospastic reactions.
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The case of a 28-year old patient with a rare complication of an extensive endometriosis externa is described. A spontaneous pneumothorax occurred on 3 occasions corresponding each time with the start of the menstrual period. The various hypotheses on the aetiology and treatment of this rare condition are reviewed. To date only 65 patients with this interesting clinical entity have been recorded.
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Cardiac herniation is a rare but dramatic complication of pulmonary resection that demands urgent treatment. About 50 patients have been reported in the literature; 50% of them died. Symptoms vary depending on the location of the pericardial defect. Cardiac output falls, central venous pressure rises, and cyanosis develops that does not respond to oxygen administration. Right-sided herniation is characterized primarily by decreased blood pressure and tachycardia due to kinking or torsion of both superior and inferior venae cavae and subsequent reduction of cardiac filling. Left-sided herniation more often produces ischemic ECG changes and dysrhythmias due to jamming of the ventricles between the edges of the pericardial defect. Without intervention irreversible myocardial damage may rapidly result. Luxation typically arises at the end of the operation or in the early postoperative period. Precipitating factors are suction on the chest tube, changes in the patient's positioning, positive pressure ventilation to expand the remaining lung segments, coughing and extubation. In right-sided luxation an anteroposterior chest X-ray will substantiate the diagnosis without difficulty; in left-sided luxation the chest film may not show a similarly striking finding. Often dramatic deterioration in the patient's status may not allow time for diagnostic procedures. In case of doubt, immediate rethoracotomy is indicated. In the case observed, a 47-year-old woman underwent right pleuropneumonectomy with partial pericardectomy and intrapericardial ligation of the pulmonary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
Among malignant tumors of the mediastinum lymphomas are no indication for operation. In our experience, however, fine needle puncture, computed tomography (CT), nuclear magnetic resonance, mediastinoscopic biopsy of lymph nodes and intraoperative freeze section histology can only rarely differentiate between lymphomas and other tumors of the mediastinum. Only CT-guided or direct parasternal biopsy including immunhistochemistry can yield a reliable preoperative diagnosis and prevent unnecessary operation of lymphomas.
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Acute embolic arterial occlusion is the most frequent emergency in vascular surgery; the patients usually have significant heart disease and additional risk factors due to high age. Since 1966 acute embolic occlusions of major vessels of the lower extremity have been operated in 1496 patients; 82% of patients were over 65 years of age--18% even over 80 years. Standardized embolectomy from a small groin incision in local anaesthesia after preoperative check of general conditions has the best prognosis concerned limb salvage. Postoperative long term anticoagulation is performed routinely to prevent recurrent embolization. Preoperative angiography is required only when there is a clinical suspect of preexisting occlusive vessel disease with acute arterial thrombosis. If possible, this group of patients should be subjected to elective reconstructive surgery (fem. pop. bypass, profundoplasty etc.) since embolectomy alone does not mean definitive help in this group. Also for acute iliofemoral venous thrombosis high age is a significant risk factor. Among 240 patients, operated since 1966, about 25% were over 70 years of age. In these patients operative thrombectomy is the only effective means since lysis is usually not performed. Thrombectomy provided a very good result (fully patent veins, normal venous pressure response curves) in 28%. In 64% pressure curves were grossly normal, though recurrent thrombosis had occurred in either femoral or lower leg veins. Only 8% revealed total iliofemoral reocclusion. Thus also in these high risk patients thrombectomy seems to be justified to accomplish early remobilization and prevent respiratory distress syndrome.
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