Biomedical subjects
Publications and source records attributed to M Doehn.
An angiogram of the lumbar venous plexus was obtained following accidental insertion of a peridural catheter into the plexus. The problem of vascular puncture is discussed and the possible methods of prevention of intravascular injection of local anaesthetic are outlined.
In order to elucidate pulmonary changes after sclerotherapy of esophageal varices animal experiments were performed. Polidocanol was injected into the submucosa of the distal esophagus and into a branch of the pulmonary artery. The submucous infiltration of the lower esophagus often causes congestive pulmonary alterations near the injection area. The subsequent disturbances of gas exchange as well as the negative inotropic effect of Polidocanol demands therapy in a number of cases.
Parenteral nutrition with carbohydrates is limited, inter alia, by the occurrence of a dose-dependent hyperlactataemia. Thiamine deficiency, which can be provoked by an eight weeks' diet which is deficient in thiamine, will produce clearly elevated lactate levels in rats, leading eventually to lactate acidosis as a result of glucose load, compared with a control group on a normal diet. It is recommended to initiate a high-dosage level thiamine therapy before parenteral feeding with carbohydrates, if thiamine deficiency appears possible on the grounds of previous history of the case (alcohol abuse) or because of the underlying disease (e.g. oesophageal strictures, carcinoma of the oesophagus).
Thiamine deficiency leads to a moderate hyperlactacidemia. As a result of an acute alcohol exposure the hyperlactacidemia is increased. In addition metabolic and respiratory acidosis with a distinct low pH value occurs. These changes constitute vital risks and may be considered as basic arguments for the explanation of sudden death in chronic alcoholics.
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Report on a serious disturbance of amino-acid metabolism in a 56 year old male patient suffering from thiamine-(vitamin B-1) deficiency, as proven by clinical history and examination and by laboratory data. In comparison with a group of 75 normal male persons also evaluated by the same laboratory this patient--while thiamine deficient--had markedly elevated serum concentrations outside the physiologic range of glutamic acid, glutamine, proline, citrulline, ornithine, histidine, lysine, phenylalanine, tyrosine and leucine, whereas his serum concentrations of taurine, serine and isoleucine were comparably definitely lowered. Following six to seven days of daily i.m. injections of 200 mg of thiamine each, this imbalance of amino-acid homeostasis disappeared except for that of taurine and--questionably--that of phenylalanine. In view of the absence of other exogenous or endogenous potential causes for this, it must be presumed that the thiamine-pyrophosphate deficiency caused the imbalance of amino-acid metabolism by consecutively disturbing the function of the alpha-ketoglutarate-, pyruvate- and p-hydroxy-phenylpyruvate- decarboxylase chains respectively. Possible connections between thiamine-deficiency and lowered serum concentrations of serine, taurine and isoleucine are being discussed.
This is report of a patient receiving preoperatively parenteral nutrition free of vitamin B1. Intraoperatively a severe lactate acidosis developed. This specific metabolic disorder was normalized only by adequate vitamin B1 substitution. Therefore one has to consider vitamin B1 deficiency as another cause of metabolic acidosis.
The known B1 - deficiency reaches excessive high values with light exercise. This results in decompensation of the base-acid balance with metabolic acidosis. Therefore B1 - deficiency has to be considered in the differential diagnosis of all metabolic acidosis situations.
The pathophysiology of respiration and hemodynamics during the agonal period of death by obstructive asphyxia was investigated. Experiments were carried out on ten dogs that were strangulated by ligature (seven cases) or asphyxiated by occlusion of the intubation tube (three cases). The following parameters were registered: Blood pressure in the arteria femoralis and arteria pulmonalis, electrocardiogram, endotracheal pressure, respiratory frequency, electroencephalogram. These were the most important findings: (a) An excessive and distinctly biphasic hypertonic reaction takes place after strangulation by ligature whereas occlusion of the intubation tube results in a slight increase of arterial blood pressure. (b) After occlusion of the tube more than after strangulation the endotracheal pressure becomes deeply negative during the inspiration trials. (c) After cessation of respiration a distinct pulmonary arterial hypertension develops in both forms of obstructive asphyxia. (d) The paralysis of the respiratory center takes place after about 4 min at the same time when the circulatory breakdown develops. The final cardiac failure occurs after about 9-10 min. The dysregulation of respiration and hemodynamics in the agony of obstructive asphyxia can be differentiated from other shock models. This results in special morphological alterations of the lung tissue which have been described elsewhere.
A laparotomy was performed on 23 dogs with and without ligation of the mesenteric artery. Twenty-eight laboratory parameters of blood samples taken immediately and then every two hours after the operations were checked for systematic trends. The analysis of variance showed some differences between both groups. It was impossible to use the individual results of this investigation for a general diagnostic approach. Difficult and long-lasting biochemical investigations are of dubious value since time loss is one of the most important problems in mesenteric occlusion. Indications for invasive diagnostic procedures and for laparotomy should not be postponed; they should depend on the different aspects of clinical symptoms, as it is practised now.
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In 10 intensive care patients with a risk of stress ulcer intragastric concentrations of lecithin, lysolecithin and bile acids were determined and compared to values in seven normal persons. All results were increased to multiple normal values. In particular lysolecithin and bile acids showed highly abnormal concentrations. These substances have a pathogenic importance for the occurrence of stress ulcers.
The effects of respiratory acidosis on the pancreas were studied in 25 Wistar rats. Ligation of the duct combined wiht respiratory acidosis resulted in the development of acute pancreatitis. In explantation of the results it is suggested that exhaustion of the buffering capacity causes a dramatic fall in pH of the pancreatic juice. The clinical relevance of findings is discussed.
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