Biomedical subjects

M Hirschl

Publications and source records attributed to M Hirschl.

42 records · Page 3Linked to original sources

PubMed1983

[Emergency endoscopy in patients with liver cirrhosis].

A report is given about emergency endoscopy in 389 patients because of bleeding from the upper gastrointestinal tract; 60 of these patients had cirrhosis of the liver as confirmed by biopsy. In the total group 17.4% were found to have bleeding from esophagus varices, in the cirrhotic group the incidence was 53%. Erosive lesions of the stomach came second in incidence, accounting for 27% of the cases in the latter group. In 60% of patients with cirrhosis, who had had acute bleeding, esophageal varices were present in abundance, whereas only 27% of patients without bleeding did have such excessive formation of varices. Thrombotest and thrombocyte count were equal in both groups. In 50% of 133 patients with cirrhosis of the liver without acute bleeding complications, a second potential source of bleeding beside esophageal varices could be detected. This underlines the importance of emergency endoscopy in patients with cirrhosis of the liver suffering from acute upper gastrointestinal bleeding.

Acute Disease↗

PubMed1982

[Acute venous thrombosis: localization, extent and aetiology with special consideration of paraneoplasia].

Among 279 consecutive patients (average age 53.8 years) with acute venous thrombosis, "complete" or "nearly complete" search for neoplasm was undertaken in 93 (average 60.6 years), "not complete" search in 186 (average 50.1 years). Subsequently the patients were followed regularly for possible malignant tumour (average follow-up period 36.9 months). In the group as a whole the following causes of thrombosis were identified: contraceptives 9.3%; post-operative 9%; malignant tumour diagnosed immediately or within 12 months 5.8%; traumatic 5%; immobilization 3.2%; post-partum 2.9%; diverse other causes 8.2%; unknown 59.5%. Neoplasm was found in 12.9% of 93 somewhat older "completely" examined patients. Taking into account age, 7.8% of all patients over 50 years developed thrombosis in association with neoplasm. In 6 of 16 patients with malignant tumour the venous thrombosis followed a particular course. Extensive thromboses in several bouts predominated. In 48.4% there were three-bout thromboses, in a further 27.4% four-bout thromboses involving also the pelvic vein. Isolated lower-leg venous thrombosis occurred in 9.2%, while the remaining one or multiple-bout thromboses occurred only in a few. Massive pelvic and leg vein thrombosis occurred in 43% of patients with malignant neoplasm, much more frequently than in those without neoplasm.

Acute Disease↗

PubMed1982

[Effect of parenteral administration of fat on the glucose and fat metabolism in acute pancreatitis].

Glucose intolerance is well known in acute pancreatitis. The question of this study was to clarify, if fat used partly instead of glucose in the parenteral nutrition of these patients allows to reduce the insulin necessary to control the blood glucose. A second question was if hypertriglyceridemia is caused by long term infusion of fat in such patients. 10 patients with acute necrotising pancreatitis were divided in two groups: group I (5 patients) were infused with a parenteral nutrition with fat, group II (5 patients) with a parenteral nutrition without fat. As parameters the amount of insulin needed to maintain the blood glucose at levels less than 200 mg% and the serum triglycerides were used. The blood glucose was controlled three times a day. For statistical evaluation the Student-t-test was used. The patients in group I (parenteral nutrition with fat) were infused 44 days and received insulin on 40 days. 69 units insulin/day were needed with a glucose dose of 243 g/day. The insulin dose per 100 g glucose was 29.9 U. The fat dose was 74 g/day. Group II (parenteral nutrition without fat) was infused 45 days and received insulin on 38 days. 103 units insulin/day were needed metabolized 295 g of glucose. The insulin per 100 g glucose was 28.7 units. The dose of insulin per 100 g glucose was not different between the two groups. In 1 patient a hypertriglyceridemia occurred after infusion of fat and disappeared immediately after withdrawal of the fat infusion. In the other patients no hypertriglyceridemia occurred during fat infusion. The parenteral infusion of fat has no influence on the glucose intolerance of patients with acute necrotising pancreatitis.

Acute Disease↗

PubMed1980

[Transaminase increase: a largely unknown side-effect of heparin treatment (author's transl)].

GOT, GPT and some other enzyme levels were measured systematically in 46 patients receiving subcutaneous heparin treatment. The heparin dosage varied between 5,000 and 15,000 IU, given every eight hours. During heparinisation a rise in GPT (average maximal values 67.0 +/- 7.3 U/l on the eighth treatment day) occurred in 89% of patients, while a rise in GOT (mean maximal values 39.7 +/- 3.9 U/l on the fifth treatment day) occurred in 82%. On reaching maximal value, enzyme activity decreased to the initial value despite continuing heparin treatment. A certain dependence of the incidence and (or) extent of the transaminase increase on heparin dosage was noted, especially comparing low-dose and full heparinisation. An increase in gamma-GT during subcutaneous heparinisation occurred in 37% of patients, while there was no significant change in alkaline phosphatase and lactate dehydrogenase.

Adolescent↗

PubMedDate not supplied

The electrophysiology of cardiac allograft rejection: independent effects of rejection and perioperative ischemia on the sinus node recovery phenomenon after cardiac transplantation.

We characterized the effect of cardiac allograft rejection on the sinus node (SN) recovery response from overdrive suppression. A total of 54 corresponding data sets (SN recovery time [SNRT]/endomyocardial biopsy [EMB]) was available in 24 transplant recipients with normal SNRT. Data were pooled in the rejection vs the no-rejection group (n = 16 vs n = 38, respectively). During cardiac rejection (defined as a 7-day period starting 3 days prior to and lasting until 3 days after the EMB) the SNRT curves were moderately, but significantly shifted towards higher values (F = 13.4, p = .0003). All changes occurred within accepted normal limits for the SNRT. Multivariate analysis indicated independent effects of donor heart ischemic time (p = .0005) on SNRT in addition to that of rejection. After accounting for that influence of ischemic time respective F values regarding the influence of rejection on the SNRT excursions were 10.8 (ischemic time < 100 min, p = .0014) and 4.36 (ischemic time > or = 100 min, p = .039). This study shows that cardiac allograft rejection significantly delays the SN recovery response from overdrive suppression. These changes, however, are subtle and, hence, are an unlikely explanation for the often grossly abnormal postoperative SN function.

Adolescent↗

PubMedDate not supplied

Carotid endarterectomy (CE) of the internal carotid artery (ICA) with and without patch angioplasty: comparison of hemodynamical and morphological parameters.

The aim of this study was to show, if patch angioplasty or direct closure of the blood vessel following carotid endarterectomy of the ICA resulted in any hemodynamical or morphological differences. Studies were carried out in eighteen and twenty patients, respectively within an average postoperative period of twenty-six month. All patients were examined with continuous-wave Doppler ultrasound, multi-channel pulse Doppler ultrasound and Duplex ultrasonography scanning. Comparing the two groups, differences are predominantly found at or near the site of the endarterectomized segment. Patients who received PTFE (Gore-Tex) patch angioplasty to close the arteriotomy, show in about 50% of all cases a dilatation--pantaloon effect (10)--at the carotid bifurcation (lumina greater than 1.1 cm) when investigating the vessel lumen with duplex sonography. This results in a statistical significant increase in turbulent flow disturbances at the bulb and the origin of the ICA. Furthermore, ICA flow velocity patterns after the endarterectomy point are still within the normal range when compared with patients not receiving a patch plasty, but still significantly elevated. Changes of the vessel wall, as such as intima elevation and intraluminal deposits are more frequently found distal to the endarterectomized segment and do obviously reduce the lumen. However, changes of flow volumina were not quantifiable. Atherosclerotic patients who underwent surgical treatment show as a characteristic finding due to atherosclerosis, a less laminar flow-pattern within the whole extracranial area, when compared with a normal healthy population.

Aged↗