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Biomedical subjects

M J Polonius

Publications and source records attributed to M J Polonius.

At least 19 recordsLinked to original sources
PubMed2005

[Quality of surgical continuing education in Germany].

BACKGROUND: One of the reasons for young doctors to leave the clinical work to go abroad or into non-clinical fields is insufficient quality of training under bad circumstances. Aim of the study was to evaluate the surgical training in Germany from the viewpoint of the residents. METHODS: A questionnaire was prepared by residents and consultants and approved by the German surgical societies (Deutsche Gesellschaft fur Chirurgie und Berufsverband der Deutschen Chirurgen). It was sent to surgical residents between June 2003 and June 2004, published in "Der Chirurg BDC" and distributed among residents taking part in courses conducted by the BDC. It could be answered anonymously by email, mail or online. RESULTS: The questionnaire was sent back by 584 surgical residents (about 30 % of all). 58 % of the residents declared that they finished the training in the intended time (6 years). Rotation-systems as part of a structured residency program existed for 43 %. Standard surgical procedures were discussed or explained before the procedure in only 46 %. 61 % of the residents were not satisfied with the teaching assistance by their clinical teachers in the OR. Only 33 % had regular talks with the Chief about their progress in surgical training. 18 % of residents felt, that the hospital is interested in their progress in training. Indication-conferences took place in 52 % and mortality-conferences in only 20 % of programs. Regular seminars on recent issues took place in 62 %, and 61 % of residents did not get financial support to attend congresses. 36 % of residents had to use their holidays to attend congresses. CONCLUSIONS: Surgical training structures are not well established in about 50 % of the training hospitals from where we got answers to our survey. The training potential of daily surgical work is not used appropriately. It is therefore imperative to develop guidelines for surgical training, the use of log-books and rotation-programs.

Congresses as Topic↗
PubMed1993

Highly acute course of ruptured papillary muscle of the tricuspid valve in a case of blunt chest trauma.

The sudden onset of tricuspid insufficiency following a blunt chest trauma is extremely rare. We operated on a young woman in a state of severe shock following a riding accident, in whom complete severing of the papillary muscle of the posterior tricuspid leaflet had occurred. The valvuloplasty operation itself and the postoperative course ran smoothly, apart from a late pericardial tamponade which required surgical revision. In accordance with other reported cases we believe that traumatic tricuspid insufficiency is still a very underestimated pathological occurrence. Echocardiographic examination should therefore be regarded as an essential standard procedure in all cases of blunt chest injury.

Acute Disease↗
PubMed1993

[Mitral valve endocarditis caused by Salmonella enteritidis].

The epidemiology of salmonellosis has undergone a change during the last 2 years. An increase in the number of cases of enteritis and sepsis caused by Salmonella enteritidis has been observed. We report on the case of a 65-year-old woman with mitral valve endocarditis due to Salmonella enteritidis. The infective endocarditis occurred without prior episodes of gastroenteritis. After having undergone prosthetic valve replacement and antibiotic therapy with ciprofloxacin, the patient recovered completely.

Aged↗
PubMed1987

Aneurysm of the superior mesenteric vein.

A superior mesenteric vein aneurysm was diagnosed by ultrasound, computed tomography, and angiography in a 55-year-old woman. It was successfully treated by partial resection and reconstruction of the confluent veins.

Aneurysm↗
PubMed1985

[Successful therapy of recurrent hypoglycemias by surgical removal of a malignant hemangiopericytoma].

Tumor growth in a 72-year-old male patient with malignant haemangiopericytoma in the left hemithorax could be followed radiologically for 4 years before symptoms of recurrent hypoglycaemia appeared. The endogenous insulin level in serum was maximally and serum IGF-1 and IGF-2 markedly reduced. An intravenous arginine load test showed a normal stimulation capacity of the pancreatic glucagon secretion but not that of insulin. After resection of the tumor, blood sugar metabolism was completely normalised. The insulin level, IGF-1 and IGF-2 in serum returned to normal.

Aged↗
PubMed1980

Cardiac surgery in the Federal Republic of Germany during 1978 and 1979. A report by the German Society for Thoracic and Cardiovascular Surgery.

This is a report of the first 2 annual summaries of cardiac surgery performed in 21 units throughout the Federal Republic of Germany during 1978 and 1979. Including hospital mortality rates of the more conventional cardiac procedures, this register demonstrates development in and emphasis on cardiac surgery throughout the country over the years as well as it enables each cardiac surgeon to compare the work of his unit with that of other by giving a nationwide standard.

Cardiac Surgical Procedures↗
PubMed1979

Hemofiltration during extracorporeal circulation (ECC).

In cardiac surgery hemofiltration can be used: 1. to balance fluids during ECC, especially in long-term perfusion; 2. to carry out open heart procedures in patients with terminal renal insufficiency; 3. to treat acute hyperkalemia. The model of the 12.5 by 4.5 cm DIAFILTER TM and the model of operation are described. The compounds of the ultrafiltrate (UF) are identical with that of plasma water. Particles with a molecular weight of less than 50,000 can pass freely across the filtration membrane. The filtration capacity is 100 cc/min UF (Q blood: 300 cc/min, pressure across the membrane 600 mm Hg and hematokrit (Hkt) 25%). The technical details of operation are explained. Its general use as well as its simplicity is demonstrated in 10 patients.

Adult↗
PubMed1978

[Preoperative localization of myocardial areas requiring revascularization in coronary artery disease (author's transl)].

At the time of preoperative coronary angiography in 44 patients left ventricular angiograms immediately after high frequency stimulation and after administration of nitroglycerin were performed. For interpretation we used the shortening (in percentage) of 8 vertical semi-diameters and of longitudinal axis in biplane angiograms. The data found in 15 healthy persons were used for comparison. Looking at the rate of shortening after high frequency stimulation myocardial areas endangered by hypoxia could be unmasked. By giving nitroglycerin thereafter we were able to differentiate between reversibly and irreversibly damaged areas. In 7 patients this has already been proven by postoperative examination. In preoperatively reversibly damaged myocardial areas no hypokinesis could be observed any more after successful revascularization. In contrast there was no improvement seen in preoperatively irreversibly damaged areas in spite of graft patency. The described preoperative angiography-test allows: 1. to unmask myocardial areas endangered by hypoxia. 2. to differentiate preoperatively between reversibly and irreversibly damaged areas. 3. more precise indication as well as better control of the results of revascularization.

Coronary Angiography↗
PubMed1978

[Heterologous and alloplastic grafts for haemodyalisis (author's transl)].

In cases of the malfunction of av-fistulae for haemodialyses a kind of prosthetic graft has to be used. Since 1973 alloplastic protheses (Sparks-Mandril) have been used in 7 patients, since 1976 heterologous (Solko-graft-calf-carotis) ones in 12 patients. In an average follow-up period of 18 months the heterologous prostheses proved to be more suitable because of longer patency-rates, simpler handling during surgery and earlier use for dialyses. As a major late complication only one case of an aneurysmatic enlargement was observed in one of the heterologous protheses. Long-term results have still to be waited for.

Animals↗
PubMed1977

[Classification of psychopathological disorders after open-heart surgery (author's transl)].

A better discrimination of phenomenology and severeness of psychopathological disorders after open-heart surgery has been obtained: a) There is no equal distribution of degrees of severeness, a high correlation of severeness with duration of the disorders, a low correlation with age and no dependance of sex. b) Disorientation, clouding of consciousness and disorders of awareness arise earlier, delusions, hallucinations and paranoid ideas tentatively later after surgery. c) Three psychopathological syndromes have been identified. They appear in different frequency, intensity and can be combined.

Age Factors↗
PubMed1977

[The regulation of the circulatory system in the early postoperative period after open-heart surgery during physical therapy and orthostatic exercise (author's transl)].

17 patients, who underwent open heart procedures, were examined during and after standardized exercises at the first, second and third postoperative day. At 10 defined time intervals the following parameters were measured: arterial blood pressure, right and left atrial pressure and in the pulmonary artery, arterial and venous blood gases and cardiac output by thermodilution. Oxygen consumption and cardiac index were calculated. The results show that the majority of patients after open heart surgery are well able to adjust to additional work load even early postoperatively.

Adult↗
PubMed1976

[Long-term cardiac arrest by cardioplegic coronary perfusion (author's transl)].

UNLABELLED: The Mg++ aspartate-procaine-cardioplegia has been proven in animal experiments as well as from 1970 til 1975 in more than 1000 open-heart-procedures by a myocardial temperature of 32 degrees C and aortic crossclamping time up to 40 minutes superior to all other known procedures of cardiac preservations. To guarantee a safe myocardial protection of the arrested heart for a remarkable longer period of total ischemia, we further developed the cardioplegic technique in the animal lab, and use it now clinically. PRINCIPLE: The arrest is induced by cardioplegia (Mg++ aspartate-procaine), than the arrested heart is cooled down to 15-20 degrees C by cardioplegic coronary perfusion maintaining the oxidative metabolism. The perfusion is stopped. The begin of ischemia is still under normal ATP-levels and continuous cardioplegia. TECHNIQUE: 1. Crossclamping of the aorta; 2. cardioplegic induced cardiac arrest by Mg++ aspartate-procaine (Kirsch); 3. Surface cooling of the heart; 4. Coronary perfusion by hypothermic cardioplegic solution (8-10 min, flow 80-120 ml/min, perfusion pressure maximal 30 mmHg). Perfusate: O2-saturated, erythrocyte free, 6% hydroxyethyl starch solution added 2 mM Mg++ aspartate, 4 mM procaine, 50 mM Na+, 5 mM K+, 0,5 mM Ca++, 25 mM HCO3-, 10 mM glucose, 200 mM mannitol, 250 mg/l 6-methylprednisolone. RESULTS: 84 patients (29 ACVB; 55 valve replacements); crossclamping time: 71 min (SD 22); total time of ischemia: 57 min (SD 18; max 96, min. 27 min); reperfusion time restoring normal excitation-contraction of the heart: 3 min (SD 2); weaning off bypass: 23 min (SD 14). Hemodynamic 12 h postop.: SO2 venous 76% (SD 6). No sympathicomimetics were used. Only 30% of myocardial ATP is splitted after 120 min of cardiac arrest. Electron microscopic findings show only small, reversible alterations of fine structure.

Adenosine Triphosphate↗