Thoracoscopy--a forgotten endoscopic procedure?
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Humans↗
Biomedical subjects
M Thermann
Publications and source records attributed to M Thermann.
[Etiology and therapy of spontaneous pneumothorax. Discussion of conservative or surgical procedure based on personal results].
The treatment of spontaneous pneumothorax is discussed on the basis of the experience we have gained in 78 patients. Therapy is determined by the pathophysiology and aetiology of the condition. The treatment and follow-up results are compared with those reported in the literature, and the rationale of our own procedure is explained. It is emphasized that surgical treatment that takes account of the aetiology, produces good results with respect to freedom from recurrence and pulmonary function. Particular attention is drawn to the higher mortality rate of pneumothorax in the aged when surgical treatment is required, so that in these patients, it is justified to proceed as conservatively as possible, making use of the less aggressive procedures indicated here.
Adolescent↗
Evaluation of tomography and mediastinoscopy for the detection of mediastinal lymph node metastases.
In a prospective study of 88 patients seen consecutively with proven or suspected bronchial carcinoma, the validity of x-ray tomography and routine mediastinoscopy was tested for the detection and evaluation of mediastinal lymph node metastases. Positive mediastinum was defined as malignant tissue found in the mediastinum and negative mediastinum as mediastinoscopy with negative results plus a negative intraoperative mediastinal lymph node dissection. Thirty-four patients were eliminated from the analysis because carcinoma was not found or because mediastinal evaluation was incomplete by these criteria. Twenty-eight of the remaining 54 patients had mediastinal metastases. Sensitivity was 67% for tomography and 79% for mediastinoscopy. Specificity was 92% for tomography and 100% for mediastinoscopy. The differences were not significant. Sixty-six of 85 mediastinoscopies were unnecessary or unhelpful in the decision to exclude a patient from surgical intervention. Among 19 patients with lesions presumed to be inoperable based on results of mediastinoscopy (i.e., perinodal metastatic growth suspected by palpation or histologically proven), 14 patients had positive tomographic scans and 1 could not be evaluated radiographically because of right upper lobe atelectasis. We conclude that tomography of the upper mediastinum should be used to select patients for mediastinoscopy.
Adenocarcinoma↗
Surgically treated bronchial carcinoma patients--results of systematic follow-up.
A systematic follow-up was carried out on 63 patients treated surgically for bronchial carcinoma. Thirty-four patients died within 2 years after the operation. No evident benefit was noted when comparing their preoperative and postoperative physical status. The quality of life was considerably influenced by surgery and adjuvant therapies. While 19 patients died from the tumor disease alone, the death of 14 patients was caused by additional therapeutic complications (surgery, irradiation, cytostatic treatment). Eighteen patients survived more than 2 years without evidence of recurrence. Performance status reached the preoperative level after 9 months. All had good or excellent objective findings, but the disease had altered the lives of 7 patients considerably, psychological problems being the main reason.
Adenocarcinoma↗
[Rhabdomyosarcoma of the pulmonary artery (author's transl)].
A case of a 55-year-old man with the histological diagnosis rhabdomyosarcoma of the left pulmonary artery has been seen. Lung scanning and pulmonary arteriography are the clues for the diagnostical procedure. 55 cases from the literature are reviewed and clinical findings of the early and late stages of the diseases are discussed. Surgical treatment is the therapy of choice if ever possible; aggressive chemotherapy might be an acceptable alternative.
Cyclophosphamide↗
[Validity of retro- and prospective data analysis (authors' translation)].
Retrospective chart analysis of 88 operated patients with bronchial carcinoma showed grave deficiencies. In 15% the reason for admission to hospital was not available and the exact smoking habits of 74% were not known. Retrospective TNM-classification was possible in only 59%. It was known in 67% whether a radiotherapy and in 17% whether a cytostatic therapy was additionally performed. Only 13 of the 20 surviving patients participated in the follow-up. In contrast with these figures, a prospective collection of data (44 patients) has an effectiveness of 95% or more for all parameters.
Bronchial Neoplasms↗
["Randomization", a differently interpreted word].
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Humans↗
Hemodynamic parameters and blood gas analyses in the normal and the cirrhotic rat.
Thioacetamide-fed rats developed cirrhosis with portal hypertension (P portal=23.0 +/- 5.2 cm H2O, controls: 14.4 +/- 1.0 cm H2O). The PO2 of liver tissue was markedly reduced in cirrhosis (PO2=7.6 +/- 3.4 torr, controls 22.3 +/- 5.8 torr), and the aortal pH was significantly lower as well. No correlation was found between portal hypertension, development of large--nodular cirrhosis, and ascites.
Animals↗
[The early urogram in experimental acute stenosis of a renal artery (author's transl)].
1. Renal excretion as seen in the urogram does not parallel changes in blood flow. The significance of the early urogram as a test of function is therefore very limited. 2. Following acute stenosis of one renal artery, there is simultaneous excretion by both kidneys until flow is reduced to 60%; exretion is delayed, with values of 0.5 to 7.5 minutes, following reduction to 30 to 60% of the original; there is no excretion below 30%. 3. Unilateral delay in excretion occurs at about the level of "critical occlusion pressure". 4. Delayed excretion is observed at the level of the so-called "critical stenosis" of the renal artery. A reduction of flow above 20% follows a reduction of the artery in excess of 66%, corresponding with a reduction of the lumen of more than 90%. 5. These findings indicate that delayed excretion in the early urogram is to be expected only as a result of severe stenosis of the renal artery and represents a late feature of renal vascular disease.
Acute Disease↗
[The haemodynamic effects of renal artery stenosis (author's transl)].
Three reasons are suggested for the difficulty of judging the haemodynamic effects of renal artery stenosis: 1. The flow characteristics in the renal arteries of dogs indicate that, at the critical level of reduction to one third of normal diameter, a further change of only 0.5 mm. will cause a 50% alteration in flow volume. Variations of this order of magnitude cannot be reliably measured on the angiogram. 2. The production of turbulence, which can increase the effect of a stenosis considerably, depends, amongst other things, on the nature of the surface of the stenosis and this cannot be judged. 3. The effect of a stenosis depends on peripheral resistance in the kidney.
Animals↗
[Manometric studies of the anal canal in chronic primary fissure before and after management using dilatation or sphincterotomy].
Manometric investigations in patients with primary chronic fissure in ano were performed before and after stretching or sphincterotomy in a randomized clinical trial. Length of the functional anal canal was not influenced by the procedures. At a six-month follow-up, the maximum resting anal pressure was significantly lower in both groups. After stretching and sphincterotomy, the site of maximum pressure in the anal canal had moved orally. This demonstrates that an elevated resting anal pressure is one of the pathogenetic mechanisms for the development of a primary chronic fissure. It is successfully cut off by either stretching or sphincterotomy.
Adult↗
[Plasma histamine level during and following kidney allotransplantation in man].
In human kidney allotransplantation, elevated plasma histamine levels were measured before surgery, following revascularization, and in single cases also several days after surgery. The maximum extent of this histamine release must be tested with respect to time and to localization. Its significance must be established. The intermittently increasing plasma histamine levels (greater than 1 ng/ml) must be considered as a possible risk regarding stress ulcer pathogenesis.
Adult↗
Influence of H1- and H2-receptor antagonists on the circulatory system and on the endogenous plasma histamine concentrations in dogs.
The effects of the H1-receptor antagonist dimethpyrindene and the H2-receptor antagonist burimamide on circulatory and respiratory parameters and on plasma histamine levels were tested in 21 mongrel dogs. Both drugs released histamine. The incidence for this effect was 10/11 in the case of dimethpyrindene and 5/10 in the case of burimamide. Following dimethpyrindene all animals showed arterial hypotension, pulmonal hypertension, decrease in peripheral resistance and hyperventilation. The portal venous pressure was increased in dogs reacting by a histamine release. Following burimamide both an initial arterial hypertension and a subsequent hypotension were observed the latter being more pronounced in the group with histamine release. In this group the portal venous pressure raised considerably. In the non-reacting animals cardiac output was elevated, probably due to a release of catecholamines. It seemed remarkable that the effect of exogenous histamine on portal venous pressure was completely blocked by dimethpyrindene, but not the action of histamine released by the drug itself. It is concluded that the effects of anti-histaminic drugs on possibly histamine-induced physiological and pathophysiological processes should be interpreted very carefully as far as their specificity is concerned.
Animals↗
[Histamine concentration and diamine oxidase activity in the small intestine in superior mesenteric artery occlusion].
During intestinal ischemia in rabbits histamine concentration and diamine oxidase activity were altered in the intestinal wall and in the perfusate of mesenteric vessels. The results were interpreted as a histamine release and an increased catabolism of diamine oxidase. Thus, the combination of release of vasoactive histamine and partial elimination of a protective enzyme may contribute to the fatal outcome after mesenteric ischemia.
Amine Oxidase (Copper-Containing)↗
[Treatment of primary chronic fissure-in-ano by anal dilatation versus sphincterotomy (author's transl)].
A double-blind, randomized, controlled trial in the treatment of primary chronic fissure-in-ano by digital stretching of the anal canal or by a modified lateral subcutaneous sphincterotomy is reported. Whereas there was no difference in the postoperative course of both groups, by checking 65 of 66 patients 6 months postoperatively, we found significantly more lacks of continence after stretching. There was no difference regarding recurrence rate. Pressure monitoring of the anal canal showed significantly higher values at rest in both groups before operation. No correlation between results of monitoring anal pressure and defects of anal continence has been seen. These results point out that in treatment of primary chronic fissure-in-ano the lateral subcutaneous sphincterotomy is superior to anal dilatation regarding postoperative defects of anal continence. The recurrence rate in the present study does not force to prefer one of these two methods. Manometric investigations show that the resting pressure in anal canal seems to be elevated in primary chronic fissure-in-ano.
Adult↗
Histamine release in human subjects by modified gelatin (Haemaccel) and dextran: an explanation for anaphylactoid reactions observed under clinical conditions?
Histamine release by modified gelatin (Haemaccel) and dextran (Macrodex) has been demonstrated in volunteers by direct and indirect methods. In a pilot study of Haemaccel, histamine release was observed in six of seven volunteers. The highest plasma histamine concentration was 4.8 ng/ml, the lowest 1.7 ng/ml: two of the subjects showed slight allergic reactions. Using Haemaccel batch 2551, 10 out of 12 subjects reacted to the rapid infusion of Haemaccel with increased plasma histamine concentrations, whereas none reacted to Ringer's solution. None of the 10 subjects had an allergic reaction, but an increase in gastric secretion was observed in eight. Changes in the venous basophil granulocyte count were found in both those who reacted and those who did not react to Haemaccel. After the rapid infusion of dextran the highest plasma histamine concentration was 5.0 ng/ml, the lowest 1.3 ng/ml. The withdrawal of blood had no influence on plasma histamine concentration. The incidences of histamine release produced by Haemaccel varied with different batches. Thus, it seems unlikely that immunological mechanisms are principally responsible. Nine instances of allergic and anaphylactoid reactions to plasma substitutes have been reported, seven after Haemaccel infusion, and two after dextran administration. One of the patients who received dextran died. Histamine release was always associated with Haemaccel infusion and corresponded in extent to the clinical symptoms observed, but there was no significant histamine release associated with the reactions to dextran.
Adult↗
[Effects of intraluminal pressure increase on oxygen consumption of the rabbit ileum and its possible pharmacological modification].
Elevated intraluminal pressure of rabbit small bowel induces a decrease of tissue pO2 of the bowel wall dependent on the applied pressure. After decompression local pO2 exceeds the initial pO2 values. While the i.v. application of 25 microgram/kg glucagon is not able to improve local oxygen supply of the distended bowel, local pO2 increases considerably after infusion of 7.5 ml/kg dextran 40. Decompression by operation or intestinal tube as well as application of dextran 40 are recommended in the treatment of ileus.
Animals↗
[Modification of the oxygen supply of the small intestine demonstrated on the ileus model].
Elevation of the intraluminar pressure of rabbit ileum lowers the oxygen supply of the bowel wall in a pressure dependent manner. After decompression local PO2 exceeds the initial values. The infusion of Rheomacrodex-Sorbit induces an increase of local PO2 in the nondistended ileum. The reaction is enhanced in the distended bowel. The application of glucagon does not influence tissue PO2 significantly in either the distended or the undistended bowel. The infusion of Rheomacrodex-Sorbit as well as decompression of the distended bowel are recommended to improve oxygen supply of bowel wall in ileus.
Animals↗