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Biomedical subjects

P Kirschner

Publications and source records attributed to P Kirschner.

At least 73 records · Page 4Linked to original sources
PubMed1988

[Clinical experiences in 210 percutaneous removal of kidney and ureteral calculi].

The introduction of percutaneous nephrolithotomy and ureterolithotomy has greatly widened the therapeutical spectrum of urolithiasis. In this paper indications and contraindications of percutaneous stone removal will be discussed as well as techniques of this procedure. 210 percutaneous stone operations were performed after an initial training period primarily using local anesthesia (neuroleptanalgesia). This operative procedure allowed stone removal in patients otherwise inoperable because of increased operation risk or of advanced age. With increasing experience the success rate has been improved, though the stage of difficulties in nephrolithotomy and ureterolithotomy has increased too. Percutaneous operation primarily in connection with extracorporal shock wave lithotripsy is the first treatment modality for patients with staghorn stones. Possible complications (bleeding, perforation, injury to neighbouring organs) and their treatment are discussed.

Adolescent↗
PubMed1987

[Initial experience using the new Weill cementless threaded ring in acetabulum replacement].

First experiences with a new threaded ring for acetabulum arthroplasty developed by D. Weill are reported. These experiences are based on 59 implantations, whose clinical courses and complications are lined out. The Weill acetabular arthroplasty turned out to be a very valuable device for both primary and revision hip arthroplasty. It provides all advantages of cementless fixation. The fixation is gained by a selftapping thread on the outside of the titanium ring. Thus a very high primary stability is achieved. A bone grafting possibility in the fossa region is provided. The relative less tolerance of the Weill ring concerning improper orientation predisposing to dislocation is a disadvantage as we experienced.

Acetabulum↗
PubMed1987

In situ detection of enteroviral genomes in myocardial cells by nucleic acid hybridization: an approach to the diagnosis of viral heart disease.

We have developed an in situ hybridization assay capable of detecting enteroviral RNA in myocardial cells, using molecularly cloned coxsackievirus B3 cDNA as a diagnostic probe. Because of the high degree of nucleic acid sequence homology among the numerous enteroviral serotypes, including the group A and B coxsackieviruses and the echoviruses, detection of these various agents commonly implicated in human viral heart disease is possible in a single hybridization assay. We demonstrate the considerable potential of this method for an unequivocal diagnosis of enteroviral heart disease as well as for pathogenicity studies. Using athymic mice persistently infected with coxsackievirus B3 as a model system, we show that the myocardium is affected in a disseminated, multifocal manner.

Animals↗
PubMed1984

Perioperative blood transfusion adversely affects prognosis after resection of Stage I (subset N0) non-oat cell lung cancer.

Recent studies suggest that pretransplant blood transfusions prolong kidney graft survival by nonspecific immune suppression. Since immune suppression in patients with cancer is associated with early recurrence and poor prognosis, we studied the relationship of perioperative blood transfusion to recurrence of Stage I (subset N0) lung cancer. Technique-related variables were minimized by limiting the study to one surgeon (P. A. K.). Life-table and Cox proportional hazards analysis of age, sex, tumor size, histopathology, admission and discharge hematocrit values, estimated operative blood loss, duration of operation, extent of resection, anesthetic agents, and blood transfusion revealed two statistically significant prognostic factors: extent of resection (p = 0.0056) and use or non-use of transfusions (p = 0.0283). The cumulative 5 year disease-free survival rate of the 15 patients undergoing pneumonectomy was 42% compared to 75% for 150 patients undergoing lobectomy and lesser procedures. Transfused patients had lower disease-free rates within 5 years than nontransfused patients (62% versus 76%, p = 0.0132). Survival advantage was also noted in nontransfused patients after deleting patients subjected to pneumonectomy. These results indicate that perioperative transfusion in patients with lung cancer undergoing resection accelerates the appearance of recurrent or metastatic cancer. This supports the findings of previous studies of breast and colon cancer that blood transfusion is detrimental to the patient with cancer.

Humans↗
PubMed1982

[Diagnostics and therapy of osseous elbow lesions in the growing skeleton].

Osseous elbow lesions in the growing skeleton often involve problems of diagnosis, indication and therapy which are essentially different from those occurring in adult persons. Beyond its task to prove or to exclude a fracture line, X-ray diagnosis also has to search systematically for discernible soft tissue modifications (adipoid signs) or for disturbed correlations of positions and axes. When adopting an indication for conservative or surgical treatment, it has to be considered that rotation faults are not compensated during the further growth of bones and that an insufficient reposition of an epiphysis fracture causes a tendency towards an increase of the joint deformity when the bone is growing. The treatment of a bone fracture aims not only at a good elbow joint function which can be achieved even by a conservative, insufficient reposition, but also at an exact reposition and a reliable fixation during the short healing time. In most cases, the latter is only possible by means of fine metal implants (drilling wires and screws for little fragments which, by way of exception, do not touch the epiphyseal cartilage). This is the only way to avoid joint deformations and defective positions in adolescents which can promote the formation of destructive arthroses in adults. As opposed to fractures in adult persons, the functional result is not deteriorated by an additional immobilization for a period of three to four weeks effected in order to guarantee the so-called "minimal osteosynthesis".

Adolescent↗
PubMed1981

[Special fractures of the capitulum humeri (author's transl)].

Whenever radiographs in the elbow region do not present a clear picture, the physician should consider the possibility of a lesion of the capitulum humeri, despite the fact that this is rather rare. In such cases, the anteroposterior radiographs of the elbow may not present any abnormal findings. In most cases, crescent-shaped or elliptic bone chips in the bend of the elbow or dorsally in the interarticular space of the elbow joint will lead to the proper diagnosis. Classification into groups according to Hahn-Steinthal, Kocher-Lorenz and Krösl can lead to errors if employed too rigidly. In our opinion, lateral tomography of the elbow should always be performed whenever there is any suspicion of a lesion of the capitulum humeri. This will definitely clarify the origin and nature of the fragment, which may be of importance for the selection of the surgical approach and the type of surgical treatment chosen.

Adult↗
PubMed1981

[Tibial infectious pseudarthrosis. Treatment and results. Clinical study of 25 cases].

Our follow-up results demonstrate that in the majority of cases the infected pseudarthrosis is the result of a primary, relatively unfavourable initial condition. Second and third grade, open comminuted fractures of the tibia are particularly endangered. Despite correct treatment the amputation rate came up to 10%. With a strict, long-term treatment plan which emphasizes sufficient stabilisation of the infected pseudarthrosis, however, it is possible to achieve relatively good results in about two thirds of all cases. This has been confirmed by the clinical as well as the functional results obtained.

Adult↗
PubMed1980

[Hemodynamic effects of medical and surgical therapy of hypertrophic obstructive cardiomyopathy (author's transl)].

In order to assess the hemodynamic effects of medical (propranolol) and surgical (transaortal subvalvular myectomy) therapy, we determined in 20 patients with hypertrophic obstructive cardiomyopathy the following circulatory parameters at rest and during maximal exercise before and after therapy: heart rate, stroke volume, cardiac output, and pulmonary artery pressure. 9 patients were re-investigated after medical therapy of 3.5 weeks to 7 months (averaging 3 months) with a daily dose of 120 to 360 mg (mean 198 +/- 80 mg) propranolol, 11 patients 1 week to 28 months (averaging 7.5 months) after operation. Propranolol induced a significant reduction of heart rate and cardiac output averaging 20.9% and 20.3%, respectively (p in both cases < 0.0001) at equal exercise levels, no change in stroke volume, and a slight increase in the pathologically elevated exercise mean pulmonary artery pressure, with the pulmonary vascular resistance remaining unchanged. Although 3 of the 9 patients reported a slight subjective improvement, exercise capacity did not change significantly from a mean of 66.7 to 69.4 watts. Myectomy, on the other hand, induced no change in heart rate, but a significant increase in exercise stroke volume by 14.9% (p < 0.025) and a distinct increase in cardiac output by an average of 11.2% (not significant), whereas the pathologically elevated exercise mean pulmonary artery pressure fell significantly by 23.8% from a mean of 45.0 to 34.3 mm Hg (p < 0.025). 10 of the 11 surgically treated patients reported a usually marked subjective improvement, and the exercise capacity increased from an average of 61.4 to 81.8 watts (p < 0.01). Thus, the clinical and functional result of surgical therapy was significantly better than that of medical therapy and included, in contrast to medical therapy, a significant hemodynamic improvement and increase in exercise capacity.

Adult↗
PubMed1980

[Traumatic injuries to the ileosacral joint; late results (author's transl)].

Injury to the ileosacral joint is the result of particularly severe traumatic violence. On the average, it is accompanied by 3 additional injuries to the osseous pelvis. Treatment depends on the nature and seriousness of the trauma to the anterior or posterior pelvic girdle and concomitant injuries. Operative stabilization is necessary if the accompanying injuries are severe. Conservative treatment was aimed at in all other cases. Of the 45 patients followed-up, 40 complained of persistent subjective discomfort. Clinical examination of the ileosacral joints revealed that it was the cause of late complaints in 32 patients, while in the remaining 8 the cause could be traced to other parts of the pelvis. X-ray findings showed no correlation to the complaints. Even in those cases where the interarticular space appears normal in the X-ray, complaints can be expected with the same frequency and intensity as in arthrotic or ankylotic joints. With regard to the late results, the surgically treated patients can only be conditionally compared with those treated conservatively. Nevertheless the late morbidity of these patients appears to be particularly high.

Adolescent↗
PubMed1979

[Skateboards: a dangerous toy? (author's transl)].

Eighteen persons (average age 12.4 years) with injuries from skateboard accidents were admitted between 1 March to 5 June, 1977--4.4% of all accidents and 7.5% of all sports accidents treated during this interval. These kinds of accidents are now in fourth place as to frequency, after accidents during play (81), bicycling (45), football (35) and motorcycling (28). To avoid skateboard accidents attention must be paid to technically high-grade equipment, reasonable skill and training, and restriction of skateboarding to enclosed areas, as well as protective clothing.

Adolescent↗
PubMed1979

[Diagnostic and therapeutic problems in tumors of the bones of the hand].

The diagnosis and treatment of tumors of the skeleton of the hand are reviewed. Benign enchondromas were found to be the most common. Primary osteogenetic sarcoma was rare as was malignant degeneration in initially benign tumors and in the bony manifestations of systemic disease such as neurofibromatosis or hyperparathyroidism. Tumors were more common in phalanges and metacarpals than in the carpus and showed their highest incidence in the 4th decade. Diagnosis was aided by angiography and bone-scanning. Some difficulties were encountered in pathological examination. Treatment involved curettage and cancellous grafting in small tumors, en bloc resection followed by osteosynthetic stabilisation in larger instances and radical ablation followed by chemotherapy in malignancy.

Adolescent↗
PubMed1978

Reconstruction of a large chest wall defect using greater omentum.

A 56-year-old woman was admitted for treatment of a large carcinoma that involved the chest wall. Fourteen years earlier, she had undergone a radical mastectomy, which was followed by chemotherapy and radiation therapy. The carcinoma was excised and the large anterior chest wall defect reconstructed using Marlex mesh, an omental pedicle flap, and a split-thickness skin graft.

Female↗