Biomedical subjects
Publications and source records attributed to P Klaue.
179 times the diagnostic peritoneal tap and lavage showed a positive result in 450 patients with blunt abdominal trauma including 70 children and 290 patients with multiple injuries. Results were negative 221 times and weakly positive 55 times. With 2 false positive and 1 false negative result the reliability of lavage was above 99%.
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Of 542 splenectomies performed from 1964 to 1977, 242 were incidental to gastrointestinal surgery. The highest rate of complications was observed in these patients as opposed to those who underwent splenectomy for trauma or Hodgkin's disease. Eighteen laboratory studies did not show significant changes 1.5 to 10 years postoperatively in 96 patients. Ninety-three patients questioned because of late symptoms had the highest rate of complaints after incidental splenectomy.
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Trnascutaneous PO2 measurements are suitable for an objective control of free skin transplants and pedicle flaps if used with standardized and controlled hyperemia. They are also suitable for monitoring the rejection of skin allografts and to investigate the influence of drugs on skin transplants in general.
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The control of ionized calcium (Ca++), total calcium, and citrate levels in serum were determined in dogs during autotransfusion (AT) of blood stabilized with heparin, ACD (formula B) and CPD. Blood samples were taken according to the changes of aortic pressure (AOP), which was continuously monitored. Taking the values during the stable phase of AOP preceding the AT as baseline, Ca++ dropped by 27% with ACD and by 34% with CPD at the maximum decrease of AOP immediately after the AT. The corresponding increase of citrate was 174% with ACD and 521% with CPD, while total calcium remained stable. Thus cardiac depression after AT of citrated blood seems to be mainly caused by the drop of Ca++, which is significantly more pronounced with CPD, corresponding to the higher content of citrate.
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The condition of skin autografts and allografts in rats and rabbits was checked by transcutaneous PO2 measurement according to R. HUCH, D. W. LUBBERS and A. HUCH. The tcPO2 values obtained with standardized maximal hyperemia allow conclusions concerning the oxygen supply and thus the vascularization of a transplant. This method seems suitable to monitor the healing of autografts and to register quantitatively the progress of rejection in allografts.
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In 29 patients (12 vascular and 17 trauma cases) the effect of intraabdominal bleeding and surgical management under intraoperative autotransfusion on several plasmaproteins was examined. The following parameters were monitored immediately before and after autotransfusion as well as 24, 48, 72 hours and one week later, in the thawed serum: 1. albumen and the carrier proteins prealbumen, transferrin, retinol-binding protein, 2. acute phase reactants: c-reactive protein coeruloplasmin, haptoglobin, 3. fractions of complement: C1q, C3c, C5 and C 3-activator, 4. serum-cholinesterase. With usual treatment by infusion of electrolyte solutions during operation and the following days, and further applicated blood transfusion, plasma and fresh frozen plasma by clinical needs, while the immediate blood loss during operation was replaced by autotransfusion, there was no change in preoperative dates. Only at the 3rd day the typical picture of catabolic situation of the postoperative period was observed in vascular cases and not at all in trauma cases. Thus the changes were closely related to the preexisting disease or state of shock, without further detoriation by intraoperative autotransfusion. 7 days later a sometimes overshooting normalization of the parameters was observed. Only cholinesterase remained extremely low, especially in vascular cases.
During massive autotransfusion in the dog, the different anticoagulation processes have an important influence on heart work and performance. This is especially marked with citrate, depending on the amount and the transfusion rate. In spite of normovolemia both parameters show a transient decrease up to 40% - 50% with ACD and up to 60% - 70% with CPD. These different reactions may be due to the corresponding composition of each stabilizer. The effect is abolished by simultaneous use of citrate and calcium, which may prove that the observed changes are caused mainly by a depletion of ionized calcium caused by the rapid transfusion. This is comparable to the well-known citrate intoxication. In contrast both cardiac parameters decrease only about 10% with heparin anticoagulation. Heparinization seems to be preferable to citrate as regards heart work and performance during massive autotransfusion. Also the two citrate stabilizers significantly differ in their effect on both cardiac parameters, the use of ACD being favoured.
Of the patients at the Chirurgische Universitätsklinik Würzburg, 29 were treated for multiple carcinomas in the period from 1970 to 1976. Reports in the literature confirm this relatively high figure. The generally greater life expectancy and increasing survival rate in treated first carcinomas suggest a further increase in this figure for the future. This possibility should therefore be borne in mind for every carcinoma patient, particularly since a second carcinoma has the same prognosis as the first and not the unfavorable prognosis of a metastasis or a recurrence.
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