Biomedical subjects
Publications and source records attributed to P Schmidt.
A follow-up study is given of 138 fractures of the base of the metatarsale V. In the years 1976-1980 124 of these fractures were treated conservatively, 14 operatively. In 1982 all patients were examined personally to find out the treatment with the best results. According to these results the authors consider the conservative treatment the preferable method.
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A 55-year-old patient presented with terminal renal insufficiency caused by lower urinary tract obstruction due to prostatic adenoma. The case history of the patient on regular dialysis treatment was complicated by recurrent, therapy-resistant urinary tract infections accompanied by septic fever outbreaks and anemic relapses. Following suprapubic transvesical adenomectomy, no fever episodes, negative urine cultures and improvement in the anemic condition were all noted. Due to the fact that the upper age limit for acceptance into a hemodialysis program and possible kidney transplantation has been raised, it is important to note that an increasing number of men with prostatic adenomas may be encountered in these collectives. Dialysis patients require successful treatment of urinary tract obstructions prior to transplantation. Immunosuppressive therapy which follows transplantation increases the risk of infection which can endanger the graft and the patient's life.
In this study, the appearance of renal cysts in 43 chronic hemodialyzed patients (mean duration of dialysis treatment: 26.3 months) was investigated by sonography with a high resolution (3.5 MHz) sector scanner. In an investigation of the patients' own kidneys, 23 renal transplant patients (mean observation time: 51.3 months after transplantation; mean dialysis treatment before transplantation: 22.8 months) were also studied by sonography. Cysts could be demonstrated in 21 of 43 (49%) patients on maintenance hemodialysis. In 10 of these patients a previous investigation at the beginning of dialysis did not demonstrate any cysts. The diameter of the cysts varied between 5 and 30 mm. With regard to the duration of dialysis, cysts could be demonstrated by sonography in 9 of 23 (39%) dialyzed patients, with a maximum dialysis duration of 2 years, and in 12 of 20 (60%) patients who had been dialyzed for more than 2 years. The development of acquired cystic disease of the kidneys in dialysis patients seems to be promoted by the longer survival of uremic patients. Cysts could be found in the patients' own kidneys in only 4 of 23 (17%) renal transplant patients. The difference in the demonstration of cysts between patients on maintenance hemodialysis and renal transplant patients was statistically significant. This suggests that cystic transformation may possibly be a reversible process.
Plasma oxalic acid concentrations were measured in 13 chronic haemodialysis patients. The mean plasma oxalic acid concentration was 128.0 +/- 48.6 mumol/l, being approximately 8 times higher than the plasma concentration of 14 volunteers (mean = 16.8 +/- 5.2 mumol/l). Ultrafiltrates obtained in vivo from these patients showed a mean oxalic acid concentration of 138.2 +/- 56.5 mumol/l. Since in vivo ultrafiltrates are free of erythrocytes and plasma enzymes, an in vitro synthesis of oxalic acid from precursors by erythrocytes and plasma enzymes can be excluded. As the oxalic acid concentration of plasma corresponded to that of in vivo ultrafiltrates, it is concluded that any in vitro formation of oxalic acid in haemodialysis patients must be negligibly small, and is irrelevant for the measurement of plasma oxalic acid levels in patients receiving regular haemodialysis.
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Fermented milks (yogurt, kefir, sour milk), compared with milk for their non-protein nitrogen and free amino-nitrogen contents gave higher values prior to as well as 1, 2 and 3 h after pepsin digestion in vitro. In feeding trials of 6 weeks duration with diets based on casein, milk and fermented milks, respectively, those groups of weanling (50 to 60 g) male Wistar rats showed the maximum increments of body mass which had been fed the diets based on fermented milks. The highest values of the protein utilization index (increase in body mass in g per protein intake in g) were found in the animals kept on the fermented milk products. The favourable protein utilization and body mass increment on fermented milk diets are attributed to a better digestibility of proteins in these products.
In a comparative study of milk versus fermented milk (yogurt, kefir, sour milk) diets concerning their effect on body mass and on liver regeneration in partially (70%) hepatectomized male CFY rats significantly higher values were found three weeks after the operation in the groups fed on fermented milk diets than in those fed on milk-based diets. No differences between the chemical components of the regenerated liver (solids, total lipids, total N) were found either between the individual groups, or between the various groups and the control. The regenerated liver corresponded to the normal organ in every respect. The values reflecting the increments of solids, total lipids and total N of the regenerating liver, whether expressed in absolute figures or in per cents, were found to be higher in the animals fed fermented milk diets than in those fed milk-based diets. The invention that the biochemical changes associated with bacterial fermentation of milk are beneficial to liver regeneration provides new evidence in support of the high biological nutritive value of fermentation.
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Terms such as "Vorgang" (course of events) and "Drehpunkt" (crucial point developed in connection with dramatics are investigated with regard to their suitability for describing psychotherapeutic phenomena. Since the interactions between audience and cast are similar in some respects to those between therapeut and patient, particulary in respect of fantasy and creativity, these terms can be used to define cooperation in the cognitive sphere more closely.
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Renal disorders complicating liver disease are a frequent finding. Extrahepatic causes like intoxications and circulatory dysfunction or diseases that simultaneously affect both the liver and the kidney, like multisystem or viral diseases (hepatitis B) have to be differentiated from clinical entities in which, like in liver cirrhosis or in fulminant hepatitis, the manifestation of renal disease has to be understood as a consequence of the hepatic disorders. Functional disturbances like the increases in tubular sodium reabsorption or the hepatorenal syndrome have been thoroughly investigate because of their clinical importance. Substantial research dealing with the consequences of the increased intrahepatic vascular resistance on systemic and renal hemodynamics and with vasoactive substances, either arising from the liver or accumulating due to poor inactivation by the liver, have led - in the last years - to a better understanding of the pathophysiology of renal involvement in liver disease. However, the exact pathophysiologic role of factors like the effective blood volume, the sympathoadrenergic tonus, the activation of the renin-angiotensin-aldosterone system, changes of kinin activity or in prostaglandin release and the accumulation of "false" neurotransmitters and endotoxins still remains to be established.
Plasma glycollate and oxalate concentrations were measured in 20 patients undergoing chronic haemodialysis treatment. The mean plasma glycollate level was 173.7 +/- 52.9 mumol/l, which was not significantly different from the normal value (means = 145.8 +/- 37.8 mumol/l). The mean plasma oxalate concentration (means = 128.7 +/- 25.6 mumol/l) was about 8 times higher than the value found in normal volunteers (means = 16.8 +/- 6.0 mumol/l). During haemodialysis lasting for 6 hours the plasma oxalate concentration decreased by 53.5%. However, no decline in plasma glycollate levels was noted. Since glycollate was not found in ultrafiltrates obtained in vivo, it is concluded that glycollate is not eliminated during haemodialysis treatment.
A significant decrease of the glutamic oxalacetic transaminase activity of erythrocytes (EGOT) was found in patients on regular dialysis treatment. When pyridoxal-5-phosphate, the active metabolite of vitamin B6, was added to the samples, EGOT activity increased in dialysis patients and in normals, but the activity obtained after stimulation was not as high in haemodialyzed patients as in volunteers. In normals and in patients under pyridoxine treatment the EGOT activity was significantly higher when compared to the corresponding groups without vitamin B6 administration, the EGOT activity depending on duration of pyridoxine treatment.
The influence of acute hepatitis B on erythropoiesis has been investigated in 30 chronic hemodialyzed patients (mean age 48.3 years; mean duration of dialysis until first demonstration of Hbs-antigen 6.5 months). After onset of hepatitis the mean hematocrit value increased significantly (p less than 0.005) and in 15 of the 30 dialysis patients this increase was more than 10% of the initial value. In these 15 patients the mean value of the hematocrit increased from 21.7 to 27.7%. This maximum value was observed after 4 months on average, and the favourable effect on erythropoiesis was observed for 7.8 months on average. The groups of patients with and without increase in hematocrit (more than 10% of the initial value) after hepatitis differed significantly (p less than 0.01) in extent of the observed increase in transaminases. The importance of extrarenal, hepatic erythropoietin production for the stimulation of erythropoiesis during hepatitis in chronic hemodialyzed patients is discussed.
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