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Biomedical subjects

R Kunz

Publications and source records attributed to R Kunz.

At least 73 records · Page 4Linked to original sources
PubMed1994

Fracture of the occipital condyle as an incidental finding during CT-evaluation of a maxillary fracture.

A 43-year-old male presented with blunt facial trauma after a motor-vehicle accident. CT-evaluation revealed a right-sided maxillary fracture and a fracture of the left occipital condyle. The fracture of the occipital condyle is potentially unstable and fatal cases have been described. Plain radiographs are not diagnostic. This occipital condyle fracture was an incidental finding during CT-evaluation of a maxillary fracture and is probably the first case with coronary CT scans of this type of fracture.

Adult↗
PubMed1993

[Laparoscopic herniorrhaphy of inguinal hernia. Reinforcement of the transverse fascia with surgical mesh].

A basic principle of inguinal herniorrhaphy is the reconstruction of the transverse fascia. This laparoscopic technique described, consists in an augmentation of the transverse fascia by nonabsorbable mesh in pre-peritoneal position. Some aspects should be recommended for laparoscopic herniorrhaphy: The anatomic structures must be dissected exactly. The prosthetic mesh should be fixed to the fascia by multiple staples. With indirect inguinal hernias the mesh should encircle the spermatic cord.

Adult↗
PubMed1992

[Laparoscopic cholecystectomy versus mini-lap-cholecystectomy. Results of a prospective, randomized study].

Laparoscopic cholecystectomy (LCCE) was gaining acceptance rapidly, when several institutions could demonstrate the safety of this minimal invasive treatment modality. Nevertheless prospective randomised studies still are missing to prove the advantages of this new treatment modality in contrast to open cholecystectomy. 77 patients with symptomatic cholelithiasis were treated by LCCE (n = 40) or mini-lap CCE (n = 37) in a prospective, randomised study. As preliminary results, there were no differences in duration of anesthesia and operation time, perioperative complications or postoperative need for analgetics. Patients with LCCE had significant less postoperative pain, less restriction of total vital capacity and a shorter postoperative hospital stay as parameters of a diminished operative trauma.

Cholecystectomy↗
PubMed1991

Oxygen radicals in liver ischemia and reperfusion--experimental data.

The generation of free oxygen radicals is presumed as a substantial pathogenetic principle in reperfusion injury. Although demonstrated in gut, muscle and kidneys its role in liver reperfusion injury is still under investigation. In an experimental rat model of warm liver ischemia of 60 min and 8 h reperfusion electron resonance spectroscopy assessed the increased generation of free radicals in early reperfusion period, leading to a decrease of polyunsaturated free fatty acids in liver tissue within 15 min of reperfusion. Histologically, single cell death, local and patchy necrosis of hepatic lobuli could be observed after 8 h reperfusion (n = 6). These histologic signs of liver injury could be attenuated by administration of superoxide-dismutase in combination with catalase but not by allopurinol. Best results could be obtained by deferoxamine. This indicates that increased generation of free oxygen radicals in reperfusion is not caused by the known conversion of xanthine-dehydrogenase to -oxidase but is mediated by an increased generation of hydroxyl-radicals, which can be scavenged by deferoxamine.

Allopurinol↗
PubMed1991

[Ischemia/reperfusion damage of the liver caused by free radicals--direct radical detection using electron spin resonance (ESR)].

The generation of free oxygen radicals is presumed to be a pathogenetic principle in various conditions, primarily in postischemic reperfusion injury. Their assessment is difficult. ESR is an excellent tool to assess free radicals directly. In an experimental model of rat liver ischemia and reperfusion the increased generation of free radicals during reperfusion in liver tissue could be demonstrated after 60 min of liver ischemia. Elevated production rates of radicals could be detected after 5 min of reperfusion for at least 45 min with a maximum after 15 min of reperfusion. Scavenging of these radicals has to start in the very beginning of reperfusion.

Animals↗
PubMed1991

[Gallbladder carcinoma as an incidental finding].

Between March 1982 and December 1990, 903 patients underwent elective cholecystectomy. In 40 patients cholecystectomy was performed for gallbladder carcinoma. 15 malignomas (1.7%) were found incidentally. Preoperatively no anamnestic or diagnostic tumor signs were found in this group of patients. An en-bloc-resection of the gallbladder with resection of the bordering liver segments was performed when gallbladder carcinoma was diagnosed intraoperatively. When the diagnosis was established by postoperative histology, a relaparotomy with liver resection and lymphnode-dissection was done, except in one case (T-1a stage). Histology showed adenocarcinoma in 11 out of 15 cases. No significant difference in the course of the disease was observed in patients with gallbladder carcinoma of different types. The hospital mortality rate was 0% after curative and palliative surgical treatment of gallbladder carcinoma. Patients with T-1 and T-2 stage have survived without tumor-recurrence up to now. The median survival time after surgery for gallbladder carcinoma in T-3 stage was 17 months, and 8 months in T-4 stage. The morbidity rate after elective cholecystectomy is low and hospital mortality is 0%. According to the short survival times in advanced stages of gallbladder carcinoma, a prompt cholecystectomy in symptomatic gallbladder lithiasis or chronic cholecystitis is advocated.

Adenocarcinoma↗
PubMed1991

[Allergic contact dermatitis due to prednicarbate].

Two female patients developed an allergic contact dermatitis after using Dermatop cream and -ointment for several weeks. Patch tests were positive with the reagent prednicarbate itself. No cross reactions to other glucocorticosteroids were observed. Type-IV-sensitization to glucocorticosteroids should be considered if chronic dermatitis does not improve, or even becomes worse, in spite of adequate therapy. With regard to possible cross reactions or multiple sensitization, epicutaneous tests with other glucocorticosteroids are necessary.

Adolescent↗
PubMed1989

[Successful treatment of a cheilothorax in lymphangiomatosis of the ribs (Gorham-Stout syndrome)].

In 1955 Gorham and Stout described the syndrome of lymphangiomatosis of the bone resulting in widespread monofocal osteolysis in the skeletal system. The results of therapy are difficult to evaluate as the disease may come to a sudden stand-still. If angiomatosis arises near the thorax, pleural effusion occurs due to simultaneous involution of the thoracic duct. This complication has a fatal outcome and effective treatment is required. A case is reported in a 61-year-old male in whom radiotherapy of the lower ribs on the right thorax reduced the lymphangiomatous swelling and healed the chylothorax.

Bone Neoplasms↗
PubMed1989

[Studies of myocardial metabolism using P-31-NMR spectroscopy and a simple heart perfusion model of slaughtered animals--an approach to avoiding in vivo animal experiments].

In research cardiology large numbers of in vivo animal experiments, mostly with dogs or pigs, are necessary. It was the aim of this study to test a simple in vitro perfusion heart model from swine harvested in the slaughterhouse as a potential substitute for in vivo animal studies. 32 unselected hearts of slaughterhouse swine after 10 to 15 min of warm ischemia were subjected to reperfusion with warm oxygenized blood and were examined for mechanical recovery, which occurred in 56%, increasing to 95% if primarily using only hearts that were in relaxation. In 21 of selected relaxed heart models the energy phosphate pattern as an index of viability was measured by P-31 MRS on a 4.7 Tesla NMR tomograph in 37 experimental runs with the following perfusion protocols: 1) immediate cardioplegia with cold Bretschneider or Collins solution, transportation under cooling, MRS after approximately 1 h; 2) immediate cardioplegia, transportation, reperfusion with oxygenated warm blood, MRS; 3) immediate blood perfusion with genuine fresh arterial blood from the slaughterhouse, cold plegia perfusion, transportation, MRS; 4) immediate blood perfusion with transportation MRS; 4) immediate blood perfusion with genuinefresh arterial blood, cold plegia perfusion, transportation, reperfusion with oxygenated warm blood, MRS during reperfusion; 5) An experimental pig heart was made plegic in vivo and reperfused with oxygenated warm blood during MRS as reference.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1988

[Expert assessment following total and partial loss of the spleen].

Post-splenectomy sepsis is a possible consequence, following traumatic loss of the spleen. An incidence of 1.05 per cent and mortality of 0.5 per cent may be assumed. The risk of infection for patients with traumatic loss of the spleen was found to be 60 times higher than that facing the general population. Spleen-preserving operations were found to ensure immune competence only in patients with not less than 30 per cent of intact spleen substance and under conditions of unimpaired blood supply. Occupational disablement usually occurs to 30 per cent of post-splenectomy patients during the first year from operation. Ten per cent were disabled for good, provided absence of complications.

Bacterial Infections↗
PubMed1987

[Traumatic ruptures of the thoracic aorta].

1) Traumatic rupture of the thoracic aorta is most frequently caused by a traffic accident with deceleration. Approximately 80% of these patients die immediately. In 29 patients (1973-1986) reaching surgical treatment, all aortic lesions were located at the aortic isthmus (28 covered and 1 free rupture). 25 (86%) of them had serious associated injuries of the head, other thoracic or intraabdominal organs and/or the extremities. A seat belt could not prevent the deceleration injury of the aorta but reduced associated injuries of the head and the intraabdominal organs. 2) The widely accepted surgical rule that every diagnosed traumatic aortic rupture should have an immediate surgical repair is no longer acceptable. In all patients with a clinically and angiographically stable covered rupture of the aorta with serious associated injuries and symptoms of shock the surgical treatment of the aortic lesion should be undertaken with delayed emergency after some hours or several days. This changed surgical concept is based both on the rarity of secondary free rupture of the aortic lesion and on the chance to stabilize the circulatory condition by a primary shock treatment including the surgical elimination of other sources of blood loss. The group with such a delayed aortic vascular repair (n = 12) showed a remarkably improved outcome with reduced operative mortality and reduced risk of paraplegia (47% vs. 25% respectively 35% vs. ca. 10%). None of these patients with a delay up to 17 days for vascular repair developed a secondary free aortic rupture. Up to recently this risk has been obviously overestimated on the basis of earlier studies in the sixties. 3) The immediate repair of the aortic rupture with its high operative mortality and high rate of ischemic paraplegia can be restricted to a few exceptional cases with a secondary free rupture in the hospital. The transvenous DSA is the best approach for an early diagnosis and for the surgical decision to perform vascular repair immediately or with delay.

Accidents, Traffic↗
PubMed1986

[Assessment following total or partial splenic loss].

Expert opinion after splenectomy: In splenectomized patients after trauma the risk of infection is up to 60 times increased. The incidence of sepsis amounts to 1.05, mortality to 0.5%. Spleen-preserving surgery guarantees an immunocompetence only if at least 30% of the spleen is preserved. The professional performance of people having undergone splenectomy is restricted by 30% during the first year ("MdE" of 30%), later by 10% if additional complications occur.

Disability Evaluation↗
PubMed1986

[Gas permeable contact lenses in the management of problem cases and in prolonged wearing time].

The continuous improvement of contact lenses (copolymers with high gas permeability) makes better care possible in problem cases. They can also be used for continuous wear. The present authors report upon 104 cases in which a contact lens made of P3, was tested. This is a hard, flexible contact lens with a DK value of 33, which is produced without additional treatment of the surface.

Astigmatism↗