Biomedical subjects
Publications and source records attributed to V Lange.
Percutaneous transhepatic cholecystolithotripsy (PTCL) by laser or ultrasound is a minimally invasive form of treatment for gallstones. All the steps of the procedure can be performed in a single session. In clinical use severe side effects have not been observed.
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The systematic schizophrenias are marked genetically by a significant surplus of the Gc serum type 1-1 (p less than 0.0005), what can be demonstrated by the separated analysis of the hebephrenias (p less than 0.0005), paraphrenias (p less than 0.01) and catatonias (p less than 0.05) also. Furtheron there is some evidence that the Gc subtype 1F plays a predominant role within the Gc 1-1 excess (p less than 0.01). The unsystematic schizophrenias (periodic catatonias and affective paraphrenias) do not deviate in their Gc distribution from the corresponding control values, but they exhibit contrary to the systematic forms a surplus of the haptoglobin serum group 2-2 like phasic psychoses. The marker findings are discussed with respect to the relevant data of biological psychiatry and biochemical genetics.
Laser induced shock wave lithotripsy is a new procedure to destroy gallstones. Stones of up to 500 mg are destroyed within 5 min. Severe reactions of the soft tissue cannot be observed in animal studies. No perforations, stenoses or thermic lesions after wound healing were observed. The development of an optomechanical transducer replacing the optical lens system at the end of the transmission guide allows its handling in flexible endoscopes. Clinical use is therefore possible from the technical aspect.
Reported in this paper are 22 patients with recurrence of anastomosis, following curative resection of colorectal carcinoma. Recurrence in all cases was diagnosed by colonoscopy. Seventy-five per cent of all patients under follow-up care were without symptoms, and 83 per cent underwent intended radical surgery to cope with their recurrence. Curative re-operations were followed by mean survival of 39.4 months, while the five year survival rate amounted to 44 per cent. Hence, the prognosis of recurrence at the suture line appeared to be better than that of colorectal carcinoma recurrences localised elsewhere.
The problem of chronical calcifying pancreatitis is demonstrated in two female patients. Resection of the pancreas is necessary, if prepapillar concrements cannot be extracted. By two new techniques, ultrasound-lithotripsy and laser-induced shock-wave-lithotripsy, it is possible to destroy concrements and to remove them. These new techniques are now used primarily in surgery.
Gastric bezoars, especially those of the phytobezoar type, are a rare sequela of gastroduodenal surgery or other uncommon circumstances. When they produce symptoms, removal is always necessary. In the past, treatment has shifted from surgical to non-surgical intervention, of which gastric lavage and/or slow enzymatic dissolution have been attempted. A safe, simple and rapid endoscopic method for the removal of the bezoar has previously been reported by 3 authors. With our two patients there are now ten cases of successful fragmentation of phytobezoars by this technique using a pulsating jet of water through the endoscope. This success recommends the procedure as treatment of choice, and it should be used more widely.
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Colorectal cancers treated for cure by operative means show tumour recurrences and metastases in about 20% of the patients. Of these colon or rectal cancers 75 and 90% respectively can be only operated for palliation. These patients have a better prognosis than those operated primarily for palliation. 25% of the cases especially with suture line recurrences can be operated upon radically enough and exhibit a total five year survival rate of 50%.
Besides the method of laser coagulation and electrocoagulation the endoscopic injection therapy of gastrointestinal bleeding in the stomach and in the duodenum seems to be a successful, inexpensive and simple method. In our hospital 62 pat. were treated by endoscopic injection therapy since 1978. A definitive hemostasis could be achieved in 83%, while the method did not succeed in 17% of patients.
Colonic stenosis following resection and end-to-end-anastomosis of the colon is observed in 2-5% of all patients. The authors report that a patient with repeated episodes of colonic stenosis after resection of the sigmoid was successfully treated with an Eder-Puestow dilatator by means of a flexible endoscope.
The biological base of psychoses is controlled by multifactorial genotype compounds using sometimes the same gene locus or DNA information section for diverse diseases, but always in different and repeatable combinations. These compounds can be formed by special regulatory or junction genes. With the help of inherited serum markers of the haptoglobin and the Gc system including quantitative studies of the ceruloplasmin and transferrin serum level, the combinations of diverse biological factors have been presented especially for cycloid psychoses, unsystematic schizophrenias, and paranoid psychoses with late onset and a cyclic axis syndrome. Considering the specifications of genetic control and clinical course no indefinite mixtures in the sense of schizo-affective psychoses should be discussed furthermore.
Granular cell tumors (Abrikossoff's tumor) are rather rare tumors of the esophagus, which are benign in most cases. 59 tumors have been described in 49 patients. Therapy of choice is surgical removal. Periodic endoscopic follow up may substitute for surgery only in patients, which are considered to be high risk during surgery, and whose tumors are small, asymptomatic and benign. Removal by endoscopic means should be performed only in selected cases, that is if tumors are small and removable by biopsy forceps or if they are quite prominent.
A method for the treatment of segmental ureteric stenosis is demonstrated. The stenosis was successfully dilated by a Grüntzig pneumatic balloon catheter.
By the study of hereditary serum protein markers in psychotic patients and normal controls, a surplus of Gc 1-1 (p less than 0.01) and transferrin B variants (p less than 0.0027) has been established in schizophrenias. Affective psychoses are characterized by an excess of the haptoglobin (Hp) serum type 2-2 (p less than 0.001). These general statements have to be modified in regard to the clinical and psychopathological subdivision beyond the traditional classification into two major groups of endogenous mental disease. Using Leonhard's criteria, the prevalence of Gc 1-1 is restricted to the systematic schizophrenias reaching its highest value in hebephrenias, which are followed by paraphrenic and catatonic forms in this trait. In contrast to this, periodical catatonia and affective paraphrenia, classified as subgroups of the unsystematic schizophrenias, have Gc 1-1 frequencies like healthy controls. On the other hand, the Hp 2-2 value is not increased in the systematic schizophrenias, but it displays a relative overplus in the unsystematic forms. Concerning the Hp 2-2 and Gc 1-1 frequencies a certain similarity can be observed between affective paraphrenia and the paranoid psychoses with late onset, it they are characterized by a cyclic axis syndrome as described by the Vienna school. The cycloid psychoses are marked by an extreme surplus of Hp 2-2 (p less than 0.001) and an overweight of Gc 1-1 (p less than 0.05). Probably the Gc and Hp alleles play a role as risk factors or accidental effectors in the multifactorial genetic systems responsible for the biological background of psychoses. For both serum systems a selective interaction is discussed considering the vitamin D transport by the Gc proteins with the relation to neuronal consolidation and the possible influence of Hp 2-2 on transport and receptor functions.
Essential features of the methods and results of an automated system-analytic investigation procedure with well-defined psychic load are described. This was developed with the aim of recognizing disturbances in the psychophysiological system behaviour as premorbid stages of the most important cardiovascular diseases. Results thus obtained show a.o. that healthy subjects and patients suffering from ischemic heart disease can be classified with high reliability according to their psychophysiological system behaviour. A differentiation could be obtained as well on the basis of personality characteristics. The results support the hypothesis underlying the development of this procedure.
In the distribution of their serum groups the totality of 48 patients with paranoid psychoses of late onset is characterized by failure of the well-known markers of manic-depressive or schizophrenic illness. However, when differentiated psychopathologically, the haptoglobin (Hp) type 2-2 as a risk factor of cyclothymic psychoses is found to be significantly overrepresented in the patient group with a cyclic axis syndrome. On the other hand, an excess of Hp 1-1 can be observed and statistically confirmed in comparison with the population level among the patients offering a schizophrenic axis syndrome or resting unclassified. Possibly, the Hp serum groups play a role in the bioregulation of emotionality. The 'noncyclic' group does not show the marker traits of process psychoses, but in this sampling there is, in contrast to the 'cyclics,' a higher concentration of the immunoglobulin G serum level on the statistical border line, which perhaps is caused by destructive factors. The results correspond with the special state of the examined psychoses basing on biological determinants of different origin.
The 93 patients of the present study resemble each other in their psychosis by phasic course and complete recovery. Frequently the attacks showed an anxious and paranoid syndrome in monopolar repetition or in bipolar change with ecstatic symptoms. Rarely an incoherent state of agitation or stupor could be observed. Considering the distribution of simple inherited serum groups, there is a significant increase of Gc 1-1 and Hp 2-2 in the patient collective. Evidently these serum groups are risk components in a multifactorial hereditary system possessing with Gc 1-1 a marker of the schizophrenic disposition and with Hp 2-2 a determinating trait for affective psychoses. A selective interaction is discussed for both serum groups regarding the vitamin D transport of the Gc fraction with their relation to enuronal function and the possible role of Hp 2-2 in a transport or regulatory system.