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Biomedical subjects

W Maurer

Publications and source records attributed to W Maurer.

At least 19 recordsLinked to original sources
PubMed1992

Lateral differences indicate future glaucoma.

Since eye pairs are anatomically and pathologically asymmetrical, we attempted to determine whether the transition from ocular hypertension to glaucoma might be typified by lateral differences in either intraocular pressure (IOP), papillary excavation, or visual field. Such lateral differences were sought in a retrospective study of the medical records of 47 patients exhibiting ocular hypertension, of whom 25 remained hypertensives and 22 developed glaucoma during the period considered. Although all visual field indices in the latter group had remained within the normal range, the same side consistently yielded significantly worse results in mean sensitivity, and the absolute value for the lateral difference in these individuals was significantly higher than that found for the patients who did not develop glaucoma. Future glaucoma is manifested when the mean sensitivity remains worse in one eye.

Adult↗
PubMed1992

[Early operation in radiologically negative adhesion ileus].

From January 1987 to December 1990 46 patients underwent laparotomy for mechanical ileus by adhesive bands at the Bürgerspital Solothurn. Supine and upright X-ray films of the abdomen had been taken in all cases. 31 patients presented typical radiographic signs. In 15 patients (32.8%) no air-fluid levels and no distention of small bowel loops were visible initially. Despite negative X-ray signs 7 of these patients underwent surgery within a median of 2 hours after hospital admission. Six times the indication was based on clinical findings alone and once on further examinations. On average symptoms had been present for 9 hours. The rate of resection was 14%. Eight cases underwent primary clinical observation. This resulted in a median delay to operation of 23 hours and a rate of resection of 50%. The 31 cases with initially positive radiologic findings had a lower rate of resection (25%) despite of a significantly (p = 0.011) longer duration of symptoms (46 hours) before admission. Diagnostic problems arise especially when X-ray signs are negative. Our cases confirm, that negative radiographs can not exclude the presence of an ileus. Quite to the contrary this group accumulates a significantly higher (p = 0.004) number of strangulation ileus. The accentuated pain leads to a significantly (p = 0.011) earlier hospital admission at a time when X-ray signs are not yet visible. Because of the real danger of intestinal necrosis the typical clinical symptoms and signs should lead to surgery without waiting for the later appearance of air-fluid levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed1991

[Bronchopulmonary sequestration].

Intrapulmonary sequestration is a rare disorder which should be considered when an intrathoracic mass is found in the lower part of the lungs. The clinical symptoms range, as in our two patients, from an asymptomatic mass in the chest X-ray film to frequent pulmonary infections. A definite diagnosis is possible only by visualization of the aberrant artery by arteriography, which is also helpful to the surgeon at lobectomy.

Adult↗
PubMed1991

Metoclopramide does not decrease the incidence of nausea and vomiting after alfentanil for outpatient anaesthesia.

Sixty patients were studied in a randomized, double-blind manner to determine whether metoclopramide added to droperidol decreased further the incidence of emetic symptoms (nausea, retching, vomiting) in outpatients receiving alfentanil anaesthesia for nasal surgery. Group 1 (n = 30) received metoclopramide 0.15 mg.kg-1 and Group 2 (n = 30) received placebo. In addition, both groups received droperidol 0.02 mg.kg-1 immediately before anaesthesia which was supplemented by alfentanil 20 micrograms.kg-1 at induction followed by an infusion of 0.25-1 micrograms.kg-1.min-1. Emetic symptoms were assessed 0-3 hr, 3-6 hr and 6-24 hr after surgery. Both groups received similar doses of alfentanil (mean +/- SD; Group 1 4641 +/- 1894 micrograms, Group 2 4714 +/- 1640 micrograms). The percentage of patients who had either nausea or vomiting at 0-3, 3-6 or 6-24 hr was 23%, 14% and 13% in Group 1; and 20%, 17% and 10% in Group 2. The overall incidence for each group was 8/30 (27%). There was no difference in the incidence of emetic symptoms between the groups at any time interval or throughout the study. Metoclopramide did not improve upon the antiemesis of droperidol during alfentanil anaesthesia for outpatient nasal surgery.

Adult↗
PubMed1991

[Femoropopliteal venous bypass in distal duplication of the great saphenous vein with bridge veins. Case report].

A 74-year-old patient with peripheral arterial obstructive disease II B presented a full-length obstruction of the superficial femoral artery and additionally a segmental 10 cm long obstruction of the deep femoral artery. The arteries of the calf were patent. In this situation a bypass with an autologous vein was taken in advice. At surgery in December 1988 the great saphenous vein from the contralateral leg was prepared. It was found to be duplicated and contained numerous bridging veins. The duplication was maintained to compensate for the difference of calibre. The proximal anastomosis was done with the double-lumen graft including in between a split bridging vein. This arrangement provided favourable anatomic and functional outlets to the two saphenous branches. At follow-up in January 1990 the patient was fully reintegrated and had an unlimited walking distance. Doppler sonography showed normal closing pressure in the peripheral arteries. The intravenous digitalized subtraction angiography demonstrated regular perfusion of both branches of the duplicate bypass.

Aged↗
PubMed1990

[CO2 embolism during hysteroscopy].

During CO2 hysteroscopy the intracavitary pressure increases up to 80 mmHg. This can result in a CO2 embolism, especially after injury/lesion of the endometrium. A 49-year-old female Caucasian patient underwent curettage, and the following day while a hysteroscopy was being performed in general anesthesia a CO2 embolism occurred, with bradyarrhythmia, drop of arterial blood pressure, superior vena cava syndrome, metallic heartsound and hypercapnia. It was possible to achieve recompensation of the right heart failure with drug therapy. Other causes (lung embolism, hypoventilation, increased CO2 production, cardiac causes) could be excluded.

Carbon Dioxide↗
PubMed1989

[Recidive inguinal hernia with subcutaneous displaced spermatic cord. Operative procedure and results].

Following Bassini-Kirschner repair the rate of recidives is higher than after currently applied procedures. From the first of January 1971 to the first of November 1986 54 male patients were operated upon a recidive of inguinal hernia with the spermatic cord situated in the subcuticular tissue. 3 of them had a repair of both sides. 42 operations have been done for the first, 13 for the second an 2 for the third recidive. Beginning on the 10. 9. 1974 hernial repair was progressively accomplished by reconstructing a short oblique channel. In appropriate cases with a lateral recidive and a well healed plasty in the medial area this region remained untouched. This type of repair has been done in 12 cases. 38 patients (40 cases) were controlled personally 13 to 166 months postoperatively (mean 77.7 months), 8 of them with a short oblique channel. 12 patients were dead, 2 had returned to foreign countries. 2 patients refused control. There were 3/40 recidives: 2 recidives occurred out of 6 cases with Bassini-Kirschner procedure again, 1 recidive out of 22 cases with a Bassini repair. 2 patients with simple closure of a medially situated leakage and one patient each with McVay repair or semicastration were doing well, as well as the 8 patients with a short oblique channel.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1989

[Duodenopancreatectomy. Continuous single pancreaticojejunostomy (video)].

From 1972 to January 1988 42 pancreato-duodenectomies were performed. There was no hospital death. In the last 7 patients the pancreatojejunostomy was done over-and-over in one row. In one of those patients the anastomosis had to be redone later on using an identical technique. The video shows selectioned steps in resection and reconstruction, in detail the preparation of the pancreatic stump as well as the anastomosis itself. In 2 cases there was massive secondary gastrointestinal hemorrhage. The bleeding artery could be localized by selective angiography to the jejunal side of the pancreatic anastomosis in 1 case, to the jejuno-jejunostomy in the other patient. Definitive hemostasis was accomplished by reoperation. The one row over-and-over-anastomosis is done without problems in the situation of a fibrotic pancreas and dilatation of pancreatic duct (3 patients). It is suitable too, when alterations of the pancreas are missing (5 cases).

Duodenum↗
PubMed1989

[Surgical tactics in complicated sigmoid diverticulitis].

Between January 1972 and February 1988 139 admissions (136 patients) for diverticulitis were registered. Treatment remained conservative in 47 cases. 23 cases underwent elective surgery. In 69 patients emergency-laparotomy had to be done. In 41 cases (3 deaths) the abdomen was washed out and drained, followed by a proximal colostomy. In 23 of these patients a free perforation had to be oversewn. 6 patients were treated by Hartmann resection (1 death). Primary resection, anastomosis and proximal colostomy were performed in 15 cases. 3 patients underwent exterritorization and resection. 4 patients with colonic ileus were initially treated by colostomy alone. There were 2 late deaths both from pulmonary embolism. Of the 63 patients who had a colostomy constructed 4 (6.3%) never had the stoma closed. There were 2 persistent stomas in the 41 patients who had a preliminary colostomy alone (4.9%) and the incidence of persistent stoma in 5 patients who had a Hartmann resection was 40% (2 cases). -The three-stage resection makes good results, provided that a free perforation is solidly oversewn to prevent further fecal contamination. Primary resection with anastomosis and proximal colostomy, which is more and more used in suitable cases, considerably shortens duration of treatment. Hartmann resection remains second choice because of the known high incidence of persistent stoma. It is submitted to surgeon's experience to choose at any situation the best procedure regarding age and general state, local findings and extent of peritonitis. With this tactic hospital lethality of emergency operation was 4 of 69 patients (5.8%), overall lethality 6 (8.7%). Intestinal continuity was restored in 94% of surviving patients.

Adult↗
PubMed1987

[New aspects in the surgical treatment of hyperparathyroidism].

As a result of routine serum calcium determinations an increasing number of primary hyperparathyroidism (pHPT) cases are detected. While surgical treatment of the symptomatic patient with pHPT is generally accepted, this may not be the case in asymptomatic and especially elderly patients. The value of preoperative localization of parathyroid tumors has not been clearly established. In our experience dual parathyroid imaging with thallium and technetium has provided the best results. With the growing number of dialyzed patients, secondary (sHPT) and tertiary hyperparathyroidism (tHPT) are assuming increasing importance. Patients suffering from symptomatic sHPT or tHPT should undergo parathyroid surgery. After respective follow-up of 3.8 years (pHPT) and 2 years (sHPT and tHPT), all the cases with pHPT showed a relevant fall in serum calcium levels and PTH.

Biopsy↗
PubMed1987

[Acral rewarming. I: "Normal data" of a healthy adult population].

The acral rewarming test was investigated in 285 healthy subjects (mean age: 44.1; 20-71) to establish "normal" or reference values as a basis for interpreting patient data. The study was disposed in a manner to look also for possible diurnal and seasonal variations of the rewarming parameters. Healthy controls show a considerable interindividual variability in the speed and the pattern of acral rewarming, with a striking bimodal distribution of the individual values. This variability is mainly due to the factors "season" and "gender", while "age" and "daytime" are more related to basal finger temperature as to the rate of rewarming. According to these findings seasonal variations must necessarily be included in the definition of normal reference values of the rewarming test. In the healthy subjects neither personality characteristics (Freiburger personality inventory) nor the individual's psycho-social situation (Life Event questionnaire) and "depressivity" (Beck inventory) correlate with rewarming parameters. However, momentary "fatigue" (Visual Analogue Scale) correlates negatively and the sum of "somatic complaints" positively with acral rewarming time. The issue of variability in normative data is discussed with reference to clinical applications of the rewarming test in part II.

Adult↗
PubMed1986

HLA-matching and pretransplant blood transfusions in cadaveric renal transplantation--a changing picture with cyclosporin.

613 patients were included in a study to assess the extent to which HLA-matching and pretransplant blood transfusions affect the outcome of cadaveric renal transplantation in patients treated with cyclosporin and low doses of prednisolone. Matching for the HLA-DR-antigens significantly reduced the frequency of rejection episodes, but neither HLA-matching nor pretransplant blood transfusions influenced the patient and graft survival rates.

Analysis of Variance↗
PubMed1986

[The treatment of Basedow's disease. The agony of selection].

The treatment mode of Graves' disease should be chosen individually for each patient. This requires a thorough knowledge of the advantages and disadvantages of the various methods, and also bias-free interdisciplinary cooperation. Surgery reestablishes euthyroidism in about 80%, with 10% becoming hypothyroid. In centers practising more radical surgery hypothyroidism has developed in up to 49% and there is now evidence of occurrence of late hypothyroidism in the same way as after radioiodine. Radioiodine is cheap and causes minimal inconvenience to the patient. Because prevalence of hypothyroidism rises in a cumulative way over decades, lifelong follow-up is necessary with an examination every 1 to 2 years. The genetic risk and the danger of thyroid carcinoma have been shown to be negligible by gonadal dose calculations and by longterm prospective follow-up. Antithyroid drugs inhibit incorporation of iodide into thyroglobulin and produce rapid clinical improvement. It seems probable that, in longterm treatment, they also specifically suppress the synthesis of thyroid-stimulating immunoglobulins. The significance of "allergic" reactions such as skin rash, leukopenia and agranulocytosis is usually overestimated. The hematologic side effects are rare, dose-related and reversible in most cases. The major drawback of antithyroid drugs is the high recurrence rate (50%) of hyperthyroidism after cessation of therapy. It is still undecided whether a long course of treatment (one year or longer) produces better longterm results than short courses.

Antithyroid Agents↗
PubMed1986

HLA-matching in cyclosporine treated renal transplant recipients: a prospective Swedish-Norwegian multicenter study.

1. In this prospective study of 613 CD and 205 one haplotype mismatched LRD transplant recipients treated with CyA, there was no influence of HLA-matching (A, B, DR or combinations) on graft survival rate at one and two years. 2. Patients who successfully received HLA-DR-matched kidneys (CD or LRD) had fewer rejection episodes during the first six months after transplantation. 3. Three factors significantly reduced the cadaveric graft survival rate: (a) presence of panel reactive T-cell antibodies in a current recipient serum, (b) cold ischemia time beyond 27 hours, and (c) recipient age above 55 years. 4. The survival rate of one haplotype mismatched LRD kidneys was excellent and is considered to be the optimal treatment for uremia also in CyA-treated patients. 5. Based on this study, exchange of well HLA-matched CD kidneys to non-sensitized patients has been terminated provisionally in Scandia-transplant. Exchange of HLA-A, B-matched kidneys will be maintained, however, for sensitized patients inasmuch as this will increase the chance of obtaining a negative cross-match and possibly improve graft survival in this high-risk patient group.

Cyclosporins↗