Biomedical subjects
Publications and source records attributed to W Teichmann.
The Gastroenterological Society of the GDR was founded on May 19th, 1965. A survey is given of the number of its members, its presidents, the meetings organized by it, and the awards presented by it.
In an overview of the history of gastric intubation, the first use of a stomach tube in 1790 is reported, and the importance of the works of Kussmaul and his assistants as well as of Leube, Ewald, Boas, and Einhorn are specially stressed. With the development of new possibilities of investigation by means of the gastric tube gastroenterology began to emerge as a special field.
As like as the introduction of the gastric tube inaugurated new possibilities of investigation, the concept of gastroenterology was rounded up by the study of physiology and pathology of gut, liver, bile-ducts, and pancreas. In form of X-ray examination, topographic gliding palpation, and endoscopy, gastroenterology gained valuable diagnostic methods. The development confirmed Boas' prediction that specialization in the end is for the benefit of total science.
The designation of "gastroenterology" was coined in 1896 by Hemmeter. In this article, the foundation of the first gastroenterological societies in the USA, in Japan, and in Poland is reported; the foundation of international societies of this specialty is mentioned too. The establishment of gastroenterological journals in Japan and in France is pointed out. Finally, the arrangement of the governmental acknowledgement of the sub-specialization in gastroenterology in the German Democratic Republic is described.
In 50 patients with angiographically proven coronary artery disease (CAD) and typical angina pectoris, and in 35 patients with normal angiographic findings the amplitudes of R-waves (sigma R) in 36 precordial ECG leads were measured before and after application of 0.8 mg glycerol trinitrate (GTN). In 21 patients the examination was repeated after coronary bypass surgery. In the CAD-patients decrease of sigma R was shown after sublingual GTN: 19.5 +/- 26.4 mm (p less than 0.05). The control group showed a slight increase of sigma R: 18.7 +/- 16.2 mm (p less than 0.05). After bypass surgery the decrease of sigma R after glycerol trinitrate could no longer be shown. These result support the hypothesis that glycerol trinitrate is capable of reducing enhanced R-amplitudes in resting ECG due to ischemia.
Among others as cause of the sigma R-amplitude in the ECG changes of the ventricular filling and the stroke volume, respectively, the sympathetic tone and the coronary blood supply are discussed. Patients with absolute arrhythmia in atrial fibrillation as well as patients with extrasystoles represent model examples, in whom of the three factors mentioned above only the stroke volume is changed. Measurements of the sigma R-amplitude as well as of the Einthoven/Goldberger leads as well as of the Wilson leads on the same patient showed higher sigma R-values for the heart beats which were preceded by a short diastolic filling phase (rapid phase of the absolute arrhythmia, interpolated extrasystoles) than in the heart beats with previous long diastolic filling time (slow form of the absolute arrhythmia, extrasystole with compensatory interval). The findings considerably change in their size from patient to patient, however, they are statistically to be ascertained in their tendency. In the practical valuation deviations of the sigma R-amplitude values which do not correspond to this relation should be referred to other determinants of the R-amplitude.
In 50 patients with acute infarction who were admitted within 6 hours after the beginning of the complaints randomizedly an intravenous streptokinase short-term lysis or a conventional heparin phenprocoumon treatment was performed and 4 weeks later the results were objectified by coronarography and ventriculography. The patients were subdivided into 3 groups: 1. control group (without fibrinolysis), 2. early lysis (within 4 hours) and 3. late lysis (4-6 hours). Four weeks after the infarction the proportions of the open infarction vessels are approximately of the same size in all three groups, the functional results are best (end-diastolic pressure and kinetics of the cardiac wall) in the group of patients who underwent an early lysis. Successfully lysed patients with remaining residual stenosis must be regarded as particularly threatened by infarction and remain under special control (residual angina, ergometrically objectified exercise tolerance, perhaps coronarography) in the phase of rehabilitation.
Etappenlavage, a new concept of scheduled multiple laparotomies with abdominal lavage for diffuse peritonitis, has been in use since 1979. The purpose of etappenlavage is to ensure exclusion of the infected source, promote maximal elimination of toxic necrotic material, and allow prompt recognition of complications to effect immediate repair. Patients with diffuse peritonitis at high risk of developing multiple system organ failure (as assessed by high scores in the Peritonitis Index Altona and Acute Physiology and Chronic Health Evaluation classifications) were routinely reexplored on a daily basis until evidence of improvement or healing was noted. From 1980 to 1984, 61 patients with intra-abdominal sepsis were treated. Thirty-four cases were due to spontaneous perforation of an intestinal viscus, and 27 cases were secondary to postoperative infections. In 51 cases the primary process was present for more than 48 hours. A total of 235 etappenlavages were performed (mean, 3.9 per patient). In ten cases, additional bowel lacerations were noted and repaired at the second laparotomy. In the last 31 patients, closure with a zipper has facilitated reoperation. No drains were used. After definitive closure, primary wound healing was seen in 79% of cases. The overall mortality in this high-risk group was 22.9%.
Seven lipid parameters, including apoproteins A1, A2 and B were determined in blood from different parts of the cardiovascular system in two groups of patients one with and the other without coronary heart disease. In addition, HDL cholesterol levels were compared in patients with coronary heart disease and primary monogenic combined hyperlipoproteinaemia. None of the seven parameters showed significant differences in samples from the pulmonary artery (mixed venous blood) and the hepatic vein of the control and patient groups. The expected significant concentration gradient between the two vascular regions was confirmed in the groups with and without coronary heart disease. HDL components showed a contrary behaviour: the hepatic vein and pulmonary artery exhibited significantly lower values of HDL cholesterol in patients with coronary heart disease than in the controls, but this was not true for HDL apoproteins A1 and A2. Patients with coronary heart disease and primary hyperlipoproteinaemia showed a significant concentration gradient between the two vascular regions for total and HDL cholesterol. These observations reveal the importance of genetic disturbances of lipid metabolism, particularly the implication of various lipid fractions in the pathogenesis of atherosclerosis.
In 46 patients with coronarographically proved stenosing changes of the coronary vessels and typical angina pectoris as well as in 23 patients with coronary system without pathological findings before and after application of 0.8 mg glycerol trinitrate the sum of the R-amplitudes (sigma R) was determined with the help of a precordial mapping system comprising 36 leads. In 10 patients the examinations were repeated after application of an aortocoronary venous bypass. In the coronary patients after glycerol trinitrate a decrease of sigma R was shown. The control group revealed a slight increase of sigma R. The differences between the two groups were statistically significant. After bypass operation the decrease of sigma R under glycerol trinitrate practically disappeared. These results plead with reservation for the thesis that by glycerol trinitrate in coronary patients a reduction of the R-amplitude induced and enlarged by hypoxia may be achieved.
In comparison to the commissurotomy on the open heart the conventional cardiovalvulotomy even nowadays is a recommendable alternative. It is burdened by an insignificant early lethality (1.8%). After 10 years the calculated survival probability is 87.6%. Using the ultrasound cardiography, the image intensifier radioscopy and in exceptional cases the invasive ventriculography to a higher degree those patients can be comprehended preoperatively, in whom a more intensive calcification of the mitral valves or a shrinking of the subvalvular apparatus is present. In these cases primarily the valvulotomy and a substitute of the valve on the open heart, respectively, is to be aspired to.
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In its introduction, this review deals with the influence of normal pregnancy on the liver. Then, intrahepatic cholestasis of pregnancy and acute fatty liver of pregnancy as diseases peculiar to pregnancy are considered intensively. A second part will be dedicated to liver diseases independent of pregnancy.
Integral cooperation of a clinical psychologist or psychotherapist in an internal medicine rehabilitation clinic is required because the presence of (contributory) psychic causes is evident beyond any doubt in numerous complaint syndromes. Regrettably, decision-making bodies frequently fail to acknowledge the necessity of competent psychological help. Various activities have developed as specific psychotherapeutic tasks, among them individual interviewing and above all group work (client-centered psychotherapy, staff-client meetings, health education, autogenic relaxation training, creativity therapy, biofeedback, and so on). Client-centered psychotherapy indications are outlined. Medical psychology, psychotherapy, and psychosomatic aspects of disease concepts must not be ignored if major concerns in medial rehabilitation and inpatient rehabilitative treatment programmes are to be dealt with effectively.
The effectiveness of levamisole in the immunmodulatory treatment of chronic hepatitis was assessed in a multicentric double blind trial. Twenty patients received in the first week 50 mg, in the second 100 mg and thereafter 150 mg, levamisole on two days every week for 6 months, 20 others received a placebo. Five patients dropped out (non-compliance 1, pregnancy 1, adverse effects 3). The diagnoses were confirmed by clinical, biochemical immunological and histological data. After 6 months 26 subjects allowed us to take a control liver biopsy. The results showed that the rate of improved, unchanged and impaired cases was not significantly different in the levamisole and placebo groups. No correlation was found between etiology, activity or histological type of chronic hepatitis, skin test reactivity (DNCB, PPD, Streptokinase) and therapeutic effect, respectively. Clinical improvement was not associated with the elimination of HBs antigen. In general levamisole was well tolerated, but we saw one case of severe agranulocytosis.
The pacemaker patient stimulated by unchanged frequency may realize the necessary regulation of his minute output of the heart only through a change of the stroke volume, not through the otherwise usual change of the heart rate. Thus this circle of persons shows a restricted breadth of regulation in orthostatic stress or physical work. Pharmacological or physiotherapeutic measures with vasodilatory effect increase the inclination to orthostasis with security for the acute application, potentially also in a long-term therapy. Greater loads may, probably by a release of catecholamines, reduce the degree of severity of a blockage and evoke a parasystoly in patients with devices with unchanged frequency. Patients with ventricle-regulated pacemaker do not show such disturbances as long as the heart may follow the own regulation and the own rhythm. By the transition to the stimulation with unchanged frequency possible at any time, however, may appear incisive restrictions also in this group of patients. The data of literature are to be confirmed that atrium-regulated pacemakers give the best prerequisite concerning the maximum stress of the patients. In all regulated devices the maximally possible heart rate is demarcated by the pacemaker itself. It is in most cases approximately 120/min. Independent of the type of the pacemaker moreover must be taken into consideration additional restrictions of the functional capacity which are very different from case to case and which are to be referred to the cardiologic basic disease.