Showing papers in "Wiener Klinische Wochenschrift in 1984"

The epileptic mother and her child

Abstract: This study is a review of the literature on the influence of epilepsy and antiepileptic medication on the course of pregnancy and the foetus, as well as of the effect of pregnancy on the disease. Antiepileptic treatment is supposedly responsible for the increased rate of abnormal bleeding after delivery. Data on the perinatal mortality of epileptics are conflicting. The offspring of epileptic women are often smaller than normal neonates, indicating retarded growth, and the incidence of malformations is 1.25 times higher. Until now there has been no direct evidence of a teratogenic effect of the commonly used antiepileptic drugs, and the risk of malformations may possibly be correlated with the severity of the epilepsy. The effect of pregnancy on seizure frequency seems to be quite variable. Higher seizure frequency is seen during pregnancy, but this is not a universal phenomenon. The incidence of seizures in gestational epilepsy has no predictive value with respect to the course of later pregnancy. A positive correlation seems to exist between the development of eclampsia and later epilepsy, a family history of epilepsy and cerebral dysrhythmias. Status epilepticus is uncommon in pregnancy. The requirement of several antiepileptic drugs is increased during pregnancy. The metabolism of carbamazepine, primidone, and clorazepate is probably accelerated in the gestational period, but data on other antiepileptic drugs are inconclusive or lacking. The intestinal absorption of antiepileptic drugs may be impaired during pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

The development and rationale of pressure-controlled intermittent coronary sinus occlusion--a new approach to protect ischemic myocardium.

Abstract: The early concept of global retroperfusion and arterialisation of the coronary sinus was discarded because of unacceptable damage to the myocardium, although many authors provided evidence on the improvement of cardiac function during ischemia. Furthermore, the exact mechanism of coronary sinus retroperfusion remained poorly understood. The lack of a strong physiological basis for retroperfusion as well as the development of coronary bypass grafting lessened interest in this revascularisation technique. Renewed interest in myocardial protection via the coronary sinus emerged because of a more aggressive therapy of acute myocardial ischemia. We developed a simple retroperfusion system conceptualized as a periodical occlusion of the coronary sinus and as a redistribution of venous flow to compromised areas during acute myocardial ischemia, sweeping out toxic substances and edema during coronary venous drainage. To allow sufficient filling of the infarcted area as well as venous drainage, the occlusion versus release phase is controlled by the coronary sinus pressure. This pressure-controlled intermittent coronary sinus occlusion (P-ICSO) represents a closed loop system and therefore guarantees optimal physiologic function of the system. This report explains the proposed nature of action of enhanced washout of myocardial edema induced by P-ICSO. Moreover, beneficial effects of P-ICSO observed during canine studies are summarized. It is concluded that this new simple retroperfusion technique has the clinical potential to serve as interim support to protect deprived myocardium until definite reperfusion is available.

Recurrence of duodenal ulcer after therapy with Sucralfat or cimetidine

Abstract: Relapse rates of duodenal ulcer after treatment with sucralfate or cimetidine were investigated in a one-year follow-up study. During this period 23 out of 27 patients (85.1%) initially treated with sucralfate relapsed, in comparison with 17 out of 21 patients (80.9%) after cimetidine therapy. Recurrence after cimetidine was more often asymptomatic than after sucralfate. These results suggest that recurrence rates of duodenal ulcer are not essentially influenced by the mode of action of the initially used drug. Cytoprotection by sucralfate did not result in fewer or later relapses than reduction of acidity by cimetidine.

[Polyvinylpyridine N-oxide (Bay 3504, P-204, PVNO) in the treatment of human silicosis].

Abstract: After having demonstrated the therapeutic effectiveness of polyvinylpyridine-N-oxide (PVNO) for experimental silicosis in numerous animal studies, and after having finalized the toxicological examinations, a tolerance test was run in a controlled clinical assay with human subjects. After having shown that PVNO infusions did not result in toxic side-effects its therapeutic effectiveness was clinically studied in two different cohorts: matched pairs studies were conducted in 8 miners (group 1) and in 20 stone-cutters (group 2). The study demonstrates the therapeutic potency of PVNO for man as well, subject to certain moderating conditions as follows: the degree of silicosis, the age of the silicotic focus and the dust-type influenced the outcome of the treatment. The minimal dose should be between 300 and 400 mg per kg bodyweight and should be given in intervals of one to two years.

Plasmapheresis in multiple sclerosis

Abstract: 8 patients suffering from multiple sclerosis were treated with plasmapheresis. Other methods of management such as cortisone or azathioprine therapy were discontinued one month before plasmapheresis. The patients were investigated before, and on the 1st, 2nd and 3rd day after plasmapheresis using the Kurtzke Disability Score and the Hamilton Rating Scale. No improvement in neurological or psychiatric symptoms or signs was detected following plasmapheresis.

Value of determination of beta 2-microglobulin in toxic nephropathy and interstitial nephritis.

Abstract: Beta 2-microglobulin (beta 2-m) is a low molecular weight protein of importance in the evaluation of the reabsorptive capacity of the proximal kidney tubule. This is based on the properties of beta 2-m: the daily production is constant and it leaves the body almost exclusively by glomerular filtration; 99.9% of the filtered amount is reabsorbed by the proximal tubule. The urinary excretion of beta 2-m is elevated (greater than 370 micrograms/day) in patients suffering from proximal tubular dysfunction with disturbance of tubular reabsorption. It is of great value as a marker of tubular involvement in toxic nephropathies, interstitial nephritis and the non-invasive method of choice to distinguish between renal and lower urinary tract infections.

[Diagnosis of psoriatic osteoarthropathy: comparison of clinical, radiologic and scintigraphic findings].

Abstract: Among the group of seronegative spondarthritides psoriatic osteoarthropathy can be differentiated from rheumatoid arthritis as a separate disease with generalized osseous proliferation. 33 cases were evaluated and clinical data, X-ray films and nuclear bone scans were compared. Pathological alterations in the bone structure can be found by bone scintigraphy already at very early, even subclinical stages of the disease, thus allowing early diagnosis. In a high percentage of our cases pathological alterations could be demonstrated by scintigraphy long before they were revealed on X-ray films. Scintigraphic methods may help to evaluate the activity of the disease. Furthermore, in many of our cases, localization and concentration of the tracer in the skeleton were so typical, that they may be considered pathognomonic for psoriatic osteoarthropathy. Thus bone scanning appears to be a useful tool for the diagnostic evaluation and follow up in cases of psoriatic arthropathy, in particular if the low exposure to radiation is taken into account.

[Cryotherapy. Behavior of joint temperature during ice application-- a basis for practical use].

Abstract: Changes of intraarticular temperature were measured in ten young animals during long-term cryotherapy. The use of cold packs of -23 degrees C and an application time of 30 minutes resulted in a decrease of intraarticular temperature of means = 6.56 +/- 1.04 degrees C. The original temperature was reached again after an average of 215 minutes. With cryotherapy there is an initial reflex increase in temperature is the primary object of therapy, all movements commencement of application. Since movements of a joint result in the mixing of synovia of various temperatures, we recommend the following procedures in cryotherapy: 1. during the application of cold (cooling phase) the patient is ask to move his joint from time to time, in order to attain a faster and more effective decrease in temperature in the joint. 2. But in this cases, in which an intraarticular decrease in temperature is the primary object of therapy, all movements should be avoided during the phase of rewarming. The effect of long-term cryotherapy (Kern, 1980) is a decrease in temperature of sufficient magnitude and duration resulting in a reduction of joint metabolism, thereby of the activity of cartilage degrading enzymes. Accordingly, long-term cryotherapy can be recommended using cold packs of -20 to -23 degrees C for 30 minutes every 5 to 6 hours in acute rheumatic arthritis, posttraumatic oedema and in the acute therapy of sports injuries. A thin towel or blotting tissue is used to avoid local freezing. Slight exercise during the cooling phase can improve the results of cryotherapy.

[A 60-year-old patient with sialadenitis, pulmonary round foci and vulvar ulcer].

Abstract: The unusual case of a 60 year-old woman is discussed. She presented with sialadenitis, paresis of the facial nerve, keratoconjunctivitis and ulcus vulvae. Basic anamnestic information revealed primary enlargement of the submandibular gland, fever, otitis, sinusitis and a pulmonary tumour. The serum immunoglobulin E level was raised. In addition to the necrotic granulomas in the lungs, spleen and kidney, characteristic changes were found in the lymph nodes, liver, pancreas and colon.

Purified complex of factor VIII coagulant moiety and phospholipid: high factor VIII coagulant activity in factor VIII inhibitor plasma.

Abstract: A complex of factor VIII coagulant moiety and phospholipid was purified by means of immunoadsorbent chromatography of factor VIII concentrate and consecutive dissociation of the immobilized factor VIII complex by human placental phospholipid (Fibraccel). The complex of factor VIII coagulant moiety and phospholipid displayed factor VIII coagulant activity (VIII C) and factor VIII coagulant antigen (VIII C:Ag), but no factor VIII related antigen (VIII R:Ag). When incubated with factor VIII inhibitor plasma, the complex of factor VIII coagulant moiety and phospholipid exerted higher factor VIII coagulant activity than native factor VIII complex, and than purified factor VIII coagulant moiety alone. Our results prove that in activated prothrombin complex concentrates a complex of factor VIII coagulant moiety and phospholipid is the active mechanism exerting procoagulant activity in factor VIII inhibitor plasma.

[Optic nerve hypoplasia and growth hormone deficiency: de Morsier's syndrome].

Abstract: The association of optic nerve hypoplasia and deficiency of the septum pellucidum and hypopituitarism is known as the De Morsier syndrome or septo-optic dysplasia Four children with blindness and growth retardation due to growth hormone deficiency are described Frequent recurrent episodes of severe hypoglycaemia, starting in the newborn period, were observed in three of them Although visual impairment was noted during the first year and growth failure was detected between the first and sixth year of life in all four patients, the diagnosis of septo-optic dysplasia was delayed for two to six years Early diagnosis and treatment with growth hormone should prevent attacks of hypoglycaemia and their sequelae and bring about normal growth

Foam cells in the development of human atheroma: a morphological and autoradiographic approach.

Abstract: Human arterial biopsies were studied by morphometrical, cytochemical, autoradiographic and ultrastructural methods with the aim of determining whether intimal lesions in atherosclerosis are characterized by definite cytological patterns. The results have shown: 1. a strong association between fibro-atheromatous plaques and foam and monocyte-like cells; 2. very few foam cells in diffuse intimal thickening and pearly-white fibrous plaques; 3. macrophages and foam cells were the only cytotypes consistently labelled with 3H-TdR and presumably proliferating in the fibro-atheromatous plaques.

Value of preventive immunoglobulin administration in cadaveric kidney transplantation

Abstract: Transplant recipients have a high risk of infection, especially during the early postoperative period, due to impaired immune responsiveness. In a prospective randomized trial comprising 50 consecutive renal allograft recipients, a study was undertaken of the impact of prophylactic administration of immunoglobulins (Intragam) on the rate of infection. Similar numbers of infections were observed in both groups. They predominantly affected the lungs or the lower urinary tract. An unexpected result revealed by the study was that only 17 out of 25 patients of the immunoglobulin group, in comparison with 22 out of 25 of the control group were discharged with a functioning graft. It thus appears that the prophylactic administration of immunoglobulins to asymptomatic allograft recipients is not only useless, but probably also dangerous.

Continuous arteriovenous hemofiltration in the therapy of acute renal insufficiency

Abstract: 30 patients with acute renal failure were treated in an intensive care unit by continuous arterio-venous haemofiltration (CAVH). This procedure has less side effects as compared with intermittent haemodialysis, peritoneal dialysis and haemofiltration (hypotension, bio-incompatibility and lack of biochemical steady state) and CAVH is clearly superior with regard to fluid removal. In removing the uraemic toxins CAVH is more effective than peritoneal dialysis and, in most instances, satisfactory as sole renal replacement therapy in acute renal failure.

Glomerular proteinuria in pregnancy hypertension

Abstract: In view of the lack of reliable diagnostic parameters for predicting pregnancy-induced hypertension (PIH) the aim of this study was to test the prognostic value of electrophoretic urinary protein patterns. Based on experience with this method in nephrology, molecular weight related polyacrylamide-gel-electrophoresis (PAGE) of urinary proteins was used to distinguish between the different kinds of renal lesions (glomerular, tubular, combination, extrarenal). The analysis was carried out in two independent groups: urines of 126 non-selected pregnant women (1st group) were analysed at regular intervals. By chance, none of them had a history of previous PIH or hypertension, nor any signs of impaired renal function before or during the present pregnancy. In a 2nd group 124 women after severe PIH (pd greater than or equal to 110 mm Hg) were examined in part using PAGE, postpartum renal biopsy and long-term clinical follow up (greater than or equal to 1 year after PIH). In 29/124 cases data for all mentioned parameters was collected. 24 women of the prepartum group developed an electrophoretic pattern characteristic of glomerular proteinuria, which was persistent once found. PIH appeared greater than or equal to 8 weeks after the appearance of this pathological pattern in 15/24 women of this subgroup; 5 of 9 remaining women developed PIH in a subsequent pregnancy. None of the 102 women with other protein patterns developed PIH. In the 2nd group a close relationship was found between the glomerular protein patterns 0.5 to 3 years after PIH, clinical long-term follow up and renal biopsies about 1 year after PIH.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term results of selective proximal vagotomy].

Abstract: Highly selective vagotomy was performed in 361 patients over the past 10 years. The mortality was 0.3% in uncomplicated, and 1.6% in complicated duodenal ulcer. With a mean follow-up period of 52 months the recurrence rate was 7.4%. The known advantages of this operation, namely low mortality and low postoperative morbidity (dumping 0.8%, diarrhoea 0.8%, unintentional weight loss 0%, food intolerance 1.9% and epigastric fullness after meals 1.9%), were confirmed in our patients. The overall clinical result was excellent or good (Visick I or II) in 87% of patients. Clinical failures were most often caused by recurrent ulceration. Highly selective vagotomy is still the operation of choice in uncomplicated duodenal ulcer. It can also be recommended in selected cases of complicated ulcer disease.

Initial results of echographic staging in cervical cancer

Abstract: Twenty women with invasive carcinoma of the cervix were investigated by means of rectal sonography. A radical Wertheim's operation was performed in all cases. Ultrasound investigation was more accurate than rectovaginal palpation. Comparison between ultrasound or rectovaginal palpation with the pathohistological findings confirm that ultrasound is factual while palpation still includes bias. However, it is not yet possible to differentiate between inflammatory and carcinomatous infiltration of the parametria. The size of carcinomas restricted to the cervix can be estimated by means of ultrasound.

Management of alcoholics and other addicts

Abstract: Mankind has always been familiar with drugs which change the state of consciousness. For a long time their utilization was of a ritual future. Intake was practised on the occasion of special ceremonies and, therefore, self-limiting. Through the diminution of mysticism, drugs increasingly assumed a pleasure-gratifying character, thereby becoming subjected to abuse. Drug abuse of a time- and/or regionally-restricted nature, can periodically be observed. Alcohol has represented Austria's most prominent and widely abused drug for centuries. Addictive behaviour depends on several factors and, according to specific accentuation, divergent addiction theories have been proposed, all of which, however, essentially concur on the concept that addiction represents a development rather than a disease. It appears strange that the pertinent literature fails to supply detailed information on dosage or intake frequency. The therapist concerned with addiction is, however, called upon to provide an unbiased, precise diagnosis, and an efficacious treatment schedule, which is possible only if basic scientific information on recognition and development of addiction and treatment possibilities is made available.

[Clinical, endocrinological and pathohistologic aspects of beta-HCG positive seminoma].

Abstract: The most important aspects of the clinical findings, endocrinology and course of the disease in 14 patients with the histological diagnosis of pure seminoma of the testis and positive serum beta-HCG levels are presented. In addition to routine investigations, immunohistochemical examination of the formalin-fixed specimen by the immunoperoxidase technique was also carried out. Serum alpha-feto-protein levels remained normal in all 14 patients. There was no correlation between serum beta-HCG level and tumour stage. The longest period of observation was 76 months and the shortest 8 months. Patients with no evidence of metastatic disease (5 patients, N0M0) or patients with low-stage disease (5 patients, N1 or N2M0) respond very well to radiotherapy. 4 patients (N3-N4M0) with large retroperitoneal metastases or distant lymph node metastases underwent different combinations of treatment.

Platelets in atherogenesis and thrombogenesis.

Abstract: The old thrombogenic hypothesis of atherosclerosis delivered by the Austrian pathologist Carl von Rokitansky has recently appeared in modern costume as claims that platelets contribute to atherogenesis in three ways: through damaging arterial endothelial cells by releasing various agents, the release of a factor responsible for smooth muscle cell proliferation and the formation of persistent mural thrombi being organized into intimal thickenings. An updated view of the role of platelets in atherosclerosis and thrombogenesis is presented in relation to the ideas of Carl von Rokitansky.

[Combined occurrence of renovascular hypertension, coarctation of the abdominal aorta, occlusion of the celiac and mesenteric arteries and kyphoscoliosis with neurofibromatosis--a case report].

Abstract: The case is reported of a 16 year-old girl with arterial hypertension, generalized neurofibromatosis, coarctation of the abdominal aorta, bilateral renal artery stenosis, occlusion of the coeliac artery and superior mesenteric artery and kyphoscoliosis.

[Follow-up of patients with differentiated thyroid cancer: determination of serum thyroglobulin in place of routine 131I scintigraphy?].

Abstract: A comparison was conducted in patients with differentiated thyroid carcinoma still under 131I therapy (n = 18) between 2 mCi-131I scans, posttherapeutic scans and radioimmunologically measurable serum thyroglobulin (TG). All 3 parameters were positive in only 9 cases; among the other 9 patients TG appeared to be the better indicator (ratio 5:1) of residual tumour tissue than the 2 mCi-131I scan. In a second group of patients who had completed 131I therapy the 2 mCi scan and TG were compared (n = 21). Both indices were negative in 15 cases, whereas TG was positive in 6 patients in spite of a negative scan. TG generally remained within the clearly positive range also during T4 therapy. TG was highest in metastatic disease and practically uninfluenced by T4, i.e. by the endogenous TSH level. TG antibodies were found in 15% of cases, generally with low titres only; this did not interfere with TG determination as tumour marker. In summary, TG measurement appears to be superior to 2 mCi-131I scans for follow-up of cases with differentiated thyroid carcinoma.

[Gonadotropin-secreting liver cancer in ulcerative colitis].

Abstract: The authors present the clinical and pathological data of a 28 year-old female patient, who died after several months of observation. The patient had a 15-year history of mild ulcerative colitis. On admission the diagnosis of primary sclerosing cholangitis was made, but subsequently paraneoplastic gonadotropin secretion became apparent. At autopsy a cholangio- and hepatocellular carcinoma was found and the extrahepatic bile ducts were infiltrated by the cholangiocarcinoma. Using the immunoperoxidase method, the hepatocellular part of the tumour was found to contain human choriogonadotropin.

[Mono- or polytherapy of epilepsy?].

Abstract: Although anticonvulsant polytherapy has been widely and traditionally used in the treatment of epilepsy, there is little evidence of its advantages over monotherapy. It does, however, lead to problems of chronic toxicity, drug interactions, failure to evaluate individual drugs, and sometimes exacerbation of seizures. There are many complications of polytherapy which could be avoided by more careful monitoring and supervision of therapy. Studies in new, previously untreated referrals suggest that there is considerable potential for monotherapy. In the event of failure of optimum monotherapy, the value of polytherapy is not yet clear. In chronic patients on polytherapy there may be scope for careful rationalization to two or sometimes one drug, with reduction in chronic toxicity and sometimes improved seizure control. Reduction of therapy, however, may be impossible or hazardous due to withdrawal seizures. Even after successful reduction, seizure control is much less satisfactory than in new referrals. It is easier to avoid polytherapy than to reduce it. There is a need to define carefully the limits of effective anticonvulsant therapy.

Leydig cell function in idiopathic oligozoospermia

Abstract: Repeated blood sampling at 10-minute intervals over a 4-hour period (15.00 until 19.00) for simultaneous determination of FSH, LH and testosterone was carried out in 7 normospermic men and 8 patients presenting with idiopathic oligozoospermia. Fluctuations of LH and testosterone were observed within the 4-hour sampling period. Only minor alterations of FSH were found. Planimetric assessment of the areas under the curves of FSH, LH and testosterone did not show any significant difference in FSH. Testosterone was found to be significantly decreased in the oligospermic group (p less than 0.025), while LH showed a tendency to be increased (p less than 0.1). These results point out that single determinations of LH and testosterone do not provide exact information, due to the wide range of hormone fluctuation. Serial sampling of the hormones demonstrates Leydig cell dysfunction in patients with moderate idiopathic oligozoospermia.

Deficiency anemias in tropical countries

Abstract: Nutritional anaemias are common in tropical areas. The commonest cause is iron deficiency, which mainly arises from impaired absorption of iron from food. Substances which inhibit iron absorption in various diets play an important role in the pathogenesis of iron deficiency anaemia. Iron deficiency is further aggravated by blood loss in hook-worm infestation. Folic acid and vitamin B 12 deficiency are less important causes of nutritional anaemia. The efforts of the World Health Organization to supplement iron in food are described.

[Urinary enzymes in the non-invasive diagnosis of kidney epithelial lesions in acute kidney failure].

Abstract: The present investigation describes the urinary output of four different enzymes localized within nephron cells in two models of experimental acute renal failure. The activities of fructose-1,6-diphosphatase (FDP), glutathione-S-transferase (GST), N-acetyl-beta-D-glucosaminidase (NAG) and pyruvate kinase (PK) were determined in the urine of rats after maleate or HgCl2 intoxication. 2 hours after maleate intoxication the urinary output of FDP, GST and NAG was significantly increased above control values. 6 hours after HgCl2 poisoning FDP, GST and NAG showed increased urinary enzyme activities. The urinary activity of each enzyme was significantly increased 24 hours after intoxication. These results are in good accordance with the damage observed on light and electron microscopic investigations carried out with both experimental models. Furthermore, general problems of urinary enzyme measurements are discussed in this paper.

Reanastomosis of the rabbit fallopian tube with fibrinogen concentrate

Abstract: In order to investigate the use of fibrin glue in reconstructive surgery of the oviduct, tubal reanastomosis was performed with homologous fibrinogen concentrate in 26 rabbits. The contralateral tube was clamped. The pregnancy rate was 25%. No adhesions were seen in the area of the anastomosis on examination of the abdomen 3 months after operation.