RESUMO
The diagnostic and therapeutic management in 80 cases with ectopic pregnancy is analysed. Only in 36 cases (45%) there was an accordance of installation diagnosis with the intraoperative status. 44 patients (55%) were suspicious to suffer from acute pelvic inflammatory disease, abortion or irregular uterine bleedings. Only in 28 cases (35%) the clinical symptomatology was so characteristic for ectopic pregnancy that operation had been performed without any other diagnostic procedures. In 34 cases (43%) a laparoscopy was necessary to get the correct diagnosis. In all the other 18 patients (22%) the indication for operation was made by punction of the cul-de-sac, curettage, and/or ultrasound. Because of an increased blood loss more than 500 ml an intra- or postoperative blood transfusion was necessary in about 1/3 of all treated patients. In 32% it was possible to preserve the fallopian tube. The corresponding operative procedure consisted of salpingotomy and manual expression of tubal pregnancy. Local vasoconstrictive acting substances are recommended. If there are hints at an ectopic pregnancy by histologic examination of tissue got by curettage quick and well-organized management is necessary to use the possibility of conservative operation-procedures. Histologic examination of all abortion tissue is requested.
Assuntos
Gravidez Ectópica/diagnóstico , Adolescente , Adulto , Tubas Uterinas/cirurgia , Feminino , Humanos , Ovariectomia , Ovário , Gravidez , Gravidez Ectópica/cirurgia , Gravidez Tubária/diagnóstico , Fatores de Risco , Ruptura EspontâneaRESUMO
Results obtained from autopsy are parameters of importance to efficacy of diagnosis and therapy. To enable better overseeability of higher numbers of cases, the necessary congruence between clinical and postmortem diagnoses should be consistently settled on the basis of identical criteria used by clinicians and pathologists. Aspects relating to the problem are discussed in some detail, and suggestions are made on how to formulate final evaluations in postmortem reports.
Assuntos
Autopsia , Causas de Morte , Diagnóstico , HumanosRESUMO
Within five years (1982-1986) there were in the Dept. Obstet. Gynec., Main Hospital of Suhl 382 curettements after 7,462 term deriveries (greater than 37. week of pregnancy). This is a frequency of 5.2%. Only in 25% there was a histologic confirmation of placental tissue. Discussion about possibilities to reduce the frequency of such curettements post partum without neglecting necessary interferences.
Assuntos
Vilosidades Coriônicas , Coristoma/cirurgia , Dilatação e Curetagem/estatística & dados numéricos , Transtornos Puerperais/cirurgia , Neoplasias Uterinas/cirurgia , Feminino , Alemanha Oriental , Humanos , GravidezRESUMO
Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.
Assuntos
Vasos Coronários/patologia , Infarto do Miocárdio/patologia , Adulto , Fatores Etários , Criança , Angiografia Coronária , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Consumo de Oxigênio , Oxiemoglobinas/metabolismoRESUMO
We have undertaken esophagoscopy 1/2 to 17 1/2 years after surgery in 20 patients with a total gastrectomy and an esophago-jejunal anastomosis. In 5 cases we found a complete columnar lining of the distal esophagus (Barrett-esophagus). 2 other cases showed a multilocular columnar epithelium. One case with a Barrett-esophagus had endoscopy before surgery, and it could be proved that the columnar lining developed after surgery. We suspect that it was the same in the remaining cases. All examined patients, except one, showed an erosive esophagitis of varying severity. These observations support the current view that the columnar lined esophagus is usually an acquired one. The pathogenesis is not completely clear, but reflux of digestive juices destroying the squamous epithelium and impairing healing is the condition for columnar lining. The observations on patients with total gastrectomy prove that it must not necessarily be gastric juice. The very urgent question of the origin of columnar lining cannot be answered at present.
Assuntos
Doenças do Esôfago/etiologia , Síndromes Pós-Gastrectomia , Adulto , Idoso , Doenças do Esôfago/patologia , Esofagite Péptica/etiologia , Esôfago/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
The autopsy reports of the Pathological Institute Erfurt of the period from 1.1.1951 until 31.12.1969 were scored for cases of coronary atherosclerosis and myocardial infarction and analysed concerning frequency and distribution of age and sex, resp. In 89.05 per cent (2131 cases) of all myocardial infarctions a coronary sclerosis was present. Males suffered significantly more frequent from these forms of ischaemic heart disease. During the period of nineteen years a significant increase of the coronary atherosclerosis in combination with a myocardial infarction was observed. This is due to the more frequent occurrence of severe forms. The increase of the frequency of the myocardial infarctions and of the weak and moderately coronary sclerosis particularly concerns the younger age groups. Callous infarcts were more frequent than fresh and relapsing ones.
Assuntos
Doença das Coronárias/patologia , Infarto do Miocárdio/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Autopsia , Doença das Coronárias/complicações , Feminino , Alemanha Oriental , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Fatores SexuaisRESUMO
The autopsy reports of the Pathological Institute Erfurt of the period from 1.1.1951 until 31.12.1969 were scored for cases of myocardial infarction and coronary thrombosis. Among 2,393 morphologically analysed myocardial infarctions 454 coronary thromboses (18.97 per cent) were found. Males were significantly more affected than females. Fresh infarcts showed significantly more thromboses than callous infarcts. We found fresh and occluding vessel thromboses more frequently in fresh infarctions. The analysis of age distribution yielded an increase of the rate of thrombosis in cases with myocardial infarction. On the other hand, the frequency of infarctions in cases with a coronary thrombosis was decreasing. It is suggested that the risk for infarctions is larger in younger people with coronary thrombosis than in older ones. No infarctions were detected in 165 cases of thrombosis. Preferably this group includes those cases in which the patients deceased within 6 to 8 hours and, therefore, the infarction was not morphologically detectable.
Assuntos
Doença das Coronárias/epidemiologia , Infarto do Miocárdio/epidemiologia , Adulto , Fatores Etários , Idoso , Autopsia , Cicatriz , Feminino , Alemanha Oriental , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
Coronary thrombosis is a perilous disease. Animal experiments may contribute to investigate its pathogenesis and treatment. The development of an experimental model of coronary thrombosis on closed thorax is important. In this report the methodics of such model is entered into, pointing at its dangers and possible complications.
Assuntos
Doença das Coronárias/patologia , Animais , Cães , Eletricidade , Métodos , SuínosRESUMO
The authors give a report on occasional difficulties concerning the radiological and endoscopic clarification of the malignant changes at the gastric stump after treatment of resection. Four relevant cases are stated and explained. The endoscopy (glass fibre gastroscopy) together with the biopsy is at present the most reliable method for the diagnosis of the pathological processes in the remaining part of the stomach. A regular endoscopic and radiological control of patients with gastric resection is desirable.
Assuntos
Gastroscopia/métodos , Síndromes Pós-Gastrectomia/diagnóstico , Neoplasias Gástricas/diagnóstico , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/cirurgia , Fatores de TempoRESUMO
A case report is given on a male patient who was 52 years old when he died. 9 years ago a nephrectomy was performed because of a densely-packed mesenchymal tumor of the adipose tissue of the pelvis renalis. 7 years after the surgical intervention he suffered from several hypoglycemic crises. An operation was performed, and 2 large tumor nodes were removed from the greater omentum. A retroperitoneal relapse was inoperable. Nevertheless, the disorder of the carbohydrate metabolism disappeared after the operation. At the autopsy, one year later, a large retroperitoneal tumor with metastases in the lymph nodes was found. The neoplastic growth was classified as a malignant histiocytoma, and the hyperglycemia was taken as a paraneoplastic syndrome (Doege-Potter).
Assuntos
Histiocitoma Fibroso Benigno/complicações , Hipoglicemia/complicações , Neoplasias Retroperitoneais/complicações , Humanos , Neoplasias Renais/complicações , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Omento , SíndromeRESUMO
2393 cases of myocardial infarctions autopsied during the period from 1.1. 1951 until 31. 12. 1969 in our Institute were scored for aneurysm and rupture of the cardiac wall as well as for partietal thrombosis and endocardial fibrosis, and analysed concerning frequency and distribution of sex. Aneurysm of the ventricle walls was present in 23.94 per cent of myocardial infarctions. Most of the aneurysms were found in the posterior wall of the left ventricle. Callous infarctions showed more aneurysms than fresh myocardial lesions. A rupture was present in 31.82 per cent of acute aneurysms and in 4.53 per cent of old aneurysms. Parietal thromboses we found in 13.92 per cent of all infarctions. In 14.21 per cent of all myocardial infarctions endocardial fibroses were present. Parietal thromboses and endocardial fibroses were significantly most frequent in infarctions of the right ventricle.
Assuntos
Doença das Coronárias/patologia , Infarto do Miocárdio/patologia , Doença Aguda , Autopsia , Doença Crônica , Doença das Coronárias/complicações , Feminino , Aneurisma Cardíaco/complicações , Humanos , Masculino , Infarto do Miocárdio/complicações , Ruptura , Fatores SexuaisRESUMO
At autopsies between 1951 and 1969, 246 of 2393 cases with myocardial infarctions and heart muscle scars showed no thrombi and no artery sclerosis to be worth mentioning. The 7 comprehensive morphologically investigated observations of a second case group were discovered in a prospective study from 1970 to 1973. This study included 255 cases with myocardial infarctions or heart muscle scars. Comparatively to the investigations with sclerosis of the coronary arteries, myocardial infarctions without occlusive coronary disease were stated more frequent in woman than in men. Furthermore, more young people were affected from these infarctions. In 3 of 7 cases without sclerosis or thrombosis of the coronary arteries the infarctions were located more frequent subendocardial that in these cases with coronary sclerosis or thrombosis. Respectively to the size the 246 infarctions of the first group, they did not differ from those taken in a respecting group of 2147 cardiac infarctions with stenosing processes of the coronary arteries. Infarctions without sclerosis or thrombosis of the coronary arteries were located more frequently in the ventricular septum and in the wall of the right ventricle. For these infarctions a coincidenceof several, separate not relevant factors in supposed to be the cause. Theinfarctions without stenosing processes of the coronary arteries occupy insome respects an exceptional position, but on principle they do not differ in the morphological findings from the other myocardial infarctions.
Assuntos
Infarto do Miocárdio/patologia , Adulto , Fatores Etários , Idoso , Autopsia , Vasos Coronários/patologia , Feminino , Alemanha Oriental , Septos Cardíacos , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Estudos Prospectivos , Fatores SexuaisRESUMO
Coronary thrombosis was induced in 14 miniature pigs by means of direct current. The induction electrode was introduced via the common carotid artery into the coronary artery. The intensity of current (1 mA) and the duration of current flow (60 min) were kept constant in all the experimental animals. 6 miniature pigs survived the period of observation (48 h). In all instances, an injury to the intima was the morphopathological location factor. With the exception of one animal, which died after an induction time of 60 min, coronary thrombosis was stated in all the miniature pigs. The experimental arrangement which produces closed-thorax coronary thrombosis is suited for cardiosurgical, physiopathological and pharmacological experiments, especially because the anatomy and the degree of development of the porcine heart are most similar to those of the human heart.
Assuntos
Doença das Coronárias , Modelos Animais de Doenças , Tórax , Angiografia , Animais , Artérias Carótidas , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/fisiopatologia , Ligadura , Modelos Biológicos , SuínosRESUMO
By means of electric induction without opening the chest in 23 dogs coronary thromboses were produced with the aid of a standardized method based on a test model of Salazar (1961). The morphological results are reported. 13 of the dogs showed coronary thromboses. At the same time in 12 animals a myocardial infarction could be registered. Altogether, we observed 17 myocardial infarctions. The electric field led to differently severe lesions in the walls of the coronary arteries. The significance of this test model is discussed.
Assuntos
Doença das Coronárias/patologia , Animais , Doença das Coronárias/complicações , Cães , Eletricidade , Feminino , Masculino , Infarto do Miocárdio/complicaçõesRESUMO
With the aid of a standardized method basing on a report of Salazar (1961) coronary thromboses in pigs were produced by means of electric induction without opening the chest. 12 of 13 pigs showed thromboses in coronary arteries, in 8 animals with embolization of the thrombotic material. At the sametime in 8 pigs a myocardial infarction could be registered. The significance of these experiments discussed.
Assuntos
Doença das Coronárias/patologia , Animais , Eletricidade , Feminino , Masculino , Infarto do Miocárdio/patologia , Suínos , Tromboembolia/complicaçõesRESUMO
The autopsy reports of the Pathological Institute Erfurt of the period from 1.1 1951 until 31.12. 1969 were scored for cases of coronary sclerosis which were analysed concerning frequency and distribution of age and sex, resp. In 52.26 percent of all autopsies (55.77 percent of men, 48.06 percent of women) a coronary sclerosis was present. Weak or moderately severe coronary sclerosis appeared more frequent (34.47 percent) than severe forms (17.80 percent of all autopsies). The difference in the relative frequency of coronary sclerosis between our material and the data of other authors we explain by subjective factors in the interpretation of the morphological changes of the coronary vessels. Males suffered significantly more frequent from all forms of coronary sclerosis. During the period of nineteen years a significant increase of the coronary sclerosis was observed. It is due to the more frequent occurrence of weak to moderately severe coronary sclerosis in both sexes, and of severe forms in men. The increase of the frequency of the coronary sclerosis particularly concerns the younger age groups.