On the surgical treatment of cerebellar infarction (author's transl)

Recently we have experienced two cases of acute uncomplicated cerebellar infarction which had been surgically treated. Onset of the disease in both cases was an attack of vertigo with nausea and vomiting, followed by the signs of an expanding lesion in the posterior fossa. There were thirty-one surgically treated cases and only six were fatal so far as we have reviewed cases reported in the literature. The clinical pictures of cerebellar vascular accident are typical in most cases and those of cerebellar infarction are similar to those of cerebellar hemorrhage. These two are frequently indistinguishable on the clinical as well as angiographic grounds, however, CT-scan may be of great value in the differential diagnosis. It is important to realize the cerebellar infarction is also a surgical lesion and not to spend valuable time in differentiating cerebellar infarction from cerebellar hemorrhage. Low mortality rate and low morbidity in cerebellar infarction adequately treated surgically confirm importance for early exploration.     

Results of surgical treatment of early carcinoma of the stomach (author's transl)

From 1961 to 1975, 53 patients were operated on for early carcinoma of the stomach, 24 of the total of 57 cancer sites being limited to the mucosa, 33 having already infiltrated into the submucosa. Macroscopically, most of them were ulcerative carcinoma, while histologically the intestinal type predominated. The cumulative five-year survival rate (excluding hospital deaths) was 86.5%, while after "typical" carcinoma resection by the Billroth II procedure with removal of the greater and lesser omentum it was 100% for mucosal and 93% for submucosal carcinoma.     

Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases (author's transl)

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.     

Adhesive otitis: 30 surgical cases (author's transl)

Adhesive otitis accounts for 3% of all cases of chronic otitis. It is characterized by the attachment of the entire epidermal layer of the drum to the inner wall of the cavity. Three causative factors are identified: abnormal permeability of the auditory tube; absence of the fibrous layer of the tympanic membrane; a predisposing milieu. This is a very different condition from tympanosclerosis and its scleroadhesive sequelae. It can, however, be associated with cholesteatoma. An analysis of 30 cases in which surgery was performed points to the real progress brought about by the use of tympanic homografts. One problem remains: permanent aeration of the new tympanic cavity.     

Treatment of acute myocardial infarction with sodium nitroprusside (author's transl)

In 12 patients with acute myocardial infarction, seven of whom had high and five low blood pressure measurements, sodium nitroprusside infusions were given to reduce the myocardial oxygen consumption. The dosage was between 20 and 300 mug/min. Sodium nitroprusside led to a considerable reduction of the systemic arterial pressure, while the left ventricular filling pressure was less influenced. In normotensive patients the filling pressure could often not be sufficiently lowered as a too severe reduction of arterial pressure occurred beforehand. In hypertensive patients the relationship between left ventricular filling pressure and arterial pressure was better: in all patients the arterial pressure could be lowered to normal values and the filling pressure also became normal in most cases. Angina pectoris improved markedly in all patients. These results show that sodium nitroprusside has a satisfactory effect on the haemodynamics in hypertensive infarct patients, whereas it is less suitable for the treatment of normo- or hypotensive patients.     

Left coronary disease in postero inferior myocardial infarction (author's transl)

Postero-inferior-myocardial-infarction (MI) results usually from the occlusion of the right coronary artery. Recent pathological and angiographic studies have pointed out that in such cases occlusion of the right coronary artery was often (30 to 80 per cent of cases) associated with a severe (greater than or equal to 70 %) stenosis of the left anterior descending coronary artery. Thus, serious left coronary artery disease is frequent and unrecognized in patients with chronic even uncomplicated MI. Exercise test does not allow to recognize accurately this high risk group of patients which should be identified by coronary arteriography.     

Pulmonary artery end-diastolic pressure recordings after myocardial infarction (author's transl)

29 patients with acute myocardial infarction were subdivided into 3 groups using the information gained by continuous measurement of the pulmonary artery end-diastolic pressure (PAEDP) during a stay of 3 to 5 days in the coronary care unit of this hospital. Group I comprised patients with a PAEDP of below 12 mm Hg (without treatment), group II those with a PAEDP of between 12 and 20 mm Hg and group III those patients with a PAEDP of above 20 mm Hg. 3 to 6 months after rehabilitation and ambulant "coronary training' a follow-up control PAEDP measurement was performed at rest and during ergometric stress with the bicycle exercise test. 2 out of the 15 patients in group I had a pathological PAEDP at rest, whilst exercise of 50 watts raised the PAEDP to pathological values in 40% of this group of patients. Group II: 58% of the patients with an initially-raised PAEDP showed a normal value at follow-up examination 3 months subsequently. Exercise of 50 watts raised the PAEDP to pathological values in 66% of the patients in this group. Group III. The pathologically high PAEDP recordings at rest made it impossible to subject these patients to stress with the bicycle ergometer. The prognostic value of the classification of patients with myocardial infarction into pressure groups and the importance of PAEDP follow-up measurements on patients after myocardial infarction at rest and after ergometric stress are discussed.     

Atrial fibrillation and flutter as a complication of acute myocardial infarction (author's transl)

Among 909 patients with acute myocardial inarction treated in an intensive care unit between 1970 and 1974, atrial flutter and (or) fibrillation occurred in 124 (13.6%). The incidence of these arrhythmias rose with increasing age and predominantly in paroxysmal form (78%). The clinic mortality of patients with arrhythmias was 42%, while in the remaining 785 it was only 26% (P less than 0.001). Patients with atrial fibrillation and (or) flutter had a higher mean age, more frequently cardiac failure (P less than 0.001) - especially in the prognostically unfavourable severe forms with pulmonary oedema (P less than 0.05) and combined right and left heart failure (P less than 0.001) - and other disorders of impulse conduction or formation and chronic arterial hypertension (P less than 0.01).     

Results of treatment of carcinoma of the nasopharynx (author's transl)

Study of survival amongst a group of 101 patients with epithelial tumours of the nasopharynx treated by cobalt irradiation between 1967 and 1972 indicates the prognostic significance of the following factors: the histological type, extension of the tumour, the degree of lymph node involvement, age and sex. The optimal dose is 1,800 to 2,000 rets NSD and should be modified in the light of these factors, and above all the histological type and the tumour category. Cumulative survival for all cases was 36% at 5 years, with a more favourable prognosis in lympho-epitheliomas in comparison with spindle cell epitheliomas.     

Results of pertracheal punction (author's transl)

36 pertracheal biopsies with following cytological control have been performed. The results - 21 cases with a confirmed diagnosis give raise to the conclusion, that this method is a suitable supplement of the possible bioptic investigations during the bronchoscopy.     

Concomitant infarction of the right ventricle in patients with acute transmural myocardial infarction (author's transl)

In 56 patients with acute transmural myocardial infarction hemodynamic parameters were studied. 21 patients proved to suffer from anterior infarction and 35 patients an inferior infarction. By clinical as well as by hemodynamic findings 10 patients out of the group of the 35 patients with inferior infarction were suspect of having a concomitant infarction of the right ventricle. As it is known from literature and documented by the present results this is not a rarity. Failure of the right ventricle is the main cause of death in these patients.