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  • 1
    ISSN: 1573-2568
    Keywords: acute pancreatitis ; pancreatic abscess ; infected pancreatic necrosis ; necrotizing pancreatitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Local septic complications in acute pancreatitis need to be exactly characterized and defined in order to develop improved concepts for their prevention, early diagnosis, and therapy. While up to now all local septic complications have been termed abscesses, the present study for the first time delineates the morphologic, clinical, and laboratory criteria needed to distinguish between two separate clinical entities: the infected necrosis (IN) and the pancreatic abscess (PA). IN is defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue, but without any significant pus collections. On the other hand, the morphologic substrate of PA is a localized collection of pus surrounded by a more or less distinct capsula. IN becomes clinically evident during the early phase of acute pancreatitis (AP). The patients with IN present both the signs of sepsis and the laboratory findings of AP. Thus in these patients the most fulminant course of AP is observed; 51.8% and 35.7% of them have pulmonary or renal insufficiency, respectively. The mortality of the patients with IN is high and amounts to 32.1%. Pancreatic abscess, on the other hand, does not develop before the fifth week after onset of symptoms and after subsidence of the acute phase of pancreatitis. In these patients laboratory signs of AP-like amylasemia, hypocalcemia, hyperglycemia, and rise of LDH are rarely observed. Corresponding to the lack of pathophysiologic effects of APper se, pulmonary and renal insufficiencies occur in only 33.3% and 16.7%, respectively, and mortality in these patients is 22.2%. While an abscess may readily be identified by computed tomography, the differentiation between IN and non-IN can be very difficult. The prognostic significance, however, makes this distinction absolutely necessary. According to our experience, surgical debridement is the procedure of choice for patients with IN.
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  • 2
    ISSN: 1573-2568
    Keywords: oxygen radicals ; pancreatitis ; glutathione ; lipid peroxidation ; purine metabolites ; scavengers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this study was to evaluate the effect of free radical ablation therapy in acute hemorrhagic pancreatitis. Acute pancreatitis was induced in 64 rats by retrograde injection of 5% sodium taurocholate. Thirty animals were pretreated with 100,000 units/kg/hr of superoxide dismutase (SOD) and 400,000 units/kg catalase within the first 3 hr. After 0.5, 3.5, and 12 hr of observation time, serum enzymes and the tissue content of conjugated dienes, malondialdehyde, reduced and oxidized glutathione, as well as ATP, ADP and AMP were measured. In addition, tissue samples were examined by light microscopy. Untreated rats (N=34) developed within 12 hr an acute hemorrhagic necrotizing pancreatitis with a concomitant increase in serum enzyme levels and a decrease in reduced glutathione and ATP. Within the 12-hr observation period, 57% of the animals died. Scavenger treatment improved the tissue damage and attenuated the increase of the serum enzyme levels and the decrease in reduced glutathione and ATP. Moreover, the lethality rate was significantly lower. Oxygen radicals seem to be instrumental for the development of acute hemorrhagic pancreatitis. Thereby, antioxidant treatment reduces tissue damage, biochemical alterations and extrapancreatic complications, thus improving the final outcome.
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  • 3
    ISSN: 1435-2451
    Keywords: Pancreatico-duodenectomy ; Food assimilation ; Partielle Duodenopankreatektomie ; Nahrungsverwertungsstörungen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Resorptive, digestive und endokrine Störungen wurden bei 11 Patienten nach partieller Duodenopankreatektomie untersucht. Die Rekonstruktion des Gastrointestinaltraktes erfolgte immer mit der proximalen Jejunumsehlinge. 1. Bei allen Patienten bestand eine Störung der Fettdigestion; eine leicht eingeschränkte Eiweißdigestion hatten 3 Patienten. 2. Eine Malabsorption kam nur bei einem Patienten zur Beobachtung. 3. Die Insulin- und Gastrinkonzentration im Blut waren infolge Verminderung der BetaZell-und G-Zell-Masse erniedrigt.
    Notes: Summary In 11 patients we investigated digestive, resorptive, and endocrine functions after pancreatico-duodenectomy. In order to improve the nutritional state of the patients after pancreatico-duodenectomy we performed the reconstruction of the upper alimentary tract with particular attention to the proximal jejunum. We observed: 1. unpaired fat digestion in all patients; 2. a slight restriction of protein digestion in 3 patients; 3. diminished gastrin and insulin concentrations in the basal state.
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  • 4
    ISSN: 1435-2451
    Keywords: Vagotomy, selective ; Drainage ; Stomach, emptying ; Selektive Vagotomie ; Pyloroplastik ; Magenentleerung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 94 Patienten mit einem Ulcus duodeni wurde die Magenentleerung einer markierten Nahrungsprobe vor und nach organerhaltenden Magenoperationen gemessen. Op.-Verfahren: 1. selekt. gastr. Vagotomie + Finney-Pl. (24 Pat.); 2. selekt. gastr. V. + part. Pylormyektomie (26 Pat.); 3. selekt. prox. V. + part. Pylormyektomie (16 Pat.); 4. selekt. prox. V. (17 Pat.). Bei allen Patienten bewirkte die Operation eine Verzögerung der Magenentleerung in der frühpostoperativen Periode. Die Dauer der Magenentleerungsverzögerung - z. T. bis zu einem Jahr postoperativ- hängt ab vom Typ der Vagotomie und dem Ausmaß der Durchtrennung der Antrummuskulatur.
    Notes: Summary In 94 patients suffering from duodenal ulcer, stomach emptying was observed by means of a labeled nutrition specimen before and after organ-conserving gastric surgery. The surgical procedure was: (1) selective gastric vagotomy + Finney pyloroplasty (24 patients); (2) selective gastric vagotomy (16 patients); (4) selective proximal vagotomy (17 patients). In all these patients the operation provoked slow stomach emptying during the early postoperative period. The duration of the period of slow stomach emptying-in some cases up to one year-depends on the type of vagotomy performed and the extent of the division of the musculature of the antrum.
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  • 5
    ISSN: 1435-2451
    Keywords: Gastric carcinoma ; Geriatric surgery ; Total gastrectomy ; Proximal gastrectomy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In der vorliegenden Untersuchung wird über Operationsletalität und Langzeitergebnisse der Magencarcinomchirurgie bei über 70jährigen Patienten berichtet. Die Operationsletalität bei 50 Patienten mit einer erweiterten Magenteilresektion (B I/B II) betrug 16%, bei 24 Patienten mit einer totalen Magenentfernung 33,3% und bei 14 Patienten mit einer Kardiaresektion 28%. Häufigste Todesursache (40% der Verstorbenen) war eine Pneumonie. Zwischen präoperativer Lungenfunktionsprüfung und postoperativer Pneumo niefrequenz bestand keine Beziehung. Von prognostischer Bedeutung erwies sich lediglich der Schweregrad arteriosklerotischer Vorschädigungen. Die Langzeitergebnisse werden auch beim alten Menschen vom Tumorstadium zum Zeitpunkt der Operation bestimmt. Von 60 Carcinompatienten, die die Operation überlebt hatten und deren weiterer Verlauf kontrolliert werden konnte, waren nach einem halben Jahr noch 47 (78,3 %), nach 1 Jahr 35 (58,3 %) und nach 2 Jahren noch 25 Patienten (41,6%) am Leben. Von 17 nachuntersuchten Patienten (mittlere überlebenszeit 28 Monate) waren 14 körperlich und geistig in einem sehr guten Zustand. Aus einem Vergleich mit den in der Literatur mitgeteilten Operationsergebnissen bei jüngeren Patienten geht hervor, daß es nicht berechtigt ist, in der operativen Behandlung von Patienten mit einem Magencarcinom willkürlich eine Altersgrenze zu ziehen. Für die Operationsindikation sind vielmehr aktueller biologischer und psychischer Zustand des alten Patienten entscheidend.
    Notes: Summary In this study it is reported about operative mortality and long-term results of surgery of gastric carcinoma in patients over the age of 70 years. The operative mortality in 50 patients with a distal partial gastrectomy was 16%, the mortality in 24 patients with total gastrectomy was 33.3 % and in 14 patients with a proximal gastrectomy the mortality was 28%. The main cause of death (40%) was a pneumonia. There was no correlation between frequency of pneumonia and preoperative results of measurement of lung function. Only advanced arteriosclerotic disease in the heart and brain has a fatal influence on mortality rate. In the old patients the long-term results are determined by the staging of the tumor at the time of operation, too. In the 60 patients, who had left the hospital and who are in our control, the half year survival rate was 78.3%, the 1-year survival rate was 58.3% and the 2-years survival rate is exceeding 41.6%. 14 patients of the 17, who are still alive and who are after 21/2 years again explored, are in a very good condition. In comparison with the literature it is to conclude that for the indication to surgery of gastric carcinoma there is important not only the real age of the patient but rather the biological and mental condition of the patient.
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  • 6
    ISSN: 1435-2451
    Keywords: Endotoxin ; Peritonitis ; Endotoxin ; Peritonitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Endotoxin wurde bei 10 Beagle-Hunden mit Perforations-Peritonitis aus dem systemischen Blut, dem Pfortaderblut, der Peritonealflüssigkeit und der Lymphe bestimmt. Alle Tiere starben 4–8 Tage postoperativ (Ø 6 Tage). Der erste positive Endotoxin-Nachweis gelang in der Lymphe und Peritonealflüssigkeit, dann im portalen und systemischen Blut (0,1-10 ng/ml). Die letzten Messungen vor dem Tod der Tiere zeigten weit höhere Konzentrationen (10–1000ng/ml). Die Endotoxin-Konzentrationen korrelierten mit dem klinischen Befund und dem Verlauf sowie den bakteriellen Untersuchungen. Die Resultate sind schnell zu erhalten und haben prognostischen Wert.
    Notes: Summary Endotoxin was measured in ten beagle dogs with intestinal perforation using a modified Limulus test. Samples were obtained from the blood of the portal and the cava vein, the peritoneal fluid and from the lymphatic juice every 4h. All animals died 4–8 days postoperatively (average of 6 days). The lymphatic juice was the first to become positive, but portal and systemic blood consistently became positive between 24 and 96 h (0.1–10 ng/ml). The last measurements of endotoxin before death gave higher levels: 10–1000 ng/ml. Endotoxin correlates with the clinical state and outcome of the animals. It correlates also with the bacterial findings, but results are quicker to get and of more prognostic value.
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  • 7
    ISSN: 1435-2451
    Keywords: Insulin secretion ; Insulin metabolism in the liver ; Computer compartment model ; Insulinsekretion ; Insulinabbau Leber ; Computer-Kompartment-Modell
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zur Simulation des Insulinstoffwechsels in der menschlichen Leber wurde ein 4-Kompartment-Modell entwickelt. Als Grundlage dienten Insulin-Konzentrationsmessungen in der Pfortader, der Lebervene und Cubitalvene von Patienten nach Abdominaloperation. Ergebnisse: 1. Die Leber extrahiert 25–70%. des Pfortaderinsulins. 2. Die Insulinkonzentrationen im peripheren Blut sind weitgehend unabhängig vom Leber-Blutdurchfluß (Verhältnis Arteria hepatica/Pfortader).
    Notes: Summary To avoid methodological difficulties, a computer compartment model was developed. The basis for the computer calculations were measurements of insulin concentrations in the portal vein, liver vein, and cubital vein in patients after abdominal surgery.Results: (1) The liver removes 25 %–70% of the endogenous insulin measured in the portal vein; (2) insulin concentrations in the peripheral vein blood are largely independent of the hepatic blood flow (relationship of the arteria hepatica to the portal vein).
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  • 8
    ISSN: 1435-2451
    Keywords: Pressures ; Stomach ; Duodenum ; Drucke ; Magen ; Duodenum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei Magengesunden und chronisch Ulcus-Duodeni-Kranken bestehen hinsichtlich Verteilung der Häufigkeit der Amplituden, der Steigung und der Dauer von Druckereignissen im Antrum und im Duodenum keine signifikanten Unterschiede. Betrachtet man aber das Verhältnis der Kontraktionen des Antrums zu denen des Duodenums bei den einzelnen Individuen, so finden sich insbesonders im Bereich zwischen 5 und 30 mm Hg signifikante Unterschiede (P 〈 0,02). Es zeigt sich, daß in diesem Bereich bei Gesunden auf ein Druckereignis im Antrum im Mittel 6,6 Ereignisse im Duodenum kamen, beim chronisch Ulcuskranken waren es hingegen nur 2,3 Freignisse
    Notes: Summary Comparison of healthy subjects and patients with chronic duodenal ulcer reveals no significant differences in the distribution of amplitudes, slopes, and duration of pressure events in the antrum and duodenum, but there are significant differences in the ratio of the contractions of the antrum to those of the duodenum in individual patients, especially in the range of 5–30 mm Hg (P 〈 0.02). In this range, for 1 pressure event in the antrum there are 6.6 events in the duodenum of healthy persons, but only 2.3 in the duodenum of patients with duodenal ulcer.
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  • 9
    ISSN: 1435-2451
    Keywords: Necrotizing pancreatitis ; Follow-up ; Nekrotisierende Pankreatitis ; Nachuntersuchung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Marseiller Klassifikation fordert die Restitutio ad integrum nach akuter Pankreatitis. Die akute nekrotisierende Pankreatitis stellt jedoch eine Sonderform der akuten Pankreatitis dar und führt nach den vorliegenden Ergebnissen bei etwa 50% der Patienten (n=21) zu endokrinen und/oder exokrinen Funktionseinbußen (oraler Glucosetoleranztest, Sekretin-Takus-Test). Morphologische Veränderungen am Pankreas entwickelten sich bei etwa $${\raise0.5ex\hbox{$\scriptstyle 3$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 4$}}$$ der Patienten, vor allen Dingen narbige Strikturen des Pankreasganges (ERCP und Computertomographie). Der Befund einer normalen Pankreasfunktion nach ausgedehnter Parenchymnekrose bei etwa 40% der Patienten kann mit der enormen Funktionsreserve erklärt werden.
    Notes: Summary The Marseille classification requires restitutio ad integrum following acute pancreatitis. Acute necrotizing pancreatitis, however, represents a distinct form of acute pancreatitis and, as in our results in 21 patients, leads to definite endocrine and/or exocrine functional loss (oral glucose tolerance test, secretin-ceruletide tolerance test). Morphological alterations developed in about threefourths of the patients, which were predominantly cicatricial lesions, as shown by ERCP and CT scan. The finding of normal pancreatic function after extended necrosis in about 40 of the patients can be explained by the enormous functional reserves of previously intact pancreatic parenchyma.
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  • 10
    ISSN: 1435-2451
    Keywords: Gastric resection ; Pancreatic insufficiency ; Fluorescein-dilaurate test ; Magenresektion ; Pankreasfunktionsstörung ; Pankreolauryltest
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Mittels dem indirekten Pankreasfunktionstest mit Fluoresceindilaurat wurde die Pankreasfunktion bei 23 Patienten nach B II and 10 Patienten nach B I-Resektion untersucht. Sowohl nach B II als auch nach B I-Resektion finden sich bei 70% der Patienten pathologische Testergebnisse im Sinne einer sekundären exokrinen Funktionsstörung. Primaräe Pankreaserkrankungen wurden bei allen Patienten durch CT, Sonographie oder ERCP ausgeschlossen. Eine Malabsorption scheidet aufgrund normaler Fluoresceinresorption nach alleiniger oraler Verabreichung des Farbstoffes aus. Die pankreatische Maldigestion sollte mit Enzymen therapiert werden.[/AB]
    Notes: Summary Exocrine pancreatic function was investigated by the fluorescein-dilaurate test in 23 patients following the Billroth II and 10 patients after the Billroth I procedures. In both groups there were 70% pathological test results, indicating secondary pancreatic insufficiency. Primary pancreatic diseases were excluded by CT, ultrasonography or ERCP. There was no indication of malabsorption because fluorescein absorption and excretion following oral application of free fluorescein were normal. Pancreatic maldigestion should be treated by pancreatic enzyme therapy.
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