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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 68 (1997), S. 763-769 
    ISSN: 1433-0385
    Keywords: Key words: Surgery ; Anesthesia ; Analgesia ; Liver diseases ; Hepatic dysfunction ; Hepatotoxins. ; Schlüsselwörter: Chirurgie ; Anaesthesie ; Analgesie ; Lebererkrankungen ; Leberinsuffizienz ; Hepatotoxine.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Erhöhte „Leberwerte“ sind ein häufiges klinisches Problem von unterschiedlicher Signifikanz. Die Entscheidung über die Indikation zur weiteren hepatologischen Abklärung ist im Kontext der klinischen Präsentation und Fragestellung zu sehen. Präoperativ erhöhte „Leberwerte“ sind bei Elektivoperationen Indikation zur weiteren Abklärung und ggf. Therapie. Symptomatische Patienten mit Hepatopathie haben ein erhöhtes Operationsrisiko. Zur Reduktion der erhöhten Morbidität und Letalität von Patienten mit akuter oder chronischer Hepatopathie ist ein Verständnis der pathophysiologischen Zusammenhänge für die optimale prä-, intra- und postoperative Betreuung von großer klinischer Relevanz.
    Notes: Summary. Elevated liver enzymes are a frequent clinical finding. Their significance depends on the clinical presentation and setting. Symptomatic patients with acute or chronic liver disease carry an increased surgical risk. To reduce the morbidity and mortality associated with symptomatic liver diseases the understanding of the pathophysiology of liver dysfunctions is of paramount importance for the pre-, intra- and postoperative management of such patients.
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  • 2
    ISSN: 1432-2218
    Keywords: Cecostomy ; Ileus ; Decompression ; Surgical endoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Endoscopic decompression of the distended colon has become a useful method of treating non-obstructive colonic ileus. We propose a method of establishing a cecal fistula by means of percutaneous puncture of the colon and pull-through of a Pezzer catheter. Although until now we have only performed this procedure twice, it seems to be a valuable therapeutic approach in cases of paralytic distension of the large bowel.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 68 (1997), S. 310-316 
    ISSN: 1433-0385
    Keywords: Key words: Incisional hernias ; Closure technique ; Autologous-alloplastic repair of defects. ; Schlüsselwörter: Narbenhernie ; Verschlußtechnik ; autologe-alloplastische Defektplastik.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Narbenhernien sind häufige Komplikationen abdominalchirurgischer Eingriffe. Die Verschlußtechniken der direkten Naht, der Fasciendoppelung und der plastischen Defektdeckung mit autologem oder alloplastischem Material erreichen bei adäquatem Einsatz den Verschluß der Hernie. Rezidivquoten von 30–50 % belegen, daß die Verhinderung des Rezidivs das eigentliche Problem darstellt. Eine sorgfältige Vorbereitung des Patienten und eine physiologisch und anatomisch begründete Operationstechnik sind Voraussetzung des Operationserfolgs. Der technisch korrekte Einsatz und die Berücksichtigung der speziellen Indikationen der Operationsverfahren helfen, das Rezidiv zu verhindern. Der gezielte Einsatz von Defektplastiken verstärkt das vorhandene Gewebe. Neue Ansätze durch spannungsorientierte Verschlußtechniken repräsentieren einen erfolgversprechenden Weg.
    Notes: Summary. Incisional hernias are a common complication following abdominal surgery. However, when performed correctly, the techniques utilized for direct hernia repair, Mayo's closure and plastic covering of the defect appear to be effective in the management of primary hernia closure. The recurrence rates of 30–50 % continue to represent a significant challenge in the initial management of incisional hernia repair. Fortunately, there is evidence that, with correct preparation of the patient and with correct anatomical reconstruction, better results can be achieved. Also, the use of strictly applied technical skills in combination with standardized operative techniques may help to eliminate further complications and recurrences. In addition, the application of mesh or cutis transplantation to reinforce the attenuated tissue has also been shown to reduce the recurrence rate. With the diligent application of the above measures, as well as of new concepts, which at present include a promising technique called tension-adapted closure, there may be positive developments in the treatment and management of incisional hernias.
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  • 4
    ISSN: 1432-1335
    Keywords: Ornithine decarboxylase ; 2-difluoromethyl-ornithine ; Colonic carcinoma cell lines ; Gastrin ; Gastrin receptor blockers ; EGF
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Polyamines are essential factors of cell growth and differentiation. Modulation of the cellular polyamine content by 2-difluoromethylornithine (DFMO) inhibiting ornithine decarboxylase (ODC), or by hormones inducing ODC, influences cell growth. Gastrin acts trophically on some colonic carcinomas and their growth is inhibited by gastrin receptor blockers. The mechanism of the trophic action of gastrin on colonic carcinomas is not known. In this study the effect of gastrin, gastrin receptor blockers, epidermal growth factor (EGF) and DFMO on growth and ODC activity of four human colon carcinoma cell lines (SW 403, SW 1116, LS 174 T and Lovo) was investigated. Growth and ODC activity of all cell lines were inhibited by DFMO. Growth of the SW 403 cell line was increased by gastrin and inhibited by the gastrin receptor blocker benzotrypte. The other cell lines did not respond to gastrin and the gastrin receptor blocker. In SW 403 cells ODC activity was increased by gastrin, and was also elevated after treatment with the gastrin receptor blocker. These in vitro results were confirmed by studies on tumours that developed from SW 403 cells in nude mice. Combination of benzotrypte and DFMO did not enhance the antiproliferative effect. EGF increased growth of SW 403 cells, but no induction of ODC activity was measured. LS 174 T cells were not stimulated by EGF. Medium replacement was the strongest stimulus of ODC activity in SW 403 cells already inducing ODC after 3 h. During cell culture ODC activity was high after seeding and decreased continuously with increasing cell density. These data suggest that gastrin induces ODC in gastrin-sensitive colonic carcinoma cells. DFMO appears to be a valuable antiproliferative agent in colonic carcinoma cells.
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  • 5
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Darmerkrankungen ; chronisch entzündliche ; M. Crohn ; Therapie ; Colitis ulcerosa ; Therapie ; Proktokolektomie ; Minimal Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema Auch wenn konservative Maßnahmen in der Behandlung chronisch entzündlicher Darmerkrankungen den Vorrang haben, werden bei vielen Patienten chirurgische Eingriffe notwendig. Wegen des unterschiedlichen chirurgischen Vorgehens ist präoperativ eine möglichst sorgfältige differenzierende Diagnostik hinsichtlich des Vorliegens eines M. Crohn bzw. einer Colitis ulcerosa erwünscht, was allerdings in 10-15% der Fälle nicht gelingt. Über die chirurgischen Interventionen und ihre Indikationen sowie Komplikationen berichtet die folgende Arbeit. Dabei wird auch über die neuerdings häufiger ausgeführten minimalinvasiven Techniken der laparaskopischen Chirurgie referiert, die dann angewendet werden können, wenn akute Obstruktion, Perforation oder toxische Dilatation zuvor ausgeschlossen worden sind. Für operative Maßnahmen chronisch entzündlicher Darmerkrankungen stellt das Alter keinen limitierenden Faktor dar. Wundheilungsstörungen zählen zu den häufigsten Frühkomplikationen, als Spätkomplikationen nach restaurativer Proktokolektomie werden Stromakomplikationen und die Pouchitis beobachtet, die sogar bei ungestörter Pouchfunktion auftreten kann und deren Genese ungeklärt ist. Die Rezidivraten nach chirurgischer Intervention bei Morbus Crohn und Colitis ulcerosa sind je nach Schweregrad der Erkrankung und elektiver Operation teilweise hoch; auch dies wird differenziert erläutert.
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  • 6
    ISSN: 1432-1335
    Keywords: Gastrin ; Nude mice ; Cell culture ; Colorectal carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The growth-regulating effects of pentagastrin, gastrin and the gastrin-receptor antagonist proglumide were investigated in three established cell lines derived from human colorectal carcinomas in vitro and after transplantation into nude mice. In vitro a significant increase of cell growth in the SW 403 cell line incubated with pentagastrin or gastrin was observed. In the Lovo cell line this effect was only detected after synchronization of cell growth. Pentagastrin and gastrin had no effect on the growth of the Ls 174 T cell line. Proglumide reduced cell proliferation in all three cell lines as well as in the L929S cell line derived from fibroblasts, which served as control. After transplantation into nude mice all tumor cell lines increased, Love and Ls 174 T as undifferentiated tumor, SW 403 as differentiated. Pentagastrin increased and proglumide decreased growth in SW 403 tumors, whereas no effect was observed on Ls 174 T and Lovo tumors. We therefore conclude that growth of some colorectal carcinomas is regulated by gastrin, but that the effect of proglumide is unspecific rather than related to blockage of gastrin receptors. The growth-regulating effect of gastrin could be due to tumor differentiation.
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  • 7
    ISSN: 1432-1335
    Keywords: Colorectal carcinoma ; Gastrin ; Gastrin-binding protein ; Gastrin/CCK-B receptor ; RNase protection assay
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate further the presence of an autocrine proliferative loop involving gastrin in colorectal carcinomas and to clarify the receptor responsible, 102 human colorectal carcinomas and 10 hepatic metastases were investigated for the expression of the genes encoding gastrin, the gastrin/CCK-B receptor and the gastrin/CCK-C receptor. Levels of RNA expression were assayed by RNase protection assay. In addition, gastrin/CCK receptors on crude membranes of tumour tissue were assayed by radioligand binding. High-affinity gastrin/CCK-B receptors were not detected in any of the carcinomas investigated, whereas in 36% low-affinity binding was observed, consistent with the expression of the gastrin/CCK-C receptor. RNase protection assay detected the RNA for the gastrin/CCK-B receptor in 11% of the carcinomas investigated, whereas the RNA for the gastrin/CCK-C receptor was demonstrated in 75% and the RNA for gastrin in 86% of the carcinomas investigated. These results confirm the recent demonstration of progastrin fragments in colorectal carcinomas. One possible explanation for progastrin expression is that such progastrin fragments may participate in an autocrine proliferative loop. The receptor involved in this loop is more likely to be the low-affinity gastrin/CCK-C receptor rather than the gastrin/CCK-B receptor, which is rarely expressed in colorectal carcinomas.
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  • 8
    ISSN: 1432-2218
    Keywords: Key words: Intestinal ischemia — Emergency laparoscopy — Spectrophotometry — Pulse oximetry — Doppler-ultrasound — Laser-Doppler
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic diagnosis of intestinal ischemia is difficult. Dark-colored bowels are not a reliable indicator for infarction, because there is no correlation between color and oxygenation. The same picture is produced by intraluminal blood or feces. False diagnoses are described. Methods: We analyzed various techniques for assessing intestinal oxygenation and perfusion to support laparoscopic diagnosis. In this study laparoscopy was performed on eight pigs. A 10-cm segment of intestine was fixed to the abdominal wall and rendered ischemic. Measurements of the ischemic segment and normal intestine were taken using laser-Doppler, Doppler ultrasound, spectrophotometer, and pulse oximeter. Doppler ultrasound and pulse oximetry were unsuitable in our model, as was laser-Doppler flowmetry. Results: Only the spectrophotometer proved a highly sensitive means of assessing bowel oxygenation. Conclusions: This method provides the desired additional information about intestinal oxygenation, thus helping to interpret the laparoscopic picture of dark bowels.
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  • 9
    ISSN: 1432-2218
    Keywords: Intestinal ischemia ; Emergency laparoscopy ; Spectrophotometry ; Pulse oximetry ; Doppler-ultrasound ; Laser-Doppler
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic diagnosis of intestinal ischemia is difficult. Dark-colored bowels are not a reliable indicator for infarction, because there is no correlation between color and oxygenation. The same picture is produced by intraluminal blood or feces. False diagnoses are described. Methods: We analyzed various techniques for assessing intestinal oxygenation and perfusion to support laparoscopic diagnosis. In this study laparoscopy was performed on eight pigs. A 10-cm segment of intestine was fixed to the abdominal wall and rendered ischemic. Measurements of the ischemic segment and normal intestine were taken using laser-Doppler, Doppler ultrasound, spectrophotometer, and pulse oximeter. Doppler ultrasound and pulse oximetry were unsuitable in our model, as was laser-Doppler flowmetry. Results: Only the spectrophotometer proved a highly sensitive means of assessing bowel oxygenation. Conclusions: This method provides the desired additional information about intestinal oxygenation, thus helping to interpret the laparoscopic picture of dark bowels.
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  • 10
    ISSN: 1573-2568
    Keywords: colonic cancer ; signal transduction ; epidermal growth factor receptor ; ras ; Raf-1 kinase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Epidermal growth factor receptors (EGFR) andras mutations are known to play a significant role in controlling cell growth and tumor promotion. Both of them transmit mitogenic signals to the nucleus by activation of Raf-1 kinase. In this study, the expression of EGFR and mutant Ras proteins, and, for the first time, the expression, phosphorylation and kinase activity of Raf-1 kinase have been determined in paired samples of colorectal cancer and mucosa. The tumor and mucosa samples did not differ significantly with regard to Raf-1 kinase content and activity. A major difference between tumors and mucosa was found, however, in the phosphorylation of Raf-1. Most of the mucosa samples (13/20), but only 1/20 of the cancer samples, contained hyperphosphorylated Raf-1. EGFR were significantly (p=0.0025) decreased in the tumors. The decreased phosphorylation of Raf-1 in colonic carcinomas could be the result of activation of Raf-1 phosphatases or inactivation of kinases phosphorylating Raf-1. New forms of treatment based on EGFR overexpression do not seem to be suitable for the majority of colonic cancers.
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