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Biomedical subjects

I Klempa

Publications and source records attributed to I Klempa.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Prevention of thromboembolism in surgery--results of a survey in West German hospitals].

UNLABELLED: In 1990 a questionnaire on methods for prevention of deep venous thrombosis (DVT) and pulmonary embolism (LE) was mailed to 940 surgical centers in West Germany (FRG). The return rate was 60% or 564 answers, covering about 1,200,000 operations/year. The results are as follows: (1) Physical therapeutic measures (early mobilisation, elastic stockings) and drug administration are routinely used in all centers. The duration of prophylaxis is 3-8 days in 36% of centers, up to mobilisation in 31%, 9-16 days after operation in 17% and until demission in 16%. (2) A single drug regime is employed in 60% of centers (49% standard heparin, 9% low molecular heparin in combination with DHE) 40% of centers use all three drugs without clear cut guidelines concerning the indications. (3) The reported rates of thromboembolic complications diagnosed by clinical criteria are 0.55 +/- 0.62% for DVT and 0.22 +/- 0.29% for fatal or nonfatal LE. There is no evidence from the analysed data that the drug regimes influences the clinical outcome. CONCLUSION: The need for administration of drugs prevent DVT is widely accepted. A polypragmatic approach seems to be effective. However, standardized regimes for defined clinical conditions are desirable.

Bandages↗
PubMed1991

[Effect of somatostatin on basal and stimulated exocrine pancreatic secretion after partial duodenopancreatectomy. A clinical experimental study].

In a prospective trial 30 patients underwent pancreaticoduodenectomy (Whipple operation) for cancer. They were randomly assigned to receive Somatostatin (SST) (n = 15) or not (n = 15). SST was started at laparotomy with 250 micrograms/h and given over a period of 5 days. A small catheter, which was placed into the duct of the pancreatic remnant, gave access to the pancreatic juice. Volume, amylase, lipase and protein as well as bicarbonate outputs were analyzed. As regards endocrine function, insulin and glucagon plasma levels were measured. The nitrogen balance was calculated. A stimulation test was done on the fifth postoperative day. Six patients (3/3) were assessed as drop-outs. A significant reduction was found for volume, amylase, lipase, protein and bicarbonate with SST, this effect lasting for two days. Lipase however was reduced significantly for 5 days. Pancreatic exocrine function was reduced as well after stimulation, if SST was given. Insulin and glucagon were inhibited with SST, the latter more effectively. We found a positive nitrogen-balance as early as on the second postoperative day in the SST-group, whereas without SST this did not occur before the fourth postoperative day. This findings were significant on the third and fourth postoperative day. The inhibitoric effects of SST, which are demonstrated by our laboratory investigations, conform very well with a more favorable clinical course and a reduction of perioperative morbidity and mortality.

Ampulla of Vater↗
PubMed1991

Liposarcoma of the esophagus.

Presented here is a report on an unusual liposarcoma of the esophagus. A 66-year-old-woman was treated successfully by surgical excision without removal of the esophagus. Thirty months after surgery and radiation she presented with neither complaint nor recurrence.

Aged↗
PubMed1990

Morphometry and function of islet cells after different forms of drainage at pancreatic transplantation in rats.

The survival of endocrine cells of the islets is crucial for a successful transplantation of the pancreas in the treatment of diabetes mellitus. In the present investigation, we compared the effect of four techniques of whole pancreas transplantation in rats on the endocrine cells of islets of Langerhans. Impairment of the endocrine function of the pancreas with a decrease in the k value was seen after 6 months in the group with duct ligation, and after 12 months in the groups with latex and ethibloc occlusion. An open pancreatic duct maintains a more stable endocrine function than in duct-ligated or occluded grafts. Fasting plasma insulin and somatostatin were elevated in transplanted rats. Whichever method of transplantation we chose, the cell ratio remained unchanged compared with the control group, even after 12 months. Therefore, only intact islet architecture enables a normal endocrine pancreatic function.

Animals↗
PubMed1989

[Subtotal adrenalectomy versus autotransplantation of the adrenal cortex--an alternative procedure in bilateral adrenalectomy in MEN II?].

Complete loss of steroid production is a very remarkable effect of total adrenalectomy. This is the reason why attempt was made to preserve some adrenal cortex function in cases with bilateral adrenalectomy. Till now successful autografting of adrenal cortex has been reported only in cases with Cushing's syndrome. We now report on two cases with MEN II syndrome, in whom autografting into the rectus muscle was done successfully. In order to compare results, data on two patients with subtotal adrenalectomy are given. Outcome was similar. In all 4 cases function of adrenal cortex was demonstrated by scintigraphy and by blood chemistry. In one case with autotransplantation and in another with subtotal resection, the remaining adrenal tissue showed response to ACTH. Provided more experience, in our opinion subtotal adrenalectomy and adrenal autotransplantation in cases of MEN II syndrome might turn out to prove as equivalent procedures.

Abdominal Muscles↗
PubMed1988

[Problems and results of reinterventions on the adrenal gland].

109 cases of surgery on the adrenal glands are reported. 8 cases (7.3%) were reoperated because of relapse. This was Cushing's disease in 5 cases, malignant neuroblastoma in 2 cases and benign pheochromocytoma in 1 case. Only the latter and 1 with Cushing's disease were cured. Reoperation revealed carcinoma in 3 cases of Cushing's disease, though microscopic examination did not show malignancy in the specimen taken at the first operation. In another case microscopic examination again failed to show malignancy, but the patient died from her metastases. 2 cases of malignant neuroblastoma were reoperated for palliation.

Adenoma↗
PubMed1986

[Intrahepatic bile duct cysts].

Because of the risk of carcinoma, choledochal cysts always should be completely removed. If the cyst is extrahepatic, this should not offer any problem. Radical excision of an intrahepatic cyst, however, can present as a major problem and is in fact not always achievable. The anatomical situation (involvement of both lobes of the liver) or the general condition of a patient can force us to limit the surgical procedure. We report our experience with 5 cases of intrahepatic choledochal cyst, emphasizing the difficulties of achieving the before mentioned therapeutic goal. Details on today's pathogenetic theories and classification of choledochal cysts are reported from the literature.

Aged↗
PubMed1984

Low doses of somatostatin do not suppress postprandial serum gastrin levels in dogs.

MUe effect of 0.1, 0.4, 1.0, 2.0 and 5.0 micrograms kg-1 h-1 somatostatin on food-induced rise of serum gastrin concentrations was studied in 4 dogs. Whereas it has been shown previously that these doses of somatostatin reduce postprandial release of other gastroenteropancreatic hormones, there was no evidence of suppression of serum gastrin levels. A dose of 12.6 micrograms kg-1 h-1 somatostatin abolished the gastrin response completely. The study shows that low doses of somatostatin are not a uniform suppressor of gastroenteropancreatic hormones.

Animals↗
PubMed1984

Investigations on the toxicity of bile salt solutions, Capmul 8210 and a bile salt-EDTA solution for common bile duct perfusion in dogs.

The following perfusion media for dissolving bile duct calculi were infused via a cutaneobiliary tube into the biliary tract of 12 mongrel dogs: 4.3% cholate solution, 0.34% chenodeoxycholate solution, Capmul, GMOC (special formulation of Capmul), BA-EDTA and 0.9% saline. Infusion lasted 50 h. Postmortem examination revealed hemorrhagic, partly phlegmonous cholangitis, acute duodenitis, necrosis and abscesses in the liver. The lesions were most pronounced after the cholate solution and with Capmul and GMOC, but were only detected to a slight extent after BA-EDTA and the chenodeoxycholate solution. 0.9% saline had no side effects. The investigations could demonstrate that it is the very irrigation media that today are recommended for treatment of bile duct stones in patients, that cause considerable morphologic side effects. The alternating administration of an EDTA solution with a Capmul preparation may diminish local toxicity of the latter.

Animals↗
PubMed1983

Contribution of the antrum and duodenum to circulating forms of gastrin in the dog.

Gastrin release was stimulated in four anaesthetized dogs with meat extract and acetylcholine. The different forms of gastrin were analyzed in antral and duodenal mucosa and in blood from antral, duodenal and peripheral veins by use of radioimmunoassay with a region-specific antibody, Sephadex gel filtration, and SDS-gel electrophoresis. The duodenum contributed less than 4% of antral gastrin to circulating gastrin. The molecular forms of antral and duodenal gastrins were similar. On the basis of the electrophoretic results and the properties of the antibody, gastrin in the antral and duodenal veins consisted of a minor fraction of G 17 and a predominant fraction of C-terminal fragments of smaller molecular size. This fraction was even more marked in the peripheral venous circulation. In the peripheral blood, however, not only smaller forms of gastrin were present but also an increasing ratio of big gastrin immunoreactivity. Thus, there is active postsecretory processing of gastrin in the circulation of the anaesthetized dog.

Animals↗
PubMed1983

The use of human fetal pancreas for transplantation: experimental and clinical results.

Human fetal pancreata (15-22 weeks of gestation) were precultivated in vitro for 7 to 25 days and transplanted subcutaneously to thymusaplastic nude mice and an insulin-dependent diabetic patient. In mice, precultivated xenotransplanted pancreata showed typical transplant growth in the recipients. Histology revealed typical islets formation. Whereas without precultivation human fetal pancreas older than 16 weeks showed no transplant growth, after precultivation human fetal pancreas even up to 22 weeks of gestation developed. Transplantation of a precultivated human fetal pancreas to a diabetic patient was without effect, e.g. the required insulin dose remained unchanged after transplantation and no C-peptide was detectable.

Adult↗
PubMed1982

[Changes in the diagnosis and treatment of Zollinger-Ellison syndrome (author's transl)].

A gastrinoma was found in 12 of 23 patients with Zollinger-Ellison syndrome. Those with gastrinoma were not different from those without as regarded fasting gastrin level, increased gastrin secretion after secretin and calcium, acid secretion, or survival time. Five of the 23 patients have died, four immediately postoperatively, the fifth of the metastasizing tumour. Treatment with the H2-receptor antagonist cimetidine avoided emergency operation and thus decreased operative mortality, giving time for localization by ultrasound, computed tomography and selective arteriography. The rate of false-negative results was high. Transhepatic selective catheterization of the pancreatic veins with gastrin determination gives localization of the tumour and identification of the secreted hormone. In three patients tumour resection was possible under cover of H2-receptor antagonist administration which normalized gastrin and acid secretion. There is a change in the treatment of the Zollinger-Ellison syndrome, away from total gastrectomy to conservative treatment with H2-receptor antagonists and an attempt of curative treatment by removal of the tumour.

Adult↗
PubMed1982

[Transplantation hyperparathyroidism--tumorlike growth and autonomous function of autografts of the hyperplastic parathyroid (author's transl)].

The results of clinical and morphologic studies performed in 41 patients with chronic, renal failure and secondary hyperparathyroidism, who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. In five cases, 7--33 months after autotransplantation we found transplantation tumors developing in the forearm. Explanted grafts showed invasive growth of parathyroid tissue in the adjacent structures, into the musculature and blood vessels. The increased incidence of mitosis otherwise seen as evidence of malignant neoplasia of parathyroid tumors, indicated atypical focal proliferation of the transplanted tissue. This is justification for not performing transplantations any more in the treatment of renal osteodystrophy.

Chronic Kidney Disease-Mineral and Bone Disorder↗
PubMed1982

Dose-response study of somatostatin on meal-stimulated levels of pancreatic polypeptide and insulin in the dog.

A dose-response study of the effect of 0.1-5.0 micrograms kg-1 h-1 somatostatin was performed on food-induced rise of pancreatic polypeptide and insulin in 4 dogs. There was a dose-dependent suppression of the release of pancreatic polypeptide and insulin with an ED50 of approximately 0.65 and 0.8 microgram kg-1 h-1, respectively, during the first 45-min period. In the second 45-min period, high doses of somatostatin failed to suppress insulin concentrations whereas, the serum concentrations of pancreatic polypeptide were reduced by a similar degree as in the first 45 min. The differing effects of somatostatin on food-stimulated serum concentrations of insulin and pancreatic polypeptide indicate that somatostatin does not represent a uniform suppressor of pancreatic hormones.

Animals↗