[Cor biloculare in a 40 year old man].
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Biomedical subjects
Publications and source records attributed to J Lenz.
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Animal experiments were performed to investigate bloodflow distribution before and after selective vagotomy to explain gastric mucosa necrosis found in some patients after vogtomy. Flow measurements were made using the microsphere technique. Changes in the microcirculation were determined under basal and stimulated conditions (250 mg 2-desoxy-D-glucose). After selective vagotomy a reduction in bloodflow of up to 50% could be observed in all layers of the stomach. There were no differences in the bloodflow along either the lesser or greater curvature under basal conditions. In the stimulated stomach, however, the increase in bloodflow along the lesser curvature was higher, although the vessels of this region were mostly altered by SPV operative procedure. From these results it can be concluded that a reducton of arterial input after selective proximal vagotomy is probably compensated for by intramucosal or submucosal anastomoses. Therefore, necrosis in the gastric wall is not due to SPV but probably to other accompanying diseases.
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In the examinations presented the gastric wall blood-flow of the dog was measured scintigraphically by using the gamma camera and quantitatively by making use of the microsphere method under different functional conditions. In doing so it became apparent that not only the individual functional stomach regions (corpus-antrum) but as well the individual stomach wall layers (mucosa-muscularis) can show a counter blood flow procedure. The two methods mentioned above have proved to be suitable both for the determination of the gastric wall blood flow in the individual layers and the optical reproduction of the regional blood-flow procedure.
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Experimental disseminated intravascular coagulation (DIC) without considerable effect on blood pressure is shown to produce within 80 min acute mucosal bleeding in stomach and duodenum. A documented high degree of tissue hypoxia caused by mucosal microthrombosis is necessary for the genesis of mucosal lesions. These results stress the necessity to look for DIC in patients with upper gastrointestinal "stress ulcers".
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Blood flow in the mucosa of fundus and antrum behave quite contrary after TV: Whereas mucosal flow of the fundus is reduced, mucosal flow of the antrum increases significantly. But 3 weeks after TV flow values of the fundus are in the range of the initial blood flow and are decreased significantly in the antrum. The early diminution of the blood flow in the mucosa of the fundus can be partly responsible for the favourable effect of TV, which is observed on erosive bleedings in this region.
A new method for the control of complete gastric vagotomy. Anew method is presented to control the completeness of gastric vagotomy. The procedure is based on measuring of gastric mucosa tissue oxygen pressure as an equivalent for the diminished perfusion of gastric mucosa after vagotomy. The results up to now proved the method reliable. Since we practice this method in quite a number of vagotomies primarily not severed vagal branches could be found and cut later.
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1) Following acute portocaval anastomosis in healthy dog liver tissue - pO2 drops by 23%, an extent regulary occuring in hour long laparotomy. 2) Intravenous octapressin lowers splanchnic blood flow, concomitantly liver blood-flow and tissue -pO2 is decreased. 3) In contrast to octapressin orciprenalin improves liver blood-flow and tissue-pO2. 4) By shunting of arterial blood through the gut norepinephrine causes a rapid and lasting elevation of liver tissue-pO2.
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