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Biomedical subjects

N G Kock

Publications and source records attributed to N G Kock.

At least 73 records · Page 4Linked to original sources
PubMed1980

Morphological and histochemical changes in the mucosa of the continent ileostomy reservoir 6--10 years after its construction.

Morphological and histochemical changes in the mucosa of the continent ileostomy reservoir were studied in 13 patients who had been provided with a continent ileostomy reservoir 6--10 years before the investigation. Biopsy specimens were taken for evaluation of basal morphology, morphometry, and enzyme histochemical analyses. The villi were predominantly finger-like, but the villus height was reduced compared with normal. The crypt layer and the number of cells in each crypt were increased. The number of mitoses was normal or slightly subnormal. In comparison with biopsies taken 1 year after construction of the reservoir, there was an increase in villus height and mucosal volume and a decrease in the number of mitoses, whereas the number of cells per crypt was unchanged. The surface to volume ratio decreased progressively during the 6- to 10-year period. This decrease was partly caused by an increase of the mucosal volume. The epithelial cell layer was intact, and no changes were seen in the microvillus layer. No alarming changes in terms of dysplasia, fibrosis, or progressive atrophy were found. Histochemical investigation showed a high enzymatic activity in the epithelial cells as concerns both the oxidative metabolism and the secretory function.

Acid Phosphatase↗
PubMed1980

Intestinal intussusception valve for prevention of duodenogastric reflux after partial gastrectomy. An experimental study in dogs.

For prevention of duodenogastric reflux after partial gastric resection three types of intussusception valves were developed and tested in an experimental study in dogs. The three experimental groups were compared with regard to duodenogastric reflux and body weight with a control group of dogs subjected to partial gastric resection (BI-dogs). Reflux was determined by use of an isotope method whereby the reflux was graded according to radioactivity measured in gastric samples. A gastroduodenal valve constructed in five dogs failed, probably because of its inability to withstand the high pressure during the duodenal cap systole. Interposition of an isoperistaltic jejunal segment provided with an intussusception valve between the gastric remnant and the duodenum was successful in preventing reflux. Reflux was demonstrated in ten out of 13 dogs with conventional gastroduodenostomy whereas no reflux was found in the dogs with competent intestinal intussusception valves. The satisfactory postoperative weight recovery indicated that the procedure had no harmful effects on gastrointestinal propulsion and absorption.

Animals↗
PubMed1980

Determination of duodenogastric reflux by use of 14C-labelled cholic acid. An experimental study in dogs.

A method for determination of duodenogastric reflux was elaborated in animal experiments. The bile acid pool was labelled by intravenous injection of 14C-cholic acid and the activity in consecutively collected gastric samples was determined. The gastric samples were taken approximately 24 hours after injection of the tracer. In one dog, provided with a continent duodenostomy, the radioactivity in duodenal samples was found to vary moderately 24-32 hours after injection of labelled cholic acid. The method was tested in three different groups of dogs: a) "normal dogs", B) dogs having undergone partial gastric resection (B I), and C) dogs provided with a reflux-preventing valve after partial gastric resection. Radioactivity was measured in gastric samples from one out of 15 normal dogs and in samples from 11 out of 13 dogs after partial gastric resection. After interposition of a reflux-preventing valve, no radioactivity was found in samples from six tested dogs. Measurement of radioactivity in gastric samples collected approximately 24 hours after labelling of the bile acid pool seems to be a reliable and simple method for semi-quantitative determination of duodenogastric reflux.

Animals↗
PubMed1980

Construction of a stable nipple valve for the continent ileostomy.

Construction of the continent ileostomy has been beset by a high incidence of late complications due to malfunction of the nipple valve. A modification of the technique for the construction of the valve was developed in animal experiments and tried out with success in clinical tests. The operation technique is described and preliminary clinical results reported.

Animals↗
PubMed1979

Absorption studies in patients six to 10 years after construction of ileostomy reservoirs.

The absorption of fat, bile salts, and vitamin B12 was studied in 14 proctocolectomised patients six to 10 years after construction of a continent ileostomy. All patients were in excellent health and displayed no signs of malnutrition. Schilling test disclosed subnormal absorption of vitamin B12 in one patient and borderline values in five. Faecal loss of bile acid was increased in 12 patients and fat malabsorption occurred in two. Except for slightly pathological liver tests in two patients, routine laboratory tests, including plasma concentration of vitamin B12 and folic acid, were normal. There were no signs of sodium or potassium depletion.

Adult↗
PubMed1979

Faecal excretion of intravenously injected 14C-cholic acid in patients with conventional ileostomy and in patients with continent ileostomy reservoir.

Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum has also been removed. As compared with 16 healthy controls, FBS was moderately increased in the conventional ileostomy patients, but still within normal limits. After conversion to ileostomy reservoir all patients had pathological FBS, although less severe than in the ileostomy patients with ileal resection. Bacterial contamination probably contributes more than the structural mucosal changes to the bile malabsorption in the pouch, whereas reduced mucosal surface and short small-intestinal transit time are the main causes of malabsorption in ileostomy patients in whom an appreciable amount of the terminal ileum has been resected.

Adult↗
PubMed1978

Gastric emptying of a liquid meal in health and duodenal ulcer disease.

In the present investigation an extension of the method of George was used, which allows the rate of emptying of the gastric content (GC) to be assessed. The aim of the study was to find out whether ther is any difference in gastric emptying rate of a liquid meal of 750 ml 10% glucose (glucose monohydrate, mol. wt. 198) between healthy subjects and duodenal ulcer patients (DU). The straight numerical volume of GC, the logarithm and the square root of GC were related to time, and these functions were compared. The correlation coefficient for the regression line for these functions showed that data both for healthy subjects and DU gave a better fit to the GC/time and GC/relationship than to a semi-logarithmic function, when the starting point at time zero was excluded. Regardless of the type of transformation of the basic data, there was no difference between healthy controls and DU as regards the regression coefficient, indicating that from 20 min after the installation of the test volume the GC is decreasing at the same rate in the two groups. When the straight numerical volume of GC was used, there was a significant difference in the extrapolated Y-intercept for the regression lines between healthy subjects and the DU, indicating an increased initial emptying in the DU patients. This was further confirmed when the volume emptied during consecutive 20-min periods was estimated. Furthermore, there was a shorter emptying time in patients with duodenal ulcer than in healthy controls.

Adult↗
PubMed1977

Ileostomy.

Explore the source record for details and available documents.

Animals↗
PubMed1977

Gastric emptying after different surgical procedures for duodenal ulcer.

Gastric emptying has been studied in patients operated upon for duodenal ulcer by either 1) parietal cell vagotomy without or 2) with pyloroplasty, 3) truncal vagotomy combined with pyloroplasty or 4) antral resection, 5) gastric resection a.m. Billroth I or 6) Billroth II. Isotonic saline and 10% glucose solution have been used as test meals. Volumes of meal remaining 10 and 30 minutes after the instillations of the saline and the glucose meal respectively have been estimated. After parietal cell vagotomy without pylorplasty (PCV) the gastric emptying rate of 10% glucose solution was significantly faster than in unoperated duodenal ulcer patients. After all the other surgical procedures the gastric emptying rate of saline as well as of glucose solution was in turns significantly faster than after PCV. These results indicate the importance of the antrum-pyloric region for the control of gastric emptying rate of isotonic saline and hyperosmolar glucose solution.

Duodenal Ulcer↗
PubMed1976

[Artificial anus. Advantages and disadvantages of ileo- and colostomy].

The majority of patients with ileostomy adapt to their new situation and are able to live a nearly normal professional and social life. This does not mean that there is not a need for improvement in the ileostomy construction. It merely proves the great adaptive mechanism in man. In spite of the improvement in surgical techniques in the construction of the ileostomy and the development of modern ileostomy appliances, a proportion of the patients still experiences serious problems. In order to improve the situation for patients with ileostomy a new type of ileostomy has been developed. From the terminal ileum an intraabdominal, intestinal reservoir is constructed and the outlet from the reservoir is provided with a "nipple valve" preventing leakage of gas and faeces through the outlet. The continent ileostomy has now been under clinical trial for more than seven years. The success-rate has increased along with improvements in technique and introduction of methodological modifications. More than 90% of 164 patients provided with this type of ileostomy had at follow-up satisfactory functional results of their ileostomy. That means that they had no need for carrying external ileostomy appliances. A method for constructing a continent colostomy has been tested in dogs. The sigmoid colon was divided and the distal end closed. At the proximal end a "nipple valve" was constructed by intussuscepting a part of the intestine into its lumen. All dogs were continent from the time of operation until they were sacrificed one to eight weeks later. The method is now under elaboration for clinical trial.

Animals↗
PubMed1976

Spontaneous partial regression of malignant melanoma and its first metastasis. Case report.

A case of malignant melanoma with partial regression of the original lesion and its first metastasis is reported. At the time of almost complete disappearance of the primary lesion a lymph node metastasis was removed and it consisted of necrotic tissue containing masses of melanin pigment. There then was a rather rapid progress of the original lesion and of other metastases and the patient died of disseminated metastases of malignant melanoma three years after the operation.

Aged↗
PubMed1975

[Continent ileostomy--indication and possibilities].

Proctocolectomy with conventional ileostomy cures patients with severe ulcerative colitis but ileostomy appliances must be worn for the rest of their lives. The continent ileostomy, as devised by Kock, provides the patient with an intraabdominal ileal reservoir and a valve constructed by invaginating the efferent ileal segment into the reservoir. The patient empties his reservoir 2-3 times a day by inserting a catheter through the valve. Our experience with 14 patients is reported. The continent ileostomy was in most cases constructed as a second procedure after proctocolectomy. Minor postoperative complications, such as abscess, fistula or partial luxation of the valve were easily corrected. One patient who underwent proctocolectomy and simultaneous construction of a continent ileostomy died in acute liver failure due to a severe preexisting cirrhosis. All the other patients are continent for feces and gas and do not need external appliances. The construction of a continent ileostomy as a secondary procedure can be recommended in patients with proctocolectomy. It offers patients a life situation with differs only insignificantly from that of normal persons.

Colitis, Ulcerative↗