Another challenge to the Opie myth.
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Animals↗
Biomedical subjects
N Runkel
Publications and source records attributed to N Runkel.
Is the hydrogen clearance technique a useful tool for measurements of pancreatic blood flow during acute experimental pancreatitis?
Changes of pancreatic blood flow (PBF) during acute pancreatitis (AP) have been under investigation by means of electromagnetic flowmeters, radioactive microspheres, isotope fractionation, radioactive gas clearance, and venous outflow techniques. All methods, however, have certain drawbacks, which make the application of other techniques desirable. In this study, the hydrogen clearance technique (HCT) was tested for the first time in a well-established foxhound model of AP. PBF, systemic blood pressure, and heart rate were monitored over 90 min after the onset of AP and 60 min after therapeutic infusion of Dextran-40 (10 ml/kg body wt). Our results fully agree with the data found by other techniques in this experimental model. Sixty-five of 73 electrodes implanted into the pancreas of eight foxhounds were found working. From 1,024 registered clearance curves, 876 were identified as monoexponential. In the other cases, and only then, we found either dislocation of the electrode tips (n = 6) or perielectrodal hemorrhage during histological examination (n = 4). We believe that the HCT is a feasible and reliable tool for measuring PBF in experimental settings like AP.
Acute Disease↗
[Isolated Ledderhose fibromatosis plantaris].
Plantar fibromatosis or Ledderhose syndrome has rarely been discussed in the medical literature. This clinical entity includes nodular Dupuytren-like indurations of the plantar aponeurosis. We present a case of a young man with isolated disease of his right foot and describe the clinical and pathomorphological features of this disease as well as its characteristic findings at magnetic resonance tomography. The therapy of choice is a subtotal resection of the plantar aponeurosis to prevent irreversible contractions of the toes. The prognosis following fascietomy is good.
Adult↗
Hormonal control of opossum sphincter of Oddi motility: role of myoneural continuity to duodenum.
Motilin and caerulein are known to affect motility of the sphincter of Oddi (SO) and the gastrointestinal tract. The role of SO-duodenal myoneural continuity in the action of these peptides was studied. Five opossums had translocation of the duodenal papilla into the jejunum, while preserving the blood supply to the SO and duodenum. Serosal electrodes were placed in the SO, duodenum, and jejunum. Five control animals had electrode placement alone. Myoelectric recording was obtained during fasting and after administration of motilin (400 ng/kg) or caerulein (500 ng/kg/hr). Motilin induced premature phase III-like activity in the SO and intestine in controls. After the translocation of the papilla, the spike frequencies during phase II and phase III were significantly lower than in controls, whereas those during phase I and phase IV were not different. Motilin caused premature intestinal phase III and increased SO spike activity. However, the increase in SO spike activity was insufficient to form phase III. Caerulein produced a sustained increase in spike activity in both regions in both groups, but the increase was less in the translocation group than in controls. These data suggest that duodenal activity stimulated by motilin and caerulein participates in the activation of SO motility via intrinsic myoneural pathways.
Animals↗
Advantages and disadvantages of using the hydrogen clearance technique to measure pancreatic blood flow.
This study was undertaken to identify the advantages and disadvantages of using the hydrogen clearance technique (HCT) to measure pancreatic blood flow (PBF) in the opossum over short and long periods. An open study was performed on 8 opossums. A total of 72 platinum electrodes were implanted into the pancreas. On the fifth day 41 additional electrodes were implanted. All implantation sites were examined histologically after five days. Measurements of pancreatic blood flow were taken every other day for five days. Three measurements were taken from each electrode and the mean of the three was used for analysis. In the anaesthetized animal mean PBF (SD) was 63.5 (12.8) ml min-1 100 g-1 immediately after electrode implantation and 34.3 (11.4) ml min-1 100 g-1 on the 5th postoperative day. Of the implanted electrodes, 35% failed during the experimental course, mainly as the result of proliferation of scar tissue around the electrodes. Mild to moderate fibroproliferation had taken place around the platinum tips of the remaining 65%. Primary electrode implantation caused no or negligible trauma to the pancreas. We recommend the HCT only for short-term measurements of PBF. Implantation of electrodes for any length of time leads to inflammatory changes around the platinum tips that cause proliferation of scar tissue and lead to failure of the electrodes, misleadingly low PBF recordings, and fewer monoexponential clearance curves.
Animals↗
Transduodenal sphincteroplasty with transampullary septectomy for stenosing papillitis.
The papilla of Vater and its sphincter of Oddi, lying at the confluence of the bile and pancreatic ducts in man, have long been suspected as a source of upper abdominal pain. Enlarging the opening of the transpapillary segment of the bile and major pancreatic ducts by using a transduodenal sphincteroplasty with transampullary septectomy resulted in death in a patient with a peripapillary diverticulum and pancreas divisum. Eight-six patients followed for 1 to 10 years experienced a 75% success rate. Thirty-six patients had a marked stenosis of their duct of Wirsung, suggesting that their pain was primarily from the pancreas. The remainder had either a generalized narrowing (40 patients) or a normal (7 patients) papilla. Pain was not satisfactorily resolved in patients with an associated pancreas divisum, chronic pancreatitis, and recurrent episodes of acute pancreatitis with alcoholism.
Abdominal Pain↗
[The value of classification for therapy and prognosis of acute pancreatitis. Analysis of a patient sample of the Heidelberg Surgical University Clinic 1986-1989].
116 patients admitted for acute pancreatitis were analysed. In 80% of patients presenting biliary pancreatitis cholecystectomy and bile duct exploration was the prevalent treatment, in 7.8% pancreatic necrosis was removed. Indications to operate on patients with non-biliary pancreatitis included enhancement of pancreatic inflammation revealed by computed tomography and multi-organ-failure or sepsis complicating the course of the disease (incidence of laparotomy 20.3%, incidence of necrosectomy 12.3%). According to this concept 2 out of 3 patients presenting partial pancreatic necrosis recovered without operation. Lethality of patients with acute necrotizing pancreatitis (6.9%) was accounted 25%, over-all mortality 6%. Methods used for classification of severity of acute pancreatitis (Mainz classification, Ranson criteria) turned out to be not reliable. Clinical staging of pancreatitis was not in accordance with intraoperative findings in 51.9% of cases. As a prerequisite for stage-dependent therapy new objective data to access severity and clinical course of acute pancreatitis have to be worked out.
Acute Disease↗
The role of prostaglandins in reperfusion injury after liver transplantation in pigs.
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Animals↗
Sphincter of Oddi cyclic motility. Effect of translocation of the papilla in opossums.
The role of myoneural continuity between the sphincter of Oddi and duodenum in coordinating sphincter cyclic motility and the duodenal migrating myoelectric complex was studied in conscious opossums. Five animals underwent implantation of the duodenal papilla into the jejunum. Myoelectric recording was obtained from the sphincter, duodenum, and jejunum in these animals and from 5 other animals as controls. The mean spike frequency of the sphincter of controls was 1.6 per min during phase I, 4.2 per min during phase II, 11.0 per min during phase III, and 3.6 per min during phase IV of the duodenal migrating myoelectric complex. After translocation of the papilla, the spike rates during phase II (2.2 per min) and phase III (2.8 per min) were lower than in controls (p less than 0.02), while those during phases I and IV remained unchanged. Feeding disrupted the migrating myoelectric complex and increased sphincter spike activity in both groups; however, the plateau frequency after feeding was lower after the translocation. These data suggest that the duodenum does not control cyclicity of sphincter motility but sphincter-duodenal intrinsic myoneural continuity is important in the increase in sphincter spike activity during phases II and III and after feeding.
Ampulla of Vater↗
Stenosis of the sphincter of Oddi.
"Stenosing papillitis" is a descriptive term for an anatomic deformity of the papilla of Vater that is characterized by narrowing of the lower end of the bile duct and the proximal end of the duct of Wirsung. The defect is secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. Patients with papillary stenosis from gallstones may present with episodes of severe upper-abdominal pain several years after cholecystectomy. The pain is often incapacitating, and patients are often addicted to narcotic analgesics. The work-up includes abdominal ultrasonography and CT scanning and endoscopic retrograde cholangiopancreatography even though the findings usually are normal. Liver and pancreatic enzymes are not frequently elevated with the painful episodes. Transendoscopic manometry may reveal elevated pressures within the papillary portion of the distal bile duct. Some patients are relieved of their pain by transduodenal sphincteroplasty and transampullary septectomy, thereby ablating the sphincter of Oddi around the bile and pancreatic ducts and enlarging their openings.
Cholestasis, Extrahepatic↗
Effect of nifedipine on the motility of the sphincter of Oddi and small bowel of the opossum.
The effect of the calcium-channel blocker nifedipine on the electromyographic activity of the small bowel and sphincter of Oddi was studied in conscious opossums. Electromyographic and arterial pressure recordings were started 7-10 days after implantation of seven pairs of electrodes along the small bowel and sphincter of Oddi. Continuous infusion of nifedipine caused a dose-dependent reduction of the frequency of spike bursts in the small bowel and sphincter of Oddi. Nifedipine at high doses abolished the migrating motor complex in the gastrointestinal tract. The frequency of slow waves was unchanged. This drug possibly inhibits the membrane influx of calcium into the smooth muscle cells of the gastrointestinal tract. We conclude that nifedipine causes an intense decrease in the motility of the small bowel and sphincter of Oddi.
Ampulla of Vater↗
Effect of analgesic drugs on the electromyographic activity of the gastrointestinal tract and sphincter of Oddi and on biliary pressure.
Continuous biliary pressure and electromyographic activity of the sphincter of Oddi and gastrointestinal tract were recorded in conscious opossums following administration of analgesic drugs. Morphine, meperidine, and pentazocin increased significantly the duration of the migrating motor complex (MMC) cycle. Periods of 1-2 minutes of intense burst of spike potentials were seen in the sphincter of Oddi and duodenum following administration of morphine (8 experiments), meperidine (6 experiments), and pentazocin (3 experiments). The biliary pressure in the control studies was similar to that following administration of all analgesics in the animals with gallbladder and following instillation of tramadol, metamizol, and acetylsalicylic acid in animals with no gallbladder. However, the biliary pressure was significantly higher following administration of morphine, meperidine, and pentazocin in the animals with no gallbladder. It is concluded from this study that morphine, meperidine, and pentazocin may cause important disturbances in the motility of the sphincter of Oddi and gastrointestinal tract. These myoelectric disturbances may cause an increase in the biliary pressure in animals that have been subjected to cholecystectomy, but not in animals with intact gallbladder. The gallbladder may accommodate the bile produced by the liver during periods of sphincter of Oddi dysfunction and thus impede an increase in the biliary pressure.
Ampulla of Vater↗
[A new video recording system for the operating room].
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Germany, West↗
Plasma renin activity and cardiovascular changes in patients with chronic bladder distension.
Arterial plasma renin activity, arterial blood pressure, heart rate and respiratory frequency were measured in 10 patients with chronically distended bladder due to benign prostatic hyperplasia before and after bladder drainage. After suprapubical bladder puncture there was a decrease in all the values. Similar changes were also found in 3 patients with artificially induced acute bladder distension, who did not suffer from infravesical obstruction. A significant correlation was found between the changes of the arterial pressure and arterial plasma renin activity. It is therefore suggested that the renin-angiotensin system might be involved in patients with bladder distension.
Aged↗
Elevated carbohydrate-deficient transferrin predicts prolonged intensive care unit stay in traumatized men.
Carbohydrate-deficient transferrin (CDT) is reported to have a higher specificity in alcoholism than conventional markers. As the morbidity and mortality rates amongst chronic alcoholics are raised following trauma, the objective was to investigate if CDT could be used to predict prolonged intensive care unit (ICU) stay and an increased morbidity in patients with multiple injuries admitted to the ICU. In this prospective double-blind study, 66 traumatized male patients were transferred to the ICU following admission via the emergency room and operative management. Blood samples for CDT determination were taken upon admission to the emergency room, the ICU and on days 2 and 4 following admission. The patients were allocated a priori to two groups: high CDT group (CDT >20 U/l on admission to the emergency room) and low CDT group (CDT < or = 20 U/l). CDT values were determined by microanion-exchange chromatography and radioimmunoassay. Thirty-six patients had an elevated CDT value on admission to the emergency room. The high CDT group had a significantly prolonged ICU stay (median high CDT group: 13 davs; median low CDT group: 5 days). Major intercurrent complications, such as alcohol-withdrawal syndrome, tracheobronchitis, pneumonia, pancreatitis, sepsis, and congestive heart failure, were significantly increased in the high CDT group. The increased risk of pneumonia in the high CDT group may be related to the significantly increased period of mechanical ventilation. As high CDT values were associated with an increased risk of intercurrent complications and a prolonged ICU stay, it seems reasonable to use CDT as a marker in intensifying research work into preventing alcoholism-associated complications.
Adolescent↗