[Manual suture or stapler technic in anastomoses of the esophago-intestinal tract?].
Explore the source record for details and available documents.
Anastomosis, Surgical↗
Biomedical subjects
R Bittner
Publications and source records attributed to R Bittner.
[Gastrectomy de nécessité].
According to the principle "gastrectomie de nécessité" a total gastrectomy may have to be performed when the distance between the proximal edge of the tumour and the cardia is less than an adequate margin of security. The main reason for advocating this principle is that a large number of patients (ca. 20%) can profit by the advantages of a partial resection above all concerning the nutritional status and the quality of life. Against this principle it is argued that in the presence of a diffuse type carcinoma the risk of local recurrence is considerably higher.
Follow-Up Studies↗
Pancreatic abscess and infected pancreatic necrosis. Different local septic complications in acute pancreatitis.
Local septic complications in acute pancreatitis need to be exactly characterized and defined in order to develop improved concepts for their prevention, early diagnosis, and therapy. While up to now all local septic complications have been termed abscesses, the present study for the first time delineates the morphologic, clinical, and laboratory criteria needed to distinguish between two separate clinical entities: the infected necrosis (IN) and the pancreatic abscess (PA). IN is defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue, but without any significant pus collections. On the other hand, the morphologic substrate of PA is a localized collection of pus surrounded by a more or less distinct capsula. IN becomes clinically evident during the early phase of acute pancreatitis (AP). The patients with IN present both the signs of sepsis and the laboratory findings of AP. Thus in these patients the most fulminant course of AP is observed; 51.8% and 35.7% of them have pulmonary or renal insufficiency, respectively. The mortality of the patients with IN is high and amounts to 32.1%. Pancreatic abscess, on the other hand, does not develop before the fifth week after onset of symptoms and after subsidence of the acute phase of pancreatitis. In these patients laboratory signs of AP-like amylasemia, hypocalcemia, hyperglycemia, and rise of LDH are rarely observed. Corresponding to the lack of pathophysiologic effects of AP per se, pulmonary and renal insufficiencies occur in only 33.3% and 16.7%, respectively, and mortality in these patients is 22.2%. While an abscess may readily be identified by computed tomography, the differentiation between IN and non-IN can be very difficult.(ABSTRACT TRUNCATED AT 250 WORDS)
Abscess↗
[Magnetic resonance tomography of intrathoracic tumors].
65 patients suspected of having intrathoracic masses were studied using magnetic resonance imaging (MRI) and computed tomography (CT). The intensity difference between mass and adjacent normal tissue or mediastinal fat was greater on MRI than on CT images. MRI was superior to CT in differentiating bronchogenic carcinomatous tumours from postobstructive pneumonia and/or lobar collapse. MRI images most clearly depicted obstructed mediastinal vessels and were also able to indicate intravenous flow reductions. The latter could be demonstrated by an increase of signal intensity within venous structures proximal to the obstruction. In patients with lung cancer no significant differences were found between the two imaging methods for the evaluation of tumour extent or node involvement.
Bronchogenic Cyst↗
High sensitivity and specificity of CA 19-9 for pancreatic carcinoma in comparison to chronic pancreatitis. Serological and immunohistochemical findings.
The serum carbohydrate antigenic determinant (CA 19-9) was assayed in patients with various diseases (87 patients with pancreatic carcinoma, 747 patients with benign diseases, and 547 patients with extrapancreatic malignant growths) and it proved to be particularly sensitive for adenocarcinoma of the pancreas (80 of 87, 92%) as compared to only 14% in the group of patients with benign diseases. Twenty-seven percent of the patients with chronic pancreatitis and 28% of the patients with acute pancreatitis showed elevated CA 19-9 concentrations of more than the upper normal value of 37 U/ml. In 38% and 32% of our cases with carcinoma of the stomach and colorectal carcinoma, respectively, CA 19-9 was estimated as being above the normal range. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinoma decreases after curative resection of the carcinoma to values within the normal range. However, in no CA 19-9 estimation following a palliative surgical intervention or in cases of inoperable carcinomas a serum concentration of less than 37 U/ml was recorded. In immunohistochemical specimens we found a difference between CA 19-9 antigen concentrations on the cell surface and secretion in pancreatic carcinoma and chronic pancreatitis.
Adenocarcinoma↗
Sepsis indicators in acute pancreatitis.
Twenty-one routine clinical and laboratory data in 161 patients with necrotizing pancreatitis (NP) undergoing surgical treatment were analyzed. The necrotic tissue at operation was bacterially infected in 41% of the patients. The goal of the study was to evaluate whether there was any special clinical feature in cases of an infection. The parameters were recorded during 48 h after admission as well as during 48 h before operation, and the frequencies submitted to both a univariate and a multivariate analysis (logistic regression model). In the period after admission, patients with infected necrosis significantly more often had a rectal temperature greater than 38.5 degrees C (p = 0.001). Before operation (i.e., after maximum conservative treatment), four findings were significantly related to an infection: rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, hematocrit less than 35% (all p = 0.0001), and paO2 less than 60 mm Hg (p = 0.001). The multivariate analysis, which calculates and quantifies the mutual influence of factors, showed a combination of three findings (rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, and hematocrit less than 35%) to be related to necrosis infection before operation. All three criteria in a patient imply a probability of infection of 83%. It is noteworthy that the sepsis indicators were equally distributed in patients with focal, extended, or subtotal/total infected necrosis, but correlated with the necrosis extent in sterile necrotizing pancreatitis. Moreover, all parameters not related to the pancreatic infection [e.g., hyperglycemia, hypocalcemia, rise of lactic dehydrogenase (LDH), and the white blood cell count] correlated with the three necrosis categories.
Acid-Base Imbalance↗
The value of CA 19-9 in gastric and colorectal carcinoma.
We have conducted a prospective study of 441 patients, to investigate the utility of a new tumor marker CA 19-9 for the diagnosis and monitoring of patients with cancer of the gastrointestinal tract (93 patients with colorectal carcinoma, 57 with carcinoma of the stomach, 10 with esophageal carcinoma, 45 with malignancies outside the gastrointestinal tract, and 236 with benign general surgical disease). Results were compared to those obtained for carcinoembryonic antigen (CEA) in the diagnosis of carcinoma of the stomach and colon/rectum. CEA is more sensitive than CA 19-9 in all stages of carcinoma of the stomach and colon/rectum. During treatments of gastrointestinal carcinomas, CEA and CA 19-9 were determined at the same time in 66 and 165 patients with surgically treated carcinoma of the stomach and colorectal carcinoma, respectively. It was noted that CEA is more sensitive than CA 19-9 in detecting recurrence. However, CA 19-9 is more specific. The best results were obtained when both markers were used together.
Adult↗
Effect of prenatal insulin and glucagon injection on the glycogen content of rat placenta and fetal liver.
The placental glycogen content per g wet weight decreases after the 16th day of gestation but remains nearly constant till the 21st day of gestation when expressed per placenta as whole organ. Injection of insulin to rat fetuses at the 21st day of gestation gives rise to hypoglycemia and an increase of the glycogen content in liver and in placenta. Intrauterine glucagon application makes fetuses hyperglycemic in consequence of a mobilization of the placental glycogen stores. Hepatic glucose production appears in later stages because of the low activity of glucose 6-phosphatase as demonstrated by the effect of glucagon on the hepatic glucose 6-phosphate concentration.
Animals↗
[Esophagojejunostomy--how safe is manual suture today?].
Between 1982 and 1986 a total of 137 patients were gastrectomized for cancer of the stomach. The esophago-jejunal anastomosis was always carried out as an end-to-side anastomosis applying the conventional two layer technique. Only in 1 patient (0.7%) an insufficiency of this anastomosis was observed; 9 reoperations (6.6%) were necessary and 3 patients (2.2%) died in the postoperative course. These results confirm that with a precise, standardised conventional suture technique the esophageal anastomosis can be safely performed today.
Adult↗
[Duodenum-preserving pancreas head resection].
Explore the source record for details and available documents.
Chronic Disease↗
[Nuclear magnetic resonance tomography of superior vena cava obstruction].
The potential of magnetic resonance tomography (MRT) to demonstrate the mediastinal veins was evaluated retrospectively in 6 patients with superior vena cava obstruction. In each instance, MRT provided detailed information about the extent of venous obstruction and the precise site of the causative oncological pathology. Transaxial images most clearly and unequivocally depicted obstructed superior vena cava. MRT was also able to indicate some secondary effects of superior vena cava obstruction such as slow intravenous flow. The latter could be demonstrated by a significant increase of signal intensity within venous structures proximal to the obstruction. Peripheral venous collaterals in the chest wall were better seen with contrast enhanced computed tomography scans.
Collateral Circulation↗
[Peptic ulcer: therapeutic principle of vagotomy].
The selective proximal vagotomy (SPV) is the surgical procedure of choice today in patients with duodenal ulcer. The ulcer can be cured in 90-95% of all cases, if the indication for surgery is correct and the operation is performed by a technically experienced surgeon. The rate of complications and postoperative side-effects is extremely low as compared to the risks in patients suffering from an ulcer complication. If the peptic ulcer is located in the prepyloric region or high in the stomach, the SPV cannot be generally recommended; its application in these cases has so far been justified only within the scope of clinical studies.
Gastric Acidity Determination↗
CA 19-9 and pancreatic adenocarcinoma.
The diagnostic place value of CA 19-9, a tumor-associated antigen, was tested in 611 patients. This group of patients included 273 patients who suffered from a malignant disease (48 patients with pancreatic carcinomas and 225 patients with extrapancreatic malignant growths) and 338 patients with benign diseases (66 patients with chronic pancreatitis, 36 patients with acute pancreatitis, and 236 patients with general surgical diseases). In 93% of the patients with pancreatic carcinoma (media value, 528 U/ml), in 37% and 19% of the patients with carcinoma of the stomach and colorectal carcinomas (median value 8 U/ml), respectively, the CA 19-9 value was estimated as being above the normal limits of 6 to 37 U/ml. A sensitivity of 93% and a specificity of 85%, as well as a total accuracy of 82%, were established in pancreatic carcinoma during preoperative observation. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinomas dropped after curative resection of the carcinoma to within normal limits. However, a serum concentration of less than 37 U/ml was not recorded in any CA 19-9 estimation after a palliative surgical intervention, or in any case of inoperable carcinomas.
Adenocarcinoma↗
Hemodynamic data pattern in patients with acute pancreatitis.
In 16 patients with necrotizing pancreatitis and in 6 patients with edematous-interstitial pancreatitis, hemodynamic studies were conducted between the first and the 12th day after the onset of illness. Patients with necrotizing pancreatitis had a high cardiac index of 4.47 +/- 0.75 L/min X m2 and a low total peripheral vascular resistance of 884 +/- 180 dyn X s/cm5, a low mean pulmonary vascular resistance of 84.3 +/- 25.7 dyn X s/cm5, and a high pulmonary shunt fraction of 24.2% +/- 6.6% of the cardiac output. This hyperdynamic vascular pattern was not found in patients with edematous-interstitial pancreatitis associated with gallstone disease. The group of patients with edematous-interstitial pancreatitis had a cardiac index of 3.21 +/- 0.8 L/min X m2, a total peripheral vascular resistance of 1337.8 +/- 248.2 dyn X s/cm5, a mean pulmonary vascular resistance of 130.7 +/- 48.2 dyn X s/cm5, and a pulmonary shunt fraction of 13.6% +/- 3.5% of the cardiac output. There was a significant difference between the patients with necrotizing pancreatitis and those with edematous-interstitial pancreatitis in the following hemodynamic parameters: heart rate (p less than 0.02), cardiac index (p less than 0.01), total peripheral vascular resistance (p less than 0.001), arteriovenous oxygen difference (p less than 0.02), and pulmonary shunt fraction (p less than 0.01). These findings in patients with necrotizing pancreatitis demonstrate an opening of intrapulmonary shunts and peripheral vasodilatation probably due to the release of pancreatitis-associated toxic agents in the early phase of the disease.
Acute Disease↗
Bacterial contamination of pancreatic necrosis. A prospective clinical study.
In a prospective clinical study including 114 patients with acute necrotizing pancreatitis, but excluding patients with a pancreatic abscess, necrotic material obtained at surgery was tested bacteriologically. Intestinal microorganisms were cultured in 39.4% of the cases. The contamination rate was 23.8% in patients operated on during the first 7 days of the attack; it rose to 71.4% in the third week and decreased to 32.5% after the fourth week. Intra- and extrapancreatic necrosis was more widespread and pancreatitis-associated ascites was more frequent in patients with proven contamination. The number of objective signs was 4.5 (median) and postoperative mortality was 37.8% in bacteriologically positive subjects, whereas the number was 3.5 (median) and mortality was 8.7% in bacteriologically negative patients. Morphologic and clinical alterations were more severe, and the mortality rate was significantly elevated, in patients with a short history of disease and bacterial contamination of necrotic tissue. All 5 patients with pancreatic sepsis who were operated on in the first 7 days of the disease, as compared with 2 of 16 patients with sterile necrosis, died. Thus, it is demonstrated that bacterial contamination of pancreatic necrosis occurs early and frequently, causing a significant increase in morbidity and mortality, particularly when it develops in the initial stages of the attack.
Abscess↗
Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging.
One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety per cent of the cases with extensive and 79% of those with minor necroses of the pancreas had been demonstrated with contrast enhanced computed tomography. Ultrasound failed to be diagnostic in 24% of the patients due to meteorism; the sensitivity of the diagnostic studies for pancreatic necrosis was 73% regardless of the extent of the process. Using the early objective signs, seven patients with acute interstitial pancreatitis were classified as having a severe attack, whereas 30 patients with necrotising pancreatitis were categorised as mild attacks. We conclude that the contrast enhanced computed tomography is an aid in deciding on conservative or surgical treatment in a case of acute pancreatitis. Ultrasound does not appear to be an adequate method for determining pancreatic necrosis. The early objective signs fail to sufficiently identify the necrotising form of acute pancreatitis.
Acute Disease↗
Influence of age and sex on anal sphincters: manometric evaluation of anorectal continence.
To investigate the exact nature of anorectal continence, a manometric evaluation was performed in 88 healthy test persons with a two-balloon catheter. The pressure in the anal canal (PAC) and the rectal ampulla at rest (PAR), the maximum squeeze pressure (PAC max) and pressure rise in the anal canal after dilatation of the rectal ampulla delta PAC) were evaluated separately for men and women, and the test persons were divided into 3 age groups (group I: under 40 years, group II: 40-60 years, group III: over 60 years). PAC showed a statistically significant difference between men and women and a constant decrease with age--statistically significant for men and for women between groups II and III--whereas the statistical significance of the 3 other values had to be restricted to a constant decrease with advance in years. Anorectal continence is characterized by a PAC at rest of over 40 mm Hg, a PAC max reaching at least 80 mm Hg, a pressure gradient between rectal ampulla and anal canal of over 20 mm Hg and a delta PAC of more than 10 mm Hg. These values as well as the differences depending on age and sex should be kept in mind for the evaluation of the continence function.
Adolescent↗
[Resorption and hormonal reaction in the perioperative phase following enteral administration of glucose].
It was the aim of this study to find out whether a postoperative enteral nutrition with glucose is possible. Therefore, an intraduodenal glucose load (15 g/7.5 min.; 20% solution) was applied in 14 patients with normal weight and no metabolic disorders before and on 4 consecutive days after a medium severe abdominal operation. The results show that the resorption of the enterally applied glucose is reduced only on the first postoperative day. After the peak values have been reached, the decrease of glucose from the blood is delayed up to the second postoperative day, although during the whole testing period the insulin secretion--calculated according to the insulinogenic index - corresponds to the glucose stimulation. Thus, an early postoperative enteral nutrition with glucose seems to be possible, but the reduced absorption over a short period has to be taken into consideration.
Abdomen↗