[Spontaneous abdominal hematoma during jogging under acetylsalicylic acid therapy].
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Abdomen↗
Biomedical subjects
V Lange
Publications and source records attributed to V Lange.
Stimulation of L-type Ca2+ current in human atrial myocytes by insulin.
OBJECTIVE: The L-type calcium current (ICa,L) in isolated human atrial myocytes was investigated as a possible target of insulin in the regulation of cardiac function. METHODS: Atrial myocytes were obtained from patients undergoing cardiac surgery. Using the whole-cell configuration of the patch-clamp technique, we investigated the stimulation of ICa,L by insulin in single human atrial myocytes. RESULTS: We found a dose-dependent stimulation of ICa,L by insulin at concentrations of 100 nM, 1 microM and 10 microM. Maximum stimulation of ICa,L over basal ICa,L was 140 +/- 12% (n = 11) at 10 microM insulin. The maximum conductance of ICa,L was increased by 10 microM insulin from 4.0 +/- 0.3 nS to 8.3 +/- 1.0 nS (n = 6). The stimulation of ICa,L by insulin was dose-dependent and reversible. Isoproterenol (10 nM) that stimulates ICa,L by 271 +/- 48% (n = 10) over basal ICa,L acted faster than insulin. The half-maximum stimulation of ICa,L by isoproterenol and insulin (10 microM) was reached after 31 +/- 2 s and 52 +/- 5 s, respectively. The insulin effect shown was totally reversed by acetylcholine (3 microM) which is known to inhibit adenylyl cyclase activity/cAMP-production via Gi-proteins. Also, the selective insulin receptor tyrosine kinase inhibitor (hydroxy-2-naphthanelyl-methyl)phosphonic acid completely inhibited the insulin induced effect. CONCLUSION: Our data show that insulin stimulates the L-type calcium current in isolated human atrial myocytes in a dose-dependent and reversible manner which appears to involve the insulin receptor tyrosine kinase. Insulin regulation of ICa,L in human atrial myocytes may be an interesting system for the analysis of the metabolic syndrome in man.
Acetylcholine↗
[Acute pancreatitis. Classification, diagnosis, therapy].
Acute pancreatitis is a multietiologic entity with rather diverse clinical courses. Whereas edematous pancreatitis has a mortality of less than 1%, nowadays; still approximately 20% of all patients with the necrotizing form succumb to the disease. To further improve therapeutic results a standardized approach should be used. For effective treatment the differentiation between edematous and necrotizing pancreatitis is crucial. All patients with signs of pancreatic necroses during abdominal ultrasound and patients with organ insufficiencies should undergo a CT-scan to define exactly the nature and the extent of the disease. Primarily all patients are treated conservatively. Main indications for operative intervention are signs for infection of pancreatic necroses and an acute abdomen due to local complications of acute pancreatitis. In cases of biliary origin an elective cholecystectomy has to be performed during a free interval to prevent a recurrence.
Acute Disease↗
[Techniques of laparoscopic preparation and current-induced complications. Results of a survey in Germany].
138 surgical institutions in Germany retrospectively answered a questionnaire on available energy sources, techniques of preparation and complications due to the use of electric current in laparoscopic surgery. The median experience in this field of surgery was 6 years. For common laparoscopic operations the majority of surgeons use electrosurgery; only 8% never do so. Except in appendectomy, monopolar cautery is preferred for all operations. Other energy devices are of minor importance. The overall number of operations reported was nearly 138,000. The rate of complications due to the use of electric current was 0.1%. This figure is accounted for in equal part by intra- and postoperative burns. The complication rate is at the lower end of the range known from the literature. Even though the retrospective nature of this analysis may hide a certain number of injuries electric, current plays a minor role for complications in laparoscopic surgery.
Burns, Electric↗
Comparison of the effect of FK 506 and alpha/beta-T-cell antibody R73 on transplant vascular sclerosis after heterotopic rat heart transplantation.
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Animals↗
Effect of hemodynamics on graft rejection in the heterotopic heart transplantation model.
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Animals↗
Expression of cGMP-dependent protein kinase I and its substrate VASP in neointimal cells of the injured rat carotid artery.
BACKGROUND: Neointimal fibroproliferative lesions after balloon angioplasty remain a major clinical problem, frequently leading to restenosis of initially successfully dilated coronary arteries. The cGMP-dependent protein kinase type I (cGMP-PK I) and its substrate vasodilator-stimulated phosphoprotein (VASP), molecular targets of the atrial natriuretic factor (ANF) and nitric oxide (NO) signalling pathways, are likely to be involved in various aspects of vascular wall regulation and restenosis formation. METHODS: To investigate the occurrence of cGMP-PK I and VASP in neointimal cells in situ, we performed immunohistochemistry and immunoblotting experiments on denuded rat carotid arteries. RESULTS: Although the soluble cGMP-PK I showed a homogeneous distribution throughout the neointima, VASP apparently was more concentrated in smooth muscle cells (SMCs) lining the artery lumen, possibly reflecting enhanced growth factor stimulation of luminal SMCs. The membrane-associated cGMP-PK type II could not be detected in both the non-injured vessel wall and the restenotic tissue. CONCLUSION: The presence of both cGMP-PK I and VASP, major regulators of the actin cytoskeleton and cell motility, in neointimal tissue suggest that this emerging signal transduction pathway could be a target for the regulation and control of restenosis.
Animals↗
Lipid peroxidation and cardiac troponin T release during routine cardiac surgery.
Myocardial injury after cardiac surgery with cardiopulmonary bypass may be related to free oxygen radical-induced lipid peroxidation. The purpose of this study was to monitor perioperative changes of cardiac troponin t and malondialdehyde as an indicator of lipid peroxidation in patients who underwent routine cardiac operation and had no signs of perioperative myocardial infarction. Patients with thoracic surgery alone served as controls. We studied 20 patients with cardiopulmonary bypass (CPB) and 9 patients with other thoracic operations. Serum troponin t, malondialdehyde, myoglobin, creatine kinase (CK) including CK-MB isoenzyme levels were monitored before CPB, immediately after cessation of CPB, 20 and 44 h after CPB. Patients with signs of myocardial infarction before or up to 44 h after surgery were excluded. Of 20 patients with CBP, 18 patients showed a significant increase of troponin t and 16 patients had elevated malondialdehyde serum levels following CPB. Troponin t serum values were raised immediately after CPB to 0.60 +/- 0.12 microg/l and increased further to 0.90 +/- 0.17 microg/l after 44 h (p < 0.005, in comparison to preoperative: 0.08 +/- 0.02 microg/l). Patients undergoing the other thoracic operations showed neither any detectable troponin t serum values nor significant changes of serum malondialdehyde during the observed period. In the CPB group serum malondialdehyde peaked immediately after CPB to 98 +/- 9 nmol/g albumin (p < 0.005) and returned to preoperative levels (63 +/- 3 nmol/g albumin) within 20 h (60 +/- 3 nmol/g albumin). Individual maximal troponin t serum levels did not correlate with individual maximal serum malondialdehyde levels. The observed increase of troponin t levels had no influence on patients' outcome followed up for 18 months. The results demonstrate that troponin t and lipid peroxidation increase during uncomplicated cardiac surgery in patients without signs of myocardial infarction. Following uncomplicated cardiac surgery, a moderate increase of cardiac troponin t may not reflect severe cardiac injury.
Cardiac Surgical Procedures↗
[Quality of life after inguinal hernia operation--results of a prospective study (Shouldice, Lichtenstein, TAPP)].
Data concerning quality of life and rehabilitation after inguinal hernia repair are still poor. A prospective survey on 269 patients was conducted following standardized Shouldice, Lichtenstein and TAPP hernioplasty by means of questionnaire. General health perception, pain scores and physical activity were significantly improved by all of the mentioned techniques. Laparoscopic repair was beneficial in indirect, recurrent and bilateral hernia and small defects of the transverse fascia.
Adult↗
[Coincidence of pulmonary cryptococcoma in an immunocompetent patients with a chondrohamartoma and chronic tuberculoma--differential diagnostic considerations concerining pulmonary coin lesions].
Of primary importance in the differential diagnosis of multiple circular foci in the lungs are the lung metastases. This study involves a patient with three circular foci, each of which could have been metastases. They proved, however, to be a rare coincidence of three benign lung affections, namely, an old tuberculoma, a chondrohamartoma, and a seldom encountered pulmonary cryptococcoma. Computerized tomography utilizing the spiral technique was valuable diagnostically, as it led to the discovery of the smallest of the three circular foci in the basodorsal left lower lobe. The form of the cryptococcosis among immunocompetent patients--only rarely localized in our experience--must be included in the differential diagnostical considerations of a circular focus in the lungs. In the event there are multiple circular foci with an unknown primary tumor, surgical intervention with a pathohistological clarification regarding a possible malignancy is absolutely necessary.
Cryptococcosis↗
Sedimentation of biliary sludge: effect on composition of gallbladder bile from patients with cholesterol, mixed, or pigment stones.
BACKGROUND: Ultracentrifugation of bile has been used extensively to remove insoluble material such as sludge from bile before further studies of cholesterol nucleation. Although it has been recognized that this procedure may affect the composition of gallbladder bile, it has not been studied systematically in different gallstone populations. Therefore, we investigated the concentration of biliary lipids, protein, mucin, and bilirubin before and after ultracentrifugation. METHODS: Gallbladder bile samples were aspirated during laparoscopic surgery from 66 patients (35 with cholesterol, 16 with mixed, and 15 with pigment stones). RESULTS: Whereas the concentrations of bile acids, phospholipids, protein, and bilirubin in gallbladder bile did not change significantly after ultracentrifugation, cholesterol (20.6 +/- 1.6 to 14.8 +/- 1.2 mmol/l) and mucin concentrations (0.99 +/- 0.2 to 0.67 +/- 0.1 mg/ml) and the cholesterol saturation index (1.68 +/- 0.12 to 1.31 +/- 0.10) decreased significantly in gallbladder bile from patients with cholesterol stones. CONCLUSIONS: Sedimentation of biliary sludge may profoundly affect the composition of gallbladder bile, which has to be considered in studies of cholesterol saturation and nucleation. The cholesterol concentration difference between native and ultracentrifuged bile reflects the insoluble crystalline fraction of cholesterol and may be useful for quantitation of the mass of cholesterol crystals in gallstone-associated bile samples.
Bile↗
[Ultrasound scalpel--initial experiences with use in laparoscopic surgery].
Worldwide the use of monopolar electrocautery is preferred in laparoscopic surgery. Beside the risk of thermal injury the technique involves some inconveniences for the surgeon. The ultrasonic scalpel offers theoretical advantages, which were clinically studied in a series of 443 operations. The absence of smoke, the reduced need for cleaning of the optic and the lack of complications due to the device lead us to believe that the ultrasonic scalpel is superior to electrocautery especially for beginners in laparoscopic surgery. The costs of the system--DM 150 per patient in our prospective series--are tolerable.
Blood Loss, Surgical↗
Different techniques of laparoscopic end-to-end small-bowel anastomoses.
The aim of the study was to prove that laparoscopic stapling devices can be used to create a bowel anastomosis. Three groups with n = 6 pigs each were subjected to different techniques of small-bowel anastomoses. In groups I and II anastomosing of the bowel ends was carried out with singly placed staples using a hernia stapler. (Group I: Two-thirds of the circumference became inverted and one-third everted. Group II circumferentially everted). In group III triangular everted anastomoses were produced using a linear noncutting stapler. All animals survived the observation period of 14 days and were postmortally examined. Average construction time was 59 min for groups I and III and 47 min for group II. Average diameters were 14 mm, 16 mm, and 18 mm for groups I, II, and III, respectively. There were no significant differences between the techniques concerning the stability of the anastomoses as expressed by bursting pressures. There were two stenoses in group I animals caused by electrocautery during preparation of the bowel ends prior to anastomosing. Anastomotic insufficiencies or fistulas were not observed clinically or with Gastrografin studies. We conclude that anastomoses in the pig can laparoscopically be constructed by employing singly placed staples as well as a linear stapler. Further investigations of these techniques on large bowel and human specimens are required prior to their clinical use in humans.
Anastomosis, Surgical↗
Transesophageal echocardiographic determinants of embolism in nonrheumatic atrial fibrillation.
The purpose of the study was to determine the relation of transesophageal echocardiographic findings to symptoms of systemic embolism in patients with nonrheumatic atrial fibrillation. Transthoracic and transesophageal echocardiography were used to study 107 patients with atrial fibrillation including 49 patients without embolic complications and 58 patients who had suffered from previous cerebral or peripheral embolism. A multiple logistic regression analysis revealed that left atrial thrombi (odds ratio 9.0, 95% CI 2.4-33.6, p < 0.005) and the presence of dense left atrial spontaneous contrast (odds ratio 8.4, 95% CI 1.3-53.1, p < 0.05) were independently related to embolic symptoms. Intensive left atrial spontaneous contrast was associated with an increased left atrial diameter (odds ratio 2.0, 95% CI 1.1-3.6, p < 0.05), the presence of chronic atrial fibrillation (odds ratio 6.9, 95% CI 1.6-29.8, p < 0.01) and aortic atherosclerosis (odds ratio 2.6, 95% CI 1.2-5.5, p < 0.05). It was further negatively correlated to mitral regurgitation (odds ratio 0.4, 95% CI 0.2-0.9, p < 0.05). In conclusion, dense spontaneous echo contrast and left atrial thrombi are associated to thromboembolic complications in patients with nonrheumatic atrial fibrillation. Classifying of spontaneous contrast seems to be useful when estimating the thromboembolic risk in atrial fibrillation.
Adult↗
Correlation between biliary alpha 1-acid glycoprotein concentration and cholesterol crystal nucleation time in gallstone disease.
A biliary form of the alpha 1-acid glycoprotein (AAG) promotes cholesterol crystallization in the lower-molecular-weight, concanavalin A-bound fraction of gallbladder bile. In addition, bile AAG concentration is higher in cholesterol gallstone patients with multiple stones than in control patients without gallstone disease. In this study we sought to determine whether the increased biliary concentration of AAG in cholesterol gallstone patients is accompanied by a more rapid nucleation time in patients with multiple stones. AAG concentration in native biles was measured by ELISA. Nucleation time was measured using a standard microscopy method. The concentration of biliary AAG was then related to nucleation time in biles from the same patients. Nucleation times were significantly shorter (< or = 5 days) in cholesterol gallstone patients with raised AAG concentrations (P < 0.03). There was a significant (P = 0.004) negative correlation (r = -0.53) between nucleation time and the AAG concentration in cholesterol gallstone patients with multiple stones. The concentration of biliary AAG appears to exert an important influence on the speed of cholesterol nucleation in bile in many patients with cholesterol gallstone disease.
Bile↗
Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy.
BACKGROUND: Opioids can produce peripheral analgesic effects by activation of opioid receptors on sensory nerves. This study was designed (1) to examine a novel route of opioid administration, the intraperitoneal injection; (2) to compare this to interpleural application, and (3) to compare opioid with local anesthetic effects under both conditions. METHODS: At the end of laparoscopic cholecystectomy, 110 patients received the following injections in a double-blind, randomized manner: Group 1 (n = 18) was given intraperitoneal morphine (1 mg in 20 ml saline) and 20 ml intravenous saline. Group 2 (n = 17) received intraperitoneal saline and 1 mg intravenous morphine. Group 3 (n = 15) received 20 ml 0.25% intraperitoneal bupivacaine and intravenous saline. Group 4 (n = 20) received interpleural morphine (1.5 mg in 30 ml saline) and 30 ml intravenous saline. Group 5 (n = 20) received interpleural saline and 1.5 mg intravenous morphine. Group 6 (n = 20) received 30 ml 0.25% interpleural bupivacaine and intravenous saline. Postoperative pain was assessed using a visual analog scale, a numeric rating scale, and the McGill pain questionnaire. Pain localization, supplemental analgesic consumption, vital signs, and side effects were recorded for 24 h. RESULTS: Neither intraperitoneal nor interpleural morphine produced significant analgesia after laparoscopic cholecystectomy (P > 0.05, Kruskal-Wallis test), whereas interpleural bupivacaine was effective (P < 0.05, Kruskal-Wallis test, up to 6 h postoperatively) but not intraperitoneal bupivacaine (P > 0.05, Kruskal-Wallis test). Shoulder pain was not prevalent in the majority of patients during the first 6 h. By 24 h, about half of the patients complained of shoulder pain, which was rated "low" by about one-third of all patients. No significant side effects occurred. CONCLUSIONS: Interpleural bupivacaine (0.25%) produces analgesia after laparoscopic cholecystectomy. We attribute the lack of effect of intraperitoneal injections to the small dose and to a rapid dilution within the peritoneal cavity. The fact that interpleural morphine (0.005%) is ineffective may be due to an intact perineurial barrier in the noninflamed pleural cavity, which restricts the transperineurial passage of morphine to opioid receptors on intercostal nerves.
Bupivacaine↗
[Technique and results of laparoscopic vagotomy in chronic duodenal ulcer].
Advances made in the medical treatment of duodenal ulcer disease have lead to a sharp decrease in the number of patients who are referred for operative therapy. Today surgery may be indicated in patients with chronic and recurrent ulceration following failure of H. pylori eradication regimens and in patients with no or reduced compliance. Laparoscopic vagotomy procedures may offer this select group of patients an additional benefit and comfort, if their short-term and long-term results are comparable to those achieved following conventional open vagotomy. This is a prospective study on patients who underwent laparoscopic vagotomy using two different adapted methods evaluating short-term clinical and functional results. From October 1991 through April 1994 8 patients were studied. 3 patients received an anterior seromyotomy with posterior truncal vagotomy (according to Taylor) and 5 patients underwent anterior linear strip gastrectomy with posterior truncal vagotomy (according to Gomez-Ferrer and Morris). All patients had gastroduodenoscopy, secretory analysis of basal acid output (BAO) and maximal acid output (MAO) and evaluation of their H. pylori status performed pre- and postoperatively. Median follow-up was 15 months. 5 patients were completely asymptomatic, 2 patients complained of mild bloating or reflux and 1 patient had mild diarrhea up to 6 months postoperatively. None suffered an ulcer recurrency. All remained H. pylori positive following surgery. Secretory analysis of acid production showed a 50-70% drop in BAO and MAO after vagotomy. Both vagotomy procedures described have been specifically adapted and are well suited for a laparoscopic approach. They are expedient and easy to employ. As clinical and functional data demonstrate they achieve short-term results comparable to those seen after conventional surgery.
Adult↗
Laparoscopic repair of a Morgagni hernia.
Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate recovery after repair of the hernia and has remained free of recurrence or complaints 9 months after surgery.
Adult↗