Langenbecks Archiv fur Chirurgie最新文献

{"title":"[Sex differences in neuromodulation of mucosal mast cells in the rat jejunum].","authors":"T Gottwald, H D Becker, R H Stead","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The effect of electrical stimulation of both cervical vagal nerves on mucosal mast cells in the jejunum was investigated in an in vivo animal model with rats of both sexes. Males showed a significant increase of mast cell densities after electrical stimulation (1.0 mA, 5 Hz, 5 ms, 12 min) in the lamina propria. Simultaneously, we observed a significant increase of tissue histamine levels (ANOVA: P < 0.05), whereas serum levels remained unchanged. However, even though females had significantly higher levels throughout compared to males (ANOVA: P < 0.05), they did not show any significant reaction to electrical stimulation. These in vivo data support morphological and in vitro data from other investigators, who hypothesized a functional interaction between mucosal mast cells and nerves. However, degranulation seems to be a poor in situ indicator for mast-cell stimulation, as mast-cell densities increased in males, while the percentage of degranulated cells remained the same in all groups (about 40%). Instead, electrical stimulation of the vagal nerve seems to trigger histamine synthesis, or simply stabilization of mast cells. Interestingly, this phenomenon seems to be sex-dependent, suggesting a regulatory role for sex hormones in this scenario.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 3","pages":"157-63"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20258612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vascularization of the humerus].","authors":"J Menck, A Döbler, J R Döhler","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The proximal third of the humerus is fed by the anterior and posterior circumflex arteries of the axillary artery. They construct a fine anastomoses network at the humeral head as well as longitudinal anastomoses to the diaphysis. The middle third of the humerus is maintained by the rami musculoperiostales originating in both the brachial artery and the deep brachial artery. These periosteal vessels are formed both horizontally and vertically. The distal third of the humerus is mainly supplied by the horizontal anastomoses of the collateral arteries. The inner part of the bone is normally penetrated by just one nutrient artery entering the nutrient canal below the middle of the humerus.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 3","pages":"123-7"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20260667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pre-bending and and tension adjustment of narrow 4.5 mm AO titanium LC-DCP (limited contact dynamic compression plate)].","authors":"P Schandelmaier,&nbsp;C Krettek,&nbsp;A Ungerland,&nbsp;N Reimers,&nbsp;H Tscherne","doi":"10.1007/s004230050075","DOIUrl":"https://doi.org/10.1007/s004230050075","url":null,"abstract":"<p><strong>Unlabelled: </strong>To assess the behavior of the LC-DCP with prebending and pretensioning we tested: gap angle vs. tensioning force without prebending; Bending moment for different prebending angles; In a model using a fiber tube to simulate the bone for different prebending angles and pretensioning forces of the LC-DCP the deformation in 4 point bending open was tested. Maximum prebending angle was 24 degrees, maximum pretensioning force was 2400 N; in human cadaver tibiae angles of 3 degrees, 9 degrees, 24 degrees and forces of 300 N, 1000 N and 1500 N, were tested to look for the difference in a less idealized model.</p><p><strong>Results: </strong>1. A near linear curve for gap angle vs. force with an angle of 0.45 degree/100 N was found between 100 N and 1500 N; 2. We did not find a near linear bending moment/bending angle curve up to 8 degrees like in the DCP but an exponential curve development as it had to be expected by the lower modulus of elasticity of titanium; 3. the maximum mechanical stability was found for a angle of 24 degrees and a force of 1500 N. The titanium LC-DCP shows a different mechanical reaction to prebending and pretensioning in the bone implant complex compared to stul DCP. Optimum prebending and pretensioning for axial compression and mechanical stability in the LC-DCP are by far greater than clinically possible. From our mechanical testing a prebending angle of 24 degrees and a pretensioning force of 1500 N would allow the largest axial compression and show the most resistance against deformation in bending open. In the clinical setting this would result in difficult reduction and therefore, we recommend a prebending angle of 9 degrees and a pretensioning force of 1000 N.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 6","pages":"325-31"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20422334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Long-term outcome of continence function after ileo-anal pouch reconstruction].","authors":"S M Mühldorfer,&nbsp;K E Matzel,&nbsp;C Hübler,&nbsp;W Hohenberger,&nbsp;E G Hahn","doi":"10.1007/s004230050077","DOIUrl":"https://doi.org/10.1007/s004230050077","url":null,"abstract":"<p><p>An important aim of proctocolectomy with ileal pouch-anal anastomosis (IPAA) is to maintain anal continence. Anal sphincter disruption during IPAA is felt to play an important role in loss of continence, which is described in up to 30% of the treated patients in the early postoperative period. Although sphincter function recovers gradually after surgery, some patients stay incontinent. In our investigation of possible parameters involved in preservation of continence after this operative procedure, we focused on changes in anal manometry. We compared these findings with the functional results obtained by questioning the patients and physical examination. Anal manometry was performed with a low-compliance hydraulic perfusion system. All patients underwent a J-pouch procedure with a short rectal cuff for ileoanal reconstruction. We examined 25 patients, 13 underwent operation for the treatment of ulcerative colitis, 12 because of adenomatous polyposis. In the colitis and polyposis group, 28% of the patients reported events of soiling. Three patients (12%) were incontinent. The remaining 15 patients were completely continent. The median time after operation was 58 months, ranging from 12 to 96 months. Comparing the results of anal manometry with standard values of ten age- and gender-matched healthy volunteers, it was found that there was a significant increase in the threshold of balloon awareness and urge to defecate. These sensations were sometimes elicited by pouch contractions. Median pouch-compliance was also clearly elevated in comparison to rectal compliance (P < 0.005). Inhibitory reflexes during balloon inflation could not be evoked in any of the patients. Comparing continent with incontinent patients there were significant differences in balloon awareness, urge to defecate, and stool frequency (P < 0.01, P < 0.01 and P < 0.001, respectively). But in contrast to other publications, we could not find significant differences in anal sphincter length, resting and squeezing, anal canal pressure. Pouch compliance was lowered in incontinent patients and negatively correlated with stool frequency (P < 0.001, r = -0.82). In conclusion, our study indicates that anal sphincter resting pressure alone is not a crucial factor in continence preservation in the long-term after total proctocolectomy and IPAA. Poor pouch-compliance and concomitant higher stool frequencies seem to be related to incontinence in this patient group.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 6","pages":"337-42"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20422336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Peritoneal instillation of taurolidine and heparin for preventing intraperitoneal tumor growth and trocar metastases in laparoscopic operations in the rat model].","authors":"C A Jacobi,&nbsp;R Sabat,&nbsp;J Ordemann,&nbsp;F Wenger,&nbsp;H D Volk,&nbsp;J M Müller","doi":"10.1007/pl00014641","DOIUrl":"https://doi.org/10.1007/pl00014641","url":null,"abstract":"<p><strong>Background: </strong>Although port-site metastases occur after laparoscopic surgery, there is no generally accepted approach to prevent tumor implantation so far.</p><p><strong>Methods: </strong>In order to prevent tumor metastases, the effect of taurolidine and heparin on the growth of colon adenocarcinoma DHD/K12/TRb was measured in vitro and in a rat model. After incubation of the cells with heparin, taurolidine or both substances, the cell kinetics were determined. In a second experiment, tumor cells were administered intraperitoneally in rats (n = 60) and pneumoperitoneum was established over 30 min. Rats were randomized into four groups (I: tumor cells; II: cells + heparin; III: cells + taurolidine; IV: cells + taurolidine + heparin).</p><p><strong>Results: </strong>While tumor cell growth was not influenced by heparin in vitro, growth decreased significantly after incubation with taurolidine and taurolidine/heparin. In vivo, intraperitoneal tumor weight was lower in rats receiving heparin (298 +/- 155 mg) and taurolidine (149 +/- 247 mg) than in the control group (596 +/- 278 mg). When the two substance were combined, tumor growth was even less (21.5 +/- 36 mg). Trocar metastases were only lower in rats receiving taurolidine or the combination of taurolidine and heparin.</p><p><strong>Conclusion: </strong>In vivo, heparin inhibits intraperitoneal tumor growth only slightly, while taurolidine causes a significant decrease in tumor cell growth in vitro as well as intraperitoneal tumor growth and trocar metastases in vivo.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 4 Suppl 1","pages":"S31-6"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/pl00014641","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20267723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Therapy of peritonitis today. Surgical management and adjuvant therapy strategies].","authors":"H B Reith","doi":"10.1007/pl00014637","DOIUrl":"https://doi.org/10.1007/pl00014637","url":null,"abstract":"<p><p>Acute necrotizing pancreatitis and fylecal or diffuse purulent peritonitis are the diseases primarily responsible for mortality due to surgical infections of the abdomen. The most recent figures indicate that a mortality rate of 50%-80% in this specialized treatment group is still a reality. Without doubt, surgical sanitation of the focus is the most important therapeutic measure. A generalized inflammation reaction has been regularly observed in nearly all patients within this disease category. Local surgical therapy has the greatest effect on prognosis. If the therapeutic goal is not reached with the first intervention, adjuvant surgical therapy is necessary. The different forms are continuous peritoneal lavage (CPL), open dorsoventral lavage, and relaparotomy or scheduled reoperation (\"Etappenlavage\"). Adjuvant medical treatments include TNF alpha and interleukin-1 synthesis inhibitors or antibodies. Unfortunately, clinical studies with these mediators have only been partly successful in the subgroups, so that a general clinical adjuvant treatment is not considered viable. The bacterial properties of taurolidine destroy the bacterial membrane and, at the same time, lead to cross-linking of the membrane components and functional proteins (LPS), so that a bactericidal effect and endotoxin reduction take place simultaneously. Both local and intravenous routes of administration can be used.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 4 Suppl 1","pages":"S14-7"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/pl00014637","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20267719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Does heparin modify the course of chronic abscess-forming peritonitis in the animal model?].","authors":"A Woltmann, K Kattenbeck, R Broll, A Lebeau, S Gatermann, H P Bruch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>After laparotomy and inoculation of a Bacteroides fragilis suspension (2 ml with 10(8) CFU/ml), we induced chronic abscess-forming peritonitis in rats (n = 19, untreated). Fifteen animals were treated with heparin 30 IU, administered s.c. from day 1 after inoculation of the bacteria onwards. The main groups were divided into three subgroups (n = 8/5/6 and n = 5/5/5), which were observed for 3/7/14 days, respectively. On days 3 and 7, abdominal swabs were not only B. fragilis positive, but also showed severe polyvalent mixed infection after translocation of intestinal bacteria into the abdominal cavity. In the heparin group, B. fragilis positive swabs were reduced and translocation was inhibited (P < 0.05 for days 3 and 7). In the untreated group, blood cultures were B. fragilis positive on days 3/7/14 in 3/2/1 animals versus 0/1/1 in the heparin group. Adhesions were found in the untreated group in 1/4/5 animals, whereas in the heparin group there were no adhesions (P < 0.05 for days 7 and 14). However, intra-abdominal abscesses were also diminished in the heparin group (0/2/1) compared with the untreated animals (2/4/6, P < 0.05 for day 14). Therefore, heparin was shown to have a favourable influence on chronic abscess-forming peritonitis in an animal model.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 2","pages":"107-10"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20144655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Temporary colostomies after sigmoid colon and rectum interventions--are they still justified?].","authors":"W Wahl, A Hassdenteufel, B Hofer, T Junginger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Primary anastomosis is increasingly favored even in emergency colorectal surgery. Two-stage procedures are frequently considered obsolete. The aim of this study is to define conditions when a two-staged operative strategy with a temporary colostomy is still appropriate. We analyzed a series of 126 patients who were treated by a colostomy following resection and subsequent closure of the colostomy. In 44 cases the primary operation was a Hartmann resection, in 39 cases a resection with colostomy and mucous fistula and in 43 cases a resection with primary anastomosis and proximal loop colostomy. Complications of diverticular or neoplastic disease were generally managed by resection without primary anastomosis. Protective loop colostomy was done after low anterior resection of the rectum or in cases of anastomotic leakage. Patients were hospitalized again after an average of 6 months for closure of the colostomy. Restoration of intestinal continuity carried no significant risk of severe intra- or post-operative complications. Disturbances of wound healing occurred in 4.5% (Hartmann resection), 17.9% (colostomy and mucous fistula) and 20.9% (loop colostomy) of patients. We found an anastomotic dehiscence rate of 2.4% after discontinuity resections and of 4.7% after closure of loop colostomies. Only one patient with anastomotic leakage required surgical reintervention. The mortality after closure of a colostomy was zero. The rate of anastomotic leakage of 2.4% was lower than in published series with more than 7.2% after primary anastomosis, thus emphasizing the beneficial effect of a two-stage operative strategy. In emergency situations of sigmoidal and rectal surgery or in cases of low anastomosis of the distal rectum, unnecessary surgical complications can be avoided by resection without primary anastomosis or by performing protective loop colostomies.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 3","pages":"149-56"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20258611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Morphologic parameters for quantitative determination of inflammatory activity of the peritoneum].","authors":"A Woltmann, S Weiss, B Martens, R Broll, S Krüger, H P Bruch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The morphology of the inflammatory activity of the peritoneum has been measured qualitatively but quantitative assessments are not common. In a standardized rat model we induced chronic abscess-forming peritonitis after laparotomy and inoculation of 2 ml Bacteroides fragilis suspension at a concentration of 10(9)/ml colony-forming units. The morphological inflammatory activity was determined quantitatively by staining the specimen of the peritoneum with naphthol-AS-D-chloracetate-esterase (NASDCE); through this staining the cytoplasm of granulocytes and tissue mast cells were marked. The peritonitis group (n = 53) and controls (n = 15) were randomly divided into three subgroups (nPeritonitis = 17/18/18 vs. ncontrol = 5/5/5) and observed for 3/7/14 days, respectively. On days 3/7/14 we diagnosed intra-abdominal abscesses in 2 of 17, 13 of 18, and 12 of 18 animals in the peritonitis group. In controls there were no abscesses (P < 0.05). The total cellularity and NASDCE-positive rates on days 3/7/14 in the peritonitis group were 301/409/280 (vs. 155/240/273 in controls) and 1.8/2.9/3.6% (vs. 0.7/0.9/1.4%) in the non-abscess-forming regions and 392/661/625 and 14.4/12.9/11.5% in the abscess-surrounding regions in the infected animals, respectively (P < 0.05). We conclude that the qualitative histological evidence of the morphological inflammatory activity of the peritoneum in the form of an abscess can be supplemented by a quantitative method. Through NASDCE staining the granulocyte and tissue mast cell proportion of the total cellularity as main indicators of the local inflammatory activity can be estimated in peritonitis. This method can be helpful in deciding when to definitively close the abdomen in the course of a programmed lavage treatment in peritonitis.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 5","pages":"231-6"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20338473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Merkel cell carcinoma: follow-up of 10 patients. Current diagnosis and therapy].","authors":"A Hauschild, D Rademacher, J Röwert, E Christophers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Merkel cell carcinoma (MCC) is a rare neoplasm of the skin predominantly found on the head and extremities. Clinically MCC presents as a rapidly growing red or violaceous, dome-shaped, solitary tumor. The clinical and histological diagnosis of MCC remains difficult. Distinction from poorly differentiated small cell primary tumors or metastasis requires immunohistochemical analysis and-if available-electron-microscopic studies. We report on the follow-up of 10 patients with MCC treated in the past 6 years at our department. In nine patients the tumors were completely removable; in one patient with a large primary tumor of the upper lip no histologically proven complete excision could be performed. After a median follow-up of 42 months, local recurrence or lymph node involvement was observed in three patients. Two patients died following disseminated metastases, one elderly patient due to cardiac insufficiency. Our observations demonstrate that MCC is a potentially aggressive cutaneous tumor. Adequate primary surgical and adjuvant therapy as well as careful follow-up are mandatory.</p>","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 4","pages":"185-91"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20372592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}