Langenbecks Archiv fur Chirurgie最新文献_第4页

[Does heparin modify the course of chronic abscess-forming peritonitis in the animal model?]. 肝素是否改变动物模型慢性脓肿性腹膜炎的病程?

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01

A Woltmann, K Kattenbeck, R Broll, A Lebeau, S Gatermann, H P Bruch

{"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":"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.","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}

引用次数: 0

[Temporary colostomies after sigmoid colon and rectum interventions--are they still justified?]. [乙状结肠和直肠干预后的临时结肠造口术-是否仍然合理?]

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01

W Wahl, A Hassdenteufel, B Hofer, T Junginger

{"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":"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.","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}

引用次数: 0

[O2 utilization during hyperthermic extremity perfusion with rhTNF alpha and melphalan]. [rhTNF α和melphalan在四肢热灌注过程中的氧利用]。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01

J Haier, P Hohenberger, K Beck, P M Schlag

{"title":"[O2 utilization during hyperthermic extremity perfusion with rhTNF alpha and melphalan].","authors":"J Haier, P Hohenberger, K Beck, P M Schlag","doi":"","DOIUrl":"","url":null,"abstract":"During isolated limb perfusion (ILP) severe metabolic impairment with a subsequent alteration in oxygen consumption can be observed. The mechanisms responsible for this may be extracorporeal circulation, hyperthermia, and application of cytostatic drugs and cytokines. Thirty-three patients underwent ILP with rhTNF alpha and melphalan for melanoma or soft-tissue sarcoma. Cardiopulmonary monitoring consisted of arterial and mixed venous blood-gas analysis and a Swan-Ganz catheter was inserted after induction of general anesthesia prior to any surgical intervention. Arterial (SaO2) and mixed venous (SvO2) oxygen saturation, serum lactate and end-expiratory CO2 concentration were determined peri- and postoperatively for 72 h. Oxygen supply and consumption rates were measured systemically (DO2I, VO2I) and in the extracorporeal circuit ('DO2I, 'VO2I). For statistical analysis we used the t-test. During extracorporal circulation an increase of DO2I and VO2I was observed. A slight increase of lactate values began during the wash-out phase. Immediately after reperfusion. DO2I, VO2I and lactate increased significantly with normalization until the 2nd postoperative day. SaO2 and SvO2 remained unchanged. A significant correlation between regional toxicity and the postoperative maximum of serum lactate values was found. The increase of DO2I and VO2I in the tissues during ILP and after reperfusion was achieved by a significant increase in cardiac output while the oxygen extraction rate was not altered. Elevation of lactate values after reperfusion and the increase in oxygen utilization might be due to oxygen depletion in the perfused limb. This could contribute to the development of lactacidosis or rhabdomyolysis. Therefore, to minimize toxicity it seems to be mandatory to measure adequate tissue oxygen supply during ILP.","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 3","pages":"128-33"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20260668","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}

引用次数: 0

[Morphologic parameters for quantitative determination of inflammatory activity of the peritoneum]. [腹膜炎症活性定量测定的形态学参数]。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01

A Woltmann, S Weiss, B Martens, R Broll, S Krüger, H P Bruch

{"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":"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.","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}

引用次数: 0

[Fatal outcome factors of intestinal infarct of primary vascular origin]. 【原发性血管源性肠梗死的致命结局因素】。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01

M Gawenda, P Scherwitz, M Walter, H Erasmi

{"title":"[Fatal outcome factors of intestinal infarct of primary vascular origin].","authors":"M Gawenda, P Scherwitz, M Walter, H Erasmi","doi":"","DOIUrl":"","url":null,"abstract":"Despite diagnostic and therapeutic advances, mesenteric vascular occlusion with intestinal infarction is often fatal. Parameters determining the high mortality are seldom discussed in the literature. By univariate statistical analysis we correlated the therapeutic outcome of our patients to 20 parameters. Between 1 January 1984 and 30 April 1996 we treated 22 men and 18 women with acute bowel ischemia of vascular origin. All patients underwent laparotomy, 40% (n = 16) due to the diagnosis of mesenteric infarction. In 15% (n = 6) the laparotomy was only exploratory; in 34 cases (85%) bowel resection was carried out. Mortality for all patients was 55% (n = 22). Univariate analysis of the 20 parameters showed that the therapeutic outcome was significantly correlated to a pre-existing diabetes, the course of hospitalization, and the high ASA class. There was no correlation to the length of resected bowel. Most parameters that determine the mortality of bowel infarction are pre-existing and cannot be influenced, but survival can be achieved in some patients if radical and aggressive resection is carried out at the side of almost complete small bowel infarction and followed by an elective second-look operation. Even short-bowel syndrome can be treated. Patients can return to a near normal lifestyle with an acceptable quality of life with the aid of parenteral nutrition at home.","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 6","pages":"319-24"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20422333","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}

引用次数: 0

[Merkel cell tumor or neuroendocrine skin carcinoma]. [默克尔细胞瘤或神经内分泌皮肤癌]。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01 DOI: 10.1007/s004230050079

U Meyer-Pannwitt, K Kummerfeldt, P Boubaris, J Caselitz

{"title":"[Merkel cell tumor or neuroendocrine skin carcinoma].","authors":"U Meyer-Pannwitt, K Kummerfeldt, P Boubaris, J Caselitz","doi":"10.1007/s004230050079","DOIUrl":"https://doi.org/10.1007/s004230050079","url":null,"abstract":"Merkel cell carcinoma is a rare malignant tumor of the skin with predominance in older patients; 78.6% of patients are older than 59 years. Female and male patients are equally involved in the age group below 60 years. After 60 years, Merkel cell carcinomas are more often observed in female patients. The tumor is most often located in the head and neck region (50.8%) or the extremities (33.7%). The average size is 29 mm at presentation. Clinically, only a presumptive diagnosis of Merkel cell carcinoma can be established. The definite diagnosis is made by histological, especially immunohistological methods (detection of intermediate filaments and neuroendocrine markers). The therapy of choice is local excision. Secondary therapy may be a combination of operation and radiation or chemotherapy. Since this combination may reduce the risk of recurrences it should be applied for patients with poor prognostic features. Especially in young patients, additional lymphadenectomy should be discussed. Clinical control is necessary. Distant metastases should be treated by chemotherapy. Bad prognostic features are: lymph node metastasis, size larger than 2 cm, male sex.","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 6","pages":"349-58"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20422338","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}

引用次数: 8

[Procalcitonin. A new marker for acute phase reaction in acute pancreatitis]. (原降钙素。急性胰腺炎急性期反应的新标志物[j]。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01 DOI: 10.1007/s004230050081

T Bertsch, A Richter, H Hofheinz, C Böhm, M Hartel, J Aufenanger

{"title":"[Procalcitonin. A new marker for acute phase reaction in acute pancreatitis].","authors":"T Bertsch, A Richter, H Hofheinz, C Böhm, M Hartel, J Aufenanger","doi":"10.1007/s004230050081","DOIUrl":"https://doi.org/10.1007/s004230050081","url":null,"abstract":"Procalcitonin is a protein which is found in elevated concentrations in the blood circulation during systemic bacterial, fungal or protozoal infection. In contrast to classical acute-phase proteins like C-reactive protein or interleukin-6, it is not elevated after operative trauma. In this paper we present current opinions on the assumed induction mechanisms of the protein by cytokines and endotoxin. Furthermore, the clinical value for early detection of systemic infections in abdominal and transplantation surgery is demonstrated by examples from the literature. Our investigation shows that eight patients with necrotizing pancreatitis had a PCT mean value of 6.9 ng/ml on the day of admission. Seven patients with edematous pancreatitis had only a PCT mean value of 0.69 ng/ml. Despite these differences in the mean values, a significant difference between the normal value and the mean value of the group with necrotizing pancreatitis or edematous pancreatitis was not observed due to the wide range of PCT levels in the group of patients with necrotizing pancreatitis. The fact that only a few of the patients had a superinfected necrosis with systemic evasion of bacterias or their toxins may be the reason for this wide range. We suggest that a discrimination between superinfected necrotizing or sterile pancreatitis and edematous pancreatitis by PCT could be possible but more extensive studies with microbiological examination of the necrotic material are required to recognize the subgroups and to establish the real diagnostic efficiency of PCT in clinical practice, especially in the prediction of the outcome of acute pancreatitis.","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 6","pages":"367-72"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20422340","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}

引用次数: 21

[Local effects and changes in wound drainage in the free peritoneal cavity]. 游离腹膜腔伤口引流的局部效应和变化。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01 DOI: 10.1007/s004230050083

R Ernst, C Wiemer, E Rembs, J Friemann, A Theile, K Schäfer, V Zumtobel

{"title":"[Local effects and changes in wound drainage in the free peritoneal cavity].","authors":"R Ernst, C Wiemer, E Rembs, J Friemann, A Theile, K Schäfer, V Zumtobel","doi":"10.1007/s004230050083","DOIUrl":"https://doi.org/10.1007/s004230050083","url":null,"abstract":"In a prospective randomised study 30 mongrel rabbits received two standard colon-resections. Three types of drains were tested: (latex-rubber-) Penrose-drains, rubbertube- and silicontube-drains, which were placed in the lower abdomen. As a closed drainage-system the extraperitoneal tip of the drain was placed in a closed subcutis-pocket. One of the two colon-anastomoses also was drained. The findings were recorded on the 7th postoperative day. A single mechanic alteration was found, an ulcer caused by a silicon-drain, that pushed against the abdominal wall. The other signs of mechanic irritation were microscopically unspecified inflammatory reactions to the foreign body drain. There was no ascending infection caused by the drain. All infections came from complications of the colon resections. In contrast to common opinions the drains in the lower abdomen showed no adhesions to the abdominal wall or organs. Only the entrance of the drain into the peritoneum and the cotton-gaze of Penrose-drains showed in nearly all cases adhesions. The large amount of adhesions to the anastomosis-drains came from complications of the colon-anastomoses. As a cause of material, rubber- and latex-rubber-drains showed large fibrin-clots on their surfaces. 7 days after the operation only about 20% of the drains had sufficient function. The rest was occluded by fibrin-clots in the lumen of the drain or the cotton-gaze. Over all there is no difference in changes and effects of the three different types of drains, but silicon as material showed advantages.","PeriodicalId":17985,"journal":{"name":"Langenbecks Archiv fur Chirurgie","volume":"382 6","pages":"380-92"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20422827","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}

引用次数: 15

[Popliteal artery entrapment syndrome. Case report of an 11-year-old boy]. 腘动脉夹持综合征。11岁男童1例报告]。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01

G Fitze, H Taut, E Rupprecht, D Roesner

引用次数: 0

[Bilateral laparoscopic transperitoneal adrenalectomy in pheochromocytoma]. [双侧腹腔镜经腹膜肾上腺切除术治疗嗜铬细胞瘤]。

Langenbecks Archiv fur Chirurgie Pub Date : 1997-01-01

T Manger, S Piatek, S Klose, D Kopf, D Kunz, H Lehnert, H Lippert

引用次数: 0