[Multimodal approach in coincidence of covered ruptured abdominal aortic aneurysm and aortocaval fistula].

History And Admission Findings: A 71-year-old patient had been referred to our hospital with the diagnosis, made by angio-computed tomography (CTA), of a covered ruptured abdominal aortic aneurysm (AAA) resulting in an aortocaval fistula (ACF).

Investigations: The physical examination revealed macrohematuria and high-output heart failure with increasing circulatory insufficiency.

Diagnosis, Treatment And Course: An open endovascular procedure was not possible because the AAA had extended into both internal iliac arteries.

[Ileus disease].

Intestinal obstruction may be mechanical or non-mechanical (adynamic ileus). Adhesions and external hernias are the most common causes of obstruction in small intestine, whereas carcinoma, sigmoid diverticulitis, and volvulus are the most common causes in large intestine obstruction. Distension of the intestine caused by gas and fluid accumulation in the obstructed segment is the key pathophysiological mechanism initiating ileus with subsequent multiorgan failure and death.

Single-surgeon surgery in laparoscopic colonic resection.

Purpose: Short-term benefits have been demonstrated for laparoscopic-assisted colectomy. However, minimally invasive surgery is still in an evolutionary phase. In demonstrating that robotic devices also are useful in laparoscopic colonic surgery, it is fundamental to prove that a single surgeon can perform almost the entire operation on his own.

ETA and ETB receptor function in pancreatitis-associated microcirculatory failure, inflammation, and parenchymal injury.

The role of endothelin (ET)A and ETB receptor function in experimental pancreatitis is still not fully understood. Using a rat model of sodium taurocholate-induced pancreatitis and intravital microscopy, we therefore studied whether selective inhibition of ETA receptor function or combined ETA and ETB receptor blockade affects the development of pancreatitis-associated microcirculatory failure, inflammation, and parenchymal injury. Pretreatment with 10 mg/kg body wt of a combined ETA/B receptor antagonist, which is thought to mediate a simultaneous inhibition of both receptors, did not attenuate the pancreatitis-induced microcirculatory failure, inflammatory response, and parenchymal tissue injury.

Comparison of surgical stress between laparoscopic and open colonic resections.

Background: The magnitude of surgical trauma after laparoscopic and open colonic resection was evaluated by examining postoperative serum values of interleukin-6 (IL-6), IL-10, C-reactive protein (CRP), and granulocyte elastase (GE) for further evidence of the benefit realized with minimally invasive approaches in colonic surgery.

Methods: Altogether, 42 patients with Crohn's disease (n = 20) or colon carcinomas/adenomas (n = 22) were matched by age, gender, body mass index (BMI), and Crohn's Disease Activity Index for either a laparoscopic (n = 21) or an open colonic resection (n = 21). In both groups the postoperative serum levels of IL-6, IL-10, C-RP, and granulocyte elastase were determined, as indicators of surgical stress.

Microcirculatory derangements in acute pancreatitis.

During the past decade, a considerable number of experimental studies have confirmed the hypothesis that microcirculatory derangements play a pivotal role in the pathogenesis of acute pancreatitis, including the process of conversion from edematous to necrotizing injury. Predominant microcirculatory disorders are nutritive capillary perfusion failure, with the consequence of prolonged focal hypoxia or anoxia, and inflammation-associated microvascular leukocyte recruitment, CD11b- and intercellular adhesion molecule (ICAM)-1-mediated leukocyte-endothelial cell interaction and loss of endothelial integrity, which may result in both edema formation and necrosis. A variety of proinflammatory mediators, such as oxygen radicals, leukotrienes, platelet-activating factor, and interleukins, but also bradykinin and endothelins, seem to be involved in triggering the manifestations of these microcirculatory disorders.

Differential effects of ET-1, ET-2, and ET-3 on pancreatic microcirculation, tissue integrity, and inflammation.

The differential effects of endothelin-1, -2, and -3 (ET-1, ET-2, and ET-3) on pancreatic microcirculation, pancreatic tissue integrity, and an initial inflammatory response, which are three distinct characteristics of acute necrotizing pancreatitis, were investigated in a dose-dependent manner in rats using in vivo microscopy. Red blood cell (RBC) velocity and functional capillary density (FCD) were estimated after topical superfusion of the pancreas with ET-1, ET-2, and ET-3 (100, 10, 1 pmol), revealing that ET-1 (100, 10, 1 pmol) or high ET-2 (100 pmol) and ET-3 (100 pmol) cause a dose-related deterioration of exocrine nutritive pancreatic blood flow. Analysis of pancreatic exocrine tissue damage employing the Spormann score displayed that the ET-mediated microcirculatory impairment was paralleled by dose-dependent tissue damage, which was significant compared to the control group (topical superfusion with 1 ml, saline solution 0.

Temporary pancreatic duct occlusion by ethibloc: cause of microcirculatory shutdown, acute inflammation, and pancreas necrosis.

Temporary obliteration of the pancreatic duct has been suggested to be beneficial in chronic pancreatitis, segmental pancreatic transplantation, and following Roux-Y pancreaticojejunostomy. Little is known, however, as to whether obliteration of the duct alters exocrine pancreatic physiology. Therefore we studied in male inbred Lewis rats the immediate effects of Ethibloc-induced duct obliteration (Ethibloc: Ethicon, Norderstedt, Germany) on pancreatic microcirculation, inflammation, and tissue injury (n = 8), and compared these effects with those caused by experimental pancreatitis (4% sodium taurocholate; n = 8).

ET-1 induces pancreatitis-like microvascular deterioration and acinar cell injury.

Using in vivo microscopy red blood cell (RBC) velocities, functional capillary density (FCD) and capillary diameters were estimated after inducing acute pancreatitis by intraductal infusion of sodium taurocholate (0.8 ml; 4%) or after topical superfusion of the pancreas with ET-1 (100 pmol). Sodium taurocholate mediated a significant decrease in RBC velocities between 50 and 70%, transient decrease in capillary diameters by 10%, and a sustained decrease in FCD between 60 and 70% paralleled by a dramatic heterogeneity in blood flow.

Somatostatin attenuates microcirculatory impairment in acute sodium taurocholate-induced pancreatitis.

Using in vivo microscopy, red blood cell (RBC) velocities, functional capillary density (FCD), and overall changes in capillary blood flow (PI) were estimated following intraductal infusion of sodium taurocholate (0.8 ml; 4%) alone or in combination with systemic administration of somstostatin (single bolus SMS 100 microg/100 g body wt). Sodium taurocholate mediated a significant transient decrease in RBC velocities and a sustained decrease in FCD, which were paralleled by dramatic flow heterogeneity.

Effects of somatostatin (SMS) on pancreatic microcirculation.

The effect of bolus infusion of increasing somatostatin (SMS) concentrations (1, 10, 100, 200 micrograms/100 g body wt) on pancreatic microcirculation and pancreatic tissue PO2 were investigated by using in vivo epifluorescence microscopy and a polarographic PO2 measurement technique. Additionally, the microperfusion of the pancreas, liver, spleen, stomach, and duodenum was measured by a laser Doppler device. Bolus infusion of SMS caused a significant, transient, and dose-dependent decrease in pancreatic capillary RBC velocities (to 50% of baseline) and acinar capillary overall perfusion (to 20% of baseline), which was not caused by a macrocirculatory depression.

Acute pancreatitis in rats: effects of sodium taurocholate, CCK-8, and Sec on pancreatic microcirculation.

With use of in vivo microscopy, pancreatic duct permeability, red blood cell (RBC) velocities, functional capillary density (FCD), and overall changes in capillary blood flow (perfusion index) were estimated after intraductal infusion of sodium taurocholate (0.8 ml, 4%) alone or in combination with systemic administration of cholecystokinin (CCK, 0.3 microg/100 g body wt) or secretin (Sec, 10 microg/100 g body wt).

Comparative effects of secretin (SEC) and cholecystokinin-octapeptide (CCK-8) on pancreatic microcirculation.

Using epifluorescent microscopy, we investigated the dynamic changes in pancreatic microcirculation in vivo after bolus administration of secretin (SEC) (0.1-10.0 micrograms/100 g body wt) and cholecystokinin-octapeptide (CCK-8) (0.

[Technique and quality of laparoscopic hand-sewn intestinal anastomoses in an experimental procedure].

In conventional surgery running suture of all intestine layers is used commonly. Therefore we have tested the following manual running suture technics for laparoscopic surgery using animal experiments. 1.

[Experimental approach to left laparoscopic pancreas resection preserving the spleen].

The pancreas has been excluded from laparoscopic surgery ever since. The technical possibilities of laparoscopic left resection of the pancreas in pigs are examined in this study. Mobilization of the left pancreatic segment up to the confluence area (splenic vein and upper mesenteric vein) was possible preserving the spleen.

Coagulation inhibitors in pulmonary cancer patients.

Pulmonary cancer patients are known to have an elevated risk to suffer from thromboembolic complications. Because hereditary deficiencies of coagulation inhibitors antithrombin III, protein C and protein S are known to cause thromboembolic events it was the aim of our study to search for acquired alterations of these proteins in pulmonary cancer patients. We could demonstrate antithrombin III and protein C to be within the normal range in patients suffering from pulmonary carcinoma.

PGE2 regulates cholecystokinin-octapeptide (CCK-8)-stimulated Cl- conductance in isolated zymogen granules from rat pancreas.

In this study we have examined the effects of prostaglandin E2 (PGE2), the cyclooxygenase inhibitor, indomethacin, and a protein kinase A inhibitor (PKA-I) on the Cl- conductance in isolated zymogen granules (ZG) from cholecystokinin octapeptide (CCK-8) pre-stimulated pancreatic acini. The Cl- conductance in isolated ZG from CCK-8 pre-stimulated rat pancreatic acini increases with increasing CCK-8 concentrations and decreases at supramaximal CCK-8 concentrations. The basal and CCK-8-stimulated Cl- conductance in ZG is inhibited by pretreatment of acini with PGE2 (10(-6) M).

Effects of cholecystokinin, cholecystokinin JMV-180 and GTP analogs on enzyme secretion from permeabilized acini and chloride conductance in isolated zymogen granules of the rat pancreas.

Previous studies have shown that hormonal activation of the Cl- conductance in pancreatic zymogen granules (ZG) is closely related to enzyme secretion from acinar cells. We have now examined the role of guanine nucleotides in stimulated and unstimulated protein secretion from isolated digitonin-permeabilized pancreatic acini and in the Cl- conductance of isolated ZG. Protein secretion from permeabilized isolated acini, measured at 0.