Pathophysiological and clinical aspects of the CO2 pneumoperitoneum (CO2-PP).

Experimental studies demonstrated a severe cardiac load of the CO2 pneumoperitoneum caused by an accelerated after- and a decreased preload. Patients displaying cardiovascular risks are therefore often rejected from laparoscopic surgery. Hence, the pathophysiological changes and the intraoperative risk of the CO2 pneumoperitoneum in high-risk cardiopulmonary patients (NYHA II-III, n = 15) undergoing laparoscopic cholecystectomy are described.

[Significant value and therapeutic implications of routine gastroscopy before cholecystectomy].

Endoscopy of the upper digestive tract was performed in 338 consecutive patients undergoing cholecystectomy between January 1991 and December 1992. Pathological findings were seen in 160 (47.3%), 6.

Human galanin modulates human colonic motility in vitro. Characterization of structural requirements.

Background: Human galanin (hGal) is a 30-residue non-amidated gut-brain peptide that shows considerable sequence divergence compared with galanin (Gal) forms of other species. Conflicting results have been reported with regard to the structural requirements for its modulatory action on gut motility.

Methods: We investigated the effect of human and rat Gal and substituted analogues of Gal on the contractility of longitudinal muscle strips of the human colon in vitro.

A novel technique for long-term vascular access in the unrestrained rat.

A new system for long-term vascular access in the unrestrained rat (n = 380) is described that combines low cost with high reliability and free movement. It consists of a polyurethane catheter that is placed in the right atrium via the external jugular vein. A leather harness is applied to the animal and the catheter passed subcutaneously to the neck into the harness.

[Recurrent calculus ileus of the small bowel. A diagnostic problem].

Occlusion of the lumen by gallstones must be considered a rare cause of small bowel ileus; diagnosis and clinical symptoms have only sporadically been reported. The present paper shows that, in addition to gallstones, coproliths may also cause small bowel ileus, giving rise to identical clinical symptoms. For this reason, pre-operative diagnostic work-up should differentiate concretions in gallbladder and small bowel with respect to size, shape, consistency and X-ray contrast.

Randomized comparison of endoscopic palliation of malignant esophageal stenoses.

In a randomized study, palliative therapy of malignant esophageal and gastric stenosis was investigated by a comparison of endoscopic laser therapy (ELT) with palliative endoscopic perturbation (PEP). A total of 124 patients exhibiting a malignant stenosis in the esophagus and proximal stomach were referred to our unit between January 1, 1987, and March 31, 1990. Criteria for randomization were: (1) inoperable malignant stenosis, (2) dysphagia enabling the ingestion of semi-solid food, (3) the possibility of performing ELT and PEP, and (4) the absence of fistula formation.

Deep anterior resection with circular stapled anastomosis of congenital megacolon: clinical results.

This report deals with instrumental suture in the deep anterior rectum resection when treating Hirschsprung's disease. The concept includes: ensuring diagnosis, cleaning the intestines, antibiotic prophylaxis, intraoperative testing of the anastomosis and postoperative X-ray by a standardized technique. Our first experience in the use of the stapler was gained with ten patients.

[Esophageal tube in inoperable esophageal and cardia cancer: indications and technique].

Endoscopic tube implantation remains still one of the alternatives in palliation of inoperable patients with malignant stenosis of the esophagus and cardia. Although LASER-treatment has less complications, patients in poor general condition, patients with tracheo-esophageal fistulas, patients with external compression of the esophageal lumen, are clear indications for tube implantation. The right choice of palliative technique should depend on the individual situation of the patient.

[Endoscopic removal of an ingested foreign body--indications and choice of procedure].

The majority of ingested foreign bodies does not cause problems for the patients and leaves the gastrointestinal tract spontaneously without complications. However the low risk of modern fiberendoscopy allows a safe approach of endoscopic extraction. In children and all other cases, where general anesthesia is required for the extraction procedure, indication for endoscopic extraction should be limited.

Direct immunostaining of TSH receptor related autoantibodies in Graves' disease.

Ten thyroid specimens from patients with Graves' disease were investigated immunohistologically with respect to the localisation of thyrotropin (TSH) receptor related autoantibodies. After conventional preparation of formalin-fixed and paraffin-embedded thyroid slices for immunostaining, 3-5 micron tissue sections were incubated with a porcine thyrotropin receptor containing membrane preparation (pTSH-R). The TSH receptor containing membrane fragments bound to the thyroid tissue were revealed with a slightly modified unlabelled PAP technique according to Sternberger, using an antiserum to pTSH-R obtained from immunized rabbits.

Evidence of autoimmune pathogenesis in autonomous thyroid adenoma.

Using an immunohistochemical attempt to immunostain thyroid related autoantibodies, 30 specimens of autonomous adenomas of the thyroid were investigated. Twelve out of 23 inflammatory infiltrates surrounding the 'hot' nodules contained plasma cells, which gave a positive staining reaction for thyroid related autoantibodies. Seven adenomas showed no significant lymphoplasmacellular infiltration.

[Ulceration of large leiomyoma of the stomach].

Two case reports are given of patients harboring big gastric leiomyoma with central ulceration. X-ray, endoscopic and intraoperative findings are described; the surgical procedure is discussed.

[Hemorrhage of esophageal varices in child B and C patients. Results of sclerosing therapy].

In a 3-years period 51 patients with acute bleeding oesophageal varices with Child-stadium B and C were admitted to our department. Endoscopic sclerosing therapy was performed during emergency endoscopy. --The analysis of these patients indicates, that unsuccessful conservative treatment before endoscopic sclerosing therapy has a negative influence on the outcome of our patients.

[The injection method for hemostasis in gastroduodenal lesions. Indications and possibilities].

Endoscopic injection of polidocanol was used in a prospective study of 88 patients with gastroduodenal bleeding. Active bleeding by injecting polidocanol (1%) in 54 patients achieved initial haemostasis in 51 (94%); lasting arrest of bleeding was achieved in 39 (72%). This injection treatment was also used to prevent recurrence of bleeding where there had been signs of previous bleeding: this proved successful in 25 of 34 patients (74%).

[The concept of endoscopy-related therapy in gastroduodenal ulcer hemorrhage].

In a prospective study a new therapeutic concept was tested on 76 patients with bleeding gastroduodenal ulcers. During emergency endoscopic an exact inspection of the ulcercrater helped to determine the possibility of recurrent bleeding of the ulcer. This possibility was expressed in a modified Forrest-classification.