Langenbecks Archiv für Chirurgie
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Langenbecks Arch Chir · Jan 1984
[Psychiatric stress tolerance of acute and chronic surgical patients].
The surgical patient is subjected to psychological stress through fear of pain, operation, anesthesia and finally death. The exact definition of psychic stress and the patient's resistance to it is even more problematic than the definition of somatic stress. It is the doctor's task to alleviate the psychic stress of the patient, to instill confidence and to recognise the limits of his resistance and finally to take all this into consideration in planning his treatment.
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In experiments with dogs the influence of controlled respiration with positive endexpiratory pressure (PEEP) on the pancreas was investigated. The pO2 within the tissue was measured during the time of respiration. At PEEP 10 and PEEP 20 an average diminution was observed in the tissue pO2 of 27% and 37%, respectively. ⋯ After 24 h there were small changes of the enzyme activities in the serum at PEEP 10, whereas at PEEP 20 they were remarkably increased. These results demonstrate that PEEP 20 causes a shortage of oxygen supply of the pancreas. This shortage in connection with an edema can provoke an acute pancreatitis.
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The ulcer risk of the Roux-Y anastomosis following gastric resection was analyzed experimentally in 82 rats. After 1/3 gastric resection a Roux-Y gastrojejunostomy with jejunal loops of 3, 6, 9 and 15 cm was performed. 10 months postoperatively a follow-up was performed consisting of endoscopy, measurement of pH-values, analysis of gastric secretion and serum gastrin, gastric emptying tests and histamine stimulation. Endoscopically there was a high rate of stomal ulceration related to the length of the jejunal loop. ⋯ Gastric acid secretion unbuffered by duodenal content is discussed as the major factor in the etiology of stomal ulcer in reflux-free stomachs. So the Roux-Y anastomosis following gastric resection is a modification of the Mann-Williamson experiment. Therefore reflux-free operations are heavily ulcer prone.