Langenbecks Archiv für Chirurgie
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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.
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Langenbecks Arch Chir · Jan 1983
[Ulcer risk caused by reflux prevention? Results of jejunal interposition].
The results of isoperistaltic jejunal interposition in reconstructive ulcer surgery are demonstrated on the basis of 62 patients, operated one and a half to nine years ago. The operations had been done because of dumping, reflux gastritis and afferent loop syndrome. Now 38 (65.5%) of the followed-up patients had a Visick I or II grading, 16 (27.5%) were Visick III. ⋯ The parallelity of reflux preventive ulcer surgery and the ulcer provocation by the Mann-Williamson experiment is demonstrated. Therefore reflux preventive surgery should be used very carefully and in reconstructive procedures only. Using the jejunal interposition the segment should not be longer than 12--15 cm and a vagotomy has always to be added.
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Langenbecks Arch Chir · Jan 1982
Comparative Study[Advantages and disadvantages of regional anesthesia in comparison with general anesthesia].
The advantages and disadvantages of different anaesthetic techniques are based upon important premises, such as specific effects on the vital functions of the organism, the relationship of these effects to the general condition of the patient, the specific risk of complications due to a particular anaesthetic technique and the decision of the patient. Only with these points in mind can advantages and disadvantages of the different anaesthetic techniques be determined respective to the individual cases. The choice of a suitable anaesthetic technique should depend upon this determination.
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Langenbecks Arch Chir · Jan 1982
[Catheter epidural analgesia for treatment of postoperative and post-traumatic pain].
Postoperative epidural local anesthetics or opiates provide excellent analgesia but do not reduce the incidence of respiratory complications compared with systemic analgesics. Additional and sometimes lethal side effects reserve the routine use of epidural analgesia for highly selected patients. ⋯ TEA results in fewer pulmonary complications, shorter hospital stay, and lower mortality than artificial respiration. Late global pulmonary tests after TEA for treatment of SRF show normal results within comparable groups without rib fractures.