Endoscopic placement of a naso-vesicular catheter was successful in 90% (45/50) of patients with cholecystolithiasis. The first 7 patients were treated by MTBE dissolution alone. Dissolution was discontinued after a maximum of 14 days, as only two patients were rendered stone free. In one patient, 3 tiny pigment stones were sucked out through the catheter, and in another inoperable patient a pigtail endoprosthesis was finally inserted into the gallbladder. In the remaining 36 patients, combined ESWL and MTBE dissolution therapy was carried out. Treatment was broken off by one patient after one week, and interrupted in another due to catheter dislodgement. After an average of 10 days with 1-9 ESWL sessions (average: 3) complete stone clearance was achieved in 60% (20/34) of patients. Fourteen of the patients who completed treatment, and the one with catheter dislodgement still have sludge in the gallbladder, which is being treated with oral bile acids. The procedure-related complication rate was 10% (3 pancreatitis, 1 cystic duct perforation and 1 guidewire impaction). The mortality rate was zero. There was no evident complication due to either ESWL or MTBE dissolution.
Eleven patients who had had total pancreatic resection had hyperglycaemia (16.8 +/- 7.7 mmol/1 corresponding to 3.02 +/- 1.38 g/l) after fasting for 14 or 36 hours. After arginine stimulation there was no evidence for pancreatic glucagon. These findings indicate that (1) in man there are no sites of pancreatic glucagon production outside of the (resected) pancreas; (2) marked hyperglycaemia may occur without glucagon.
Stress ulcer means an acute mucosal lesion of the upper gastrointestinal tract in sick patients, who have not had gastroduodenal ulcer before. Most often stress ulcers follow big operations, burns and different types of shock. Complications as respiratory insufficiency, paralytic ileus or infections favor the ulcer formation. The average age is 53 years, males are more often affected. The main localisation is the proximal stomach, less frequently the lesions are located in the duodenum and terminal oesophagus. The macroscopic type is an erosion or a superficial ulceration, a solitary ulcer is typically situated in the duodenum. From the view of pathogenesis three factors are mainly involved: hydrochlorid acid, a disturbance of microcirculation due to shock and a duodenogastric reflux of bile acids and lysolecithin. Most frequent symptom is upper gastrointestinal bleeding, but more than 50% are symptomless. Medical treatment is successful in 60-70%. The surgical treatment of choise is vagotomy in combination with circular sature or resection. Prevention of shock or respiratory insufficiency, permanent gastric suction, early food administration and intragastral application of antacids and cholestyramin are the essentials of stress ulcer prophylaxis.Key words: Stress ulcer -Acute gastric mucosal lesion (AGML) -Gastric mucosal barrier-shock.Lange Zeit wurde vermutet, dab Stressulcerationen mit einer Hypersekretion ein-
A discussion of prospects suffers from the fact that preduction of the future must be based on current modes of thinking. However, without prospects, i.e., without rational planning, the individual is left to chance. Reasoning governs the careful estimation of prospects and is applied to the following areas of interest: The importance of history in surgery, the necessity of supervised studies, operative training, instructing young surgeons, rotation, assessment of position, anthropologic nosology and surgical consequences, assistance in decisions about surgical work, the kind and function of linguistics in medicine and surgery, and the relationships between surgical colleagues.
So called "classical" methods for vagotomy found an additional supplement in supraselective vagotomy. This procedure is restricted exclusively to a very subtile bilateral proximal selective gastral vagotomy. Additional drainage operation or partial gastrectomy are avoided. This paper deals with indication, eontraindication and premises. Inspite of fair short time results, at present supraselective vagotomy can't be recommended to general application.14"
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