After anterolateral thoracotomy, before incision closure, indwelling plastic catheters were inserted percutaneously under digital and/or visual control into the intercostal space of access and the two neighbouring ones. Initially, we injected 25 mg of bupivacaine through each catheter (to a total of 75 mg), and subsequently - on the patients demand - another 15 to 25 mg per catheter. To date, 25 patients received repetitive intercostal nerve blocks by this method (ICB-group). We compared their personal and perioperative data with those of another 30 patients, receiving opiates systemically after major thoracic surgery (SA-group). Multiple blood samples from the ICB-group were analyzed by gaschromatography for bupivacaine concentration-time-profiles. In 19 of 25 patients (76%) the bupivacaine-injections provided sufficient analgesia, 6 patients required additional analgesics. The duration of general anaesthesia (ICB: 174 min vs. SA: 136 min) and the operation time (ICB: 103 min vs. SA: 94 min) were not statistically different in both groups. The periods of intensive care therapy (ICB: 0.7 d vs. SA: 1.2 d), artificial respiration (ICB: 11.2 h vs. SA: 21.6 h) and hospital stay (ICB: 12.1 d vs. SA: 14.2 d) were shorter for the ICB-group. Atelectasis (ICB: 20% vs. SA: 37%) and pneumonia (ICB: 0 vs. SA: 13%) were observed less frequently than in the control group, whereas tachyarrhythmia occurred in 6 of 25 ICB-patients compared to 4 of 30 SA-patients. Nevertheless, none of these parameters reached statistical significance (p less than 0.05). Maximum bupivacaine levels of 0.65 +/- 0.21 micrograms/ml were found after 29 +/- 12 min of intercostal application.(ABSTRACT TRUNCATED AT 250 WORDS)
During 3 years, the adjustable gastric band (AGSB) was laparoscopically implanted in 224 of 873 patients with morbid obesity. The operation was done by 7 surgeons. Problems arising from the operative technique are: early pouch dilatation, gastric slippage, gastric perforation, penetration of the band, port infection, penetration of the port, defect of the band catheter. These can be avoided by care and increasing experience. The late pouch dilatation and the insufficient loss of excess weight arise from the unsatisfactory compliance of the patient. Critical selection of patients is necessary. Total morbidity in this seria was 19%, the letality 0.4% and the average excess weight loss within 2 years was 50 +/- 28%. The results may be improved by restrictive selection of patients and great operative routine.
Animal experiments in dogs were performed in order to measure oxygen tension in the gastric fundus. For this purpose an intravasal oxygen catheter electrode was inserted into the gastric submucosa. The probe recorded pO2 in an area about 2 cm in length. The oxygen tension was measured in relation to the respective blood supply of stomach. The method is suitable for determining the tendency of oxygen supply of the tissue intraoperatively as well as after implantation postoperatively. The clinical interpretation of the trend of pO2-measurements depends on further experiences.
A morphologic study of the duodenal papilla was performed by laminations in three planes. The muscle system reveals that there are no autonomic sphincters, but muscle bundles deriving from duodenal longitudinal and circular muscle layers, interdigitating and acting for opening of the papillary mouth. Activity results from myogenous rhythmic contractions of smooth muscle cells, stimulated by the ductal hydrostatic pressure, and from the duodenal peristalsis. The closure of the papilla is weak, incomplete and achieved by the oblique entrance of the duct. Interpretation of functional analysis and procedures of treatment should be based upon the knowledge of normal morphology of the papilla.
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