Vegetative Reaktionen nach Sympathicus-Operationen

Ohne Zusammenfassung     

72. Physiologische Aspekte der postoperativen Kontinenz nach ileo-analer Anastomose mit und ohne intrapelvinem Reservoir

Zusammenfassung Es wird über 6 Patienten mit ileoanaler Anastomose berichtet, die klinisch und elektromanometrisch 4 bis 12 Jahre nach der Operation nachuntersucht wurden. Die Ergebnisse werden mit elektromyographischen und motilitätsphysiologischen Ergebnissen in der Literatur verglichen. Dabei zeigt sich, dass es sowohl nach der ileoanalen wie nach Pouch-analen Anastomose zu einer Verzögerung der Peristaltik mit zunehmender Compliance und Abnahme der Stuhlfrequenz kommen kann. Bei beiden Verfahren persistieren jedoch hochamplitudige Kontraktionswellen im Bereich des distalen Dünndarmabschnittes, die tagsüber von dem Patienten durch zusätzliche Willkürkontraktionen aufgefangen, nachts jedoch im Schlaf zu unkontrollierten Stuhlabgängen führen können. Die myoelektrische Aktivität wird auch bei anisoperistaltischen Reservoiren auf Dauer nicht verändert, die verbesserte Compliance bei tiefen Pouch-Anastomosen führt jedoch im allgemeinen zu einem günstigeren Kontinenzergebnis als bei ileoanalen Anastomosen.     

Endokrine Reaktionen nach S-(+)-Ketamin

Anaesthetics, endocrine system, and stress The effects of anaesthetics on the nervous system are invariably associated with endocrine reactions, which are of great importance for the general characterization of anaesthetics or anaesthetic regimens. In this context, the endocrine stress response is mainly represented by adrenaline (A), noradrenaline (NA), antidiuretic hormone/vasopressin (ADH), adrenocorticotropic hormone (ACTH), and cortisol. Pharmacological profile and anaesthetic action of ketamine The pharmacological profile of ketamine is characterized by the term ”dissociative anaesthesia”. At the present time, the anaesthetic action of ketamine cannot be explained by a single mechanism. Its overall action might be due to different central and peripheral factors, and stereospecific effects are obvious. Endocrine responses to racemic ketamine and S(+)-ketamine In contrast to stereospecific differences in the anaesthetic action of racemic ketamine and S-(+)-ketamine, the endocrine reactions to the S-(+) isomer and the racemic mixture are very similar. When S(+)-ketamine is used as the sole anaesthetic, significant activation of the sympathoadrenergic system with increases in plasma levels of A and NA can be observed. This effect is mitigated by midazolam. In combination with propofol, sympathoadrenergic responsiveness is preserved without overwhelming effects. In contrast to monoanaesthesia with S(+)-ketamine, during combination with midazolam and propofol significant increases in plasma ADH levels are observed, which might be due to suppressed sympathoadrenergic reactivity. In addition, surgical stress activates the pituitary-adrenocortical system with increases in ACTH and cortisol. Effects of midazolam and propofol on this effect are similar. Synopsis and clinical aspects S-(+)-ketamine as a monoanaesthetic has significant sympathomimetic properties, which are beneficial during induction of patients in shock and patients with asthma. The combination of S-(+)-ketamine and midazolam has weaker sympathomimetic and general endocrine-stimulating properties, and can be used for analgosedation in patients with cardiovascular instability and exogenous catecholamine requirements. In combination with propofol, the sympathomimetic and general endocrine-stimulating effects of S-(+)-ketamine are less pronounced because of contrasting properties of both drugs. This combination might be useful in patients with endocrine deficits and for analgosedation, when rapid recovery is necessary and negative circulatory effects should be avoided.     

34. Physiologische Operationen in der Ulcuschirurgie

Ohne Zusammenfassung     

Aufwachverhalten und psychomimetische Reaktionen nach S-(+)-Ketamin

Die Anaesthesiologie - Ketamin ist ein Razemat, dessen Isomere S-(+)- und R-(−)-Ketamin ein Äquipotenzverhältnis von etwa 4:1 aufweisen. Früher wurde spekuliert, daß...     

Reoperationen nach der Fundoplicatio nach Nissen

Zusammenfassung 1. Die Ursachen der unbefriedigenden Ergebnisse der Operation der Fundoplikation nach Nissen sind in der Regel durch taktische und technische Fehler zu erklären. 2. Die Fixation des Magens zum Zwerchfell ist eine Ursache der Entstehung des Schmerzsyndroms, des TeleskopPhänomens, des teilweisen oder vollständigen Auseinanderweichens der Fundoplikationsmanschette mit nachfolgender Entwicklung eines Rezidivs der Refluxoesophagitis. 3. Die Fundoplicatio sollte in Kliniken durchgeführt werden, die Erfahrung mit Eingriffen an der Speiseröhre und am Magen haben. 4. Die Fundoplikationsmanschette muß man aus zwei Wänden (des vorderen und des hinteren) Magens nach der breiten Mobilisation des Kardiabereiches mit der obligatorischen Fixation der Manschette zur Speiseröhre bilden, die ermöglicht, Komplikationen wie Schmerzsyndrom, Abgleiten der Manschette, Rezidive der Refluxoesophagitis zu vermeiden.

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Reoperations after nissen fundoplication

Summary 1. The main causes of unsatisfactory results after Nissen fundoplication can usually be explained by tactical and technical mistakes. 2. The fixation of the stomach to the diaphragm is one case of the development of pain syndrome, telescopic phenomenon and relative or complete dispersion of fundoplication with subsequent development of a recurrent reflux oesophagitis. 3. The fundoplication should be done only in hospitals which have experience in oesophageal and gastric surgery. 4. The collar of fundoplication should be formed with the two sides (the anterior and the posterior) of the stomach after extensive mobilisation of the cardia region. The operation includes the obligatory fixation of the collar to the oesophagus in order to avoid complications like pain syndrome, sliding of the collar and recurrent reflux oesophagitis.

     

Nr. 90. Physiologische Methoden der Wundbehandlung im Feldlazarett

Ohne Zusammenfassung (Mit 3 Kurven.) Anregung und Material zu folgender Arbeit verdanke ich Herrn Stabsarzt d. L. Professor Dr. Fritz H?rtel (Halle a. d. Saale), z. Zt. Chirurg eines Feldlazaretts der Westfront.     

Neue Strategie zur Erfassung intradermaler Reaktionen nach Implantation resorbierbarer Dermalfiller

Purpose

Our investigations were aimed at early histopathological detection of intradermal reactions following implantation of various resorbable dermal fillers. The main interest was to develop a new strategy that will contribute to the quality assurance of dermal fillers and will put a new perspective on histological examinations in human skin.

Patients, material and methods

Four patients who were scheduled for excision of abdominal fat aprons were recruited. At 30 days prior to surgery, 11 different resorbable dermal fillers (0.2 ml) were injected into the abdominal skin (both left and right) of each patient. In three patients, 12 skin biopsies per patient were taken from the designated skin areas on days 14 (left side) and 30 (right side) post injection. In one patient, biopsies were already obtained 4 h after the injections. In all, 71 samples were transferred to a pathology laboratory, where they were analysed, stained with three different stains and submitted to light-microscopy and polarized light.

Results

Our results are the first to show a histomorphological reaction free of inflammation for two hyaluronic-acid fillers, Belotero Basic and Belotero Intense. The findings for both products showed the merest hint of immunological reactions and the most homogenous distribution in the tissue. In contrast to these results, 9 of 11 resorbable dermal fillers provoked a pathological immunological response with varying degrees of chronic inflammation at the injection sites and mostly irregular, sometimes nodular distribution of the material. It is reasonable to assume that fillers that provoke lesser immunological reactions will be more biocompatible than substances, which cause chronic inflammatory responses.

Conclusion

To our knowledge, we are the first to evaluate skin reactions to injections of dermal fillers into the skin of human fat aprons in humans in vivo, using histopathological methods. The new strategy facilitates early detection of potential inflammatory responses to dermal fillers, offers a high degree of protection for probands and contributes significantly to the quality monitoring of dermal fillers. The early detection of intradermal reactions seems a relevant criterion for differentiation of filling materials with a new perspective on the relevance of early histological analyses.     

Zur Behandlung der postoperativen Reaktionen des Basedowkranken

Zusammenfassung Ausgehend von der Annahme, da? hohe Kalkdosen auf das krankhaft erregte vegetative Nervensystem des Basedowikers beruhigend einwirken k?nnen, wird die Einverleibung gro?er Kalkmengen (i.v. und i.m.) bei genuinen Basedowkranken pr?operativ und zur Milderung der oft schweren postoperativen Reaktionen empfohlen. Die beim Basedow bestehende Kalkverarmung, die m?glicherweise auch z. T. an den postoperativen St?rungen mitverantwortlich sein mag, kann durch die Verabreichung hoher Kalkdosen günstig beeinflu?t werden. Diese Kalksto?behandlung ist in den F?llen zu versuchen, die auf Lugolisierung schlecht oder gar nicht ansprechen.     

Druckschaden der Haut nach Herzoperation

Decubitus after open heart surgery Abstract A case of a sacral decubitus after open heart surgery is presented, which increased by a secondary sternal dehiscence. A final healing was achieved only after five months. A malpractice claim is denied.     

Salvagestrategien nach Komplikationen der Hypospadiechirurgie

The complication rate of hypospadias repair still ranges between 20 and 30%, although operative skills and technical devices have improved. Different aspects like dressing are important for prevention of complications.Early complications are bleeding, hematoma, and infection. Late complications are fistulas, meatal stenosis, partial and complete breakdown, persisting curvature, a hairy urethra, and hypospadias cripples. Detailed preoperative diagnostics are important. There are several operative techniques that can be used for repair including the use of mesh graft or foreign material. Two or multiple stages are often needed. The surgery to correct complications after hypospadias repair is a challenge, which should only be done by an experienced surgeon.     

Langzeitergebnisse der Nabelhernienreparation nach Spitzy

A total of 140 patients presenting with umbilical hernia underwent Spitzy's operation and were included in a retrospective study to analyse the recurrence rate.The patients received a questionnaire and were invited for a physical examination including ultrasound. Participation included 108 patients (follow-up 77%). A total of seven patients (6.5%) developed postoperative wound infections.Prolonged postoperative impairment was mentioned by nine patients (8.3%). After a mean period of 16 days, the patients were able to continue their occupation, and after 27 days, they could manage their usual physical activity. The recurrence rate was 13.0%.The risk for a recurrence correlated with the relative bodyweight. In the group with a body-mass-index (BMI) of less than 30, the recurrence rate was 8.1 %, whereas 31.8% of the patients with a BMI of more than 30 developed a recurrent hernia.The size of the hernial orifice also had an influence on the postoperative result. In patients with a hernial gap smaller than 1 cm the recurrence rate was 6.3%, with hernia orifices from 1 to 2 cm the rate was 4.1%, from 2 to 3 cm 14.3%, from 3 to 4 cm 25.0% and in patients with hernial gaps greater than 4 cm the rate of recurrences was 54.5%. Considering these results,we recommend the use of alloplastic material for umbilical hernia repair for patients with a BMI greater than 30.0 and hernia orifice larger than 3 cm. The decision for use of a mesh in hernial gaps from 2 to 3 cm should depend on individual factors.