Pankreas annulare

Zusammenfassung Mitteilung über 4 operierte F?lle von Pankreas annulare aus dem eigenen Krankengut. In 2 neonatalen F?llen mit dem Bild der Duodenalatresie konnte durch Duodenoduodenostomie eine Heilung erzielt werden. Auf die Wichtigkeit der rechtzeitigen Diagnosestellung wird hingewiesen. In 2 F?llen bei Erwachsenen waren Schmerzen, Erbrechen und Gewichtsverlust die wichtigsten Symptome. Die Diagnose wurde trotz mehrfacher vorangegangener Operationen und zahlreicher Voruntersuchungen erst nach Jahren gestellt. Zur Behandlung kam einmal die Duodenoduodenostomie, einmal die Duodenopankreatektomie erfolgreich zur Anwendung.

---

Summary This is a report on 4 operated cases of annular pancreas. In 2 neonatal cases this condition presented symptoms of a complete duodenal obstruction. Duodenoduodenostomy and temporary gastric decompression by gastrostomy was performed in both cases and has proved to be satisfactory. The importance of an early diagnosis has been emphasized. In 2 adult cases the most pronounced symptoms were pain, vomiting and loss of weight. In spite of several previous operations of the abdomen and frequent examinations the correct diagnosis was not made for years. One case was treated successfully by duodenoduodenostomy, in the second case because of pancreatic fibrosis a duodenopancreatectomy was necessary.

     

Ein Catgutfaden als Ursache einer Gallensteinbildung nach transduodenaler Papillenspaltung

Zusammenfassung Es wird über einen Fall berichtet, bei dem es durch Inkrustation eines Catgutfadens zur Gallensteinbildung in den tiefen Gallenwegen gekommen war.

---

Summary We report on a case in which incrustation of a plain catgut thread caused the formation of a gallstone in the common bile duct.

     

Endarterektomie mit Ultraschall

Zusammenfassung Die Wirksamkeit des Ultraschalles zur Endarterektomie wurde bei der offenen Aussch?lung von Leichenaorten überprüft. Ultraschall hat gegenüber konventionellen Aussch?lmethoden wesentliche Vorteile. Die Aussch?lwirkung des Ultraschalles beruht nicht auf einem Vibrationseffekt, sondern auf der Kavitation, die Ultraschall in der Aussch?lebene hervorruft.     

Die Bedeutung der Süchtigkeit für die Indikationsstellung zu schmerzchirurgischen Eingriffen

Zusammenfassung Die Medikamentensucht ist eine schwere Erkrankung, die sowohl den postoperativen Verlauf als auch das Ergebnis schmerzchirurgischer Eingriffe beeinflussen kann. Eine Nachuntersuchung von 136 Chordotomien, darunter waren auch 30 süchtige Patienten, ergab, da? beide Gruppen wohl die im wesentlichen gleiche Aussicht haben, durch den Eingriff schmerzfrei zu werden, jedoch ist die Zahl der Mi?erfolge in der Gruppe der süchtigen Patienten au?erordentlich hoch. Die Süchtigkeit ist unseres Erachtens keine absolute Kontraindikation zu einer Chordotomie, mu? jedoch als ein erh?htes Operationsrisiko berücksichtigt werden. Vor der beabsichtigten Operation sollte bekannt sein, da? der Patient süchtig ist und die „stabilisierende Dosis” des Suchtgiftes sollte ermittelt werden, die in der Lage ist, das Auftreten des Abstinenz-Syndroms zu verhindern. Vegetative St?rungen, Stoffwechselst?rungen, St?rungen im Flüssigkeitshaushalt sowie eine Unterern?hrung, die bei Suchtkranken, auftreten k?nnen, müssen pr?operativ entsprechend behandelt werden. Im Hinblick auf die Suchtgef?hrdung bei Patienten, die an starken chronischen Schmerzen leiden, sollte man sich frühzeitig zu einer Chordotomie entschlie?en.

---

Summary Drug addiction is a grave disease which may influence the postoperative course as well as the result of cordotomies. An examination of 136 cordotomies, including 30 patients with drug addiction, showed that both groups had essentially the same chance to be relieved from their pains, that however, the number of failures was especially high in the group of drug addicts. The preexistence of drug addiction is not necessarily a contraindication for cordotomy, it should however be considered as a greater risk for an operation. Before a cordotomy it should be known that the patient is a drug addict, furthermore it is necessary to find out the „stabilizing dose” of the drug which may prevent an abstinence-syndrom. The manifold disturbances (vegetative, fluid-balance, malnourishment and metabolism) which may occur with drug addicts, have to be treated accordingly before the planned operation. In view of the fact that patients suffering from severe chronical pain, may likely become drug-addicted, one should decide to make a cordotomy at an early sage.

---

---

Nach einem Vortrag am Neurochirurgischen Diskussionstag, 26. Oktober 1968, Salzburg.     

An assessment of a new reminder therapy technique for ceasing digit sucking habits in children

Twenty-one digit-sucker children aged 4-12 old years participated in the assessment of a new reminder therapy technique called "long sleeve sleeping gown ". The result of this study indicated that fifteen children (71.4%) out of 21 were able to stop digit-sucking habits after the application of long sleeve's gown during child's bedtime for 6 weeks. The children who failed to cease this digit-sucking habit (28.6%) were found to not accept to complete the trial period or their mothers thought that they were too young to stop the habit. Among the success group no child was reported to return to digit-sucking 3 months after implementation of long sleeves gown.     

Raising urinary citrate lowers calcium oxalate and calcium phosphate crystal formation in whole urine

Crystal formation in whole urine was studied by the technique of rapid evaporation to 1,250 mosmol/l with and without raising citrate concentration by 40-50%. The added citrate reduced calcium oxalate crystal formation at pH 5.3 by about 25% and reduced calcium phosphate crystal formation at pH 6.8 by some 42%. These results support the view that citrate is important in maintaining calcium in solution in whole urine, and that raising the urinary citrate could be effective treatment for calcium oxalate/phosphate urolithiasis.     

Severe CD8 deficiency in a child with miliary tuberculosis

This report described a 6-month-old boy who presented with miliary tuberculosis and severe CD8 deficiency, which is most likely secondary to miliary tuberculosis since his CD8 was back to normal 6 month after therapy and primary CD8 deficiency, (ZAP 70 defect) was ruled out. To our knowledge this is the first paediatric case reported with severe CD8 deficiency secondary to miliary TB.     

Islet Transplantation in Patients with Diabetes Mellitus

Islet transplantation offers patients with type 1 diabetes mellitus freedom from long-term insulin therapy and a degree of metabolic control that is far superior to injected insulin. The hope is that near-perfect glucose control sustained over time will prevent progression of secondary diabetic complications. The selection of optimal immunosuppressive agents for islet transplantation has been a formidable challenge, given the need to overcome both autoimmune and alloimmune barriers, as well as the potential toxicity of immunosuppressive agents on transplanted islets. Early strategies relied on protocols that had proven success in solid organ transplantation and consisted of azathioprine, cyclosporine and corticosteroids. Under these protocols, fewer than 10% of patients were able to achieve insulin independence. The development of the 'Edmonton Protocol' dramatically transformed clinical outcomes in islet transplantation in recent years through the introduction of a more potent, less diabetogenic, and corticosteroid-free immunosuppressive regimen consisting of sirolimus, low-dose tacrolimus, and induction anti-interleukin-2 receptor antibody. While insulin independence rates under this protocol have been highly successful, patients must be maintained on lifelong immunosuppression. While the risk of malignancy, post-transplant lymphoma and sepsis have been low and diminishing in transplanted patients to date, fears of these complications and a host of drug-related adverse effects have precluded broader application. Patients undergoing islet transplantation today must exchange insulin for chronic immunosuppressive therapy, and therefore the procedure can only be justified in patients with very unstable forms of diabetes, or in those with another solid organ allograft who already endure the risks of immunosuppression. Advances in more specific and less toxic immunosuppressive agents together with progress in better understanding the biology of diabetes will lead to more suitable strategies to control both alloimmune and recurrent autoimmune reactions. These protocols, ultimately aimed at establishing tolerance, are an essential pre-requisite to move towards providing islet transplantation earlier in the course of the disease, including transplantation in children. This review addresses the evolution of immunosuppressive strategies in islet transplantation, and highlights some novel agents in pre-clinical development or in early clinical trials that may offer considerable promise in facilitating the induction of tolerance.