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A Kroesen

Publications and source records attributed to A Kroesen.

5 recordsLinked to original sources
PubMed2003

[Hemoperitoneum after early abortion of an abdominal pregnancy--reduced therapeutic options in case of delayed diagnosis].

BACKGROUND: Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious patients in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management. CASE: A 30- year-old woman (II-gravida, I-para) suffering for about 18 hours from "upper abdominal pain" was found in somnolent and in reduced conditions by her relatives. Unconscious and with all signs of a hemorrhagic shock, she was transferred to the emergency department of the UKBF. After stabilization of circulation, a diagnostic laparoscopy has been performed with the finding of about 2000 ml of coagulated and fresh blood, but without the confirmation of a extrauterine pregnancy (EUP): the small pelvis and his organs were without any signs of EUP. The laparoscopic approach has been changed into a secondary median laparotomy. After exclusion of other reasons for a intraabdominal bleeding (such as spleen rupture or gastrointestinal bleeding), and the complete removal of all intraabdominal blood clots, a embryo, his placenta and the place of placental insertion has been found in the mesenterium jejuni. The surgical procedure was finished in the usual way. The postoperative healing process was uncomplicated. CONCLUSIONS: Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between placenta and fallopian tubes or ovaries, resp., but definitive insertion of the placenta in the distant peritoneum. In woman in their reproductive age suffering from intraabdominal bleeding, the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient patients history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the early abortion of a abdominal pregnancy has to be made by open surgery.

Abdominal Pain↗
PubMed1999

Does microcirculation play a role in the pathogenesis of inflammatory bowel diseases? Answers from intravital microscopic studies in animal models.

The potential role of intestinal microcirculation for the development of inflammatory bowel diseases (IBD) has not been systematically investigated, mainly because of methodological problems. Using a well-established rodent model of IBD and intravital microscopy, the present study investigated whether (and when) gut microcirculation is disturbed in IBD, and whether microcirculatory disorders contribute to histological and functional alterations in the development of IBD. Colitis was induced by rectal injection of trinitrobenzene sulfonic acid. After 1, 3, and 15 days rats were laparotomized for intravital microscopic determination of mucosal colonic blood flow. In a second series it was examined whether enhancing colonic capillary blood flow by hemodilution therapy stabilizes colonic wall resistance and other electrophysiological parameters of gut permeability. Additional measurements involved hemodynamic monitoring and histological examinations. Colonic capillary blood flow was significantly decreased 3 days after colitis induction (1.8 +/- 0.05 vs. 2.6 +/- 0.04 nl/min in healthy control animals) when histology revealed signs of acute inflammation, and normal values after 15 days (2.4 +/- 0.06 nl/min) when chronic histological changes were evident. Hemodilution therapy enhanced colonic capillary blood flow in the initial stage (2.1 +/- 0.02 vs. 1.6 +/- 0.02 nl/min in saline-treated animals with trinitrobenzene sulfonic acid colitis) and improved gut resistance and electronic chloride secretion (73 +/- 15 vs. 33 +/- 8 microA cm2). Histological alterations were not significantly attenuated. Impaired colonic capillary blood flow in the initial stage of experimental colitis and improved mucosal microcirculation with stabilized gut permeability suggests that the early microcirculatory disturbances precede chronic histological changes and influence functional alterations in the course of the disease. Research should be continued in this field because important mechanisms in the pathogenesis of IBD and potentially therapeutic (vasoactive) substances may otherwise be overlooked.

Animals↗
PubMed1998

[Technique and results of ileoanal pouches in ulcerative colitis after colectomy and proctomucosectomy].

The continence preserving restorative proctocolectomy is the operation of choice for ulcerative colitis. Many technical aspects of the J-pouch procedure have been standardised. We prefer the hand-sewn pouch-anal anastomoses and construct a protective ileostomy in most patients. Latter allows to carefully assess the sphincter function postoperatively and--if necessary--to train the sphincter before restoring continence. The frequency of postoperative ileus is comparable to that after other major intraabdominal surgery. Septic pelvic complications occur in up to 10% of patients and determine the long-term prognosis of pouch function. Following pouch reconstruction, the stool frequency remains increased (4-6 per day) and continence may be partially impaired especially at night. These consequences are accepted by most patients. Because the ileoanal pouch procedure is a difficult and complicated operation, it should be performed by experienced surgeons only.

Adolescent↗