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Biomedical subjects

C Gebhardt

Publications and source records attributed to C Gebhardt.

At least 109 records · Page 6Linked to original sources
PubMed1986

[Complications in pancreatic duct occlusion: passage of the occlusant into the venous system].

In two cases, occlusion of the residual pancreas remaining after a Whipple's procedure was associated with a "spillover" of the occlusant into the venous system of the pancreas, resulting in one of the cases in embolisation of intrahepatic branches of the portal vein. In both cases, the parenchyma of the residual pancreas was well preserved. The cause of the spillover into the venous system was the injection of a too large volume into the ductal system, with subsequent rupture of small side branches. To avoid this rare complication, the filling of the ductal system should be carried out under intraoperative radiological control.

Amino Acids↗
PubMed1986

Intravenous glucose tolerance after Whipple's procedure in patients with chronic pancreatitis--relative influence of occlusion of the pancreatic duct.

An intravenous glucose tolerance test was carried out to compare chronic pancreatitis patients (n = 17) who had undergone partial duodenopancreatectomy with (n = 9) and without (n = 8) occlusion of the residual pancreatic duct by Prolamin. The results obtained in 10 healthy volunteers were plotted as background information reflecting the normal metabolic response. Insulin- and C-peptide secretion were greatly decreased after both resection alone, and resection plus occlusion. However, the glucose tolerance (integrated glucose; K-values) appeared relatively well preserved in the two groups. The decrease in insulin appeared more marked after resection plus occlusion as compared with the non-occluded group. It is concluded that partial duodenopancreatectomy without or with ductal occlusion impairs insulin secretion, and leaves tolerance to an intravenous glucose load relatively stable. The mechanism underlying the latter observation is unknown at present.

Adult↗
PubMed1986

Ultrastructure of the islets of Langerhans after long-term occlusion of the pancreatic duct system.

The long-term effect of surgically induced atrophy and fribrosis of the exocrine parenchyma of the pancreas on the islets of Langerhans was examined electron-microscopically in animal experiments in mini-pigs. Ligature of the pancreatic duct, occlusion of the pancreatic duct system with an alcoholic solution of amino acids and the combination of this occlusion with ligature of the pancreatic duct were compared. A largely similar result was found in all three experimental groups 9 months post-operatively: The islets of Langerhans are mostly subdivided into predominantly small and apparently intact islet cell complexes by peri- and intra-insular fibrosis, and, where larger islet cell complexes are found, these are, in places, also destroyed in the peripheral region. The diffusion distance between the capillaries and the endocrine cells is, in part, considerably dilated by the interposition of collagen fibres. In the capillaries, thickenings and duplications of the basement membrane, as well as swelling of the endothelial cells can be found. There are rarely signs of atrophy in the islet cells lying in clusters. Only the granular structure of the B-cells diverges from the norm. From our morphological findings a delayed and diminished hormone output after pancreatic duct occlusion can be deduced, whereby, compared to earlier short-term experiments of our own, no significant progression of the peri- and intra-insular fibrosis can be determined.

Animals↗
PubMed1986

[Improved prognosis in acute pancreatitis].

An initial retrospective analysis of cases treated between 1963 and 1980 showed the main factors improving prognosis to be delayed operative treatment, radical removal of all necrotic tissue, post-operative use of irrigation and suction drainage. The prospective use of this regime during the years 1981 to 1982 resulted in an operative mortality of 29%. A further decrease in the operative mortality to 14% could be achieved in 1983 and 1984 by performing preoperative ERCP, because the knowledge of preexisting pancreatic fistulae and other pathologic changes of the duct system allow an individualized operative treatment adopted to the special problems of each cases.

Acute Disease↗
PubMed1985

[Therapeutic pancreatic duct occlusion in chronic pancreatitis: clinical, exocrine and endocrine consequences in a 12 month follow-up study].

Therapeutic pancreatic duct occlusion (PDO) is applied to preserve endocrine pancreatic function by atrophizing and thus eliminating chronically inflamed exocrine pancreatic parenchyma. So far, efficient and lasting elimination of exocrine parenchyma is brought about only by intraoperative PDO upon partial duodenopancreatectomy. While partial duodenopancreatectomy itself reduces endocrine pancreatic function by about 40%, intraoperative PDO does not further impair endocrine function. Endocrine function is not affected at all by endoscopic PDO, which has to be improved, however, concerning its eliminatory effect on exocrine pancreatic parenchyma.

Blood Glucose↗
PubMed1985

Influence of pancreatic duct occlusion on islet hormones in peripheral and portal plasma and in the pancreas of the mini-pig.

In a total of 18 'Göttingen' mini-pigs we studied basal glucose in the peripheral plasma, and the hormones insulin, glucagon, and somatostatin in the peripheral and portal plasma, as well as in extracts of pancreatic tissue, both in animals subjected to pancreatic duct occlusion with prolamine (Occ pigs) 9 months previously and in controls. Additionally, in the pancreas the relative frequency of A-, B-, D- and PP-cells was determined by immunocytochemistry. In peripheral blood of Occ pigs glucose, insulin, and somatostatin were unchanged, while glucagon was decreased. Also after occlusion the portal plasma revealed an increase in insulin but unchanged glucagon and somatostatin, while in the pancreatic tissue insulin and glucagon were statistically unchanged, but somatostatin was reduced. The relative frequency of A-, B-, D- and PP-cells in the pancreatic islets was comparable in both control and Occ pigs. It is concluded that also in the pig pancreatic duct occlusion leads to atrophy of the exocrine pancreas, but leaves undisturbed basal blood glucose, insulin, glucagon and islet cells.

Amylases↗
PubMed1984

[Therapeutic strategy in acute pancreatitis (II). Surgical procedure].

When operative treatment of acute hemorrhagic necrotizing pancreatitis becomes unavailable, one should aim for a delayed procedure if at all possible. The best results with a mortality of only 29% are achieved by radical necrosectomy and postoperative lavage and suction drainage. An additional considerable improvement could be achieved during the last months by employing preoperative ERCP. Only one out of 15 patients died. Visualization of the pancreatic duct allows e.g. pancreatic fistulae to be identified which absolutely have to be removed during the operation.

Acute Disease↗
PubMed1984

Impact of a nutritional support service on VA surgical patients.

The impact of a multidisciplinary Nutritional Support Service (NSS) on the reduction of complication was evaluated in 78 consecutive patients who received total parenteral nutrition (TPN) on the same VA surgical service. Patients were placed into one of three groups (pre-NSS, transition-NSS, post-NSS) based on the evolution of the NSS. A significant reduction in catheter sepsis was observed and was attributable to the establishment of an NSS, specifically, a nurse specialist and protocols for catheter insertion and care.

Humans↗
PubMed1984

Glutamine synthetase of Phaseolus vulgaris L.: organ-specific expression of a multigene family.

A recombinant plasmid (pcPvNGS-01) containing sequences related to glutamine synthetase (GS) has been identified from a cDNA library constructed from poly (A)+ RNA isolated from root nodules of Phaseolus vulgaris L. The identification of this recombinant relied on the observations that: (a) the clone hybridized strongly to purified GS mRNA; (b) in hybrid-select translation experiments, the clone selected mRNA that produced a polypeptide identical in molecular weight to purified GS subunits which was immunoprecipitated with anti-GS-antiserum; and (c) the translated nucleotide sequence of the cloned cDNA was homologous to a partial amino acid sequence of higher plant GS. The cloned cDNA hybridized to poly (A)+ RNA of different mobilities from leaves, roots, and nodules of P. vulgaris. In RNA "dot" blots washed at different stringencies, differences were observed both in the relative amounts of GS mRNA in different tissues and in the strength of their hybridization to the cDNA probe. The cloned probe hybridized to several fragments of restricted P. vulgaris DNA but not to DNA from Rhizobium phaseoli. These results suggest that GS is coded for by a small multigene family showing organ-specific expression.

Base Sequence↗
PubMed1983

[Significance of peritoneal irrigation in the treatment of hemorrhagic necrotizing pancreatitis].

Irrigation of the peritoneal cavity proves reliable in the treatment of acute hemorrhagic necrotizing pancreatitis. Two different applications must be distinguished: peritoneal dialysis and postoperative irrigation and sump drainage. Peritoneal dialysis should be performed at the beginning of the disease and has the aim to overcome the serious--often deadly--early phase of pancreatitis. Irrigation and sump drainage is carried out after a previous necrosectomy is performed to wash out retained or new by developed necroses. This management shall prevent a late intoxication of the organism.

Acute Disease↗
PubMed1983

[Drainage treatment of pancreatic pseudocysts].

Between 1967 and 1980 a total of 153 benign pancreatic pseudocysts were operatively treated in 148 patients. Most frequently drainage of the cyst into the small intestine with a Roux-en-y loop was effected. The operative mortality with this method was 5.8%. The total operative mortality was 6.8%. The recurrence rate in all surviving patients was 32.6% during a mean observation period of 56.4 months. There was a correlation between the incidence of recurrence and the etiology of the cyst (chronic, acute and traumatic pancreatitis). Patients in whom the pseudocyst arose from chronic pancreatitis had a recurrence rate of 41.4% as compared to 17.8% in patients with cysts developing after acute pancreatitis. This difference is even more pronounced in the group of the 120 patients in whom a cystojejunostomy was performed. The total recurrence rate of 31.9% is mainly caused by patients with chronic pancreatitis who suffered a relapse in 43.8%. The cysts developing after acute pancreatitis on the other hand had a recurrence rate of only 8.6%. It is concluded that internal drainage of the pancreatic pseudocyst by cystojejunostomy with a Roux-en-y loop is justified in post-traumatic cysts and in those arising after acute pancreatitis. Pseudocysts associated with chronic pancreatitis on the other hand should be resected whenever possible.

Adolescent↗
PubMed1983

The importance of ERCP for the surgical tactic in haemorrhagic necrotizing pancreatitis (preliminary report).

In patients with haemorrhagic necrotizing pancreatitis who are scheduled for surgery, we have been carrying out a preoperative retrograde investigation of the pancreatic duct system for the past 3 months. The results in, to date, ten patients, all of whom survived their severe illness, revealed four different morphological findings of importance for the surgical tactic. 1. A normal pancreatic duct system with no signs of fistulae: only peripancreatic necrosectomy is required. 2. Contrast medium leaks via a ductal fistula: left resection, including the removal of the fistulous area, must be done. 3. Normal duct system with complete segmental parenchymal staining, representing total necrosis in this region: left resection of the pancreas. 4. Duodenoscopically demonstrable perforation into the duodenum of a necrotic cavity in the head of the pancreas: conservative management only, no surgery, since this lesions, resulting in drainage of the necrotic cavity into the bowel, permits self-healing, while the site of the perforation within the necrotic wall cannot be dealt with by surgery. The experience gained so far indicates that the surgical tactic can be determined with greater selectivity by the use of ERCP.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1983

Clinical studies on duct occlusion with prolamine.

To prevent recurrence the pancreatic duct occlusion firstly was employed in the treatment of chronic pancreatitis. In combination with a Whipple's procedure a duct occlusion of the situ remaining pancreatic tail was performed in 141 cases since 1978. In the late follow-up only one patient developed a recurrent pancreatitis. In patients with pre-operatively normal glucose tolerance no post-operative diabetes was induced by this method. On the basis of these findings ductal occlusion also was carried out in a case of simultaneous pancreas-kidney-transplantation. Whereas the kidney did not function satisfactorily, the grafted pancreas with obstructed duct showed good endocrine function for over 9 weeks. The patient, who previously required injections of 60 IU insulin daily, needed no insulin during this period. The serum insulin level in several determinations was markedly above that of healthy normal people (65,3 microU/ml). Because of an infection which was uncontrollable under immunosuppression, the pancreas had to be removed again.

Acute Disease↗
PubMed1983

Experimental studies on pancreatic duct occlusion with prolamine.

The effect of the occlusion of the pancreatic duct system with prolamine (Ethibloc) has been studied in animal experiments with dogs and mini-pigs. The solution becomes solid in the duct system and becomes disintegrated again within 11 days. This time, however, is sufficient to keep a high-grade atrophy of the exocrine parenchyma. With this method one doesn't risk the provocation of an acute pancreatitis. The endocrine function of the atrophied glands is satisfactory, no animal became diabetic. The basal jugular vein insulin shows no difference to that of the control group, but nevertheless the mean whole pancreas hormone content is reduced for insulin and somatostatin, but not for glucagon.

Animals↗
PubMed1983

[Retrograde pancreatic duct imaging and surgical tactics in hemorrhagic necrotizing pancreatitis. Preliminary report].

In patients with haemorrhagic necrotizing pancreatitis who are scheduled for surgery we have been carrying out a preoperative retrograde investigation of the pancreatic duct system for the past months. The results in, to date, ten patients revealed four different morphological findings of importance for the surgical tactic: 1. A normal pancreatic duct system with no signs of fistulae: only peripancreatic necrosectomy is required. - 2. Contrast medium leaks via a ductal fistula: left resection including the removal of the fistulous area must be done. - 3. Normal duct system with complete segmental parenchymal staining, representing total necrosis in this region: left resection of the pancreas. - 4. Duodenoscopically demonstrable perforation into the duodenum of a necrotic cavity in the head of the pancreas: conservative management only, no surgery, since this lesion resulting in drainage of the necrotic cavity into the bowel permits self-healing, while the site of the perforation within the necrotic wall cannot be dealt with by surgery. - The experience gained so far indicates that the surgical tactic can be determined with greater selectivity by the use of ERP.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1983

[Preoperative treatment of chronic pancreatitis].

At the beginning the treatment of chronic pancreatitis should always be conservative. On the other hand operative measures are indicated if pancreatitic complications develop or if a suspicion of pancreatic cancer cannot definitely ruled out. It is, however, unclear whether surgery is indicated in cases of severe uncontrollable pain symptomatic. In order to prevent the suffering of a prolonged burning out of the disease we also consider surgical therapy as a solution for these patients.

Chronic Disease↗