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Biomedical subjects

C Gebhardt

Publications and source records attributed to C Gebhardt.

At least 127 records · Page 7Linked to original sources
PubMed1982

[Possibilities of pancreas transplantation].

The prognosis of patients with juvenile onset diabetes which require dialysis is poor, even if blood glucose is kept in the normal range by administration of exogenous insulin in standard techniques. Animal experiments have shown, that late complications of diabetes can be prevented by transplantation of pancreatic tissue. This is why pancreas transplantation is discussed for the application in humans. Allogenic islet transplants could not show long-term function. At the present time the transplantation of segmental grafts seems to be the method of choice, especially when combined with a new technique of occluding the ductal system. This technique could be shown to prevent the early complications related to the exocrine part of the graft. Up to the end of Oct. 1980 there have been 15 living recipients, 4 of them with grafts functioning longer than one year.

Diabetes Mellitus, Type 1↗
PubMed1982

[Pancreatic duct occlusion--possible errors and misinterpretations].

A total atrophy of the exocrine pancreas by duct occlusion can only be achieved if the whole duct system is filled. Nevertheless, a residual secretion--poor in enzymes--from the tubular glands of the pancreatic duct is possible. Long-term results of pancreatic duct occlusion are now available not only from animal experiments, but also after application in humans, --the results are comparable. The effectiveness in the treatment of chronic pancreatitis can be demonstrated: in a total of 141 partial duodenopancreatectomies with intraoperative "burning out" of the pancreatic tail, we did'nt observe any postoperative complications from the remaining pancreatic tail and over the course of up to a maximum of 4 years we saw only a single case of recurrent pancreatitis. After partial duodenopancreatectomy for pancreatic cancer insufficiency of the pancreaticojejunostomy occurs in about 14%. Therefore, also in cancer surgery the application of duct occlusion to prevent postoperative complications should be discussed.

Animals↗
PubMed1982

[Anastomotic ulcer following Whipple's operation with stomach preservation].

Using the method proposed by Traverso and Longmire, a partial duodenopancreatectomy was performed on 18 patients without concomitant gastric resection sparing the bulbus duodeni. It had been reported that the postoperative increase in ulcer formation on the anastomosis could be avoided by a duodenal inhibition of gastric secretion. Since, however, ulcers were found in 7 patients on an average of 13 months following surgery, it must be presumed that the duodenal acid inhibition is not sufficient. For this reason Whipple's operation is again being performed in combination with the subtotal gastric resection.

Adult↗
PubMed1981

[Chronic pancreatitis. Results of 116 consecutive, partial duodenopancreatectomies with duct occlusion].

On the basis of a standardized, improved surgical technique, and the introduction of pancreatic ductal occlusion with Ethibloc to prevent recurrence, we have succeeded in achieving a considerable improvement in the early and late results of partial duodenopancreatectomy in the treatment of chronic pancreatitis; this improvement is reflected in a marked reduction in the surgical mortality rate from, formerly, 8.2 in 49 to 0.86% in 116 operations, together with, to date, very good late results, with freedom from symptoms in 90.2%, a recurrence rate of 1.1%, and a postoperative increase in weight of, on average, 7.8 kg in 85% of the cases so treated.

Blood Glucose↗
PubMed1981

[Oral hormonal contraceptives and benign liver tumors].

Focal nodular hyperplasia and liver cell adenomas are frequently found in women taking oral contraceptives. Between 1968 and 1979 nine women with focal nodular hyperplasia were operated at the surgical clinic of the University of Erlangen. 7 of these patients had taken oral contraceptives for periods between 4 and 13 years, average 6.7 years. In 7 cases the focal nodular hyperplasia was detected at operations performed for other conditions or in the course of clinical investigations done because of other diseases. Morphology, diagnostic procedures, indication for operation and operative therapy are discussed.

Adenoma↗
PubMed1981

[Treatment of chronic pancreatitis by left resection of the pancreas (author's transl)].

Report on 143 left resections of the pancreas for chronic pancreatitis. Good late results (81% of all patients improved or symptom-free) can be obtained by this method only in corpus-cauda-pancreatitis. Because of better results the 80-95%-resection should be preferred to the 40-80%-resection. In diffuse pancreatitis, however, a poor result is obtained in 55% of all operations. The same can be observed in cases where the main inflammatory lesion is located in the head of the pancreas and where in addition to the left resection an end-to-end pancreatico-jejunostomy is performed. In this case the Whipple's procedure should be preferred which can be combined with an intraoperative occlusion of the duct system in the pancreatic tail in order to prevent recidivation of pancreatitis. Contrary to the partial duodenopancreatectomy the left resection of the pancreas postoperatively leads to an increase of diabetes mellitus (41%).

Adult↗
PubMed1981

Pancreatic surgery: critical evaluation and perspectives.

While in the majority of cases, edematous pancreatitis responds to purely conservative intensive medical therapy, the hemorrhagic necrotizing form requires surgical treatment. The best results can be obtained with extensive necrosectomy followed by post-operative irrigation sump drainage. If possible, surgery should be delayed to between the 6th and 10th day after the onset of the disease. In the surgical therapy of chronic recurrent pancreatitis, the indirect and organ-preserving procedures have not gained widespread acceptance. While total duodenopancreatectomy must be rejected as too risky, good long-term results can be obtained with resection of the main inflammatory lesion, coupled with inter-operative occlusion of the remaining part of the organ to prevent recurrent disease. The surgical treatment of periampullar and ductal carcinoma of the pancreas should be made more radical by performing regional lymphadenectomy in the upper abdomen, both in the case of partial and in total duodenopancreatectomy. With this procedure, not only can the resection rate be increased by a factor of 2 to 3, but lymph node metastases of the second station, which would escape conventional therapy, are also removed.

Acute Disease↗
PubMed1981

[Hepatico-jejunostomy by the R. Smith-technique for the repair of central biliary ducts (author's transl)].

In order to repair a lesion of the proximal biliary duct, a wide anastomosis without tension and without reflux of intestinal content is required. If a biliary-intestinal anastomosis is technically not possible the R. Smith-procedure may be applied. For this purpose a segment of jejunum without serosal layer is pulled over a catheter into the biliary duct and the catheter fixed outside the abdomen. 11 good long-term results and 2 recurrences of stenoses could be observed by this method.

Cholangiography↗
PubMed1981

[Extended resection of pancreatic and periampullar carcinoma: regional, total and partial duodenopancreatectomy (author's transl)].

The prognosis of exocrine carcinoma of the pancreas is still quite bad; because of that, total duodenopancreatectomy following the procedure by Fortner has been our surgical approach since January 1978. Since that time surgery of periampullary carcinoma was extended as well in such a way, that first and second order lymph nodes were excised systematically. Following the introduction of these procedures the percentage of patients with exocrine pancreatic carcinoma operated upon rose from 12 to 35%, - the percentage of patients operated upon because of periampullary carcinoma correspondingly rose from 61 to 91% of all patients carrying these tumors. The incidence of lymphogenous metastases was 88% in 17 patients, which had surgery because of ductal pancreatic carcinoma, and 27% in 22 patients with periampullary carcinoma. 29% of patients with pT1-3 tumors and 71% of patients with pT4 tumors did have already lymphogenous metastases. In 22% of the cases, who would have been operated upon by conventional total duodenopancreatectomy metastases were found in the second order lymph nodes which were taken out according to the new more radical surgical approach; the corresponding figure for patients, who were operated upon by partial duodenopancreatectomy was 5%. Mortality of regional partial duodenopancreatectomy was 4% in our series, and mortality after regional total duodenopancreatectomy was similar to that of conventional pancreatectomy without dissection of lymph nodes.

Duodenum↗
PubMed1980

Decreased computerized tomography numbers in patients with presenile dementia. Detection in patients with otherwise normal scans.

Patients in their 50s who show clinical signs of dementia (possible Alzheimer's disease) often have ocmputerized tomographic (CT) scans that appear normal. This study examined the mean CT number within a 169-pixel sample in white matter in the centrum semiovale slice. Slice sizes ranged from 6,800 to 9,000 pixels; all were without contrast enhancement. The CT numbers were higher for six nondementia cases (CT numbers of 41 and above)than for 14 dementia cases (CT numbers of 40 and below). The non-overlap in mean CT numbers between the two groups was observed independent of the presence or absence of prominent sulci. Similar low CT numbers were observed for seven patients with senile dementia. Differential diagnosis between dementia and depression may be better aided by studying the CT numbers rather than the presence of prominent sulci.

Aged↗
PubMed1980

[Partial duodenopancreatectomy and intraoperative occlusion of the pancreatic tail for chronic pancreatitis (authors' translation)].

Report on 81 partial duodenopancreatectomies for chronic pancreatitis. To prevent a postoperative pancreatic fistula and the recurrence of pancreatitis the duct system of the pancreatic tail was occluded with a solution of prolamine. This occlusion leads to an isolate 'burning out' of the exocrine parenchyma. The operative mortality was 1.2%. Up to now a recurrence of chronic pancreatitis was not observed. The later results within an observation period of 28 months are favourable.

Chronic Disease↗
PubMed1980

[Intravenous glucose tolerance and islet cell function following pancreatic duct occlusion in rats (author's transl)].

Microsurgery, intraductal pancreatic occlusion by an Ethibloc bolus and intravenous glucose load in the rat enable investigations to be made into the feed-back relationships between occlusion-induced acinar atrophy and the response of the islet hormones insulin, glucagon, somatostatin, and glucose tolerance. Thirteen days after duct occlusion the latter is moderately delayed from 40-60 min, serum insulin is lowered, plasma somatostatin unchanged, and plasma glucagon moderately elevated, as compared with sham-operated control animals. It is suggested that the employed experimental conditions reveal an exo-endocrine pancreatic functional axis, but that the results obtained are not representative for states with an intact entero-insular axis.

Animals↗