Biomedical subjects
Publications and source records attributed to D Waldmann.
Endoscopic decompression of the distended colon has become a useful method of treating non-obstructive colonic ileus. We propose a method of establishing a cecal fistula by means of percutaneous puncture of the colon and pull-through of a Pezzer catheter. Although until now we have only performed this procedure twice, it seems to be a valuable therapeutic approach in cases of paralytic distension of the large bowel.
In 17 infants with hypertrophic pyloric stenosis, the pyloric diameter was measured preoperatively by ultrasound. The mean pyloric diameter was 15.12 +/- 2.11 mm (mean +/- SD), range 11 to 19 mm. During pyloromyotomy, the hypertrophic pylorus was precisely measured craniocaudally and dorsoventrally, and measurements were obtained concerning muscular thickness and length of the pylorus. The preoperative and intraoperative measurements were subsequently compared. Differences of 0.76 +/- 1.68 mm and 1.24 +/- 2.04 mm were found for the dorsoventral and craniocaudal diameters, respectively. The intraoperative measurements were consistently greater than the sonographic findings. The length of the pylorus averaged 22.0 +/- 2.66 mm, the muscular thickness 6.53 +/- 1.68 mm, respectively. This prospective study confirms the diagnostic value of sonography in congenital hypertrophic pyloric stenosis.
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The sensitivity of ultrasonographic diagnosis of pleural fluid accumulations and the value of ultrasonography guided thoracentesis were studied prospectively. 110 patients were investigated after abdominal operation and chest trauma. Most investigations were performed in a half sitting position. Pleural fluid of clinical relevance diagnosed by real time ultrasonography was treated by thoracentesis under ultrasonographic guidance in 38 cases. The amount of aspirated fluid ranged from 150 ml to 1350 ml. Sensitivity of the method was 97.1%, complication rate was 2.6%. From our view ultrasonography guided thoracentesis represents the method of choice in critically ill and immobile patients.
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The authors report on 36 premature and term infants with congenital defects of the diaphragm, including 17 patients who developed a severe respiratory insufficiency either immediately after birth or during the first 30 minutes of life. The overall mortality rate was 64%; the results of treatment were marked by a particularly high mortality rate among the patients with early respiratory insufficiency: out of 17 patients, 12 died. The evaluation of the courses confirmed that adequate preoperative primary care is of major prognostic importance in patients with early respiratory insufficiency. On the basis of personal experience the authors have formulated the following recommendations for improving diagnosis and therapy at this stage of care: greater use of sonography examination methods for antepartal diagnosis of congenital defects of the diaphragm, making it possible to treat the corresponding high-risk pregnancies at an early stage in clinics equipped for neonatologic and pediatric surgical treatment; early intubation respiration with a ventilation technique which does not overstrain the patient, in newborns with abnormal respiration and suspected congenital defects of the diaphragm; the great diagnostic importance of plain radiographs of the thorax and abdomen; neonatologic and intensive medical stabilization treatment in patients with severely suppressed metabolism prior to the anesthesiologic and surgical stress of closure of the diaphragm defect.
The effect of the mesocaval interposition shunt (n = 12) and the distal splenorenal shunt (n = 9) on the wedged hepatic venous pressure, the estimated hepatic blood flow, quantitative hepatic function, and the rate of portal systemic encephalopathy was evaluated in 21 patients who had bled from esophageal varices. After mesocaval shunt the wedged hepatic venous pressure was significantly reduced by 42% (from 26 +/- 3 mm Hg to 15 +/- 5 mm Hg, P less than 0.001) compared to 16% only (from 25 +/- 3 mm Hg to 21 +/- 2 mm Hg, P less than 0.005) after distal splenorenal shunt. The estimated hepatic blood flow also decreased significantly after mesocaval shunt by 61% (from 1.45 +/- 0.46 l/min to 0.56 +/- 0.25 l/min, P less than 0.001) compared to 29% (from 1.29 +/- 0.32 l/min to 0.91 +/- 0.39 l/min, P less than 0.05) after distal splenorenal shunt. Despite significantly different influences of both types of shunt operations on wedged hepatic venous pressure and estimated hepatic blood flow (P less than 0.001), postoperative changes of hepatic function were comparable in both groups of patients. The galactose elimination capacity, the initial plasma disappearance rate of Bromsulphalein, and the plasma ratio of valine, leucine, and isoleucine to phenylalanine and tyrosine were reduced by 13%, 26%, and 29%, respectively, after mesocaval shunt, compared to 12%, 25%, and 17% after distal splenorenal shunt. Only two patients of the mesocaval shunt group with the largest decrease in estimated hepatic blood flow developed portal systemic encephalopathy postoperatively, and the distal splenorenal shunt patients with their minor hemodynamic sequelae remained free of portal systemic encephalopathy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The worldwide introduction of H2-receptor antagonists has resulted in changes in the management of gastric and duodenal ulcers. Today surgery is reserved mainly for patients with problem ulcers or ulcer complications. In this decision a lower recurrency rate of operative treatment must be weighed against higher immediate risks of this form of therapy. The treatment of choice for duodenal ulcers is the selective proximal vagotomy (SPV) without drainage, for gastric ulcers the partial gastrectomy (Billroth I- or II-procedures) or SPV, depending on their localizations. Only the differentiated use of medical and surgical treatment modalities permits optimal ulcer therapy.
The gastro-intestinal hormone Ceruletide is used for diagnostic and therapeutic purposes. Apart from other effects, Ceruletid brings about a relaxation of the Sphincter of Oddi. In the present double-blind study, it was examined on 70 patients whether the effect of this drug can facilitate the cannulation of the Papilla Vateri. Using a dosage of 50 ng/kg body weight Ceruletid in i.m. application the examination time required by the most experienced examiner up to the cannulation of the Papilla Vateri was shortened by half with respect to the collective control group treated with placebo. In the case of less experienced examiners, there was no statistically significant difference in the time of sondage between Ceruletid and the administration of a placebo. Clinical parameters as well as chemical parameters in the laboratory did not reveal any abnormalities. Complications or incompatibilities caused by this drug were not observed.
Colonic diverticula in reality are herniations of the mucosa through a thickened musculature of the bowel wall where it is penetrated by the vasa recta. Their prevalence increases with western food and with age. Low-residue diet and increased intraluminal pressure are considered to be etiologic factors. Diverticular disease is characterised by inflammatory and bleeding complications. Diverticulitis may lead to peridiverticulitis and pericolitis with frank peritonitis. Uncomplicated diverticulosis warrants observation only under dietary guidance. Repeated complications indicate elective operation by one-stage-resection. Perforation, abscess and massive bleeding necessitate immediate operative treatment aimed at elimination of the involved segment.
Two cases of Mesenteric Cysts in infancy are described. Since there is no continuity with the lumen of the bowel radiological evaluation may be very difficult. In contrast abdominal sonography can give information about size, contents and position in relation to other abdominal organs. The use of ultrasound shortens the preoperative workup and certainly reduces the number of X-ray examinations.
Endoscopy in the early post-operative stage after an intestinal operation is seldom indicated, in contrast to control endoscopy carried out at a later stage. Experiments with animals show that endoscopy of intestinal anastomoses may be performed as early as 24 hours after an operation, if carried out carefully by an experienced endoscopist. During this early post-operative period, endoscopy is indicated only when complications arise. The most important application is the endoscopic insertion of an intestinal tube in cases of post-operative ileus. However, coloscopic suction in meteorism of the colon, and the introduction of tubes through swollen anastomoses are also possible. Bleeding of an anastomosis in the early post-operative stage is rare, whereas bleeding due to teleangiectatic granulomas in the later post-operative stage is more common. Both cases are indications for endoscopic hemostasis. Nevertheless, it must be emphasized that intestinal endoscopy in the early post-operative stage should be carried out only in exceptional cases, and then only by an experienced surgical endoscopist.
An algorithm is demonstrated which runs by means of program internal decision schedules for insulin applications during the extracorporeal blood glucose regulation by the artificial endocrine pancreas. This algorithm defines clear conditions for the regulation of the insulin pump considering the actual blood glucose concentration and its speed of change. It is easy to modify and hence feasible under different conditions.
After the failure of other medicamentous treatment attempts for paralytic ileus, Ceruletid (Takus) was used in 20 surgical patients. Ceruletid was applied as an infusion of 40 microgram in 250 ml or 500 ml physiological saline solution over a period of 2-3 hours. During this time the occurrence of bowel sounds, flatulence and defecation was observed. The most important clinical and serological parameters were measured before and after treatment. Treatment was successful in 17 cases, in 3 cases no success was achieved. Severe side effects did not occur. The use of Ceruletid in the described form of administration can be recommended for the treatment of paralytic ileus.