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Biomedical subjects

G Kieninger

Publications and source records attributed to G Kieninger.

At least 37 records · Page 2Linked to original sources
PubMed1982

[Healing of infected wounds after diathermic and scalpel cuts into the abdominal wall in rabbits (author's transl)].

The course of wound healing and the spreading of infection was investigated through a comparative procedure with 30 rabbits. We performed a laparotomy with diathermy and scalpel, afterward injecting a solution of 6 X 10(10) Staphylococcus aureus in the subcutis. The histological preparation and semiquantitative evaluation of the laparotomy wounds were performed on postoperative days 3, 7, and 14. On day 3, a clear infiltration of macrophages could already be observed in the scalpel wound, while in the diathermy wound more necrosis could be seen. On day 7, the muscle of wounds inflicted by scalpel was infiltrated with granulocytes and monocytes. In those by diathermy, the necrosis was filled with fibroblasts. On postoperative day 14, no histological difference could be seen between the two proceedings: in the subcutis, there is an abscess enveloped in a connective tissue wall; the cutis and the muscle show new scar tissue.

Abdominal Muscles↗
PubMed1982

[Results of thoracic vagotomy for stomal ulceration following Billroth I gastric resection (author's transl)].

Thoracic vagotomy is rarely considered today. This procedure is justified only in stomal ulcerations following partial gastrectomy. Since 1974, we have been using this operative method at the Chirurgische Universitätsklinik in Tübingen, Germany, routinely for all cases of stomal ulcerations following Billroth I gastric resection. In contrast to this in stomal ulcerations following Billroth II gastric resection, we perform a converting resection into Billroth I as the standard operation, since in this case control of the duodenal stump for retained antrum is mandatory. To date we have performed thoracic vagotomy in 24 patients. This approach compares well with the abdominal approach. There is a short operating time (average 70 min), a short hospital stay (average 15 days), a low complication rate, and nonexistent mortality. All ulcers, even giant ones penetrating into the pancreas, healed within 6 weeks postoperatively. None of the patients developed postvagotomy diarrhea. On follow-up examination 1.5--6.5 (mean = 4) years after surgery only three patients had a recurrent ulcer. All patients were examined pre- and postoperatively by roentgenography, endoscopy, gastric acid analysis, and serum gastrin evaluation. The Zollinger-Ellison syndrome was excluded in all cases. Because of our excellent results, we consider thoracic vagotomy a safe and successful operative method, which can be recommended as a routine procedure for stomal ulceration following Billroth I gastric resection.

Adult↗
PubMed1982

[Comparative radiological studies of different types of gastric reconstruction: Roux-Y; Longmire-Guetgemann; Tübinger reconstruction (author's transl)].

The indications for gastrectomy are increasing. More than 50 operations have been devised for reconstruction of the gastric function, but none is ideal. They should be judged particularly by their ability to form a reservoir which permits intermittent empyting of food into the small bowel. The risk of ischaemic changes or of chronic mucosal inflammation must be avoided. On the assumption that functional disturbances could be characterised by study of the morphology, we have carried out studies of three different types of gastric reconstruction (Longmire-Gütgemann, Roux-Y and Tübinger). The parameters we chose to measure were the maximum diameter of the interposed segment, the thickness of the mucosal folds and, as far as possible, th length of the segment. Most marked dilatation was found with the Tübinger procedure. Nevertheless, the increased occurrence of circular contractions following the Longmire-Gütgemann and Roux techniques may also result functionally in the formation of a reservoir. In none of the above techniques was there evidence of disturbances of blood-flow, as shown by mucosal swelling in the interposed segment.

Adult↗
PubMed1981

[Radiological evaluation of a new method for gastric replacement by the interposition of an isoanisoperistaltic jejunal segment (author's transl)].

The method of reconstruction following total gastrectomy decisively influences early and late post-operative results. The ideal form of reconstruction would create a reservoir resembling a stomach, it would prolong intestinal transit time, preserve orthograde passage through the duodenum, prevent reflux of bile into the oesophagus, and should not be very difficult technically. A new method of gastric replacement and its radiological investigation is described. The passage from the oesophagus to the duodenum is reconstructed by the interposition of an iso- and anisoperistaltic jejunal segment. The iso- and anisoperistaltic segments result in contrary movements which can be divided into various basic types. Type I is by far the most common form, comprising 70% of the patients examined; it shows characteristic to-and-fro motion of the food-contrast mixture, resulting in a reservoir function of the isoperistaltic segment and intermittent emptying into the duodenum. In type II, incomplete local ring contractions can be observed in the isoperistaltic segment, with reservoir function and intermittent emptying. In type III emptying results from overflow. The operative technique and clinical results are described.

Bioprosthesis↗
PubMed1981

[The problems of blunt abdominal trauma accompanied by cranio-cerebral trauma (author's transl)].

From 1967-80, 276 blunt abdominal traumas were surgically treated at the Chirurgische Universitätsklinik Tübingen. In the course of these, cranio-cerebral trauma was the most apparent accompanying injury. Diagnostic difficulties were considered one major cause among others for the high mortality rate of 40%. The diagnostic procedure is described and the special significance of peritoneal lavage for the diagnostic procedure and the importance of intraoperative autotransfusion for the therapy is emphasized.

Abdominal Injuries↗
PubMed1981

[The distal splenorenal shunt].

Distal splenorenal shunt was performed in 17 patients with bleeding esophageal varices and/or hypersplenism. As an elective operation the results were very good, whereas the shunt should not be used as an emergency operation. During an observation period of 6-30 months none of the 13 surviving patients developed a recurrent hemorrhage or portosystemic encephalopathy. An existing hypersplenism was improved in all cases. In our opinion the distal splenorenal shunt is the optimal elective surgical management for bleeding esophageal varices, since it offers effective control of recurrent hemorrhage without the risk of encephalopathy.

Esophageal and Gastric Varices↗
PubMed1981

[Stomach replacement by iso-anisoperistaltic jejunum interposition (Tübinger replacement stomach)].

Since 1972 we have been using a new method of gastric replacement which was developed at our hospital. The reconstruction of passage is achieved by iso-anisoperistaltic interposition of two jejunal segments (30:10 cm). The reversed segment causes delayed and intermittent emptying of the above located isoperistaltic segment. Until now this type of gastric replacement has been performed in 62 patients. Postoperative mortality was 11.3%; so far the longest survival time is nearly 8 years. By the reservoir function of the jejunal interposition digestion and absorption are essentially improved, resulting in a better quality of life for the patient. This type of gastric replacement is now used as a routine in all curative gastrectomies, provided there are no contraindications on account of the patient's age or general condition.

Gastrectomy↗
PubMed1980

[Combined use of iso and aniso-peristaltic jejunal loops to reestablish continuity after total gastrectomy (author's transl)].

Following experiments in animals, a new procedure for gastric replacement after total gastrectomy has been employed since 1972. Digestive tract continuity is reestablished by interposing two jejunal segments, on iso- and the other aniso-peristaltic, between the esophagus and the duodenum. The proximal isoperistaltic segment should be between 30 and 40 cm in length, while the distal anisoperistaltic segment should measure 10 cm. The latter segment replaces the pylorus and produces delayed intermittent emptying of the proximal iso-peristaltic segment. Their progressive dilatation results in the development of a new reservoir which reaches its maximum volume after 6 to 12 months. Radiological, cinematographic, and endoscopic examination in 58 patients in whom this reconstruction had been performed demonstrated that function was excellent. Results of metabolic studies and tests for clinical function confirmed the value of the method, which has definite advantages over previous techniques employed to reestablish continuity. For this reason, the method has become a routine procedure in patients requiring extensive total gastrectomies.

Adult↗