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Biomedical subjects

G Kieninger

Publications and source records attributed to G Kieninger.

At least 55 records · Page 3Linked to original sources
PubMed1979

[Is the jejunoileal bypass still justified? (author's transl)].

The jejunoileal bypass for the treatment of extreme obesity is being increasingly criticized because of its severe metabolic complications. With the gastric bypass, developed by Mason in 1967, there now exists an operative alternative that is equivalent concerning weight reduction, but does not create such non-physiologic conditions of absorption, and therefore is not burdened with the severe metabolic disturbances of the jejunoileal bypass. Therefore the jejunoileal bypass should not be used any longer for the treatment of obesity.

Diarrhea↗
PubMed1979

[Intraoperative autotransfusion (author's transl)].

Intraoperative autotransfusion is an advantageous and safe method of blood replacement. In our clinic this method is established as a routine procedure in all cases with suspected massive bleeding. We used the IAT in 141 cases of surgical haemorrhage. The mean indications for IAT in surgery were emergency operations necessitated by blunt abdominal or thoracic trauma. Altogether 390 l of blood have been retransfused with an AT -- volume per patient ranging from 1 to 20 l. On an average 2,8 l per patient were transfused. Contraindications of blood replacement are tumour surgery, septic surgery, contamination by large intestinal contents and rupture of the uterus. For anticoagulation ACD-solution has been used, only in vascular surgery systemic heparinization was preferred. The main advantages of autologous intraoperative transfusion are the immediate availability of blood, the absence of the risk of hepatitis and of incompatibility reactions, reduction of pressure on the blood banks and lower transfusion costs.

Anticoagulants↗
PubMed1978

[Comparative study on single layer and two layer anastomoses of small intestine (author's transl)].

The one layer anastomosis after Gambee is compared with the two layer anastomosis after Dick at the small bowel of 20 minipigs. The end-to-end anastomosis after Gambee consists of an interrupted, inverting suturing of the bowel wall. Dick suggested a closed method, applying bronchial clamps before resecting the bowel. Seromuscular sutures and inner all layer sutures are inserted interrupted. Experimental studies have been done after 4, 7, 14 and 21 days. In Histology two layer anastomoses caused delayed wound healing after 4 days. Twenty-one days after the operation histological findings in both groups were equal. Microangiographic studies showed, that in single layer anastomoses revascularization began 3 days earlier than in two layer anastomoses. Measuring of the bursting strength showed no significant differences. All parameters suggest equal value of both techniques. In our opinion the two layer anastomosis after Dick combines the advantages of a closed method with a simple, easy performable technique. We therfore apply it all over the gastrointestinal tract with exception of esophagel and rectal anastomoses.

Animals↗
PubMed1978

[Use of stoma for decompression of the paralytic ileus (author's transl)].

Indications for the construction of a stoma in the handling of paralytic ileus caused by peritonitis should be ascertained early and completely, since this method is probably the safest and fastest way to relieve advanced intestinal paralysis. There is no need for a secondary laparotomy in order to close the stoma when a catheter-entero- or colostomy is performed. Replacement of lost fluid and electrolytes through the stoma should no longer present serious problems because of the possibilities offered by modern intensive care treatment.

Catheterization↗
PubMed1978

Experimental and clinical investigations on the transfusion of autologous blood in urological operations.

In view of the known risks in homologous blood transfusions, the procedures for transfusion of endogenous blood are gaining increasing importance. Using this fact as a basis, the feasibility of direct intraoperative autotransfusion in the area of urology was investigated. 6 mongrel dogs received blood-urine autotransfusions after cystotomy and cavotomy (n = 2) as well as after left-side nephrotomy (n = 4). Coagulation and hemolysis parameters were examined 1, 2, 24 h and 7 days after the autotransfusion, and showed transitory pathological changes which were, without exception, reversible within 7 days. Clinical effects were not observed. On the basis of favorable experience, the intraoperative, machine autotransfusion was also used clinically for renal traumas (n = 13), urinary bladder traumas (n = 4) and nephrotomies (n = 3). Postoperative checks showed pathological changes in the hemolysis and coagulation values only during the first 3 postoperative days. The blood-urine autotransfusion was well tolerated without exception. Indications and contraindications for direct intraoperative autotransfusions in the area of urological operations are discussed.

Animals↗
PubMed1978

[Animal experimental and clinical experiences with carbon polymer stomas].

Biocarbon implants consist of 99.9% pure carbon and are characterized by chemical inactivity and good tissue compatibility. Biocarbon was used for subfascial implantations, as well as coecostomies, ileostomies and cystostomie on mongrel dogs. The most important clinical results was the good healing over of the material without adverse reaction. The cystostomies showed only a very slight tendency to form incrustations. Drainage was watertight without signs of leakage. The satisfying results with two patients who were provided with a cystostoma are reported and further uses of the procedure, such as ureterocutaneostomy, iliac and colonic conduit, are discussed.

Aged↗
PubMed1977

[Reversal of intestinal segments for therapy of malabsorption after small bowel resection. Experiments on animals (author's transl)].

Following massive small bowel resection malnutrition occurs as a result of impaired digestion and malabsorption. Of the numerous methods of operation suggested to improve intestinal absorption only the reversal of intestinal segments seems to be promising. Since so far this method was used clinically only in single cases, the method was studied experimentally in 50 minipigs (divided in 4 groups: 90 p.c.-small bowel resection without reversal, with primary or secondary reversal, and normal controls). The reversed segments 5 or 10 cm in length were inserted in the middle or at the end of the remaining jejunum or ileum. In comparison with the animals without intestinal reversal the animals with reversed segments showed a significant increase of intestinal transit time and of absorptive capacity, a nearly normal weight development and a considerably better adaptation of the remaining small bowel. In contrast to that the animals without reversal showed after an average of 3 months extreme cachexia. These encouraging experimental results with reversed segments in short bowel syndrome justifies in our opinion the application of this therapeutic principle in humans.

Animals↗
PubMed1977

[Reversal of small bowel segments to delay intestinal passage after total colectomy (author's transl)].

Five female mini-pigs underwent total colectomy including resection of the ileocecal valve. Sparing the terminal rectum, we reformed an end-to-end anastomosis between terminal ileum and remaining rectal cuff. In a second series 8 female mini-pigs have been colectomized using the same model. To delay intestinal passage, in addition a 10-12 cm long reversed segment of terminal ileum has been inserted between small bowel and rectal stump. Both groups were compared with a group of normal unoperated mini-pigs in a study up to 1 year, observing intestinal transit time, blood chemistry and general development of the animals. It could be proved that the reversal of a small bowel segment in colectomized animals leads to a prolongation of the intestinal transit time, to normalization of electrolytes and general appearance. Colectomy was only survived by animals with a reversed segment. The clinical application of a reversed small bowel segment following total colectomy in 1 patient was successful.

Adult↗
PubMed1977

[Animal studies on the construction of continent ileostomies and colostomies with the use of BioCarbon implants].

Ring-shaped implants of BioCarbon, a recently developed vitreous carbon polymer, were used for construction of continent ileostomies and colostomies in dogs. The stoma was fashioned by suture fixation of the intestine inside the ring, which was then placed subfascially in the abdominal wall. The exterior of the implant could be hermetically sealed with a screw cap. Implantation in 19 dogs performed so far showed a high rate of incorporation of BioCarbon devices.

Animals↗
PubMed1976

[Intraoperative autotransfusion in gynecology and surgery (author's transl)].

The technique of intraoperative autotransfusion (AT) is being used to date only in a few individual clinics. Since there is a clinically safe and economical AT-apparatus available the routine application of this rational blood replacement method is easy to perform. The authors have used this technique altogether in 111 patients, applying the Bentley-ATS-machine in the last 69 cases. In a previous series of 42 cases AT was used for ruptured ectopic pregnancy, in the series of 69 surgical cases for hemothorax or intraabdominal hemorrhages of mainly traumatic origin. The most frequent indications for AT in emergency surgical operations were ruptures of spleen and liver, and in elective surgery for portocaval shunt. Altogether 247 litres of blood have been retransfused with an AT-volume per patient ranging from 0,5 to 15 litres. For anticoagulation generally ACD was used, only in vascular surgery was heparin preferred. Methodical complications have not been seen. Technique, indications, consequences and possible complications of AT are described. The main advantages of autologous intraoperative transfusion are the immediate availability of blood, the absence of the risk of hepatitis and of incompatibility reactions, reduction of pressure on the blood banks and lower transfusion costs. The authors therefore believe that the possibility of intraoperative AT should exist at every surgical and gynecological clinic.

Abdominal Injuries↗
PubMed1975

[Experiences of control measures against hospitalism (author's transl)].

Infection caused by gram negative germs in hospitals increased 14-fold since 1957 and measures today 66p.c. of hospital infection. The following causes are mainly responsible for this fact: inadequate hygienic measures, increased antimicrobial chemoprophylaxis and-therapy, changing pattern of antibiotic resistance, increased degree of severity of operations, and the mounting number of intensive care unit patients. 13 letal pneumonias and 1 peritonitis caused by klebsiella were observed in the Department of Surgery of the University of Tübingen Hospital. Search of the source of infection as well as control measures are described. Limitation of application of antibiotics to absolutely necessary cases (5%) and strict observation of hygienic measures are requested. A full time hospital hygienist is needed for supervision.

Anti-Bacterial Agents↗