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Biomedical subjects

H J Peiper

Publications and source records attributed to H J Peiper.

At least 19 recordsLinked to original sources
PubMed1992

[Effect of pancreatic innervation on exocrine secretory performance of the pancreas].

In the present study we examined the influence of extrinsic pancreatic innervation on exocrine pancreatic response to secretin, caerulein, tryptophan and fat, and furthermore the amino acid- and fat-stimulated release of neurotensin and CCK in dogs. Denervation of the pancreas did not alter secretory response to secretin and caerulein, whereas transsection of the extrinsic nerves significantly diminished the protein response to tryptophan and fat. Release of CCK was not altered by pancreatic denervation. However, fat-evoked neurotensin plasma levels were significantly increased after denervation of the pancreas.

Animals↗
PubMed1991

Treatment of iatrogenic common bile duct injury during laparoscopic cholecystectomy through the laparoscopic insertion of a T-tube stent.

Iatrogenic injury to the common bile duct during laparoscopic cholecystectomy has previously necessitated an immediate laparotomy to alleviate bile leakage. In the course of 171 laparoscopic cholecystectomies performed at our hospital, intraoperative common bile duct injuries occurred in 2 patients. Each case was successfully treated using a laparoscopically placed T-tube, thus avoiding the need for a laparotomy. This novel intraoperative procedure successfully treated common bile duct injuries without resulting in postoperative complications.

Adult↗
PubMed1991

Myogenic basis of motility in the pyloric region of human and canine stomachs.

In vitro gastric motility was investigated in 48 human and 16 canine stomachs by measuring the mechanical activity of isolated muscle strips under auxotonic conditions. For a precise regional differentiation, we recorded the mechanical activity of longitudinal and circular strips from fundus, corpus and antrum, as well as from circular preparations of the inner and outer layer of the pyloric sphincter and from the duodenum. The analysis showed that the anatomical division of the stomach into three distinct regions resulted physiologically in different patterns of contraction in vitro for each region. The fundus exhibited purely tonic spontaneous activity and a tonic contraction pattern after application of acetylcholine whereas the activity in the circular antrum was purely phasic. A combination of tonic and phasic contractions was found in the corpus and longitudinal antrum. A major difference in the basic spontaneous activity pattern was evident between man and dog. A gradient of intrinsic frequency in the stomach from proximal to distal was seen in the dog but not in man. A physiologically distinct area exists in the pyloric region of both species adjacent to the antrum and duodenum. The pyloric ring has its own spontaneous activity (minute-rhythm), reacts to the application of acetylcholine with relatively weak contractions and, unique to the dog, was delineated by histamine-induced maximal contractions. The results provide evidence that the pyloric ring is a distinct organ with specific functional characteristics in its cellular-myogenic structure.

Acetylcholine↗
PubMed1990

Cystic neoplasms of the pancreas: a clinical and radiological study of eight cases.

Four patients with benign serous cystadenoma, one with mucinous cystadenoma, and three with mucinous cystadenocarcinoma treated in the university hospital of Göttingen between 1985 and 1988 were investigated. The main initial symptoms of these cystic tumors were abdominal pain (7/8), weight loss (3/8), maldigestion (3/8), and palpable abdominal mass (3/8), while laboratory investigations revealed nonspecific alterations (elevated ESR, mild hypochromic anemia). CA 19-9 was elevated in two patients, one of whom had cystadenocarcinoma; CEA also was elevated in this patient only. In all cases size, localization, and cystic character of the tumors were shown clearly by sonography and computed tomography; fine needle biopsy helped to distinguish between serous and mucinous cystadenoma in four of six cases. Because of their malignant potential, total extirpation of mucinous cystic tumors is the treatment of choice, while serous cystadenomas are benign and therefore may be treated conservatively in uncomplicated cases or high-risk patients.

Adult↗
PubMed1990

[Pancreatico-pleural fistula. Clinical aspects and therapy of a rare disease entity].

We report of 2 patients with pancreatic-pleural fistulas in chronic pancreatitis. In both cases abdominal symptoms were missed, the primary clinical manifestation was a recurrent pleural effusion with a high content of amylase. Endoscopic retrograde cholangiopancreaticography is necessary for a precise evaluation of the fistula and is indispensable to the surgical therapy. Computed tomography and ultrasonography showed in both cases a pancreatic pseudocyst. Our recommendation is surgical therapy when the fistula is not closed spontaneously within 2 weeks. Both patients were successfully treated by a left pancreatectomy.

Adult↗
PubMed1989

[Surgical therapy of chronic pancreatitis].

From a series of 411 surgical operations in chronic pancreatitis patients, 142 were analyzed with respect to indication, early and late mortality, and results. Average follow-up time was 10 years. Resective procedures were used in 51 patients and drainage in 24. Late mortality was twice as high for drainage (19%) as for resection (7.5%). The subjective late results were best for resection, since in these cases relapse occurred only in 16% and improvement of symptoms in 79%; for drainage the improvement rate was only 65% and the recurrence rate 39%. Drainage was followed by latent or manifest diabetes in 21% of cases, and resection in 63%. Deterioration of exocrine pancreas function was observed in 29% of resections but in only 14% of drainages. These data indicate that prognosis of the disease depends on the surgical procedure as well a withdrawal of alcohol.

Drainage↗
PubMed1989

The perfused porcine pancreas as a model for testing organ protective solutions.

The present study was designed to establish an in vitro perfused porcine pancreas preparation as a model for testing the effect of organ protective solutions on stimulated pancreatic endocrine and exocrine secretion. The pancreas was prepared and perfused for 10 min with Euro Collins solution, thereafter it was stored in the cold (4 degrees C) for various times. After 3-h and 6-h ischemia pancreatic insulin release in response to glucose was not significantly affected. After 12-h ischemia reduced pancreatic insulin secretin, increased perfusion pressure, and increased amylase and lipase release indicated pancreatic damage. Complete pancreatic dysfunction was seen after 24-h and 48-h ischemia with massive increase in perfusion pressure and low insulin secretion which did not follow a glucose-dependent release pattern, while amylase and lipase concentrations in the perfusion medium increased. Stimulated exocrine pancreatic secretion was significantly decreased already after 3-h ischemia and completely lost after 12 h.

Amylases↗
PubMed1988

[Staging in non-Hodgkin's lymphomas].

In the period from 1970 to 1986, 46 patients with non-Hodgkin's lymphoma were laparotomized and splenectomized at the Surgery Division, University of Göttingen. The operation was frequently carried out in advanced or generalized stages with a therapeutic indication and served for purely diagnostic purposes in only a proportion of the cases. The Kiel classification was chosen for the histology. Accordingly, hairy-cell leukemia (14 cases) and chronic lymphatic leukemia (12 cases) were the most frequent diagnoses, followed by LP immunocytoma and centroblastic-centrocytic lymphoma (seven cases each). In four out of the 20 clinical pictures which were not already generalized by definition, i.e. in 20% of the cases, exploratory laparotomy resulted in a change of stage (comprising two improvements and two deteriorations). The spleen was affected in 41 out of the 46 patients; in addition, lymphomatous infiltrations were found in six of the 12 liver biopsies taken and in 15 out of 17 lymph node preparations taken. The average spleen weight in the NHL patients (1,623 g) was markedly higher than in a reference group of Hodgkin patients (317 g). With critical establishment of the indication, exploratory laparotomy with splenectomy in histologically verified NHL and lymphography in the clinical staging are the most precise methods of investigation in graduated diagnosis of non-Hodgkin's lymphomas.

Adult↗
PubMed1987

Surgical treatment of pancreatic pseudocysts.

Between 1966 and 1980, 54 patients (40 men and 14 women) with a mean age of 38 years were operated on for a pancreatic pseudocyst at the Department of General Surgery, University of Göttingen. The aetiology of the cysts was alcohol abuse in 35 patients, biliary diseases in 8, blunt abdominal trauma in 4, virus-induced in 2 and unknown in 5. With the exception of those who had had trauma, all patients were suffering from chronic pancreatitis. Surgical therapy included in all cases a cystojejunostomy (52 with a Roux-Y-limb and 2 with an omega loop). The mean follow-up period was 13 years (range 6 to 20 years). The late mortality was 15 per cent (8 of 52 patients). Recurrent cysts occurred in two patients (5 per cent) and relapse of pancreatitis in one third of the patients. Deterioration of carbohydrate metabolism was observed in 20 per cent of the patients. After drainage operation stool fat content became normal in 20 per cent and deteriorated in 13 per cent. Persistence or cessation of alcohol intake influenced the long-term results. From these data we conclude that both alcohol withdrawal and sufficient drainage of the pseudocyst are important factors in the prognosis of pseudocyst.

Adult↗
PubMed1987

[Staging in Hodgkin's lymphoma. Exploratory laparotomy with splenectomy].

In the present paper, 66 Studies on exploratory laparotomy with splenectomy in Hodgkin's lymphoma from Western Europe and the USA are presented in tables. This statistical compilation on 7183 laparotomies shows that the spleen was involved in 39.9% (2685 out of 6900 cases investigated), the liver in only 7.7% (446 out of 5789) and the abdominal lymph nodes were involved in 30.3% (1389 out of 4578) of the cases. Altogether, laparotomy with splenectomy led to a change in staging in 33% of the patients (1892 out of 5745). In the period from 1970 to 1986, 123 patients with Hodgkin's lymphoma were laparotomized (and also splenectomied apart from one exception) at the Surgical Division, University of Göttingen. The patients comprised 52 cases in the context of primary staging and 71 cases in the context of secondary staging. In 43 cases (35.2%) the spleen was affected, in seven cases (5.7%) the liver was affected, and there was combination with spleen involvement in each case. Infiltration of abdominal lymph nodes was shown in 38.2% (26/68). Exploratory laparotomy led to a change in stage in 46 cases (37.1%) comprising 28 improvements and 18 deteriorations. Before laparotomy, 15 patients were in stage I, 29 in stage II, 44 in stage III and 21 in stage IV. After pathological staging, 14 were in stage I, 40 were in stage II, 47 were in stage II and 19 were in stage IV. Out of the 14 patients who could not be assigned to any stage before the operation, 11 could be definitively staged afterwards. In addition, lymphography was performed in 103 patients, liver and spleen scintigraphy in 51 patients, sonography in 30 patients and computer tomography in 22 patients. In the re-examination of the lymph node situation in the retroperitoneal space, lymphography attained a specificity of 48% and a sensitivity of 71.4% with a positive prediction precision of 35.7% and a negative prediction precision of 88.8%.

Hodgkin Disease↗
PubMed1987

[Indications for appendectomy. A retrospective analysis].

This retrospective study was conducted into 1.506 patients who had been admitted to the author's hospital for suspicion of acute appendicitis, between 1971 and 1979. Indications for appendectomy were handled with generosity, and primary laparotomy was applied to 44.2 per cent of all cases. Perforated appendicitis was of low incidence, accounting for only three per cent, while no acute inflammatory lesions were recordable at all from 36 per cent of removed appendices. Follow-up checks were made on all patients who had not been operated on, in the first place, not later than five years from first diagnosis. Only 15 per cent of these patients had to be eventually appendectomised. For them distribution of histological diagnoses was similar to that of patients with surgery as primary approach. Recurrence of pain was reported by one third of patients without surgery. However, only 14.9 per cent of them saw a doctor on their problem, and only 3.7 per cent had to be rehospitalised. Primary wait-and-see attitude caused no further increase in the incidence of perforated appendicitis.

Adolescent↗