Biomedical subjects
Publications and source records attributed to H Lippert.
The diagnosis of appendicitis in 1989 admitted patients with an age of 1 to 14 years was prospectively investigated. In 82.6% acute inflammatory changes were found. Rate of perforation was 9.9%. Between 2 and 5 years old patients 28.5% had a perforated appendix. In two cases a colon disease and in one case a malignant carcinoid was found. No death was registered after appendectomy.
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Primary mediastinal tumour or cyst was surgically treated in 129 patients (including 19 younger than 12 years) during a 16-year period. All histologic specimens and smears from fine-needle aspiration biopsy were reviewed. Intrathoracic goitre, neurogenic lesions and thymomas comprised 62% of all the tumours. Fifty lesions (39%) were found at routine radiographic examination and were asymptomatic. Eight of these 50 lesions were malignant. Chest pain, fatigue, weight loss and fever were significantly more common in malignant than in benign disease. Despite extensive investigations, the diagnosis was not established preoperatively in 32% of the cases. Chest radiography, CT-scanning and fine-needle aspiration biopsy usually provide satisfactory diagnostic information, thereby substantially reducing the need for other preoperative procedures. Early operative intervention is mandatory in these cases.
An allogenic transplantation of the total-pancreas with duodenum was carried out in the minipig model. The oral duodenum was closed blindly and the aboral part was led out as a stoma. The portal vein of the transplant was anastomosed end-to-side in the inferior vena cava and the celiac artery of the transplant in the distal aorta. Investigations for early diagnosis of rejection were carried out in this model parallelly respectively one by one. CT/MRT, selective angiography, laboratory chemical parameters were unsuitable for early detection. The pancreatic succus cytology and nuclear medical investigations show reproducible changes caused by rejection before the blood-sugar level was increased.
The diagnosis of hyperinsulinism in our 47 patients could be confirmed by clinical signs, blood sugar, insulin and C-peptide estimation. The preoperative localisation of the insulinoma was reached by angiography in 60%, by CT in 50% and by sonography in 10%. Intraoperative tumor localisation by measurement of incorporated P32 was effective in 70%. In 37 patients we enucleated one or more adenomas. In 5 children with Nesidioblastosis the left sided pancreas resection was performed. 5 patients with islet cell carcinoma were treated by duodenopancreatectomy and Streptozotocin. The longest survival time was 6 years.
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Fibrin-adhesive coated collagen fleece (Tachocomb) was used for haemostasis on 57 patients on whom different types of operations had been performed. These had been partial hepatectomies (21 cases), liver transplantations (six), and partial pancreatectomies (nine). Haemostatic effect on diffuse oozing haemorrhage was satisfactory. However, collagen fleece patches were only 8 cm X 4 cm in size and should be available in larger dimensions, particularly when it comes to larger sealing areas.
Surgical intervention in the presence of pancreatic necrosis was indicated if infection of necrosis developed. The demonstration of necrosis by CT, without clinical evidence of infection was not sufficient for operation. From 155 patients with necrotizing pancreatitis 134 had an operation upon. Surgical technique was the necrotectomy, drainage formation of a compartment and the periodic local lavage of the pancreatic cavum. 53 (39%) of 134 operated patients died.
During Shay-ulcer formation damages to the barrier of the gastric mucosa develop even before the appearance of macroscopic ulceration. Proximal selective vagotomy prevents these damages. Following pyloric ligation the prostaglandin content of the mucosa changes in parallel with the injuries of the mucosal barrier: TXB2 content of the forestomach increases, while PGF2 alpha content of both the forestomach and the antrum decreases. Following PSV operation the 6-keto-PGF1 alpha content of the mucosa decreases, whereas PGF2 alpha and TXB2 contents exhibit no alteration. As a combined effect of proximal selective vagotomy pretreatment and pyloric ligation the 6-keto-PGF1 alpha and PGF2 alpha contents of the mucosa remain low and the TXB2 increase, otherwise detectable after pyloric ligation, does not take place.
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It is a report on the heterotop transplantation of the pancreas with duodenum with or without spleen to diabetic mini-pigs. 7 days after a total resection of the pancreas the truncus coeliacus of the transplant is anastomosed end-to-side with the distal aorta. The same is done with the vena cava inferior. After having closed the duodenum orally the pancreatic juice is drained through on anus praeter. The immunosuppression is reached by giving Cyclosporin A and prednisolone after having analyzed the blood picture. The postoperative laboratory tests as well as affection tests including selective angiographic and nuclear medical in vivo controls show the efficiency of this transplantation variant to control a diabetic metabolic level for several weeks without an external insulin supply. The transplantation model described is technically uncomplicated and it is the basis for further studies.
A new method of intraperitoneal transplantation of the whole pancreas as donor-pancreaticoduodeno/recipient-cholecystostomy is described. The pancreas with duodenal segment is placed into the dorsal peritoneal cavity and the portal vein is anastomosed with the subhepatic vena cava and the long aortic segment of the graft with the distal aorta of the recipient. An anastomosis between the donor's duodenal segment and the recipient's gallbladder ensures exocrine pancreatic secretion drainage.
Mucosa damage, these appear in the Shay ulcer model before the macroscopic ulceration, can be prevented by the selective proximal vagotomy. Changes of the potential difference and the prostaglandin content were discovered after pylorus ligation, and Thromboxane was increased, PGF2 alpha and TXB2 were nearly constant, whereas 6-keto-PGF1 alpha increased clearly in the rumen. The 6-keto-PGF1 alpha and the PGF2 alpha content and Thromboxane remained unchanged and the potential difference was normalized in case of selective proximal vagotomy and pylorus ligation. The SPV is significant as you know for the secretion of H+ion and bicarbonate, but also for the normalization of increased TXB2 on the basis of our investigation results.
Nine of 38 islet isolation experiments, using the duct collagenase technique, were selected for quality checks on isolated islet tissue. Pancreas was harvested, following aortic multi-organ perfusion. The total number of islets isolated amounted to 112,461 +/- 11,828 in 13.7 ml of suspension on average. In vitro secretion of beta cells was increased by a factor of 3.8 in response to glucose stimulation. Isolated islets in morphologically intact condition were detected by histological investigations. A new viability test (MTT, Sigma) for isolated pancreas islets worked well, in that it provided very soon information on islet survival in the wake of collagenase preparation. These results produced evidence to an improvement of technical conditions for clinical use of adult islet transplantation in cases of type I diabetes.
The incidence of carcinoma of the exocrine pancreas has gone up by factors of something between 2 and 4 in countries of advanced civilization over the past 30 years. Modern diagnostic methods have enabled safe detection of the carcinoma in 85 per cent of all cases. Laparotomy is justified in situations in which the operability of a pancreas tumour cannot be reliably established by other approaches. Radical therapy should include cephalic or total duodenopancreatectomy and romal of regional lymph nodes. Diffuse metastasation or infiltration of the mesenteric superior arteries and veins, the hepatic artery, and the portal vein result in inoperability. Operations for exocrine pancreas carcinoma were performed on 226 patients at the Surgical Department of Charité, between 1979 and 1985. Tumours were radically removed in 104 cases. Surgical mortality accounted for 14 per cent. Chemotherapy or radiotherapy of pancreas carcinoma should be reverified for their life-extending effectiveness. Aggravating fatty degeneration of the liver was found to develop two years after pancreatectomy and calls for modified treatment.
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Up to now we registered all over the world 485 transplantations of the pancreas. The partial donation of organs of relatives was performed in forty cases. On August 1st 1984 297 patients (70%) survived after a transplantation of the pancreas; of them 131 had a functioning transplant (30%). 54 transplanted organs (13%) had a good function for longer than 1 year. The most frequent complications were the thrombosis of the transplant, the pancreatitis, the fistulae of the pancreas and the rejection. Of 166 human allogenic islet transplantations at present none is functioning. Early rejections were the causes for the short function times. There were no cases of death by an islet transplantation. The present research concentrates to new methods of the islet isolation from the human pancreas and the immunological influence on the isolated islets.