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I Klempa

Publications and source records attributed to I Klempa.

At least 19 recordsLinked to original sources
PubMed1992

Role of octreotide in the prevention of postoperative complications following pancreatic resection.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Double-Blind Method↗
PubMed1992

[Prevention of thromboembolism in surgery--results of a survey in West German hospitals].

UNLABELLED: In 1990 a questionnaire on methods for prevention of deep venous thrombosis (DVT) and pulmonary embolism (LE) was mailed to 940 surgical centers in West Germany (FRG). The return rate was 60% or 564 answers, covering about 1,200,000 operations/year. The results are as follows: (1) Physical therapeutic measures (early mobilisation, elastic stockings) and drug administration are routinely used in all centers. The duration of prophylaxis is 3-8 days in 36% of centers, up to mobilisation in 31%, 9-16 days after operation in 17% and until demission in 16%. (2) A single drug regime is employed in 60% of centers (49% standard heparin, 9% low molecular heparin in combination with DHE) 40% of centers use all three drugs without clear cut guidelines concerning the indications. (3) The reported rates of thromboembolic complications diagnosed by clinical criteria are 0.55 +/- 0.62% for DVT and 0.22 +/- 0.29% for fatal or nonfatal LE. There is no evidence from the analysed data that the drug regimes influences the clinical outcome. CONCLUSION: The need for administration of drugs prevent DVT is widely accepted. A polypragmatic approach seems to be effective. However, standardized regimes for defined clinical conditions are desirable.

Bandages↗
PubMed1991

[Effect of somatostatin on basal and stimulated exocrine pancreatic secretion after partial duodenopancreatectomy. A clinical experimental study].

In a prospective trial 30 patients underwent pancreaticoduodenectomy (Whipple operation) for cancer. They were randomly assigned to receive Somatostatin (SST) (n = 15) or not (n = 15). SST was started at laparotomy with 250 micrograms/h and given over a period of 5 days. A small catheter, which was placed into the duct of the pancreatic remnant, gave access to the pancreatic juice. Volume, amylase, lipase and protein as well as bicarbonate outputs were analyzed. As regards endocrine function, insulin and glucagon plasma levels were measured. The nitrogen balance was calculated. A stimulation test was done on the fifth postoperative day. Six patients (3/3) were assessed as drop-outs. A significant reduction was found for volume, amylase, lipase, protein and bicarbonate with SST, this effect lasting for two days. Lipase however was reduced significantly for 5 days. Pancreatic exocrine function was reduced as well after stimulation, if SST was given. Insulin and glucagon were inhibited with SST, the latter more effectively. We found a positive nitrogen-balance as early as on the second postoperative day in the SST-group, whereas without SST this did not occur before the fourth postoperative day. This findings were significant on the third and fourth postoperative day. The inhibitoric effects of SST, which are demonstrated by our laboratory investigations, conform very well with a more favorable clinical course and a reduction of perioperative morbidity and mortality.

Ampulla of Vater↗
PubMed1991

Liposarcoma of the esophagus.

Presented here is a report on an unusual liposarcoma of the esophagus. A 66-year-old-woman was treated successfully by surgical excision without removal of the esophagus. Thirty months after surgery and radiation she presented with neither complaint nor recurrence.

Aged↗
PubMed1990

Morphometry and function of islet cells after different forms of drainage at pancreatic transplantation in rats.

The survival of endocrine cells of the islets is crucial for a successful transplantation of the pancreas in the treatment of diabetes mellitus. In the present investigation, we compared the effect of four techniques of whole pancreas transplantation in rats on the endocrine cells of islets of Langerhans. Impairment of the endocrine function of the pancreas with a decrease in the k value was seen after 6 months in the group with duct ligation, and after 12 months in the groups with latex and ethibloc occlusion. An open pancreatic duct maintains a more stable endocrine function than in duct-ligated or occluded grafts. Fasting plasma insulin and somatostatin were elevated in transplanted rats. Whichever method of transplantation we chose, the cell ratio remained unchanged compared with the control group, even after 12 months. Therefore, only intact islet architecture enables a normal endocrine pancreatic function.

Animals↗
PubMed1989

[Subtotal adrenalectomy versus autotransplantation of the adrenal cortex--an alternative procedure in bilateral adrenalectomy in MEN II?].

Complete loss of steroid production is a very remarkable effect of total adrenalectomy. This is the reason why attempt was made to preserve some adrenal cortex function in cases with bilateral adrenalectomy. Till now successful autografting of adrenal cortex has been reported only in cases with Cushing's syndrome. We now report on two cases with MEN II syndrome, in whom autografting into the rectus muscle was done successfully. In order to compare results, data on two patients with subtotal adrenalectomy are given. Outcome was similar. In all 4 cases function of adrenal cortex was demonstrated by scintigraphy and by blood chemistry. In one case with autotransplantation and in another with subtotal resection, the remaining adrenal tissue showed response to ACTH. Provided more experience, in our opinion subtotal adrenalectomy and adrenal autotransplantation in cases of MEN II syndrome might turn out to prove as equivalent procedures.

Abdominal Muscles↗
PubMed1979

Effect of somatostatin on bile-induced acute hemorrhagic pancreatitis in the dog.

In 21 female Beagle dogs an experimental pancreatitis was induced by injection of bile into the pancreatic duct system. Beside controls, dogs received 62.5 micrograms/h cyclic somatostatin (SRIF) a continuous i.v. infusion starting with a bolus of 250 micrograms 15 minutes before or 2 hours after bile injection. Following blood parameters were determined: lipase, amylase, blood count, minerals, glucose, insulin, gastrin, secretin and CCK. Two controls died within 24 hours, the others were sacrificed after 48 hours. All pancreata were examined morephologically. The controls developed all clinical signs of acute hemorrhagic pancreatitis, whereas all SRIF-treated dogs were in much better general condition. Lipase and amylase increased in all groups. In the controls insulin, gastrin and secretin remained unchanged and CCK rose slightly. SRIF-treatment diminished insulin, CCK and the test meal-induced increase of secretin. At autopsy the pancreata of the controls were nearly entirely apoplectic. The SRIF-treated dogs showed less damage of the pancreas and no severe hemorrhagic necrosis was noted. The beneficial effect of SRIF cannot only be due to an interaction with intestinal hormones. An additional direct protective effect on the exocrine parenchyma is proposed to exist.

Acute Disease↗
PubMed1979

[Prevention of postoperative pancreatic complications following duodenopancreatectomy using somatostatin].

Somatostatin was prophylactically administered to 10 patients who had surgery for pancreatic diseases. The postoperative course uncomplicated with no increase in serum amylase levels. Bile induced acute pancreatitis in six beagles was prophylactically treated with somatostatin. The results demonstrate that SRIF not only inhibits basal but also pancreatic-induced blood amylase and enzyme activities in the dog. SRIF-treated animals were in good general condition compared with untreated controls, macroscopic and histologic aspects of the pancreas were significantly improved.

Adult↗
PubMed1978

[Recurrent hyperparathyroidism following subtotal parathyroidectomy].

Recurrent hyperparathyreoidism occurred in 3 of 9 patients in terminal renal failure from 9 months to 2 years after an initially successful subtotal parathyroidectomy. In all cases we find temporary remission of clinical signs of hyperparathyreoidism after surgery. Our clinical experience provided by followup in these patients showed an insufficient biochemical and clinical control. We find recurrence in 3 cases and repeat neck exploration was indicated for 2 patients.

Humans↗
PubMed1978

[Parathyroid neoplasm associated with hyperparathyroidism].

Over a 25-year period, two carcinomas of the parathyroid were observed in 67 cases of primary hyperparathyroidism. The most important signs and symptoms were bone disease, palpable neck metastases, renal stones, and hypercalceamia with high blood levels of parathyroid hormone. Histology revealed that in principle parathyroid carcinoma can be distinguished from adenoma by a trabecular pattern and thick fibrous bands. The presence of cellular atypia and variation or mitotic figures (regressive polymorphia) was not a useful criteria for carcinoma. Local recurrence occurred in both cases.

Carcinoma↗
PubMed1978

[Transposition of the jejunum and selective proximal vagotomy following duodenopancreatectomy].

We report the use of a new surgical procedure following pancreaticoduodenectomy in nine patients with chronic relapsing pancreatitis and its complications. The modification of the Whipple reconstruction following resection of the head of the pancreas consists in selective proximal vagotomy, transposition of a jejunal loop for bile duct, and pancreatic anastomosis. The longest follow up period has been 18 months. In agreement with reports on other procedures for resection of the head of pancreas, the patients who had been operated on suffered few symptoms. With one exception they had no pain at all; they all gained weight. The results of early follow-up examinations of the patients treated by to these procedures encourage continued use of duodenopancreatectomy.

Adult↗
PubMed1978

[Morphological aspects of parathyroid gland transplantation. Contribution on the clinical relevance of induced, invasive tissue growth].

The results of morphologic studies performed in 18 patients who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. All patients had long-standing renal disease with azotemia, hyperphosphatemia and high levels of parathyroid hormone. The histologic findings after total parathyroidectomy, before gland transplantation, are important for selection of parathyroid tissue for surgery. Diffuse hyperplasia with the development of multiple nodules of the parathyroids can possibly be adverse for the transplant. In one case, nine month after autotransplantation we found a tumor in the forearm, measuring 2.0 X 3.0 X 2.2 cm in diameter. Morphologic findings in this case before implantation showed diffuse hyperplasia with adenomatous nodules but no signs of carcinoma. The grafted parathyroid tissue after excision was seen with blood vessel invasion in the normal skeletal muscle. In the case of primary renal disease with secondary parathyroid hyperplasia, the light microscopic examination revealed an autonomous tumorlike adenomatous formation in the autografted parathyroid tissue, with graft-dependent hypercalcemia. The invasive growth with some signs of neoplasia following autotransplantation raises the question of the development of certain neoplasia.

Adult↗
PubMed1978

Total parathyroidectomy with autograft of parathyroid tissue in treatment of secondary hyperparathyroidism.

In 16 patients with severe symptomatic hyperparathyroidism reduction of hyperplastic parathyroid mass was performed by total parathyroidectomy with autotransplantation of parathyroid tissue. In all patients except one serum parathormone (PTH) levels returned to normal and postoperative difficulties in calcium homeostasis were rarely observed. Fifteen patients had normal PTH levels after surgery. Graft function was proven in 10 cases, but in 5 cases graft function could not be definitely established with the methods applied. One graft failure was observed. Total parathyroidectomy with autotransplanation of parathyroid tissue is recommended as the treatment of choice when surgical correction of secondary hyperparathyroidism is necessary.

Adult↗
PubMed1977

[Parathyreoid autoransplantation in secondary hyperparathyreoidism (author's transl)].

Subtotal Parathyreoidectomy offers no problem after surgery, nor after Kidney transplantation. But a recurrence needs extensive investigations for localisation of recurrent hyperplastic glands. The necessary reoperation is loaded with difficulties. After total Parathyreoidectomy hypocalcaemia is a severe complication. Therefore in patients awaiting Kidney transplants in a chronic dialysis program the procedure is not opportune. In 11 patients following total Parathyreoidectomy and autoplastic parathyreoid transplant, we found nearly normal parathyreoid hormone plasma levels. The advantage of this method is: The function of the autoplastic graft is testable and a possible recurrence is easily resectable.

Calcinosis↗
PubMed1977

[Improvement of the preoperative localization technique in the surgery of hyperparathyroidism (author's transl)].

The possibility of preoperatively localizing overactive parathyroid adenoma by measuring the difference in parathormone levels in selective blood samples from the thyroid venous plexus and from the periphery (large veins) by radioimmunoassay has brought a decisive advance in parathyroid surgery. We report our experience with this preoperative localization technique, which we have used in 10 patients.

Adenoma↗