Biomedical subjects

L Flautner

Publications and source records attributed to L Flautner.

At least 37 records · Page 2Linked to original sources

PubMed1997

Pancreatic pseudocysts associated with chronic pancreatitis--early and late results of 1367 operations.

The authors hereby review the data of 1367 operations for pancreatic pseudocysts. The surgical procedures of choice in particular pancreatic pathologies are analysed in the light of early morbidity and mortality, as well as long term follow-up results. The best operations for pancreatic pseudocysts have been the internal drainage procedures, which resolve the pathological alterations without the necessity of pancreatic resection. The treatment of chronic pancreatitis may require combined surgical procedure, such as cysto-Wirsungo-gastrostomy. The pancreatic resections performed for the treatment of small pseudocysts in the pancreatic head have been superseded by the less invasive blunt, forced cysto-duodenostomies, representing better results secondary to the smaller perioperative risk for the patient. The cyst-to-stomach and cyst-to-duodenum internal drainage techniques are just as effective, but with shorter operation time, than the Roux-en-Y cysto-jejunostomies.

Adult↗

PubMed1997

Multimodality treatment of pancreatic pseudoaneurisms.

Vascular lesions of pancreatitis manifest in the form of haemorrhage into the pseudocyst (PC), the development of pseudoaneurisms (PA) or splenic lesions. Between 1987 and 1996 31 patients were found to develop vascular lesions either in the form of haemorrhage into a PC (12) or PA (19). Diagnosis of pancreatic PA was established preoperatively in 8 cases only. Gastrointestinal (GI) bleeding manifested in 12 patients, but only in 6 of them was the pancreatic origin of the bleeding considered. All patients were operated. For the management of the lesions resection of the pancreas (11 cases) or ligation of the bleeding vessel with external or internal drainage of the PC was performed (12 cases). Simple external drainage of a haemorrhaged PC in 3, and cystoduodenostomy or cystogastrostomy was performed in 5 cases respectively. Intraoperatively moderate bleeding gave some concern (7 cases), while post operatively pancreatic fistula developed in 9 patients drained externally. All stopped spontaneously. In two cases severe GI bleeding occurred post operatively. In both cases embolization of the bleeding vessels was performed successfully. No operative mortality occurred. The mean follow-up time was 40.6 months (5-106). Five patients died of unrelated causes, 3 patients underwent subsequent pancreatic operation, and 74.2% of the patients are doing well. Development of pancreatic PA was associated with a longer observation or conservative treatment period. Angiography should be considered whenever severe upper GI bleeding occurs in patients with known pancreatic disease and the source of bleeding is obscure. In selected cases selective embolization of the bleeding site may provide definitive treatment.

Aneurysm, False↗

PubMed1996

Helicobacter pylori infection in congestive gastropathy.

BACKGROUND: This study determines the prevalence and significance of Helicobacter pylori infection in portal hypertensive patients. MATERIALS AND METHODS: Patients numbered 118 and consisted of 90 patients with portal hypertension (66 men; 24 women; mean age, 49.1 +/- 2.1 years) and 28 noncirrhotic patients with nonulcer dyspepsia, (12 men; 16 women; mean age, 47.6 +/- 2.8 years), who made up the control group. In all patients, diagnostic upper endoscopy was performed, and gastric biopsies were taken for histological examination and diagnosis of H. pylori. RESULTS: Of the portal hypertensive patients, 42 (47%) had congestive gastropathy, 11 (26%) of whom were positive for H. pylori, and 48 (53%) did not have gastropathy, 12 (25%) of whom were positive for H. pylori. In the control group, 15 of 28 (54%) were positive for H. pylori. H. Pylori was found less frequently in congestive gastropathy patients than in the control group. We found also that the presence and severity of congestive gastropathy is independent of H. pylori status. CONCLUSIONS: We conclude that the role of H. pylori in the pathogenesis of congestive gastropathy is unlikely, and we suggest that there is no need for its routine eradication in cirrhotic patients.

Adult↗

PubMed1994

Retinopathy of pancreatitis indicates multiple-organ failure and poor prognosis in severe acute pancreatitis.

During hospitalization for severe acute necrotizing pancreatitis, a connection between the onset of retinopathy of pancreatitis and multiple-organ failure was studied. Ophthalmoscopy was repeated every second day and continuous staging for multiple-organ failure was performed in 38 patients. Typical retinopathy of pancreatitis developed in 7 of 10 patients with multiple-organ failure and only in 4 of the 28 patients without multiple-organ failure. Retinopathy of pancreatitis was observed in 7 of the 18 cases leading to lethal outcome and only in 4 of the 20 surviving patients. No correlation was observed between the development of retinopathy of pancreatitis and hemodialysis, pre-existing diabetes mellitus, abnormal platelet count, result of hemoculture, c reactive protein value, fraction of inspired oxygen and adult respiratory distress syndrome. In the 21 control patients in grave general state but without acute pancreatitis, retinopathy of pancreatitis was never observed. In our prospective study the onset of retinopathy of pancreatitis had clinical prognostic value and indicated multiple-organ failure and poor prognosis in severe acute necrotizing pancreatitis.

Acute Disease↗

PubMed1994

Postacute pancreatic pseudocysts: definition and operative treatment.

Authors survey earlier definitions of classification of pancreatitis (Symposiums in Marseilles, 1963, Cambridge, 1983, Marseilles, 1984). They define the concept of postacute pancreatic pseudocyst based on their own clinical practice, describe its clinical view and characteristic signs. They noticed in 90 cases (9%) postacute pancreatic pseudocysts during 991 pancreatic pseudocyst operations at 850 patients in 5-year period in their own practice. That postacute pseudocysts were found 6 weeks after severe acute pancreatitis in patients who were clinically in recovering state, feverless and alimented orally. The operative treatment of postacute pseudocysts was in 70% outer drainage (in 58 cases from 63 were performed necrectomy, too), in 14% (13 cases) inner drainage and in 16% resection (from 14 cases 11 distal resections, 10 times associated with splenectomy). The chosen operative treatment was significantly (p < 0.01) more outer drainage and less inner drainage. The mortality and morbidity indexes of postacute pancreatic pseudocysts did not deviate significantly from the same values of the whole patient material.

Acute Disease↗

PubMed1994

Pancreatic pseudocysts causing compression symptoms.

The authors survey the surgical treatment of duodenal or choledochal stenosis which were detected during the operation of 991 pancreatic pseudocysts in the period of 5 years, from 1987 to 1992, at 850 patients. They found that in the case of common occurrence of mechanical jaundice and pancreatic pseudocyst in 40% of cases the drainage or resection of pseudocyst was enough to ensure the free biliary passage. In case of combined operation the stenosis of choledochus was solved in 64% of cases with sphincteroplasty. In case of common occurrence of duodenal stenosis and pancreatic pseudocyst the drainage of pseudocyst was enough in 69% of cases to ensure the free gastroduodenal passage and at 31% was necessary the combined operation.

Cholestasis↗

PubMed1993

Short report: octreotide in the treatment of external pancreatic fistulas.

The efficacy of the long-lasting somatostatin analogue, octreotide, in the treatment of high-output pancreatic fistulas was investigated in this prospective, open study. Sixteen patients with post-operative pancreatic fistulas were treated with subcutaneous injections of octreotide 0.1 mg b.d. The output of the fistulas before the somatostatin therapy ranged between 190 and 570 ml/day. The therapy was begun on average 17 days following the appearance of the fistula (range 4 to 35 days). The decrease in volume one day after initiation of therapy ranged from 26% to 69%. By the third day of treatment the fistula volume decreased to 0-45% of the initial output. The treatment resulted in the closure of 14 of the 16 fistulas; the time to closure ranging from 3 to 15 days. The results suggest that octreotide is a useful adjuvant agent in the treatment of an external pancreatic fistula.

Adult↗

PubMed1993

Perioperative use of somatostatin in pancreatic surgery.

The prophylactic effect of perioperative use of somatostatin on postoperative increase of pancreatic enzymes was investigated in this double blind, randomized study. Thirty tree patients undergoing pancreatic surgery because of chronic pancreatitis or its complications were divided randomly into two groups. Fifteen patients received somatostatin (dose 125 micrograms/hour), 18 placebo-infusion pre-, and postoperatively for a total time of 48 hours. The level of serum amylase, lipase, gammaGT, calcium, creatinine and blood glucose was determined every 12 hours. In the placebo treated group the serum lipase and amylase increased significantly (p < 0.001), while the calcium decreased. In the somatostatin treated patients only the lipase level increased significantly (p < 0.01), while the amylase and calcium showed no significant changes compared to their initial values. The postoperative increase in serum enzyme levels is interpreted as being an indicator of pancreatic injury. These results suggest that the perioperative use of somatostatin has beneficial effect for the prevention of pancreatic enzymes increases and of pancreatic injuries, associated with pancreatic surgery in patients with chronic pancreatitis. The clinical experiences suggest that the asymptomatic increase in pancreatic amylase following abdominal surgery is the result of various types of injuries of the pancreas (1-3). Included in these injuries is the direct mechanical damage of the parenchyma and ducts but it can develop secondary, as a result of vascular lesion, ischaemia, oedema as well as mechanical injury to the Oddi sphincter of the sphincter's drug induced spasm (1, 2). The asymptomatic increase in serum amylase and lipase can thus be interpreted as being an indicator of surgical pancreatic injury (3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

[Initial experience with ESWL therapy of pancreatic duct calculi].

Extracorporeal shock wave lithotripsy of pancreatic stones was performed in four patients with chronic pancreatitis and a dilated duct system harbouring stones 5-12 mm in diameter. The stones were disintegrated by shock waves using a Dornier lithotripter in one or more sessions. Disintegration of stones was achieved in 4/4 patients, initial (6-11 months) relief of pain in 3/4 patients, and total clearance of pancreatic duct in 3/4 patients. No complications were observed. In the first patient in whom ESWL was not completely successful, underwent an operation: a longitudinal pancreato-gastrostomy and the stones were found completely disintegrated. From these early data they conclude that ESWL of pancreatic duct stones is a provisional new alternative for surgery in the treatment of chronic pancreatitis.

Calculi↗

PubMed1992

[Increased use of pancreas transplantation in the management of diabetics].

The surgery looking for new ways takes part in the treatment of the type I diabetic patients. The development of pancreatic transplantation in the last decades is discussed. Nowadays the procedure has become accomplished and widely used in the transplantation practice. According to the results of the clinical trials the pancreatic transplantation can normalize the metabolism and improve the quality of life. By improving also the survival of the simultaneously transplanted kidney the procedure has become increasingly indispensable complement of the kidney transplantation in the treatment of type I diabetic patients with end stage kidney disease.

Diabetes Mellitus, Type 1↗

PubMed1992

[The place of pancreas transplantation in therapy].

Insulin dependent diabetes mellitus is one of the most ravaging diseases of the civilised world mainly because of its secondary complications. Even the most careful exogenous insulin administration can neither maintain an entirely physiological glucose metabolism nor prevent the development of the late complications. Today pancreatic transplantation is the only therapy leading to total normalisation of glucose and lipid metabolism in type I diabetic patients. Beside the improvement of the life quality resulted by the independence of the insulin administration and of the dietary restrictions, secondary complications as nephropathy, retinopathy and neuropathy are positively influenced. Best results can be obtained with the simultaneous procedure, grafting kidney and pancreas from the same donor. In this case the grafted pancreas can also increase the patient survival rate and the kidney graft function rate comparing with the results of the kidney transplantation alone. In conclusion simultaneous pancreatic-kidney transplantation is clearly indicated for the treatment of type I diabetic patients with end-stage kidney disease.

Diabetes Mellitus, Type 1↗

PubMed1992

Octreotide.

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Adult↗

PubMed1992

[Somatostatin in the prevention of postoperative increase of pancreatic enzyme after pancreatic surgery].

The prophylactic effect of perioperative use of somatostatin on postoperative increase of pancreatic digestive enzymes was investigated in this double blind, randomized study. Thirty three patients undergoing pancreatic surgery because of chronic pancreatitis were divided randomly into two groups. Fifteen patients received somatostatin- (dose 125 micrograms/hour), 18 placebo-infusion, pre- and postoperatively for a total time of 48 hours. The level of serum amylase, lipase, gammaGT, calcium, creatinine and blood glucose was determined every 12 hours. In the placebo group the serum lipase and amylase increased significantly (p less than 0.001), while the calcium decreased. In the somatostatin treated patients only the lipase level increased significantly (p less than 0.01), while the amylase and calcium showed no significant changes compared to their initial values. The postoperative increase in serum enzyme levels is interpreted as being an indicator of pancreatic injury. These results suggest that the perioperative use of somatostatin has beneficial effect for the prevention of pancreatic enzymes increases, associated with pancreatic surgery or its complications in patients with chronic pancreatitis.

Adult↗

PubMed1991

[The effect of two different methods of jejunal feeding on pancreatic function].

Pancreatic juice was continuously diverted from the Wirsungial duct by nasopancreatic drainage of the remnant of the gland after pylorus preserving partial pancreato-duodenectomy in 14 patients. On the 7th postoperative day with stabilized pancreatic secretion the juice was collected in 10 min fractions, while interdigestive secretory phases of the parenchyma were established by volume changes. At the beginning of a phase 100 ml slightly hyperosmolar (400 mosmol/L) oligopeptide diet with 90 kcal was given as a bolus injection for 7 patients or 60 min infusion into the second jejunal loop by fine needle catheter jejunostomy for 7 patients also. Pancreatic water, bicarbonate, protein, chymotrypsin, amylase levels peak, and integrated secretory responses were measured. It was observed, that infusion of the diet did not disturb cycling interdigestive phases and did not increase peak and integrated outputs. Bolus administration interrupted interdigestive phases and stimulated pancreatic water, bicarbonate, protein, chymotrypsin and amylase outputs nonparallelly. On the basis of their data authors concluded, that pancreatic secretion seems to be well preserved without duodenalregulatory mechanisms; and continuous jejunal infusion feeding seems to be useful in pancreatic disease and in other postoperative states when pancreas has to be put into rest.

Enteral Nutrition↗

PubMed1991

Effect of enteral nutrition on exocrine pancreatic function.

Twelve patients with chronic pancreatitis underwent a pancreatoduodenectomy in which the pylorus was preserved. The effects of parenteral and enteral nutrition on pancreatic secretion were compared. Postoperative nutrition was administered by needle-catheter jejunostomy in seven patients and by total parenteral nutrition in five patients. Pancreatic juice, drained directly from the pancreatic duct, was collected in 4-hour fractions. Volume, bicarbonate, protein, amylase, and chymotrypsin were measured. In the first two postoperative days, there was a slow increase in all measured indices. On the third postoperative day, an abrupt rise occurred, after which pancreatic secretion stabilized. No differences in exocrine pancreatic secretion were observed between the enteral and parenteral methods of feeding.

Adult↗

PubMed1991

Peritoneal benign cystic mesothelioma.

A case of a benign cystic peritoneal mesothelioma is reported. A 25-year-old woman presented a 8-year history of recurrent tumor and five operations because of that. On the basis of this case and of 18 cases proved by electron microscopy reported by others, the clinicopathological features and the problems of differential diagnosis are discussed. The ultrastructural examination is essential for the diagnosis of cystic mesothelioma.

Adult↗

PubMed1990

[The effect of early postoperative jejunal feeding on the exocrine function of the pancreas].

Subsequent to pancreatoduodenectomia with pylorus retention on 12 patients suffering from chronic pancreatitis we analysed the effect of artificial nutrition on pancreas-secretion by examining the pancreatic juice extracted directly from the Wirsung duct. We used post-operative nutrition administered by fine-needle catheter jejunostomy in 7 patients and 5 patients received postoperative support by total parenteral nutrition as a control-group. We analysed the pancreatic juice collected in four hour fractions for volume, direct protein, amylase, chymotrypsin, bicarbonate. It has been found that on the first two days after the operation we can see a slow increase in the measured values and on the third postoperative day after an abrupt rise the pancreas secretion became steady. Between the two methods of artificial nutrition applied it was impossible to prove an observable difference concerning their effect on the pancreas. According to our observations the two methods are equivalent in the postoperative therapy of patients operated on because of chronic pancreatitis.

Chronic Disease↗

PubMed1990

[Excision of a splenic cyst using a surgical stapler in partial splenectomy].

The authors extirpated the splenic cyst of a young girl with the use of stapler in such a way that the distal part of the spleen was preserved. During this case the types of splenic preservative operations and the question of fulminant sepsis found in the patients went under splenectomy were surveyed. According to us the advantage of using stapler in partial splenectomy than the others is that firstly it is technically simple, less time consuming, and the haemostasis is safe. This is thought to be a valuable additional procedure to the ultimately known and the procedures which are used.

Adolescent↗