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Biomedical subjects

M Butters

Publications and source records attributed to M Butters.

At least 37 records · Page 2Linked to original sources
PubMed1994

[The lost gallstone--complication after laparoscopic cholecystectomy].

In this case report a persisting fistula between the right flexure of the colon and the abdominal wall was observed after a laparoscopic cholecystectomy. This was caused by a lost gallstone and eventually resulted in the resection of a colon segment. As a consequence of this case it can be said that intra-abdominally lost gallstones--especially larger ones--have to be recovered completely. In risky cholecystectomies we should consider the use of a laparoscopic bag or the installation of additional working cannulas.

Biliary Fistula↗
PubMed1994

[Juxtapapillary intraduodenal lipoma as a rare cause of jaundice and acute pancreatitis].

A 52-year-old man was admitted to hospital with acute pancreatitis and jaundice. The patient's medical history showed a case of hospitalization due to acute pancreatitis about three years before. Diagnostic examinations (abdomen sonography, CT, contrast medium radiography of the small intestine, ERCP) revealed a juxtapapillary lipoma, approximately 1 by 6 cm, obstructing the papilla Vateri. After the examinations had been completed and the pancreatitis had largely eased off, the lipoma was removed by transduodenal surgery. There were no postoperative complications.

Acute Disease↗
PubMed1992

High frequency-low morbidity mechanical complications of tube feeding: a prospective study.

Because of preferential use of the enteral route for nutritional support, a prospective study of mechanical complications was done in 109 consecutive patients. One hundred seventy-two nasogastric tubes were placed in 60 patients, 42 esophagostomies in 28 patients, 32 gastrostomies in 22 patients and 9 jejunostomies in 8 patients. Data show that the use of enteral feeding tubes is not without complications. The complications fell into two major categories. There were 15 low frequency mechanical complications, of which four (2 carotid artery blowouts, 1 gastrointestinal perforation, and 1 aspiration) were of high morbidity and 11 of low morbidity. There were 132 high frequency-low morbidity complications with the use of 255 tubes. These consisted mainly of unplanned and untimely removal of feeding tubes with interruption of feedings and necessitating tube replacement. Data indicate that the main problems related to the use of enteral nutrition are not the dramatic complications which create notoriety but those related to the ordinary mechanical complications occurring daily and which command little attention because of their low mortality. These can assume importance because of their high frequency and as such are characterized as high frequency-low morbidity complications.

Journal Article↗
PubMed1992

[The effect of duodenum-preserving pancreatic head resection on the endocrine pancreas function in patients with chronic head pancreatitis].

In a prospective clinical-experimental study, 15 patients with chronic pancreatitis operated consecutively due to severe pain were examined for the effects of a duodenum-preserving resection of the pancreas head on endocrine pancreas function. This was done by means of oral and intravenous glucose tolerance testing before the operation, on the 10th or 11th postoperative day, and three months after the operation. In addition to glucose levels in the peripheral venous blood, levels of insulin, C-peptide, glucagon, somatostatin, and pancreatic polypeptide were determined. As indicated by the k-value, glucose tolerance improved postoperatively in 11 patients; two patients showed no change, and one patient was worse. Only one patient developed evident diabetes mellitus immediately postoperatively. The pre- and postoperative levels of insulin and C-peptide showed no significant differences. The fasting levels of glucagon were significantly lower postoperatively than before the operation (2p less than 0.01). Duodenum-preserving pancreas head resection led to improvement of the glucose tolerance in the majority of patients; a deterioration was observed only in two cases.

Adult↗
PubMed1990

[Effect of liver passage on peripheral glucose and hormone concentrations in early postoperative enteral nutrition].

Early postoperative disorders of blood glucose homeostasis and its hormonal regulation do not allow a normal caloric enteral or parenteral substrate supply in this period. Eleven land pigs were investigated to find out how the surgical trauma of a partial gastrectomy influences the absorptive capacity of the small intestine and the hormonal regulation after intraduodenal administration of a glucose solution. We therefore conducted portal vein measurements to correlate the influence of the liver passage of early postoperative changes in blood glucose and hormonal levels. Our data show that neither the porto-arterial differences in blood glucose nor those in hormonal concentrations are significant. Therefore, we conclude that peripheral measurements can be used as good and reliable parameters for such investigations of absorption or hormonal regulation in the early postoperative period.

Animals↗
PubMed1990

[Effect of enteral and parenteral nutrition on glucose tolerance in the early postoperative phase].

In a randomized clinical trial in 24 patients with colorectal resections the different behaviour of glucose tolerance (GT) in the early post-operative period was investigated. Especially, we were concerned with the way nutritional substrate were applicated. Therefore 2 groups were randomly formed for a six day period of enteral versus parenteral nutrition. To check the GT enteral tolerance-tests were done preoperatively, and on day 1, 3 and 6 postoperatively. Our results show a significant improvement of GT in the enteral group on 3, and 6, postoperative days, as well as a significantly higher insulin secretion on 3, postoperative day. C-Peptide displays similar high concentrations as a sign of elevated insulin secretion. These results prove, that enteral glucose application is superior to the parenteral way in early postoperative nutrition.

C-Peptide↗
PubMed1990

[Effect of the surgical procedure on disorders of wound healing in abdomino-perineal rectum excision].

We found the infection rate to be significantly lower performing metachronous procedures although surgery lasted significantly longer than synchronous extirpation. From our results and other data from literature we conclude that occlusion of the natural anus in case of treatment with synchronous procedure leads to high intraluminal pressures during mobilisation of the rectum from sacral cavity. This enables germs to pass through the intact intestinal wall and results in contamination of the wound cavity.

Abdomen↗
PubMed1989

[Duration of the preventive use of antibiotics in colorectal surgery--single administration versus short-term prevention].

The effect of a combination of 4 g mezlocillin and 0.5 g metronidazole for the prophylaxis against infections in a one-shot dose immediately preoperatively compared to a short-time dose of 2 days given to 90 patients with resection of colorectal carcinoma was investigated in a prospective and randomized study. 6 patients developed a wound infection in the early postoperative phase; 4 of these infections (3 were severe, 1 was mild) occurred in the one-shot group and 2 in the short-time prophylaxis group. After more than 20 days postoperatively 3 late infections were observed which had a mild course (2 cases in the one-shot group, 1 case in the short-time prophylaxis group). All infections were localized in the sacral wound region in patients with abdominoperineal resection. The abdominal wounds healed per primam in each case. Besides those, 26 infections of the urinary tract were observed, which occurred significantly more often after the one-shot dose (40.9%) than with the short-time prophylaxis (18.6%). Intraoperative smears of the lumen of the bowels showed a remaining bacterial settlement. Besides Bacteroides species, especially Escherichia coli were found among the isolates. Moreover in some cases Clostridium, Klebsiella, Proteus and Pseudomonas could be identified. Smears of the site of operation (sacral/peritoneal cavity) were contaminated in over 50%, above all by Bacteroides species; besides those, E. coli were found most often. The subcutaneous smears showed a growth of the germs only in a few cases. Aerobic bacteria in 93.8%, anaerobic bacteria except for thetaiotaomicron and B. asaccharolyticus in 85.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Perioperative glucose resorption and hormonal reaction following intraduodenal glucose administration].

Early postoperative enteral nutrition has repeatedly been described in the literature but has not found its place yet in everyday clinical life. We conducted perioperative intraduodenal glucose tolerance tests in 12 patients with a healthy metabolism who had to undergo moderately severe abdominal surgery. Our results suggest that the resorption is still markedly delayed 12 h postoperatively and that the hormonal regulation is also essentially disturbed. Therefore, we believe that enteral nutrition in the early postoperative period is beneficial only more than 24 h after surgery.

Adult↗
PubMed1988

'Entero-insular axis' and surgical trauma.

To study the optimal means of postoperative energy supply, three glucose loads (5 g, 15 g, 40 g) were given via the enteral or the parenteral route before and immediately after abdominal surgery. Pre- and post-operatively, glucose and insulin concentrations were strongly dose-related after both kinds of administration. But the postoperative insulin concentrations were higher than the preoperative ones. Likewise, in both test situations the 'insulinogenic index' was significantly higher postoperatively than preoperatively. After the enteral glucose load, however, the index was 3 to 10 times higher than after the parenteral one. According to these results, even in the early postoperative period the enteral route of glucose administration is not only feasible but seems also to be superior to the parenteral one.

Adult↗
PubMed1987

[Esophagojejunostomy--how safe is manual suture today?].

Between 1982 and 1986 a total of 137 patients were gastrectomized for cancer of the stomach. The esophago-jejunal anastomosis was always carried out as an end-to-side anastomosis applying the conventional two layer technique. Only in 1 patient (0.7%) an insufficiency of this anastomosis was observed; 9 reoperations (6.6%) were necessary and 3 patients (2.2%) died in the postoperative course. These results confirm that with a precise, standardised conventional suture technique the esophageal anastomosis can be safely performed today.

Adult↗
PubMed1986

[Resorption and hormonal reaction in the perioperative phase following enteral administration of glucose].

It was the aim of this study to find out whether a postoperative enteral nutrition with glucose is possible. Therefore, an intraduodenal glucose load (15 g/7.5 min.; 20% solution) was applied in 14 patients with normal weight and no metabolic disorders before and on 4 consecutive days after a medium severe abdominal operation. The results show that the resorption of the enterally applied glucose is reduced only on the first postoperative day. After the peak values have been reached, the decrease of glucose from the blood is delayed up to the second postoperative day, although during the whole testing period the insulin secretion--calculated according to the insulinogenic index - corresponds to the glucose stimulation. Thus, an early postoperative enteral nutrition with glucose seems to be possible, but the reduced absorption over a short period has to be taken into consideration.

Abdomen↗
PubMed1985

Total gastrectomy. A 15-year experience with particular reference to the patient over 70 years of age.

Between 1969 and 1984, a total of 186 patients underwent total gastrectomy. Seventy-four patients were more than 70 years of age. Surgical mortality was 13.4%, with only minor differences between those patients younger than 70 years and older patients--12.5% and 14.8%, respectively. Moreover, there was no major difference if surgery was curative or merely palliative. Of 27 patients with tumors at TNM stage IV, only one died. Of the 100 patients who were operated on during the five-year period between 1979 and 1984, only four died, for an operative mortality of 4%. These results suggest that this remarkable decline of mortality is due to a precise standardization of surgical technique and improvements in preoperative patient management and aftercare. The five-year survival was 15.9%; again, there was no major difference between the group of patients older than 70 years and those younger than 70 years (19.4% and 14.5%, respectively). The ten-year survival was 4.9%.

Age Factors↗
PubMed1985

[Operative therapy of small intestine ileus with special reference to patients with advanced tumor disease].

Between 1979 and 1984 a total of 233 patients underwent surgical treatment of small bowel obstruction. In 43 patients (18.4%) the obstruction was caused by an advanced tumor disease (peritoneal carcinosis, local recurrence). In patients with benign obstruction the operative mortality was 5.2%; in the tumor patients it was 14%. Wound infection and cardio-pulmonary disturbances were the most frequent complications. The mean survival time of the tumor patients was 159 days. In 65% of these patients the operation had a significant palliative effect.

Gastrointestinal Neoplasms↗
PubMed1985

Desmoplastic fibroma of the rib.

We present a 17-year-old male patient who had a desmoplastic fibroma. The diagnosis is histologically verified and differentiated from other tumors. The rare localization of this benign lesion in the rib is of particular interest.

Adolescent↗