[Unprecipitate appendectomy. Diagnosis of acute appendicitis at admission is often the first diagnostic warning sign of Crohn disease].
Explore the source record for details and available documents.
Acute Disease↗
Biomedical subjects
R M Seufert
Publications and source records attributed to R M Seufert.
[Organ-preserving treatment of splenic injuries].
Explore the source record for details and available documents.
Electrocoagulation↗
[Splenectomy in Werlhof disease without thrombocyte substitution. Prospective study of 7 consecutive cases].
As a prophylaxis against the risk of postoperative bleeding platelet mass transfusions or transfusions of whole fresh blood are recommended for splenectomy in chronic idiopathic thrombocytopenic purpura. As the efficacy of this treatment is uncertain, seven consecutive patients with platelet counts of 4000/mm3 (2000-16000) were splenectomized without this prophylaxis. Platelet counts rose to 152500/mm3 (70000--305000) 18 h after operation, in every case the critical lower limit of 50000 was exceeded. Apart from one case of transient fever of undetected origin and one small pleural effusion there were no complications. Even in patients with extremely low platelet counts splenectomy can be performed without platelet mass transfusion.
Adolescent↗
[The effect of normothermic and hypothermic gastric irrigation on blood flow of the canine stomach (author's transl)].
A gastric irrigation by an open naso-gastric tube with ice-solutions is a standard procedure in the management of upper gastrointestinal bleeding. In 6 dogs the effect of an increased intragastric pressure and of gastric cooling upon gastric blood flow was examined, using radioactive microspheres. Filling the stomach with saline solution of 38 degrees C to an intragastric pressure of 15 cm H2O reduces canine gastric blood flow from 21,3 +/- 4,4 ml X 100 g-1 X min-1 to 12,6 +/- 2,9 ml significantly. Probably as a consequence of compression only mucosal blood flow is lowered. Blood flow during local hypothermia (21 degrees C at the outer wall of the stomach) at the same intragastric pressure is 60% less than the control value at empty stomach and 33% less than the value at increased pressure without lowered temperature (p less than 0,01). Blood flow to the muscularis is now reduced too. This may be explained by vasoconstriction. However, local hypothermia causes the stomach wall bleeding time to increase three times (13), whereas irrigation by 38 degrees C fluid doesn't alter the coagulation of blood. An irrigation with high volumes of a fluid with body-temperature, which lowers gastric blood flow without changing coagulation and with an open system, which allows the cleaning of the stomach, seems to be more valuable than local hypothermia by a ballon system.
Animals↗
[Initial clinical experiences with heterotopic autotransplantation of the spleen].
Since April 1980 ruptured spleens have been removed in seven patients (6-43 years old) and reimplanted into the omentum majus using a new operative technique. This procedure took about 15 min. Two patients died because of associated trauma to other organs. There were no complications due to this autologous, heterotopic transplantation. Four months after the operation elektrophoresis of immunglobulins, Howell-Jolly bodies and "pitted" RBCs were totally normalized. A 99mTc-scintigram with human albumin-millimicrospheres showed an intact phagocytosis and ingestion by the transplant. Therefore, good protection against infection is to be expected. The heterotopic autotransplantation of the spleen should be used in cases of splenic trauma if the clinical situation demands total splenectomy.
Adolescent↗
[Acute diagnosis and therapy of severe hemorrhages from the esophagus, stomach and upper small intestine].
Explore the source record for details and available documents.
Acute Disease↗
[Studies of gastric circulation in the dog, II. Ligation of main arteries (author's transl)].
Following ligation of a single gastric artery total and regional gastric blood flows are measured using radioactive microspheres of 8 mu size. There is no significant influence on total gastric blood flow. Within the depending anatomical region no significant reduction of total wall blood flow can be determined. However, blood flow to the antrum mucosa is reduced to approximately 40% after ligation of any gastric artery. Thus, it can be concluded that ligation or embolisation of a single gastric artery in diffuse gastric bleeding does not necessarily reduce or terminate the bleeding.
Animals↗
[Studies of gastric circulation in the dog. III. Remaining blood flow in the dissected stomach (author's transl)].
After mobilisation of the stomach for high anastomosis between esophagus and stomach, gastric blood flow is maintained by only one gastric artery. Total and regional gastric blood flows are measured in 13 dogs using the microspheres method after ligation of three main gastric arteries. In any part of the stomach blood flow does not decline below 40% of the initial blood flow. Blood flow to mucosa of corpus and fundus is hardly reduced even after this drastic reduction of total gastric blood flow. Blood flow in the muscle layer of the fundus is reduced to about 38% if supplied only by the right gastroepiploic artery. Different operative procedures of replacements of the esophagus are discussed.
Animals↗
[Gastric blood flow in animals. I. Normal blood flow (author's transl)].
Total and regional gastric blood flow were measured in 15 dogs under control conditions (mean AOBP 100 mm Hg) using microspheres labelled with different isotopes (125J, 141Ce, 85Str, 46Sc) of 8 mu size. The mucosa in fundus and corpus showed significantly higher blood flow compared to the antrum. There was no difference in the muscular layer for either part of the stomach. It is concluded from these data that differences in regional blood flow in the unstimulated stomach of the dog are related to different energy-demands within the stomach.
Animals↗
The role of ischemia in the pathogenesis of stress induced gastric lesions in piglets.
Ten conscious piglets were subjected to hemorrhagic shock for three hours. Nine surviving piglets showed severe stress induced gastric mucosal lesions in the gastric fundus and corpus. Total as well as regional gastric blood flow was measured, 8 micron radioactive microspheres, in the same piglets before--control--and during hemorrhagic shock. Total gastric blood flow fell almost 90 per cent uring shock. There was a significantly higher flow reduction in the mucosa of the corpus and fundus, where almost all of the stress lesions were found. Measurement of blood flow within these lesions demonstrated a fall approximately to zero. Ischemia seems to be an important pathogenetic factor of gastric stress lesions. This may possibly render the gastric mucosa more susceptible to other injurious factors.
Animals↗
[Local gastric fibrinolysis].
Local fibrinolytic activity was studied in normal and hemorrhagic gastric juice and in the gastric wall of men and pigs. This activity was definitely higher in hemorrhagic juice than in normal gastric juice, and its probably released from hemolyzed erythrocytes and mucosal lesions of the gastric wall.
Animals↗
[The effect of vagus and sypathetic nerves on blood flow in the swine stomach].
Porcine gastric blood flow (radioactive microspheres) was studied (aortic blood pressure controlled) under five conditions: control (n = 8), electric stimulation of the splanchnic nerves (n = 8) and the vagus nerves (n = 8), truncal vagotomy (n = 8), and gastric sympathectomy (splanchnicotomy, n = 5). Highly significant increase in corpus mucosa flow after vagal stimulation or gastric sympathectomy is antagonistic to changes after splanchnic stimulation and truncal vagotomyand is often contrary to changes of the antrum mucosa. This might be an explanation fir ischemic gastric lesions (stress ulcer) after stress-induced high sympathetic tone (1, 2) and stress ulcer prophylaxis by gastric sympathectomy (3, 4).
Animals↗
[Blood flow in the swine stomach in hemorrhagic shock].
In nine conscious piglets, total and regional gastric blood flow was measured (8 microns radioactive microspheres) in the same animals before (control) and at the end of a 3-h hemorrhagic shock period (mean AoBP = 40 mm Hg). Gastric blood flow decreased dramatically (88.4%) during shock. This decrease was most severe in the mucosa of corpus and fundus, where the highest flow was registered during control and where stress lesions are usually found. The reduction in gastric flow was significantly greater than the reduction in cardiac output (45.1%). The disproportional reduction in gastric blood flow may be explained by the high alpha-adrenergic activity of splanchnic organs (2) and by the impediment to liver outflow (1) during hemorrhagic shock.
Animals↗
[Experiences with the hemorrhagic shock in immature pigs (author's transl)].
In 74 immature pigs a hemorrhagic shock (3 hrs duration: mean arterial pressure 40 mm Hg) was established (NORTON 1972). Following this systemic stress all animals developed stress-lesions of stomach and duodenum. In comparison to other stress-models porcine hemorrhagic shock seems to be qualified to study pathogenesis, prophylaxis and therapy of gastric stress-lesions: Pigs correspond best to humans in their gastro-intestinal physiology, hypotension simulates one of the most important surgical causes of stress complications and stress-lesion produced by this model have a marked similarity to those of humans. In contrast to these advantages there are some problems in using this model: Prompt and dangerous electrolyte imbalance following correction of disturbances in acid base equilibrium; irreversible shock following protracted hypotension (3 hrs). For this reason 19% of all piglets died before (1 animal), during (10 animals) or immediately after shock (3 animals). By careful observation of the mentioned problems, however, this experimental model combines a high incidence of stress-lesions with a low rate of casualities.
Animals↗
Experimental gastric sympathectomy: an effective prophylaxis of gastric stress lesions.
Fifteen mini-pigs were bled to a mean aortic blood pressure of 40 mm Hg and maintained at that level for three hours. The control group consisted of eight animals with shock for three hours, while the test group was comprised of seven animals with a similar shock period but which had undergone splanchnicectomy 14 days earlier. In all animals a stimulated gastric secretion test was performed three days before and eight days after splanchnicectomy. All animals in the control group showed severe gastric mucosal lesions after shock. Conversely, the piglets with splanchnicectomy developed no changes (five animals) or only minor changes (two animals). The efficacy of splanchnicectomy was confirmed by a stimulated gastric secretion test in which basal acid output did not change after operation, but peak acid output increased significantly. This study suggests that gastric splanchnicectomy prevents gastric ulceration following experimental shock.
Animals↗
[Effect of truncal vagotomy on the occurence of gastric mucosal lesions induced by hemorrhagic shock in piglets (author's transl)].
3 groups of total 37 mini-pigs have been bled to a mean aortic blood pressure of 40 mm Hg for three hours (Norton et al., 1972): Group I: hemorrhagic shock along (n = 15) Group II: right thoracotomy prior to shock without vagotomy (n = 4) Group III: right thoracotomy prior to shock with truncal vagotomy right above diaphragm (n = 15) 3 animals died during shock. All others showed severe mucosal hyperaemia and hemorrhage after shock, which intensified in animals without vagotomy during 8-24 hours. Gastric mucosal lesions of vagotomized animals did not differ to those of group I and II, when the animals were killed 4-8 hours after shock. However, there was a significant reduction of early changes after 12-24 hours, when compared to groups I and II. This study shows, that truncal vagotomy has no effect on the occurence of gastric mucosal lesions, which are induced by hemorrhagic shock in piglets, but prevents these from developing into severe bleeding peptic ulceration.
Animals↗
[Lose-dose treatment with vitamin A in prevention of stress ulcer in swine].
Hemorrhagic shock in 8 piglets (mean AoBP 40 mm Hg for 3 h) was followed by severe stress-induced gastric mucosal lesions (Gr-I). When vitamin A was administered simultaneously (50,000 IE/kg = Gr. II, n = 6 and 5,000 IE/kg = Gr. III, n = 7) during the procedure, no stress lesions were observed. The study shows that the simultaneous application of vitamin A during hemorrhagic shock, in a reasonable clinical dosage, protects the gastric mucosa against stress-induced lesions.
Animals↗