Laminin localization in enterocytic basement membrane of rat small bowel grafts. A light and electron microscopic study.

In vitro laminins stimulate numerous biological effects, such as cell migration, proliferation, attachment and differentiation. In vitro laminins influence immunocompetent cells and in vivo possibly play an important role in graft rejection. To establish how laminins could be involved in the regulation of acute rejection of small bowel allografts (with and without immunosuppression), we investigated laminin distribution in rat small bowel allografts four days after transplantation, i.e., before the onset of histological signs of rejection, using antibodies against alpha1, beta1, gamma1 chain of laminin-1. In immunosuppressed allografts, the ultrastructure of the enterocytic basement membrane appeared normal, but no laminin staining was seen in this membrane, although basement membranes of intramural blood vessels and muscle cells were normally stained. In non-operated immunosuppressed rats, laminin staining was clearly reduced in the enterocytic basement membrane, demonstrating that cyclosporin A is able to affect this membrane. Since only rats in which laminin is altered survive, this laminin alteration in the enterocytic basement membrane presumably plays an important role in overcoming the acute rejection.

Apoptosis in the small intestinal allograft of the rat.

BACKGROUND: Necrosis and apoptosis are different cell death mechanisms. Necrosis is a pathological process that occurs after destruction of the cell membrane. Apoptosis is a DNA-dependent cell death mechanism, which occurs under physiological and pathological conditions. Although necrosis is a well-defined phenomenon in an acute graft rejection, the occurrence and relevance of apoptosis during this process is largely unknown. METHODS: The enterocyte apoptosis rates in allografted (n=24) and isografted (n=24) small intestines of the rat were compared using the in situ end-labeling technique. RESULTS: In situ end-labeling showed a dramatically increased number of apoptotic enterocytes in allografted small intestines, whereas increased labeling could not be observed in isogeneic small intestinal grafts. CONCLUSIONS: We suggest that graft rejection-associated apoptosis, in addition to necrosis, plays an important role in the course of organ failure, and that the degree of apoptosis represents another reliable indicator for the diagnosis and prognosis of transplant rejection.

[Laparoscopic stoma technique]. / Laparoskopische Stomaanlage.

Laparoscopic stoma creation may be performed as an independent intervention, in combination with local anorectal procedures or as a part of complex laparoscopic intestinal operations. With the exception of specialized methods to preserve continence, every type of stoma formation can be performed laparoscopically. Indications for laparoscopic fecal diversion do not differ from open surgery. Apparent advantages are the limitation of the laparotomy to the location of the stoma, rapid return of bowel function and less postoperative discomfort and morbidity, especially when intestinal diversion is required as an independent procedure. Previous surgery is not a contraindication for the laparoscopic procedure. However, dense adhesions may compromise the ability to identify the bowel segment to be exteriorized and require adhesiolysis. Therefore, the risk of intra- and postoperative complications and the frequency of conversions (reported between 4.1 and 15.7%) is increased in patients with previous surgery. The overall rate of complications reviewed in the literature, including stoma-related problems, seems to be similar or superior to conventional laparotomy. Still, laparoscopic enterostomies are not routinely performed in most institutions. Presently available data are limited and randomized trials have not been performed. We recommend the use of laparoscopic techniques for fecal diversion in patients with intestinal obstruction requiring palliative treatment and in patients with high probability for future abdominal surgery, e.g. in Crohn's disease.

[Coexistence of an extensive tubulovillous adenoma of the duodenum and a cancer of Vater's ampulla]. / Koexistenz eines ausgedehnten tubulo-villösen Adenoms des Duodenums und eines Carcinoms der Papilla Vateri.

In the present paper we report about a patient with a large tubulo-villous duodenal adenoma associated with a carcinoma of the ampulla of Vater. Despite of lacking pre- and intraoperative evidence of malignancy a Whipple operation was performed because of extensive growth of the duodenal adenoma and its location near the ampulla of Vater. The carcinoma of the ampulla could be diagnosed only postoperatively in the resected duodenum. The problems of the presented case and the operative procedure is discussed based on a review of the literature.

[Results of angled plated osteosynthesis in per- and subtrochanteric fractures in the elderly]. / Ergebnisse nach Winkelplattenosteosynthese der per- und subtrochantären Brüche beim alten Menschen.

From 1/86 to 12/89 62 old patients (average age: 82.6) with intertrochanteric and subtrochanteric fractures underwent surgery by using angeled plates. The postoperative course showed complications in 32.2%, while only 1 patient died. In 3 of 5 cases with dislocation of the angeled plate re-osteosynthesis was performed. 4 other complications (2x haematoma, 2x wound dehiscence) needed further surgery. During the first three months 3 other dislocations occurred. In two cases re-osteosynthesis was carried out. Due to these results and the high rate of complications we are of the opinion that the indication for the use of the angeled plate osteosynthesis in old patients has to be limited in favor of other methods like the dynamic hip screw or total hip replacement.

[Contribution of anal external sphincter and puborectal muscle to anal pressure (author's transl)]. / Welchen Anteil hat der Musculus shincter ani externus und Musculus puborectalis an der analen Druckzone?

During anesthesia and relaxation the separated M. sphincter ani ext. and the M. puborectalis have a constant pressure of 30 mm Hg. Therefore, these muscles also have the ability to make tonic contractions and not only phasic contractions. This means that these muscles are also responsible for the anal tonic basal pressure.

[New aspects of large intestine surgery]. / Neues in der Dickdarmchirurgie.

Use of the biofragmentable anastomosis ring led to no significant differences in clinical results when compared with the use of conventional suture techniques. The patients' prognosis and the efficiency of perioperative portal chemotherapy are impaired by perioperative blood transfusions in colorectal cancer. Regarding proved risk factors for development of local recurrence, there is no significant difference between low anterior resection and abdominoperineal excision. Lymph node dissection is one important factor for ensuring an adequate oncological strategy in colorectal surgery.

[The Chang mesocaval side-to-side shunt, an alternative shunt form after previous operations and portal vein thrombosis]. / Der mesokavale Seit-zu-Seit-Shunt nach Chang, eine alternative Shuntform nach Voroperationen und bei Pfortaderthrombose.

Over the time period from July 01, 1983 to June 01, 1993, 15 patients with portal hypertension and relapsing bleedings from esophageal varicosis were treated with Chang's mesocaval side-to-side shunt at the Department of General Surgery, University Hospital of Göttingen. All patients were pre-operated in the upper abdomen or exhibited thrombosis of the portal vein. While five cases revealed a prehepatic block, ten patients had an intrahepatic block, based on cirrhosis of the liver (Child classification A or B). The time required for operations was 180 +/- 32 minutes; the pressure in the portal circulation decreased by 56%. In three cases, patients suffered relapsing bleedings despite of regular shunt conditions. Complications which were due to the procedure were seen in two patients (one revealed intraabdominal posthemorrhage, followed by therapy-resistant coagulopathy; the other patient exhibited stenosis of the anastomosis). One patient developed encephalopathy. Given a rigid indication, we regard the procedure described herein an alternative to the mesocaval interposition shunt, and we consider the low rate of thrombosis (so far < 10%) without continued postoperative anticoagulant therapy as well as the avoidance of an interposition as important advantages of this technique.

[Stapler-dependent surgical procedures in the colorectal area]. / Staplerabhängige Operationsverfahren im kolorektalen Bereich.

Since its introduction, stapling has gained considerable interest in colon surgery. The double stapling technique is a further development. From 1984 to 1989, 110 low anterior resections were performed at the Department of General Surgery, University of Goettingen. In 73 patients anastomosis was performed by double stapling; in 37 cases the EEA stapler was used. The double stapling group had an insufficiency rate of 2.7% compared with 5.4% in the EEA group. Another useful indication for stapler techniques is a reconstructive operation according to the Hartmann procedure. In none of 43 such interventions between 1983 and 1988 was insufficiency of the anastomosis seen. Another useful employment of staplers is construction of colonic reservoirs after proctocolectomy.

[Rupture of the Achilles tendon. Causes and late results after surgical management]. / Achillessehnenrupturen. Ursachen und Spätergebnisse nach operativer Versorgung.

In a retrospective study 143 cases of surgically treated Achilles tendon ruptures were evaluated. The patients most commonly were male and between 31 and 40 years old. The majority of ruptures were sport injuries, mostly caused by indirect violence. The histological examination of the tendon very frequently revealed degenerative changes. 55 patients with unilateral Achilles tendon rupture were postoperatively evaluated by clinical examination and sonography. Because of the excellent functional and cosmetical results surgery remains the appropriate treatment of Achilles tendon rupture.

[Surgery of the gallbladder and bile ducts in the aged]. / Chirurgie von Gallenblase und Gallenwegen im Alter.

From 1972 to 1981, 806 patients suffering from diseases of the bile ducts were seen at our Dept. 20% of them were over 70 years of age. Mortality rate, types of surgery, complications and causes of death are dealt with in detail. All the facts given demonstrate the necessity of early surgical intervention in case of surgical diseases of the bile ducts.

[Allogenic small intestine transplantation in the rat model with initial CsA therapy: first detection of Th2-induced immune tolerance]. / Allogene Dünndarmtransplantation im Rattenmodell unter initialer CsA-Therapie: Erste Nachweise für Th2-vermittelte Immuntoleranz.

It is not clear how initial therapy with CsA effects indefinite allograft acceptance after small bowel transplantation in the rat. Our study of post-transplant alterations of immune parameters within donor-type mesenteric lymph nodes suggests CsA-dependent, Th2-mediated induction of graft-specific T-cell tolerance.

The role of pancreatic innervation and cholecystokinin in the intestinal phase of pancreatic polypeptide release in conscious dogs.

Besides vagal cholinergic mechanisms, pancreatic polypeptide (PP) secretion is thought to be mediated by hormones. This study was performed to delineate the role of extrinsic pancreatic innervation and cholecystokinin (CCK) in amino acid- and fat-stimulated PP secretion. In ten mongrel dogs, pancreatic denervation was performed by the method of Debas et al. [3]. Total denervation of the pancreas did not alter PP response to intraduodenal application of amino acids (integrated output 24,434 +/- 3260 pmol/1 x 120 min before vs 22,797 +/- 2470 pmol/1 x 120 min after operation) and to intraduodenal fat solution (19,595 +/- 2121 pmol/1 x 120 min vs 19,983 +/- 2031 pmol/1 x 120 min). Also, no significant differences were measured in CCK release (491 +/- 71 pmol/1 x 120 min vs 430 +/- 57 pmol/1 x 120 min for amino acids, 571 = 63 pmol/1 x 120 min vs 563 +/- 89 pmol/1 x 120 min for fat solution). Plasma PP and CCK levels were compared by linear regression analysis. Correlations between PP and CCK were high in the intact pancreas (amino acids, r = 0.92; fat, r = 0.99) as well as in the denervated pancreas (r = 0.93 amino acids and r = 0.98 fat). These results show that extrinsic pancreatic innervation does not influence PP and CCK release after intraduodenal amino acids or fat solution and that PP secretion seems to be mediated to some extent through the release of CCK.