Effects of different-shaped tissue expanders on transluminal pressure, oxygen tension, histopathologic changes, and skin expansion in pigs.

This study, performed on domestic pigs, was designed to show whether the shape and size of a tissue expander influences the amount of surface area increase. When a defect is irregular, a larger custom-fitted implant is more efficient than several smaller expanders. Oval implants gained 5 percent more skin using 50 percent less time and almost 20 percent less intraluminal pressure, while U-shaped implants yield 2.2 percent more skin in 10 percent less time with 35 to 50 percent less pressure when compared with several smaller implants covering the same surface area. Transcutaneous TpO2 measurements and histologic evaluation revealed no significant difference between all implant shapes. These results show that less time, pressure, and volume are needed in a larger implant to gain the same surface area as would be attained from several smaller implants, thus sparing the patient more discomfort, trauma, and risk of infection by reducing the number of filling domes and hence the number of fillings.

[Breast enlargement with silastic prosthesis. Critical results 6 years later]. / Mamma-Augmentation mit Silastic-Prothesen.

68 patients have undergone augmentation mammaplasties in the last 6 years in our Dept. of Surgery. 15 reoperations (capsulotomy, capsulectomy, change of the implant) had been necessary. We observed unfavorable results causing patient dissatisfaction in 22%, mostly due to capsular contracture. It should be mentioned that satisfaction was much greater in the group of unilateral hypoplasia (10 cases). Reoperation have not been necessary in this group. The range of indications for augmentation mammaplasties should be limited.

[Value of computer tomography for evaluation of local operability and choice of surgical procedure in esophageal cancer]. / Wert der Computertomographie für die Beurteilung der lokalen Operabilität und die chirurgische Verfahrenswahl beim Oesophaguscarcinom.

The correlation of the preoperative staging by CT with the post-operative or postmortem staging was investigated in 74 patients with esophageal carcinoma. Criteria for the evaluation of local resectability were analyzed prospectively. According to TNM-classification, the pre- and post-operative staging showed identical results in T1 in 3/4, in T2 in 17/26 and in T3 in 42/44 patients. Thus, the preoperative staging turned out to be correct in 62/74 cases (83.7%). By conventional diagnostic methods identical results of pre- and postoperative staging were found in 28/74 patients (37.8%). The local resectability can be judged by the sagittal infiltration area and especially by the vertical extent of tumor infiltration of the aorta and/or trachea. Esophageal resection was not possible, if infiltration had been suspected in more than 4 tomograms (8 mm-CT-sections). Only palliative resection could be performed in cases with a 3 tomogram infiltration. A suspected infiltration up to 2 tomograms did not exclude a blind dissection of the esophagus without thoracotomy. The impression of the trachea with an irregular borderline of the lumen or tumor growth surrounding the trachea are additional infiltration signs in the CT. By the differentiated interpretation of local tumor growth the CT reached a central position planning surgical strategy.

[Therapeutic modification of blood circulation disorders of the intestine due to strophantin]. / Therapeutische Beeinflussung strophanthinbedingter Durchblutungsstörungen des Darmes.

The vasoconstrictor effects of strophanthin on mesenteric hemodynamics were studied using mechanical ventricular massage to exclude the cardiac effects of the drug. The administration of a calcium antagonistic compound prior to digitalis, together with and after digitalis application, prevented the vasoconstrictor response completely. From our experimental experience the combination of cardiac glycosides with calcium antagonistic compounds seems rational.

[Glycoside induced intestinal ischemia. Therapeutic possibilities (author's transl)]. / Glykosidbedingte Durchblutungsstörungen des Darms und Möglichkeiten therapeutischer Beeinflussung

Intestinal infarction in the absence of organic vascular occlusion received increasing attention in recent years. There is strong evidence from experimental work and clinical observations that cardiac glycosides may play an important role in the pathophysiology of this disorder. Our experiments using the so called mechanical ventricular massage confirm this theory. We could demonstrate that the decrease in mesenteric arterial perfusion following the i.v. administration of ouabain is caused by extracardiac effects of the glycoside on vascular smooth muscle. The Ca++ -antagonistic compound (Verapamil) blocks and reverses the Ca++-synergistic action of the glycoside independent of the time of injection.

[Neostigmine and dehiscence of intestinal anastomoses (author's transl)]. / Neostigmin und Insuffizienz intestinaler Anastomosen.

In a study from 1968, anastomotic leakage was reported to be nine times as frequent if neostigmine was used for reversal of curare action than in control patients. Subsequent studies did not confirm this finding although it is not disputed that neostigmine activates bowel peristalsis. Both animal experiments and clinical observations indicate that anastomoses in undamaged bowel, if properly done, withstand all kinds of hyperperistalsis. However, it cannot entirely be excluded that coincident pathologic conditions (cachexia, damaged bowel, chronic steroid medication, anaemia etc.) may occur, in which neostigmine administration is unsafe. Appropriate anaesthesiological techniques to avoid the need for neostigmine include titration of the individual relaxant requirement by means of a peripheral nerve stimulator, preference of intermediate or short-acting nondepolarizing muscle relaxants and primary postoperative mechanical ventilation. If nevertheless reversal of residual nondepolarizing block is decided, it should be performed with deep halothane anaesthesia still maintained and by means of an anticholinesterase agent with little muscarinic side effect such as edrophonium (0.5-1.0 mg/kg).

[Effect of strophanthin on intestinal blood flow. A contribution to the physiopathology of hemorrhagic enteropathy]. / Die Wirkung von Strophanthin auf die intestinale Durchblutung. Ein Beitrag zur Pathophysiologie der haemorrhagischen Enteropathie

The purpose of the present study was to compare in canine experiments hemodynamic and angiographic effects on mesenteric circulation. I. v. administration of strophanthin is leading to an increase of arterial pressure and a decrease of mesenteric blood flow. Most consistent angiographic changes are attenuation and local vasoconstriction of peripheral vessels. The relationship between digitalis administration and mesenteric underperfusion leading to non-occlusive mesenteric ischemia is discussed.

[Hemorrhagic enteropathy]. / Hämorrhagische Enteropathie

Intestinal infarction in the absence of organic vascular occlusion received increasing attention in recent years. The clinical picture is discussed based on results in 9 cases, an attempt to suggest a possible pathophysiological mechanism is made. Prophylactic digitalisation especially in the elderly patient in the absence of severe heart failure and in cases with already low mesenteric perfusion may lead to a further vasoconstriction and to hemorrhagic enteropathy. Therapeutic possibilities are discussed.

The entity of non occlusive mesenteric ischemia: strophanthin effect on mesenteric blood flow in experimental animals.

Digitalis glycosides have the well known positive inotropic effect on the heart. Their effect on extracardiac vascular smooth muscle receives increasing attention. In experimental animals a significant decrease in mesenteric blood flow and an increase in mesenteric vascular resistance could be shown. Angiography of main mesenteric arteries, smaller arteries, and arterioles reveal typical vasoconstriction. Angiomorphometric measurements show good correlation between the decrease in vascular diameter and the increase in vascular resistance.