Prevalence of pancreatic exocrine insufficiency after pancreatic surgery measured by 13C mixed triglyceride breath test: A prospective cohort study.

BACKGROUND: Patients undergoing pancreatic surgery are at risk of pancreatic exocrine insufficiency (PEI) and needing pancreatic enzyme replacement therapy (PERT). METHODS: This study included 254 patients undergoing pancreatic surgery for oncologic indications. A13C mixed triglyceride breath test was performed immediately preoperative and postoperative. This test analyzes the pancreatic remnant lipase activity measuring 13CO2 in breath samples after a test meal with 1.3-distearyl-(13C-Carboxyl)octanol-glycerol. Cumulative percent dose recovery after 6 h of less than 23% confirms PEI. In addition, PEI was compared between pathology subgroups. RESULTS: In 197 patients undergoing pancreaticoduodenectomy, cPDR-6h decreased significantly from a median of 32.84% before to 15.80% after surgery (p < 0.0001). This decrease in exocrine function was significant in all pathology subgroups except in pancreatic neuroendocrine tumors. Exocrine function decreased most in pancreatic ductal adenocarcinoma (PDAC). In addition, the percentage of patients needing PERT because of PEI increased from 25.9% to 68.0% postoperative (p < 0.001). Overall, patients with an MPD diameter of more than 3 mm had a higher risk of developing postoperative PEI: 62.7% compared to 37.3% (p = 0.009), OR = 3.11. In contrast, the majority of the 57 patients undergoing a distal pancreatectomy did not experience any significant change in exocrine function. CONCLUSIONS: The vast majority of patients undergoing pancreaticoduodenectomy for oncologic indications experience a significant drop in exocrine function, are at high risk of developing pancreatic exocrine insufficiency and consequently need to be treated with pancreatic enzyme replacement therapy. Therefore, systematic screening for pancreatic exocrine insufficiency is needed after pancreaticoduodenectomy.

[Equivalence of oral and intramuscular premedication. III. Effect of premedication on anesthesia and postoperative pain]. / Gleichwertigkeit von oraler und intramuskulärer Prämedikation. III. Wirkung der Prämedikation auf Anästhesie und postoperative Schmerzen.

600 patients were given 6 different premedications in randomised design to study their effect on the course of anaesthesia and on postoperative pain. Premedication acts indirectly on anaesthesia, depending on the influence of the drug on anxiety and on the somatic correlates of anxiety. The greater the sedative-anxiolytic effect of the premedication, the easier it is to induce anaesthesia, and the more superficial the anaesthesia, resulting in earlier and stronger onset of postoperative pain. On the other hand, the more anxious the patient is, the more he consumes anaesthetic drugs, whereas anaesthesia remains superficial with the same consequences in respect of postoperative pain. In view of postoperative pain, fast and early awakening from anaesthesia must not be aimed at, particularly after operations which definitely result in postoperative pain (long-term operations in those regions of the body that cannot be immobilised).

[Parental and childhood height development. Corrected percentile standards for German children between the age of 2 and 9]. / Elterngrösse und kindliche Grössenentwicklung. Korrigierte Percentilstandards für deutsche Kinder zwischen 2 und 9 Jahren.

The conventional centile standards allow a judgement of children's height according to age-groups. It is equally important, however, to take the parental height into consideration. In 1970 Tanner ascertained for the British population the correlation between children's height and the mid-parent height (i.e. the average of father's and mother's height). From these results he set up centile standards that allow the judgement of children's height at successive ages in terms of the mid-parent height. Several conditions should be fulfilled for their application within other populations: identical correlation coefficients of parents' and children's heights which were shown in Tanner's international study; the accordance of the average height and the standard deviations, respectively, of children in each of the age groups as well as the conformity of the mid-parent height. Our investigations showed that the 3 parameters which were last mentioned differed from those of the British population. Therefore, proper standards for correction were set up. The calculations were worked out for children at ages 2 to 9 years. The methodical procedure will be shown in detail. The correction standards allow a statement as to whether the height of a child can be classified as normal or not within the framework of his family. This is particularly advantageous in regards to the diagnostic clarification of short stature, since it is often due to constitutional, genetic factors; if, for example, according to age the height of a five-year-old boy as well as the mid-parent height coincide at the 3rd centile, then the child's height centile will be 32nd. in consideration of these hereditary components. So the differential diagnosis of genetic short stature is made considerably more straightforward by the use of the present charts.

[Equivalence of oral and intramuscular premedication. I. Oral versus intramuscular premedication]. / Gleichwertigkeit von oraler und intramuskulärer Prämedikation. I. Orale versus intramuskuläre Prämedikation.

In a randomised study, 6 different premedications (oral flunitrazepam, oral pentobarbital, oral NaCl solution; intramuscular pethidine, intramuscular droperidol/fentanyl, and intramuscular NaCl solution) were administered to 600 patients, to determine the equal efficacy of oral and intramuscular application. The results show a significantly better mode of action of oral premedication.

[Equivalence of oral and intramuscular premedication. II. Effect of various conventional premedication drugs]. / Gleichwertigkeit von oraler und intramuskulärer Prämedikation. II. Wirkung verschiedener gebräuchlicher Prämedikationsmittel.

In a randomised study, 6 different premedications (oral flunitrazepam, oral pentobarbital, oral physiological NaCl solution, intramuscular pethidine, intramuscular droperidol/fentanyl, intramuscular physiological NaCl solution) were administered to 600 patients to determine the equal efficacy of the premedicative drugs in oral or parenteral administration. Patients gave the best rating to the oral application of flunitrazepam. The differences in the assessment of application and effect of the drugs are contrasted by the statement that most patients do not feel any direct influence on their preoperative anxiety by premedication. However, it is easier for them to cope with anxiety because premedication pacifies the patients, whereas each of the dependent variables, such as apprehension, is influenced differently. Oral premedication again proves superior to parenteral premedication.