[Value of laparoscopy in diagnosis and therapy of the acute abdomen]. / Die Bedeutung der Laparoskopie bei der Diagnostik und Therapie des akuten Abdomens.

While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.

Large bowel tumor promotion by diamine oxidase inhibition: animal model and clinical aspects.

UNLABELLED: In the intestinal mucosa, diamine oxidase probably is involved in a feedback regulation mechanism for the termination of proliferation. This was proven by a considerable promotion of large bowel tumors induced by diamine oxidase inhibition in a rat model. Carcinogenesis was accompanied by characteristic alterations in mucosal diamine oxidase activity. In large bowel cancer patients similar changes in intestinal diamine oxidase activity had been observed as in the animal model. CONCLUSION: Events entailing a reduction of diamine oxidase activity are suspicious for large bowel cancer promotion under experimental and clinical conditions.

Diamine oxidase as a marker of intestinal integrity in acute appendicitis.

In the operative treatment of appendicitis the so called negative appendectomy is an important issue because of its increased morbidity. From the hypothesis that the intestinal diamine oxidase activity is a suitable marker of mucosal integrity, the distribution pattern of the enzyme in appendices histologically classified as inflamed or not inflamed was studied. Histologically apparent inflammation of the appendix was connected with a significant reduction of diamine oxidase activity. The determination of this enzymic activity may be a simple and sensitive test for mucosal inflammation of the appendix even at a very early state. This could reduce the rate of negative appendectomies and influence thereby risk-cost-benefit calculations.