Characterization of I2 imidazoline and sigma binding sites in the rat and human stomach.

Radioligand binding experiments were carried out to identify and characterize nonadrenoceptor [3H]idazoxan binding sites and [3H](1, 2-di-(2-tolyl)guanidine) binding sites in the rat and human stomach. Furthermore, we examined two selected aspects of their potential functional significance. Binding of [3H]idazoxan (Kd = 11.1 nM and 12.4 nM, respectively) and [3H]DTG (Kd = 932 nM and 242 nM, respectively) to cell membranes from rat and human stomach was rapid, reversible, specific and saturable. In rat stomach, binding of the radioligands was inhibited by imidazolines and by nonimidazoline sigma-site ligands, respectively, at different rank orders of affinity, which suggests the existence of I2-imidazoline binding sites as well as sigma2-sites. In two functional models, the direct effects of I2-site ligands and sigma2-site ligands on gastric smooth muscle and glands were investigated. (1) Cirazoline, clonidine and 4-chloro-2-(2-imidazolin-2-ylamino)-isoindoline (BDF 6143) failed to contract the longitudinal muscle of the rat stomach fundus; BDF 6143 also failed to induce relaxation of this preparation when it was precontracted with 30 mM KCl. (2) Clonidine, idazoxan, BDF 6143, 1, 2-di-(2-tolyl)guanidine, agmatine and (R)-3-(3-hydroxyphenyl)-N-propylpiperidine up to 100 microM did not induce acid secretion from rabbit isolated gastric glands. Our data provide evidence that the rat stomach is endowed with sigma2 sites and I2 binding sites in addition to the previously identified non-I1/non-I2 [3H]clonidine binding sites. Our experiments also offer basic evidence of the existence of I2 and sigma binding sites in the human stomach. Neither the I2 and [3H]clonidine binding sites nor the sigma sites in rat stomach are directly related to a postsynaptic effect on gastric smooth muscle or to acid release from isolated gastric glands.

Experimental tracheal replacement using a revascularized ileal segment for transplantation in rats.

The clinical field of tracheal reconstruction is still the subject of intensive investigation. Numerous attempts to replace extensive circumferential tracheal defects have failed to demonstrate long-lasting reliable results. Commonly used alloplastic prostheses are missing a mucosal barrier which clears mucus secretions and protects against contamination by infectious organisms. Tissue granulation and formation of scar strictures at the suture lines are common sequels and mainly contribute to graft failure. We hypothesized that the small bowel could adapt and comply with the functional and physiological requirements of the respiratory tract. To further clarify this study objective, a "two-step" surgical procedure was carried out on LEW inbred rats. First, an ileal segment 6 cm in length was dissected from the intestinal continuity. The divided segment was then sidepassed in a Roux-en-y fashion. The exposed segment was stabilized by a ring-enforced PTFE (polytetrafluoroethylene) prosthesis which was cut open and wrapped around the antimesenteric outside surface of the bowel segment. After 21 days the alloplastic prosthesis was completely incorporated into the adjacent small bowel tissue. Afterward, a tracheal resection of 10 cartilage rings was performed in a second syngeneic animal and the composite graft prepared in animal one was interposed for reconstruction in animal two. In a series of 10 successful experiments, air tightness and a normal respiratory tract without signs of mucus congestion could be confirmed. A gap-free epithelial lining at the suture lines reliably prevented bacterial contamination, subsequent tissue granulation, and formation of scar stricture within the graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Thoracoscopic resection of parenchymal blebs in spontaneous pneumothorax. Indications, operative management and results.

The success rate of thoracoscopic resection of parenchymal blebs in spontaneous pneumothorax was evaluated after 54 thoracoscopies (cases) in 52 patients. Switch to open thoracotomy was necessitated by interpleural adhesions or large bullae in five cases, while 49 were treated thoracoscopically. The median duration of the operation was 75 (25-240) min, and the postoperative hospital stay was 7 (3-25) days. Early postoperative complications were haemothorax and recurrence of pneumothorax, each in one case, treated with thoracoscopy and chest drain, respectively. Forty-six patients were followed up for a median of 11 (1-32) months. there were two recurrences (at 4 and 6 months). One was successfully treated with thoracoscopy and the other with thoracotomy. Only five patients complained of slight sensitivity in the scar area, caused by weather changes. Thoracoscopic bleb resection is an effective alternative to thoracotomy, with low rates of complications and recurrent pneumothorax.

Deficiency of cartilage in the segmental bronchi of a child: congenital or acquired?

The case of a 4-year-old girl suffering from a severe bronchopneumonia of the left lower lobe is presented. Microscopically no cartilage was found in the resected lobe distal to the lobar bronchus. The case is unusual because a congenital lobar emphysema associated with an aplasia of bronchial cartilage has to be considered as well as secondary cartilage destruction due to chronic relapsing inflammations.

Long-term follow-up of different therapy procedures in spontaneous pneumothorax.

The objective of this follow-up study was to evaluate the success rate of different therapy procedures in spontaneous pneumothorax. In order to achieve comparable conditions the study was restricted to those patients who were treated because of a first episode (n = 96) in the time between January 1978 and December 1987. Seventy-one were males and 25 females, ratio 3:1. The right side to left side ratio was 3:2. Both sides were affected in 11% (n = 11). All patients received an intercostal tube drainage with a permanent suction. In case of treatment failure thoracoscopy, pleurodesis or an operation were performed. The follow-up investigations was performed in January 1990 thus to further evaluate the outcome of 79 patients (82%) after 2 to 12 years after treatment. Among the patients, 33 patients presented a persistence or an early recurrence, 26 of them were operated during their first stay in hospital. A further 25 patients presented a late recurrence, of whom 14 underwent a later thoracotomy. Consequently the drainage therapy had a failure rate of 61% (n = 58). The frequency of operation was 42% (n = 40). The results after thoracotomy (n = 26) were as follows: slight complications, which did not require surgical treatment occurred in 8% (n = 2). The long-term results after surgical intervention (lung apex resection and/or parietal pleurectomy) were excellent concerning the rate of late recurrences (0% within the follow-up group) and the general condition (96% free or almost free of symptoms) regardless the method of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term survival after curative resection for carcinoma of the rectum.

The clinical outcome of 453 patients with histologically confirmed adenocarcinoma surveyed from 1980 to 1992 was evaluated. Special consideration was given to the prognostic significance of local recurrence and distant metastases as the significant contributors to postoperative morbidity and mortality. Of 453 patients, 371 were treated by a curative surgical approach. The remaining 82 patients, with extended disease, received palliative treatment. Among those undergoing surgical treatment, the local recurrence rate was 11.3 percent; the incidence of distant metastases was 16.2 percent, and 2.7 percent of the patients exhibited combined lesions. The five-year survival rate depended on the extent of the primary lesion and lymph node status--it was highest for patients with stage I adenocarcinoma (80 percent), a rate significantly better (p < 0.01) than patients with stage II disease (40 percent), who fared better (p < 0.02) than patients with stage III disease (30 percent) (Union Internatinale Contre le Cancer [International Union Against Cancer] classification). Sixty percent of the patients with local recurrence and almost 70 percent with distant spread showed proof of failure within two years. Of 42 patients with local failure, 12 underwent reoperation without leaving residual tumor (RO-treatment) but exhibited no improvement in five-year survival compared with those with no second surgical approach. The operative techniques were abdominoperineal resection (36.9 percent), low anterior resection (58.2 percent) and transanal resection (4.9 percent). They were without significant influence on long term results. Critical analysis of the data emphasizes the urgency of adjuvant treatment for patients with poor long term prognosis, as given for stages IIB and III.

[Long-term results of thoracoscopic resection of lung cysts]. / Langzeitergebnisse nach thorakoskopischer Lungenzystenabtragung.

The treatment modality of spontaneous pneumothorax is extended by the introduction of an endoscopically applicable linear stapler. During the last 2 years 35 resections of cysts in 33 patients (24 men, 9 women, age median mean = 34 years) were started thoracoscopically in our hospital. Indications were: First pneumothorax (n = 15), recurrent pneumothorax (n = 16) and prophylactic resections (n = 4). A switch to open thoracotomy was necessary in 4 cases (11%) because of interpleural adhesions or large bullae. The median operation time was mean = 90 min. (range 60-240), the postoperative hospital stay mean = 8 days (range 4-25). Early complications occurred in 2 cases: One hematothorax, which was treated thoracoscopically, and one recurrent pneumothorax at the ninth postoperative day, which was treated by a chest drain. The follow up investigation 2 to 24 months (median mean = 6) after therapy was complete in 28 cases. It revealed that only 2 late recurrences (7%) occurred after 4 and 6 months. One was treated thoracoscopically again, the other one by thoracotomy. The endoscopically treated patients had less complaints than patients after thoracotomy. Only 4 patients complained of sensitivity in the scars due to weather changes. In conclusion the minimal-invasive resection of lung parenchyma represents an effective alternative to open thoracotomy with a much better quality of life, a low rate of complications and a comparable rate of recurrences.

[Technical aids by staplers in lung surgery]. / Technische Hilfen durch Nahtmaschinen in der Lungenchirurgie.

Linear stapling devices ensure a safe resection in lung surgery. They are not only convenient for closing the bronchial stump, but also highly efficient for dividing the main pulmonary artery or lobar veins. The superiority of stapling is immediately obvious in the division of fissures and tangential resections of lung parenchyma. Bronchopleural fistulas can be easily avoided. The safe and appropriate use of stapling divices makes a standardized procedure in lung surgery possible.

[The influence of surgery on serum enzyme changes]. / Einfluss von Operationen auf Serumenzymveränderungen

Gamma-GT, which appears as a sensitive indicator in the enzyme pattern during postoperative examination, is especially recommended (besides the GOT and GPT enzymes) in detecting and watching the course of hepatocellular lesions. Distinction between parenchymatous and obstructive icterus can in some cases be made at an early stage by comparison with AP. Distinction between increases in biliary and ossal AP activity is possible with the help of Gamma-GT. Where liver metastases are suspected clinically, increased Gamma-GT activity makes metastization into the liver appear likely.