[Diaphragmatic injuries, classification and therapy]. / Zwerchfellverletzungen, Klassifikation und Therapie.

Injuries of the diaphragm are caused either by direct or indirect violence. In all such ruptures various portions of the abdominal viscera may have ascended into the thoracic cavity. The clinical manifestations are unpredictable and of infinite variety, and especially in massively traumatized patient masked by other injuries. A presumptive preoperative diagnosis of diaphragmatic injury from chest x-ray findings is only possible in about 50% of the cases. In other cases the diagnosis can be confirmed by water.soluble contrast enema into the stomach or colon. Rupture of the diaphragm is a strong indication for operation. In cases of fresh rupture we attempt repair of the diaphragm through a laparotomy incision. In old diaphragmatic rupture we prefer a thoracotomy incision.

The biological relevance of N-terminal neurotensin fragments in the regulation of exocrine pancreas secretion.

Stimulation of the exocrine pancreas is one of the biological effects attributed to the tridecapeptide neurotensin (NT). Only the C-terminal 8-13 fragment with its extremely short plasma half-life in the peripheral circulation was considered to be necessary for biological activity. The N-terminal fragments that are detectable in peripheral blood in much greater concentrations were considered to be of no importance. In order to elucidate the biological relevance of these N-terminal fragments, five dogs were infused with neurotensin at a rate (50 pmol/kg/h) that had been determined to give physiological plasma concentrations. Pancreatic secretions were collected from previously implanted modified Herrera pouches. The effects of the N-terminal fragments NT 1-8 and NT 1-11 on the exocrine pancreas secretion were tested in the same way. It was possible for the first time to demonstrate a biological effect of the N-terminal fragments found in the postprandial circulation in vivo. The plasma concentrations determined by radioimmunoassay remained within the physiological range (less than 40 pg/ml). These N-terminal neurotensin fragments may therefore participate in the hormonal regulation of the exocrine pancreas secretion.