[Puerperal ovarian vein thrombosis in a 14-year-old patient after cesarean section for twin pregnancy]. / Puerperale Ovarialvenenthrombose (POVT) einer 14jährigen nach Sectio caesarea bei Geminigravidität.

A case of ovarian venous thrombosis in the puerperal period after caesarean section (twin pregnancy) of a 14 year old patient is reported. After removal of the attacked vein, ovary, and fallopian tube antibiotics and heparin were given. The uterus could be maintained. The problems of diagnosis and treatment were discussed.

The closed duodenal loop technique.

The closed duodenal loop (CDL) technique, one of the first experimental models producing experimental acute pancreatitis, is described in this article. Since this model was published first by Pfeffer in 1957, it has undergone several modifications. The CDL method is an easily practicable and reproducible model to investigate acute hemorrhagic pancreatitis. In view of other available experimental models, the CDL technique has lessened in popularity.

[Surgical indications, timing and method in acute pancreatitis]. / Operationsindikation, -zeitpunkt und -methode bei akuter Pankreatitis.

Treatment for acute pancreatitis was received by 462 patients at the Surgical Hospital of Greifswald University, between 1976 and 1986. Surgical therapy was applied to 117 of 141 patients with necrotising pancreatitis. Lethality rates were 46 per cent in a group with partial necrosis and 86 per cent in another with total necrosis. The Ranson approach was used in operations on 63 of 90 patients with partial necrosis. Their lethality amounted to 23 per cent. 27 patients were given surgical treatment, in spite of unfavourable prognosis, only up to ten days from onset of acute pancreatitis. Lethality in this group was 78.5 per cent. Proper localisation of the necrotic focus is important to prognosis, just as good timing of surgical intervention. Lethality rates were 25 per cent for resection in the caudal region and 38 per cent for necrosectomy of the pars lienalis. Necrosis in the head region entailed a lethality rate of 90 per cent in response to necrosectomy and a rate of 64 per cent with additional lavage. The prognosis of pancrease necrosis is affected by timing and method of surgery. Timing should depend on the clinical pattern, laboratory parameters as well as on findings recorded by computed tomography and ultrasound. Aetiological aspects and location of the process must be considered for choice of surgical techniques. Necrectomy, lavage, and revision of bile ducts seem to be adequate surgical methods.

[Quantitative determination and kinetics of dihydralazine in hypertension patients]. / Quantitative Bestimmung und Kinetik von Dihydralazin bei Hypertoniepatienten.

For the quantitative determination of dihydralazine (1) a derivative with acetylacetone in biological material was formed at pH = 4.9, extracted with n-hexane, and measured gaschromatographically with N-P-FID. Acid labile 1 was hydrolyzed with HCl (1 mol/l) for 24 h. The detection limit was 25 nmol/l plasma. Kinetic studies were performed in 16 patients with essential hypertension under steady-state conditions after the oral application of 50 mg 1. The acetylator phenotype was determined with sulfamethazine. Complete dihydralazine plasma level-time courses were found in only 5 cases. The concentrations were below the detection limit in 4 patients for the whole period. Only single values could be registered in the remaining patients. Maximal plasma levels of the free (58-314 nmol/l) and acid labile 1 (147-367 nmol/l) were reached 20-40 min after the application. The elimination half life was 23-47 min for the free 1, 55-92 min for the acid labile 1. Less than 0.5% of the applied drug were excreted into the 24 h urine in its free form, about 0.4% as acid labile derivatives. No correlation could be found between the acetylator phenotype of the patients and the kinetic behaviour of the drug. Preliminary studies concerning the biliary excretion of 1 after i. m. application in two patients with T-drain showed an accumulation of the free compound with bile/plasma ratios up to 7.4.

The influence of selective pancreatic denervation on plasma insulin and glucose tolerance in dogs.

The mechanism of reflex plasma insulin responses after oral stimulation and the influence of autonomic control on glucose- and meal -induced insulin secretion needs to be elucidated. Dogs with chronic pancreatic fistulas were studied two months after selective pancreatic denervation or bilateral truncal vagotomy and compared with fistulated controls. The normal glucose- and amino acid-independent insulinogenic reflex after an oral glucose load or after a meal was inhibited in the experimental groups. Glucose-related insulin secretion (oral or intravenous loads) and glucose tolerance were clearly reduced after vagotomy, but only partly diminished in the denervated animals. The plasma insulin increase after meat ingestion was inhibited in both experimental groups. It is concluded that the B-cells work under integrated tonic control of both the vagal and the sympathetic systems. Independent of this control, a vago-vagal insulinogenic reflex is initiated by enteric stimuli. These two mechanisms might be considered as part of the gastroentero-pancreatic axis in a broader sense.

[Vagotomy and exocrine pancreatic secretion (author's transl)]. / Vagotomie und exokrine Pankreassekretion.

In dogs supplied with chronic pancreatic fistulas, there is no change of the basal exocrine secretion of volume three weeks after a bilateral truncular vagotomy. The normal initial reflex secretion during meal ingestion or glucose loading are abolished. On the whole, the secretory activity is reduced by about 50% after feeding. Secretions of volume and of enzyme protein are inhibited to the same extent, but that of bicarbonate is more strongly influenced. After vagotomy the inhibitory influence on all secretions of a rabidly produced hyperglycemia is reinforced. In pancreatic juice there is immunocreactive insulin activity (less than 1% fo the daily secreted amount). Insulin secreted in pancreatic juice after feeding is strongly reduced after vagotomy. This is the best reproducible proof of an influence on the exocrine pancreatic function of vagotomy.

[Influence of vagotomy on glucose tolerance and on the responses of plasma insulin and exocrine pancreatic function followed glucose load or food ingestion in dogs]. / Der Einfluss der Vagotomie auf die Glukosetoleranz sowie die Reaktionen von Plasmainsulin und exokriner Pankreasfunktion nach Glukosebelastung oder Nahrungsaufnahme bei Hunden

A part of the intrapancreatic nerve fibres of dogs show 1-2 months after bilateral truncal vagotomy a decay of the medullary sheath; in addition, the histochemically demonstrable insulin content of the B-cells is reduced. These animals do no longer react to oral glucose administration or feeding a meat meal with a reflectoric early rise of plasma insulin concentration and of exocrine functional parameters (all the animals were bearing exocrine pancreas fistulas). The glucose tolerance and and the decrease of free fatty acids in serum were restricted. Also, the content of bicarbonate and protein in the pancreatic juice and the insulin secretion of vagotomized animals are strongly reduced in the subsequent test phase (up to 120 min) following oral or i.v. glucose administration and after feeding meat. The inhibition of exocrine volume secretion following i.v. glucose administration was enhanced by the intervention. The findings confirm the involvement of the N. vagus in the mechanisms of the enteroinsular axis that becomes active together with exocrine gastro- and duodenopancreatic reflexes to any kind of physiological enteral stimulation.

The mechanism of insulin secretion after oral glucose administration. VII. Exocrine pancreatic function and plasma-IRI in dogs with chronic pancreatic fistulas.

During an intravenous glucose test, conscious dogs with exocrine pancreatic fistulas showed a reduction in the secretions of water, protein and of bicarbonate. This reduction is related to hyperglycemia and to IRI increase in the peripheral venous blood. After oral administration of glucose, however, a biphasic stimulation of the exocrine function was observed. During the first 15 minutes when insulin secretion increases independently of the blood glucose increase, all exocrine pancreatic functions are transiently stimulated, too. A second peak of the exocrine secretions is to be observed when glucose absorption and insulin secretion exhibit their maximum.