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  • 1
    ISSN: 1432-0533
    Schlagwort(e): Stroke-prone spontaneously hypertensive rats ; Blood-brain barrier ; Brain edema ; Plasma proteins ; Brain specific gravity
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Brain edema associated with severe chronic hypertension was studied in stroke-prone spontaneously neously hypertensive rats (SHRSP), 5 to 9 months of age. Blood-brain barrier (BBB) leakage sites and intracerebral spreading pathways for plasma proteins were delineated by an intravenously (i.v.) injected exogenous dye tracer (Evans blue), known to form a complex with albumin in blood, and by immunohistochemical visualization of extravasated endogenous plasma proteins. The tissue content of edema fluid was estimated by measuring the specific gravity of selected brain regions, stained or unstained by the tracer dye, on a bromobenzene-kerosene gradient column. Multifocal BBB leakage sites were macroscopically detected within the cerebral cortex and the deep gray matter after i. v. circulation of Evans blue-albumin for 30 min. After 24 h of i.v. circulation the dye tracer had spread not only locally in the gray matter but also into the adjacent white matter, where it was widely distributed. Immunohistochemically visualized plasma proteins showed similar distribution. Unilateral superior cervical ganglionectomy performed at 4 weeks of age neither increased the incidence of major BBB opening to Evans blue-albumin nor altered the specific gravity of the ipsilateral cerebral hemisphere in grown-up SHRSP, furthermore, the blood pressure remained unchanged. The lack of significant effect on BBB function may possibly be attributed to the extensive reinnervation of the cerebral arteries, verified in the grown-up SHRSP using the Falck-Hillarp fluorescence method for visualization catecholaminergic nerve fibers. In SHRSP raised on a low-protein and high-salt diet the mean arterial blood pressure was 212 mm Hg compared to 195 mm Hg in controls (P〈0.05) and the incidence of BBB opening was 72% compared to 25% in controls (P〈0.05). After 24 h of i.v. circulation of Evans blue-albumin, brain regions stained by the dye tracer showed significantly reduced specific gravity (P〈0.001), while unstained regions had normal values. Thus the brain edema fluid spread, as revealed by specific gravity measurements, corresponded to the intracerebral distribution of extravasated plasma proteins.
    Materialart: Digitale Medien
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  • 2
    Digitale Medien
    Digitale Medien
    Springer
    Acta neuropathologica 77 (1988), S. 5-13 
    ISSN: 1432-0533
    Schlagwort(e): Blood-brain barrier ; Hyperosmolar solutions ; Electron microscopy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Infusion of hypertonic solutions into the carotid artery is one method by which the blood-brain barrier (BBB) can be opened transiently in experimental animals. This technique has also been tried in clinical situations in which an enhanced uptake of intravenously injected chemotherapeutic drugs into the brain is desired. We have previously found that infusion of hypertonic mannitol or urea into the carotid artery of the rat, leading to a BBB opening, is associated with light microscopic signs of cellular damage in the brain parenchyma. An electron microscopic study has now been made to obtain more detailed information about the events taking place in the rat brain 1 to 72 h after an intracarotid infusion of hyperosmolar solution of mannitol. Toluidine blue-stained semithin epon sections were also available for high-resolution light microscopy of brain samples from urea-infused animals. Intravenously injected Evan's blue dye was used to confirm that BBB opening had occurred as a consequence of the carotid infusions. The infused hemispheres had numerous structural changes. The dominating light microscopic alteration was the presence of multifocal lesions in the gray or the white matter with closely packed microvacuoles causing status spongiosus. Ultrastructurally the microvacuoles corresponded to very pronounced watery swelling of astrocytic processes and to a minor degree to expansion of dendrites and axons. There was also a light or moderate perivascular astrocytic swelling. In the “spongy” lesions as well as occasionally in non-vacuolated parts of the cerebral cortex, there were collapsed electron-dense neurons with pronounced mitochondrial alterations such as severe swelling associated with rupture of christae. Rats with a survival period of 24 h or 72 h showed several disintegrating neurons and accumulation of macrophages. This study shows that carotid infusion of hypertonic mannitol in the rat may cause pronounced neuronal changes as well as multifocal astrocytic swelling. The severity of the nerve cell changes and the presence of macrophages indicate that some of the alterations are irreversible and thus, such a procedure may not be as safe as previously suggested.
    Materialart: Digitale Medien
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  • 3
    Digitale Medien
    Digitale Medien
    Springer
    Acta neuropathologica 76 (1988), S. 227-237 
    ISSN: 1432-0533
    Schlagwort(e): Stroke-prone spontaneously hypertensive rats ; Blood-brain barrier ; Brain edema ; Nerve cell injury ; Electron microscopy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The brain lesions in stroke-prone spontaneously hypertensive rats (SHRSP) are characterized by multifocal microvascular and spongy-cystic parenchymal alterations particularly in the gray matter. An essential feature of the lesions is the presence of edema with massive extravasation of plasma constituents as evidenced by specific gravity measurements, Evans blue technique and immunohistochemistry. The nerve cell injury occurring in the brain lesions in SHRSP is further characterized by light and electron microscopy in the present study. Two types of neuronal changes were seen within the blood-brain barrier (BBB) leakage sites. A small number of neurons with dark condensed nucleus and cytoplasm were found most often at the periphery of recent lesions. The majority of injured neurons were pale and showed intracellular edema confined to the dendrites and perikarya sparing axons and synapses. Their nuclei were weli preserved with finely dispersed chromatin. The swollen and watery cell processes of neurons and astrocytes gave a spongy appearance to the neuropil. The intracellular edema seemed to result in cytolysis. The results suggest that primary anoxiaischemia is not the major pathogenetic mechanism behind the nerve cell injury in severely hypertensive SHRSP, rather it is the massive BBB leakage and consequent brain edema that causes cytolytic destruction of neurons. Secondary focal ischemia as a consequence of occlusion in microvessels may, however, contribute to the nerve cell destruction.
    Materialart: Digitale Medien
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  • 4
    Digitale Medien
    Digitale Medien
    Springer
    Acta neuropathologica 44 (1978), S. 53-56 
    ISSN: 1432-0533
    Schlagwort(e): Blood-brain barrier ; Air embolism ; Horseradish peroxidase ; Cerebral cortex ; Electron microscopy ; Carotid artery ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Male albino rats were anaesthetized with diazepam, injected with horseradish peroxidase and Evans blue-labeled albumin and given an embolus of 0.01 ml air in the right common carotid artery after ligation of the external carotid branch. The pial arteries of the right cerebral hemisphere were stained blue, particularly the middle cerebral artery and its main arterial branchlets. Ultrastructurally, some endothelial cells in the right middle cerebral artery, small arteries and arterioles showed a diffuse distribution of horseradish peroxidase in their cytoplasm, although these vessels only occasionally showed peroxidase in their basement membranes. Other endothelial cells in these arterial branchlets showed few if any signs of a diffuse distribution of peroxidase but displayed several pinocytotic vesicles and occasionally trans-endothelial channels filled with peroxidase, sometimes with a slight leakage of peroxidase into adjacent basement membranes and neuropil. Scattered pinocytotic vesicles were observed in capillaries and venules, but there was usually no extravasation of peroxidase around these vessels.
    Materialart: Digitale Medien
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  • 5
    Digitale Medien
    Digitale Medien
    Springer
    Acta neurochirurgica 113 (1991), S. 171-175 
    ISSN: 0942-0940
    Schlagwort(e): Brain specific gravity ; blood-brain barrier ; endogenous albumin ; protamine sulphate ; dixyrazine
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The present study was performed to determine whether an opening of the blood-brain barrier (BBB) induced by intracarotid infusion of protamine sulphate necessarily leads to brain oedema and, if so, whether dixyrazine, a phenothiazine, can prevent the oedema. Evans blue albumin was used to detect BBB opening. Endogenous serum albumin was determined in CSF sampled before and after protamine infusion. The brain specific gravity, a sensitive indicator of brain oedema, was determined one hour after intracarotid infusion of 5 or 10 mg protamine sulphate in 100 or 200 μl solvent in rats. Both doses opened the BBB and the CSF albumin was significantly increased (p〈0.05 for 5 mg and p〈0.01 for 10 mg protamine sulphate). However, only 10 mg protamine significantly reduced the specific gravity in the cerebral cortex and basal ganglia in the right (injected) hemisphere. Pretreatment with dixyrazine 10 mg/kg completely prevented the brain oedema and significantly reduced the albumin increase in CSF. We conclude that a) a moderate opening of BBB induced by 5 mg protamine sulphate does not lead to brain oedema and b) dixyrazine can prevent the brain oedema induced by 10 mg protamine sulphate.
    Materialart: Digitale Medien
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  • 6
    Digitale Medien
    Digitale Medien
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 656-658 
    ISSN: 1432-2218
    Schlagwort(e): Laparoscopy ; Peptic ulcer ; Suture ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background: Laparoscopic vs open suture in the surgical treatment of perforated peptic ulcer were compared in a retrospective study. Methods: The outcome of 10 patients having the laparoscopic procedure was compared with the outcome of 17 patients treated with suture via laparotomy during the same time period. Results: The mortality rate and the complication rate were comparable. The laparoscopic procedure was more time consuming; hospital stay did not differ. Conclusions: The results indicate that surgery for perforated peptic ulcer can be performed with the laparoscopic technique with an outcome comparable to open surgery. No obvious advantages to the patient were noted with the laparoscopic method.
    Materialart: Digitale Medien
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  • 7
    Digitale Medien
    Digitale Medien
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 183-189 
    ISSN: 1432-2218
    Schlagwort(e): Esophagitis ; Fundoplication ; Gastroesophageal reflux ; General well-being ; Laparoscopy ; Quality of life
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract It has recently been suggested that quality-of-life investigations should be included in the evaluation of new medical and surgical regimens. We present the quality-of-life evaluations for the first 40 consecutive patients undergoing laparoscopic antireflux surgery at our department. Two well-established and validated questionnaires, the Psychological General Well Being (PGWB) Index, and the Gastrointestinal Symptom Rating Scale (GSRS), were used. The PGWB gives a general measure of patients' well-being while the GSRS concentrates on gastrointestinal complaints. In untreated reflux esophagitis patients, the PGWB score is very low. We found normal PBWB scores preoperatively during optimal medical treatment with potent acid inhibition. The average score became significantly better (than on medical treatment, P〈0.05) 1 month postoperatively, after which it fell off to normal values 3 and 8–12 months after operation. The GSRS scores were good in all subgroups postoperatively, especially regarding reflux syndrome, where scores were significantly (P〈0.05) better than on medical treatment. In conclusion: After laparoscopic antireflux surgery, patients had good quality-of-life scores, better than untreated patients and as good as or better than on optimal medical treatment. Different treatment regimens could be discriminated by adding the patients' view of the treatment effect. We suggest that quality-of-life effects should be included when evaluating new regimens in laparoscopic surgery.
    Materialart: Digitale Medien
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  • 8
    Digitale Medien
    Digitale Medien
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 917-918 
    ISSN: 1432-2218
    Schlagwort(e): Laparoscopy ; Fundoplication ; Complication
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract This case report describes a serious complication after laparoscopic Rosetti fundoplication. Two days postoperatively the proximal part of the stomach herniated into the thoracic cavity where a gastric perforation caused leakage. The patient was reoperated and a new fundoplication was constructed. Postoperatively the patient recovered. Possible mechanisms are discussed.
    Materialart: Digitale Medien
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  • 9
    Digitale Medien
    Digitale Medien
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1417-1422 
    ISSN: 1432-2218
    Schlagwort(e): Esophagitis ; Fundoplication ; Gastroesophageal reflux ; General well being ; Laparoscopy ; Quality of life
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Early experiences with laparoscopic fundoplication using the Rosetti technique are presented and compared with retrospective results from conventional fundoplication procedures. A 360° floppy fundoplication was laparoscopically constructed without division of short gastric vessels. We have performed 60 consecutive procedures. Conversion to open surgery was done in seven cases due to anatomical reasons and in two due to progressive subcutaneous emphysema and CO2-retention. The complication rate was low. The range of postoperative hospital stay is 1–4 days for non-converted patients. Symptomatic follow up has hitherto been performed in 41 patients with a follow-up time of 3–9 months. Regurgitation and heartburn had disappeared in all but one patient. The follow-up results do not differ from those achieved in patients operated upon with the conventional open Nissen (N=41), Toupét (N=9) or Rosetti (N=36) technique. Pre and postoperative control of 24h pH and lower esophageal sphincter pressure (LESP) in 19 laparoscopically treated patients showed normalisation of LESP in all cases and postoperative 24h pH〈4 ranging between 0 and 3%. Assessment of quality of life showed postoperative results in accordance with normal population for all treated groups.
    Materialart: Digitale Medien
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