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  • 1
    ISSN: 1432-0533
    Keywords: Blood-brain barrier ; Hyperosmolar solutions ; Electron microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0533
    Keywords: Stroke-prone spontaneously hypertensive rats ; Blood-brain barrier ; Brain edema ; Nerve cell injury ; Electron microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neuropathologica 44 (1978), S. 53-56 
    ISSN: 1432-0533
    Keywords: Blood-brain barrier ; Air embolism ; Horseradish peroxidase ; Cerebral cortex ; Electron microscopy ; Carotid artery ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 656-658 
    ISSN: 1432-2218
    Keywords: Laparoscopy ; Peptic ulcer ; Suture ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 183-189 
    ISSN: 1432-2218
    Keywords: Esophagitis ; Fundoplication ; Gastroesophageal reflux ; General well-being ; Laparoscopy ; Quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 917-918 
    ISSN: 1432-2218
    Keywords: Laparoscopy ; Fundoplication ; Complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1417-1422 
    ISSN: 1432-2218
    Keywords: Esophagitis ; Fundoplication ; Gastroesophageal reflux ; General well being ; Laparoscopy ; Quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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