Progress in Surgery, Vo1. 15

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1 Progress in Surgery, Vo1. 15

3 Progress in Surgery Voi. 15 Editors Μ. ΑLLΟ wεr, Basel; S.-E. BERGENrz, Malmö, R. Y. CALΙE, Cambridge; U. F. GRUBER, Basel Contributors F. W. AHIEFELD, Ulm; M. ALLGÖwΕR, Basel; H. BIsMUTH, Villejuif; T. A. Η. ENGLISH, Cambridge; D. FRπκcο, Villejuif; U. F. GRuBER, Basel; B. HUSEMANI, Erlangen; P. KIEFHA +ER, München; J. KI,IAi, Ulm; D. LIEBERIANI-MEFFERT, Basel; K. MESSIER, München; K. MoRITz, München; G. Νλτκ, München 64 figures, 1 colour plate, and 26 tables, 1977 S. Karger Basel München Paris London New York Sydney

4 Progress in Surgery Vol. 1 Vol. 2 Vol. 3 Vol. 4 XVI p., VIΙΙ p., XII p., VIIΙ p., 65 fig., 3 tab., ISBN fig., 20 tab., ISBN fig., ISBN fig., 5 tab., ISBN Vol. 5 VIII p., 118 fig., 7 tab., ISBN Vol. 6 VI p., 23 fig., 12 tab., ISBN Vol. 7 X p., 55 fig., 36 tab., ISBN Vol. 8 VIII p., 41 fig., 10 tab., ISBN Vol. 9 X p., 34 fig., 13 tab., ISBN Vol. 10 X p., 55 fig., 20 tab., 2 cpl., ISBN Vol. 11 VIII p., 38 fig., 12 tab., ISBN Vol. 12 X p., 79 fig., 47 tab., ISBN Vol. 13 X p., 109 fig., 42 tab., 8 cp1.,1974. ISBN Vol. 14 VIIΙ p., 44 fig., 8 tab., ISBN Cataloging in Publication Progress in Surgery, v. 15, 1977 Basel, New York: Karger. Editors: v. 1-6, Μ. Allgöwer; v. 7-, Μ. Allgöwer et al. Added titles in French and German, : Progrès en chirurgie; Fortschritte der Chirurgie. 1. Surgery - yearbooks. I. Allgöwer, Martin, ed. II. Progrès en chirurgie III. Fortschritte der Chirurgie Wi PR681Μ ISBN All rights, including that of translation into other languages, reserved. Photomechanic reproduction (photocopy, microcopy) of this book or parts thereof without special permission of the publishers is prohibited. Copyright 1977 by S. Karger AG, Basel (Switzerland), Arnold-Böcklin-Strasse 25. Printed in Switzerland by F. Reinhardt AG, Basel ISBN

5 Contents Immediate Postoperative Care of Cardiac Surgical Patients T. A. H. ENGLISH, Cambridge Introduction 1 The Circulation 3 Establishment of Optimal Blood Volume after Bypass 3 Persisting Low Cardiac Output 5 Haemorrhage and Cardiac Tamponade 7 Control of Dysrhythmias 8 Pulmonary Dysfunction 10 Renal Function and Postoperative Fluid Replacement 11 Infection and Its Prophylaxis 13 Summary 13 References 14 Organization of an Intensive Care Unit F. W. AHIEFELD and J. KILIAN, Ulm Introduction 16 Recovery Room 18 Intensive Observation Unit 19 Intensive Care Unit Bed Unit for Patients with Acute Danger of Life 19 Personnel Requirements 22 Physicians 23 Nursing Staff 24 Technical Personnel 25 Emergency Laboratory 26 Care of the Emergency Patient 27 Categorization of Hospitals 30 Assessment of Further Development. The Question of Specialization 30

6 Contents VI Equipment 31 Summary 32 References 34 Five Years of Experience with an Intensive Care Unit Specializing in Abdominal Surgery D. Faλνco and H. BisiurH, Villejuif Intεoduction 37 Organization of the ICU of Digestive Surgery 38 ICU Facilities 38 ICU Personnel 38 Planning of the Work in the ICU 39 Analysis of the 5-Year Activity of the ICU 40 Admissions for Postoperative Care 40 Admissions for Abdominal Emergencies 41 Admissions for Postoperative Complications 42 Discussion 44 Summary 47 References 48 Colloids for Blood Volume Support U. F. GRUBER, Basel and K. MEssiaR, Munich Introduction 49 The Flow-Improving Properties of Volume Substitutes 52 Volume Expansion 52 Colloid Osmotic Effect 53 Effect on the Rheological Properties of Blood 55 Hemodynamic Relevance of Viscosity Changes 57 Hemodynamic Compensation for Acute Dilutional Anemia 58 The Importance of Normovolemia 63 Hemodilution Studies in Man 63 Clinical Applications 63 The Antithrombotic Effect of Dextran 65 Summary 71 References 71 Metabolism after Jejunoileostomy in the Treatment of Extreme Obesity Β. Ηυsaµvµeιν, Erlangen Introduction 78 Pathophysiology of Morbid Obesity 78

7 Contents VII Weight Indices 79 Definition of `Adiposity' 79 Obesity and Secondary Diseases 80 Surgical Therapy of Obesity 81 Methods 81 Dermolipectomy 81 Jejunoileostomy 82 Gastric Bypass 83 Operational Technique for Jejunoileostomy 84 Pre- and Postoperative Care 85 Indication Contraindication 86 Results 87 Weight Reduction 87 Weight Reduction and Lenght of Intestine 87 Weight Reduction and Overweight 88 Adaptation 88 Carbohydrate Balance after Weight Reduction 88 Fat Metabolism in the Adipose Patient 90 Cholesterol 92 Protein Metabolism 93 Water and Electrolytes 94 Vitamins 95 Complications 97 Surgical Complications 97 Complications due to Malabsorption 98 Fatty Liver 99 Adaptation to Malabsorption 100 Changes in the Caloric Balance 101 Signs of Adaptation 101 Human Growing Hormone (HGH) 101 Summary 103 References 104 The Morphology of the Antrum and Pylorus in Gastric Ulcer Disease D. LIEBERMANN-MEFFERT and M. ALLGÖWER, Basel Introduction 110 Material and Methods 110 Gross Gastric Specimens 110 Histology 112 Muscle Cells 112 Nerve Cells (Auerbach's Plexus) 112 Mucosal Inflammation 112 Chemical Analysis of Antropyloric Muscle 113 Statistical Analysis 113

8 Contents VIII Results 113 Gross Gastric Specimens 113 Examination of Fresh Tissue 113 Examination of Fixed Specimens 114 Appearance of the Wall 114 Measurements and Statistical Evaluation 118 Hypertrophy Related to Age and Sex of Patients and to Site, Size and Multiplicity of the Ulceration 121 Histology 123 Muscle 123 Nerve Cells (Auerbach's Plexus) 126 Submucosa 132 Mucosal Inflammation 132 Chemical Analysis of Antropyloric Muscle 132 Discussion 133 Summary 136 Acknowledgements 136 References 137 Endoscopical Control of Massive Gastrointestinal Hemorrhage by Irradiation with a High-Power Neodymium-Vag Laser P. KIEFHABER; G. NATH, and K. MORITZ, München with 1 colour plate Laser Sources and Laser Transmission System 141 Penetration Depth of the Laser Beam into Tissue 143 The Potential of Various Laser Transmission Systems with Different Output Beam Divergence for Endoscopical Control of Bleeding 144 Comparative Studies in Endoscopical Bleeding Control with Different Wavelengths 146 Id-Yag Laser in Emergency Endoscopy 149 Patients 150 Recurrent Bleedings and Complications 152 Discussion 152 References 154

Progress in Experimental Tumor Research

Plant Tumor Research Progress in Experimental Tumor Research voι, ιs Editor: F. HOMBTJRGER, Cambridge, Mass. S. Karger Basel München Paris London New York Sydney Plant Tumor Research Guest Editor: Α. C.