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Three hundred and three consecutive patients operated on for peptic ulcer for the first time between 1 January 1984 and 31 December 1993 were evaluated in this retrospective study. Eleven variables (Period when operation took place, gender, smoking behaviour, history of former ulcers, ulcerogenic drug intake, ulcer location, epigastric pain, number of blood units substituted, patient's age, type of operation, comorbidity) were investigated regarding their influence on peri- and post-operative mortality and on the length of hospital stay after operation. We found that a high comorbidity score (>2) and the indication “emergency operation” (vs “elective operation”) had an adverse impact on survival. The importance of age was marginal. The duration of post-operative hospital stay in survivors was negatively influenced by age higher than 60 years, more than two red cell units substituted and a high comorbidity score according to Charlson.

Summary A simple method of dystopic cardiac transplantation as a left-heart bypass was experimentally studied and details of the method are described. The hemodynamic investigation of this biological assisted circulation on the normal and failing heart, which was induced by subtotal occlusion of the asc. aorta, as well as its longtime support of the chronically damaged left myocardium showed the efficacy of this method. The advantages of this biological method in comparison to that of mechanical devices and orthotopic cardiac transplantation are discussed.

Summary In 13 patients (7 women, 6 men, average age 61 year), who under Went a major abdominal operation and whose postoperative course was uncomplicated, the plasma catecholamines (noradrenaline and adrenaline) were measured one day before operation, 3 to 5 hours after operation as well as on the first and third postoperative day. The heart rate, central venous and arterial pressure, hemoglobin and body temperature were determined simultaneously.1.In the first postoperative phase total catecholamine mounts to nearly twice the initial value. However, it rises only slightly towards the first postoperative day. On the third postoperative day there is a decreasing tendency.2.Noradrenaline rises already three to five hours postoperatively to its highest mean level, while adrenaline reaches its highest mean level on the first postoperative day.3.Heart rate rises from an average 77/min to 94/min at the first postoperative day. Central venous pressure decreases toward the first postoperative day by an average of 1 mmHg, in order to reach its initial value on the third day. Arterial pressure, hemoglobin and body temperature stay unchanged during the period of examination.4.There is a certain quantitative relation between the augmentation of total catecholamine and heart rate.

Ohne Zusammenfassung:

Zusammenfassung 1.Imuran verbessert die Transplantationstoleranz wesentlich. Eine Vorbehandlung mit genügend hohen Dosen ist indiziert.2.Die neonatale Thymektomie vermindert die immunologische Reaktionsfähigkeit. Hierbei sind Wachstums-und andere Störungen unvermeidbar. Die Thymektomie zu einem späteren Zeitpunkt hat keinen sicheren Einfluß. Der Effekt von früh- und spätembryonalem Thymusextrakt, erscheint sehr fraglich.3.Wiederholter Austausch kleiner Blutmengen zwischen Spender und Empfänger läßt eine gewisse Wirkung annehmen.

Zusammenfassung Bei 10 Versuchstieren wurde die linke Lunge transplantiert. Durch Trenimon, eine alkylierende Substanz, in einer Dosierung von 1,5 bis 10 ?/kg Körpergewicht sollte die immunologische Reaktion inhibiert werden.

Ohne Zusammenfassung:

Zusammenfassung Es wird über Experimente mit Transplantation der linken Lunge berichtet, bei welchen durch Imuran die Toleranz beeinflußt werden sollte. Die mittlere Funktionszeit der transplantierten Lunge betrug bei den neun Tieren rund 50 Tage, die längste Funktionszeit 267 Tage.

Summary Complete cardiopulmonary autotransplantation performed in 13 dogs leads to following results.1.The total interruption of pulmonary innervation results in severe disturbance of respiration (with extreme decrease of the respiratory rate and prolongation of the inspiratory period). The remaining respiratory regulatory mechanisms are not sufficient to guarantee an adequate ventilation.2.A temporary depression of cardiac function with decrease of mean arterial pressure, cardiac output and heart rate. These hemodynamic changes are completely reversible except of the low heart rate. The normalisation takes place 4 to 6 h after operation.3.Alterations of hemodynamics due to cardiopulmonary denervation have no significant effect on the respiratory regulatory mechanism.4.A long time survival without artificial respiration could not be achieved because the extrapulmonary regulatory mechanism of respiration are insufficient in dogs.

Summary 1.Considerable hyperventilation occurs with inflammatory abdominal diseases. Respiratory alkalosis is characteristic for bacterial inflammation whereas metabolic acidosis is characteristic for infarction of the mesenteric artery. Gastric perforation does not produce a definite change of the acid-base-balance.2.A direct effect of the endotoxin on the respiratory centre must be regarded as the cause of this hyperventilation.3.The increase of lactate and pyruvate which is frequently associated with bacterial abdominal inflammation is not a result of hyperventilation. Rather than that, it is a result of an abnormal carbohydrate metabolism produced by the action of the endotoxin.

Zusammenfassung Bei 10 Versuchstieren wurde die linke Lunge transplantiert. Durch Methotrexate, einen Folinsäureantagonisten, in einer Dosierung von 0,1 mg/kg bis 0,125 mg/kg zweitägig in der ersten und 0,02 bzw. 0,03 mg/kg ab der zweiten Woche sollte die immunologische Reaktion beeinflußt werden. Es zeigte sich, daß die sonst zu beobachtende Reaktion mit schneller Abstoßung des Transplantates wesentlich schwächer und verzögert verlief. Auch die Belüftung des transplantierten Organs war verlängert. Ein Dauererfolg war jedoch nicht zu erzielen. Die makroskopische und mikroskopische Untersuchung zeigte hochgradige Organveränderungen bei meist noch erkennbaren Zellinfiltraten und Vorhandensein von Plasmazellen.

Es wird über Homotransplantation der Lunge bei zwei jungen Patienten berichtet, bei denen eine pulmonale Insuffizienz bestand. Bei dem einen war die Lunge durch Salzsäuredämpfe zerstört, bei dem anderen war die pulmonale Insuffizienz durch Pneumonie bedingt. Es konnte zunächst eine Verbesserung der pulmonalen Funktion erreicht werden, aber, die unterschiedlichen Widerstände zwischen dem Transplantat und der eigenen verbliebenen Lunge führten zu einer Verteilungsstörung der Ventilation und Perfusion zwischen den beiden Lungen.

Bei 45 Patienten wurde am 1. oder 2. postoperativen Tag das Herz-Zeitvolumen, der Druck in einer zentralen Vene, einer A. femoralis und bei einigen Patienten zusätzlich in der A. pulmonalis gemessen sowie die O2und CO2-Drucke in den einzelnen Blutproben bestimmt. Normovolämische Patienten reagieren auf Gabe von Dextran 40 mit einer Zunahme des HZV und des SV bei unveränderter Herzfrequenz. Die Wirkungsweise von Dextran 40 sowie seine möglichen Gefahren bei den beiden Patientengruppen werden diskutiert.

Summary Complete cardiopulmonary autotransplantation was performed in 8 dogs to establish immunologically independant factors and physiological changes of cardiopulmonary function. Haemodynamically there is in the first 2–3 h a marked reduction in cardiac output, heart rate and storke volume. The mean arterial pressure is slightly lowered and the two atrial pressures are increased. This returns to normal within a few hours without the aid of drugs so that the cardiac output reaches the initial value in ca. 6 h. Since the heart rate remains low the storke volume rises above the normal initial value. With regard to respiration there is, after this acute interruption of the Hering-Breuer reflex, a change of type of respiration and a reduction of the respiratory rate to 8–9 per min. The respiratory minute volume is reduced by over 50%, with alveolar hypoventilation as the dominant feature with a rise of arterial PCO2 to 54 mm Hg. It is remarkable that the low respiratory rate is gradually further reduced and occasionally ends in apnoea in some animals. It must be assumed therefore that the essential, so-called proprioceptive reflexes of the thoracic wall in dogs are not sufficiently developed and constitute the limiting factor for survival time.

Summary In 10 dogs, 6 weeks to 12 months after re-implantation of the left lung, a catheter was introduced through the main pulmonary artery trunk into the left and right pulmonary artery successively. With the aid of a roller pump each lung was thus perfused with a known minute volume. Under CO2 admixture during inspiration (PCO2 36 rising to 63 mm Hg) and constant flow the gradient between the pulmonary artery and the left atrium increased equally in the right innervated and the left denervated lung. The percentual change of the pressure gradient at low flow rate was 2–3 times larger than at high flow rate. The pressure in the trachea remained constant during the entire measuring period. It may be deduced from this that the transplanted, i. e. denervated lung is equally able as the innervated lung to raise the transpulmonary vascular resistance when CO2 is added to the inspired air. Whether the receptor is intra or extrapulmonary cannot be decided. In the latter case some humoral transmission mechanism must be postulated.