Leo Lehr

Bromide space, total body water, and sick cell syndrome

Displacements of the bromide space (Br-82-C, as a marker for the extracellular fluid compartment) are caused by an enhanced anatomical space and/or increased permeability of cells to bromide. The ratio Br-82-C: total body water (TBW) was evaluated to be 0.83±0.17 in critically ill patients (n=38) compared with the normal value of 0.46±0.04 (n=10). Because of normal TBW in critically ill patients (TBW=505±68 ml/kg), an increased bromide penetration into cells seems to be responsible for the enlarged ratio Br-82-C: TBW. Taking into consideration measurements in patients with malabsorption (Br-82-C: TBW=0.56±0.13; n=13) and carcinoma of the rectum and colon (Br-82-C: TBW=0.66±0.24; n=18) we think that the bromide space is a good measurement of the effective extracellular water.

Resektion Hilusnaher Gallengangscarcinome statt palliativer Gallenwegsdrainage

SummaryInstead of the widely recommended approach of treating hilar carcinoma of the bile ducts by simple palliative biliary drainage, step by step a policy of primarily aiming at resection for cure has been adopted. So far in 11 out of 22 patients excision of the tumor was possible by resection of the hepatic duct confluence; in 4 cases a left hemihepatectomy had to be added because of carcinomatous infiltration of the left liver lobe or the left hepatic artery. The multiple bile duct openings remaining after resection of such tumors were reconstructed to one or two orifices and a bi- or unilateral Roux-en-Y cholangiojejunal anastomosis performed. In further 3 cases orthotopic liver transplantation was necessary to remove all visibly infiltrated tissue. In the remaining 8 patients because of documented extrahepatic carcinomatous spread palliative biliary drainage by a percutaneous U-tube or an endoprothesis was indeed considered the only reasonable measure. Despite the relatively high resectional rate of 60% and the extensive operations performed early mortality was confined to one patient who succumbed to septic endocarditis 6 weeks after the operation. At present the longest postoperative interval without recurrence amounts to

232. Renale und respiratorische Insuffizienz als Hinweis auf postoperative Peritonitis bei Intensivpflegepatienten

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Verhalten von Ganzkörperkalium und Bromidkompartiment bei Intensivpflegepatienten

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91. Die offene Peritonealspülung zur Behandlung der schweren Peritonitis

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Aktuelle gastroenterologische Diagnostik

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Low-risk thoracic vagotomy for anastomotic ulceration

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Nutritional status in esophageal carcinoma: Preoperative risk evaluation

years. Nine patients free of recurrent disease are in perfect health; in 3 patients in whom a recurrence was observed after 1/2,